Duranti Leonardo, Leo Francesco, Pastorino Ugo
Thoracic Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. leonardo.duranti@istituto
Tumori. 2012 Mar-Apr;98(2):175-84. doi: 10.1177/030089161209800201.
In the 90s, the introduction of positron emission tomography (PET) represented a milestone in the staging of thoracic tumors. In the last 10 years, PET scan has been widely adopted in thoracic oncology, showing high accuracy in diagnosis and staging and with promising issues in defining prognosis. The aim of this systematic review was to focus on the results and pitfalls of PET scan use in the modern management of chest tumors.
The literature search was performed on May 2010 in PubMed, Embase, and Cochrane according to PRISMA protocol. The search was restricted to publications in English, using in the same string the word "PET" with 9 different chest tumors; results were then filtered by eliminating technical articles, focusing only on papers in which surgery was considered as a potential diagnostic or therapeutic tool. From 6600 papers initially selected, 99 manuscripts were fully analyzed.
Glucose uptake is a metabolic marker useful in the diagnosis and staging of chest tumors. In lung cancer screening, standard uptake value is helpful in defining the risk of malignancy of isolated pulmonary nodules. The addition of PET scan to conventional staging increases detection of nodal and distant metastases in lung cancer, esophageal cancer and malignant mesothelioma. In thymoma, a close relationship between standard uptake value, histology, and Masaoka stage has been advocated. This link between glucose uptake and prognosis suggests that PET translates biological tumor behavior into clinically detectable findings.
PET scan has a crucial role in thoracic oncology due to its impact on diagnosis, staging and prognosis. PET scan expresses the biological behavior of tumors, opening interesting perspectives in chest tumor management and improving detection and stage grouping in lung cancer. It anticipates the diagnosis in long-incubating diseases such as mesothelioma and increases biological knowledge of rare diseases, such as thymoma and other mediastinal tumors.
20世纪90年代，正电子发射断层扫描（PET）的引入是胸部肿瘤分期的一个里程碑。在过去10年中，PET扫描已在胸部肿瘤学中广泛应用，在诊断和分期方面显示出高准确性，并且在确定预后方面有前景。本系统评价的目的是关注PET扫描在胸部肿瘤现代管理中的应用结果和缺陷。
2010年5月在PubMed、Embase和Cochrane数据库中按照PRISMA方案进行文献检索。检索仅限于英文出版物，在同一检索词中使用“PET”与9种不同胸部肿瘤；然后通过排除技术文章进行筛选，仅关注将手术视为潜在诊断或治疗工具的论文。从最初选择的6600篇论文中，对99篇手稿进行了全面分析。
葡萄糖摄取是一种有助于胸部肿瘤诊断和分期的代谢标志物。在肺癌筛查中，标准摄取值有助于确定孤立性肺结节的恶性风险。将PET扫描添加到传统分期中可增加肺癌、食管癌和恶性间皮瘤中淋巴结和远处转移的检出率。在胸腺瘤中，有人主张标准摄取值、组织学和Masaoka分期之间存在密切关系。葡萄糖摄取与预后之间的这种联系表明，PET将肿瘤的生物学行为转化为临床可检测的结果。
PET扫描在胸部肿瘤学中具有关键作用，因为它对诊断、分期和预后有影响。PET扫描表达了肿瘤的生物学行为，为胸部肿瘤管理开辟了有趣的前景，并改善了肺癌的检测和分期分组。它可在间皮瘤等潜伏期长的疾病中提前诊断，并增加对胸腺瘤和其他纵隔肿瘤等罕见疾病的生物学认识。
