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Lung and Mediastinal Tumors

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Nuclear Oncology

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Abstract

Lung cancer accounts for 15% of all cancers in the USA and is the leading cause of cancer death. Non-small cell cancers (NSCLC), including squamous cell, adenocarcinoma, and large cell carcinomas account for 85% of lung cancers. Cigarette smoking is linked to the majority of lung cancers. Staging of lung cancer uses the American joint cancer committee (AJCC) TNM classification. CT is the modality of choice for lung cancer detection, and identifying adrenal involvement. Because of the low specificity of CT for characterizing lung nodules (lesions <3 cm diameter, surrounded by normal lung parenchyma) these lesions are often classified as indeterminate, and patients are enrolled in a follow-up program (measurement of doubling time) or undergo fine needle aspiration (FNA). [18F]FDG PET/CT has been used in the differential diagnosis and characterization of single pulmonary nodules. Most lung cancers >1 cm concentrate [18F]FDG. However false-positive scans can occur because inflammatory lesions such as sarcoid or tuberculosis also concentrate [18F]FDG. False-negative scans can occur due to small lesion size or malignancies such as bronchiolo-alveolar carcinoma (BAC) or carcinoid. Pretreatment [18F]FDG PET/CT provides prognostic information since there is a relationship between SUV of the tumor and outcome. CT allows accurate differentiation of potentially resectable T1–T3 lesions from unresectable T4 tumors. Contrast CT is used for N staging and the most widely used diagnostic criterion of nodal metastases is a measurement of lymph node size. [18F]FDG imaging has better sensitivity and specificity than CT, with an NPV above 90% for the detection of metastatic mediastinal nodes. In patients treated with radiation, post-radiation pneumonitis and fibrosis may be difficult to distinguish from tumor recurrence on CT. Magnetic resonance imaging (MRI) and [18F]FDG-PET/CT can be helpful to make this distinction. In small cell lung cancer (SCLC), [18F]FDG imaging is useful for detection and staging. Moreover, [18F]FDG can also assess response to chemotherapy as early as the end of the first cycle. SUV of the primary lesion is a significant prognostic factor.

Neuroendocrine tumors vary in differentiation and glucose metabolism and therefore [18F]FDG imaging alone is unable to complete the phenotyping of this disease. Ligands labeled with 68Ga such as 68Ga-DOTATATE and 68Ga-DOTATOC, which target the SSTr2, SSTr4, and SSTr5 receptor subtypes provide better and more consistent lesion visualization than [18F]FDG.

Malignant pleural mesothelioma (MPM) is an aggressive tumor of mesothelial cell origin. CT is the primary imaging modality. [18F]FDG PET can provide additional diagnostic and prognostic information since all areas of pleural thickening detected on CT do not correspond to areas of high metabolic activity, which are the most appropriate sites for biopsy.

Thymoma: Thymoma is the most common primary neoplasm located in the anterior mediastinum. Thymoma can manifest heterogeneity on CT due to cystic degeneration, hemorrhage or necrosis but has no distinctive features on MRI. [18F]FDG-PET/CT is useful in the preoperative assessment of isolated anterior mediastinal lesions, especially for planning the operative strategy (biopsy or resection). Moreover, low SUV is associated with low-grade thymoma and minimal invasive thymoma.

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Authors and Affiliations

  1. Department of Nuclear Medicine, The Chaim Sheba Medical Center, Tel-Hashomer, 52621, Israel

    Simona Ben-Haim MD, Dsc

  2. Department of Respiratory Medicine, Lister Hospital, Coreys Mill Lane, Stevenage, Hertfordshire, SG1 4AB, UK

    Thida Win MBBS, MD, FRCP

  3. Department of Nuclear Medicine, Rambam Health Care Campus, Haaliayh 8, Haifa, 35254, Israel

    Ora Israel MD

  4. Department of Medical Imaging, Rambam Health Care Campus, Bat-Galim, 9602, Haifa, 31096, Israel

    Ludmila Guralnik MD

Authors
  1. Simona Ben-Haim MD, Dsc
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  2. Thida Win MBBS, MD, FRCP
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  3. Ora Israel MD
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  4. Ludmila Guralnik MD
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Corresponding author

Correspondence to Simona Ben-Haim MD, Dsc .

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Editors and Affiliations

  1. Dept. Radiology, Div. Nuclear Medicine, Memorial Sloan-Kettering Cancer Center, York Ave. 1275, New York, 10021, New York, USA

    H. William Strauss

  2. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Giuliano Mariani

  3. Centro Regionale di Medicina Nucleare, Universita di Pisa, Via Roma 67, Pisa, 56100, Italy

    Duccio Volterrani

  4. Cancer Center, Department of Radiology, Memorial Sloan-Kettering, York Ave. 1275, New York, 10021, New York, USA

    Steven M. Larson

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Ben-Haim, S., Win, T., Israel, O., Guralnik, L. (2013). Lung and Mediastinal Tumors. In: Strauss, H., Mariani, G., Volterrani, D., Larson, S. (eds) Nuclear Oncology. Springer, New York, NY. https://doi.org/10.1007/978-0-387-48894-3_13

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