Hellwig Dirk, Baum Richrad P, Kirsch Carl
Department of Nuclear Medicine, Saarland University Medical Center, Homburg, Germany.
Nuklearmedizin. 2009;48(2):59-69, quiz N8-9. Epub 2009 Jan 14.
Currently, the German and Austrian S3 guidelines on the evaluation and treatment of lung cancer are about to be published whereas the American Colleague of Chest Physicians (ACCP) guidelines were already presented in 2007. An important part of the diagnostic workup of lung cancer will be the evaluation of indeterminate lung lesions and the mediastinal and extrathoracic staging using FDG-PET or PET/CT. The results from the literature on FDG-PET and PET/CT as well as on conventional nuclear medicine staging procedures and the clinical implications are presented.
The literature data was amassed in analogy to the meta-analyses drawn for the current ACCP guidelines. In addition, relevant more recent publications were also considered. To answer the important question for the extent of pathological confirmation needed, the residual risk of mediastinal metastases was calculated for certain constellations of FDG-PET and CT findings. Suggested recommendations were characterized with the level of evidence.
FDG-PET (PET/CT) allows the differentiation of indeterminate lung lesions with high accuracy. FDG-PET (PET/CT) is the most accurate non-invasive procedure to assess the mediastinal nodal stage, for non-small cell as well as for small cell lung cancer. It is justified to omit invasive evaluation of enlarged but FDG-PET negative lymph nodes under certain circumstances. Unexpected extrathoracic metastases detected by FDG-PET imply important changes in therapeutic management.
The upcoming S3 guideline on lung cancer will recommend FDG-PET in several indications due to its clinical efficacy well proven by data from literature (high level of evidence). The selected use of conventional nuclear medicine procedures remains beyond doubt. FDG-PET (PET/CT) belongs to the standard of care in lung cancer.
目前，德国和奥地利关于肺癌评估与治疗的S3指南即将发布，而美国胸科医师学会（ACCP）指南已于2007年公布。肺癌诊断检查的一个重要部分将是使用氟代脱氧葡萄糖正电子发射断层显像（FDG-PET）或PET/CT对不确定的肺部病变以及纵隔和胸外分期进行评估。本文介绍了有关FDG-PET和PET/CT以及传统核医学分期程序的文献结果及其临床意义。
文献数据的收集类似于为当前ACCP指南所做的荟萃分析。此外，还考虑了相关的近期出版物。为回答所需病理确认程度的重要问题，计算了FDG-PET和CT检查结果的某些组合情况下纵隔转移的残留风险。所建议的推荐意见以证据水平为特征。
FDG-PET（PET/CT）能够高精度地区分不确定的肺部病变。FDG-PET（PET/CT）是评估非小细胞肺癌以及小细胞肺癌纵隔淋巴结分期最准确的非侵入性方法。在某些情况下，省略对增大但FDG-PET阴性淋巴结的侵入性评估是合理的。FDG-PET检测到意外的胸外转移意味着治疗管理的重要变化。
即将发布的肺癌S3指南将因文献数据充分证明其临床疗效（证据水平高）而在多个适应症中推荐使用FDG-PET。传统核医学程序的选择性使用仍然毋庸置疑。FDG-PET（PET/CT）属于肺癌的治疗标准。
