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Diagnosis: (Medicare approved – non-small cell) In radiographically indeterminate solitary pulmonary nodules. Sensitivity is high for lesions approaching 1 cm size but specificity varies with incidence of granulomatous disease in the population studied since FDG may be positive in active granulomatous disease and in sarcoidosis. Predictive value of a negative scan is high with nodules 1 cm or larger. Broncho-alveolar variant of adenocarcinoma may have low FDG accumulation.
Staging: Multiple studies in direct comparisons demonstrate that PET is more accurate than CT in initial nodal (N) and metastatic (M) staging of non small cell lung cancer and that when performed in addition to CT, PET often leads to change of stage, allowing better treatment decisions to be made. Obviates need for radionuclide bone scanning as PET is both more sensitive and more specific. Also is considerably more accurate than CT in question of adrenal metastases. May be cost effective in staging small cell lung cancer but studies have not been done.
Restaging/Surveillance: (Medicare approved – non-small cell) Best single test based upon multiple studies comparing PET with CT. Excellent for assessing therapy response in small cell lung cancer but not yet Medicare approved as studies assessing the role of PET have not been done.
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