Chest

Chest

Volume 125, Issue 6, June 2004, Pages 2294-2299
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Seeking a Home for a PET, Part 1: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Diagnosis of Pulmonary Nodules or Masses

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There is a growing experience with positron emission tomography (PET) in patients with pulmonary nodules or masses. As PET imaging becomes more widely available, it is important to thoughtfully define when application of this technology is warranted. Review of the literature to date suggests that PET imaging for diagnosis of pulmonary lesions is most useful in patients who have a low or intermediate risk of lung cancer as determined by an evaluation of symptoms, risk factors, and radiographic appearance. There is little role for PET in diagnosis in patients with a very low or a high risk of lung cancer, and there is little role in patients with lesions < 1 cm in diameter, or lesions suspected to be an infection, a bronchioloalveolar carcinoma, or a typical carcinoid tumor.

Section snippets

How Should We Determine Who Should Have a PET?

Some authors have advocated PET for all patients with a pulmonary abnormality.10 However, most clinicians involved with the care of patients would accept that a pulmonary lesion should not circumvent a careful clinical evaluation. This entails an assessment of symptoms, the medical history, and risk factors for lung cancer. This allows some thought to be given to the likely diagnosis—and to the likely stage—if lung cancer is suspected. Consistent with this approach is the recommendation for a

Estimating the Likelihood of Lung Cancer

The approach to patients with a pulmonary lesion is determined to a large extent by the likelihood that a lesion in a particular patient is a lung cancer. The risk can be divided into several groups, for example as proposed in Table 2. Many factors influence the estimation of the likelihood of lung cancer, and a full discussion of these is beyond the scope of this article. Patient-related factors include the smoking history (approximately 2,000% increased risk in patients with a history of

CONCLUSION: WHO NEEDS A PET?

Recommendations for the use of PET imaging in the diagnosis of a pulmonary nodule are summarized in Table 3. Evaluating whether a patient would benefit from a PET scan starts with an assessment of the symptoms and risk factors for lung cancer, a review of sequential CXRs, and an examination of the chest CT scan. This allows an estimation to be made about the likelihood of lung cancer and the size of the lesion. There is no role for PET imaging in patients with a very low (≤ 5%) likelihood of

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    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail: [email protected]).

    †

    Members of the Multidisciplinary Thoracic Oncology Program, University of North Carolina at Chapel Hill.

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    Copyright © 2004 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.