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Clinical utility of F-18 FDG PET-CT in the initial evaluation of lung cancer

  • Review Article
  • Published:
European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript



Positron emission tomography-computed tomography (PET-CT) is a resource-demanding imaging modality with increasing popularity in the workup of patients with suspected or proven lung cancer.


To review the clinical usefulness of this imaging modality in the diagnosis, staging, and pre-operative evaluation, we conducted a systematic literature search, review, and quality assessment using the rapid evidence assessment toolkit and the Oxford Centre for Evidence-Based Medicine methodology. The literature search resulted in 4,208 records including 918 reviews, of which 139 met the predefined criteria and were read in full to identify relevant original articles on F-18 FDG PET-CT (1) in the evaluation of solitary pulmonary nodules (n = 14), (2) in curative-intent treatment trials (n = 9), and (3) in planning of invasive procedures (n = 18).


We found the following important results from the literature review:

  1. 1)

    PET-CT can rule out malignancy in most solitary pulmonary nodules due to high sensitivity (recommendation level A).

  2. 2)

    PET-CT reduces the number of futile treatment trials (recommendation level A).

  3. 3)

    The sensitivity of PET-CT in general is insufficient to rule out mediastinal lymph node metastasis (recommendation level A).


  1. 1)

    With few exceptions, solitary pulmonary nodules can safely be considered benign if the PET-CT scan is negative. Exceptions consist of small (<1 cm) and non-solid, solitary pulmonary nodules. These abnormalities should be followed up by CT in a structured programme.

  2. 2)

    No curative-intent treatment should be commenced until a PET-CT scan has excluded occult distant metastases.

  3. 3)

    In general, lymph node metastasis in the mediastinum cannot be ruled out on the basis of a negative PET-CT, and confirmative invasive staging should be performed in most patients before mediastinal metastasis is confirmed or ruled out.

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Authors and Affiliations


Corresponding author

Correspondence to Poul Henning Madsen.

Ethics declarations


No funding was received for this study.

Conflict of interest

PHM has received personal fees from the Region of Southern Denmark, Intermune, Sandoz and Astra-Zeneca. PHM has received travel grants from Norpharma, Intermune, Olympus, and Sandoz. JBC has received personal fees from the Region of Southern Denmark. PCH and PFHC have no conflicts of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Appendix: search terms

Appendix: search terms

Lung cancer synonyms:

  • Bronchogenic Carcinoma

  • Bronchogenic Carcinomas

  • Bronchial Carcinoma

  • Bronchial Carcinomas

  • Small Cell Lung Cancer

  • Small Cell Lung Cancers

  • Small Cell Lung Neoplasm

  • Small Cell Lung Neoplasms

  • Small Cell Lung Carcinoma

  • Small Cell Lung Carcinomas

  • Small Cell Lung Tumor

  • Small Cell Lung Tumors

  • Small Cell Lung Tumour

  • Small Cell Lung Tumours

  • Small-Cell Lung Cancer

  • Small-Cell Lung Cancers

  • Small-Cell Lung Neoplasm

  • Small-Cell Lung Neoplasms

  • Small-Cell Lung Carcinoma

  • Small-Cell Lung Carcinomas

  • Small-Cell Lung Tumor

  • Small-Cell Lung Tumors

  • Small-Cell Lung Tumour

  • Small-Cell Lung Tumours

  • Oat Cell Lung Cancer

  • Oat Cell Lung Cancers

  • Oat Cell Lung Neoplasm

  • Oat Cell Lung Neoplasms

  • Oat Cell Lung Carcinoma

  • Oat Cell Lung Carcinomas

  • Oat Cell Lung Tumor

  • Oat Cell Lung Tumors

  • Oat Cell Lung Tumors

  • Oat Cell Lung Tumour

  • Oat Cell Lung Tumours

  • Oat-Cell Lung Cancer

  • Oat-Cell Lung Cancers

  • Oat-Cell Lung Neoplasm

  • Oat-Cell Lung Neoplasms

  • Oat-Cell Lung Carcinoma

  • Oat-Cell Lung Carcinomas

  • Oat-Cell Lung Tumor

  • Oat-Cell Lung Tumors

  • Oat-Cell Lung Tumors

  • Oat-Cell Lung Tumour

  • Oat-Cell Lung Tumours

  • SCLC

  • Non Small Cell Lung Carcinoma

  • Non Small Cell Lung Carcinomas

  • Non Small Cell Lung Cancer

  • Non Small Cell Lung Cancers

  • Non Small Cell Lung Neoplasm

  • Non Small Cell Lung Neoplasms

  • Non Small Cell Lung Tumor

  • Non Small Cell Lung Tumors

  • Non Small Cell Lung Tumour

  • Non Small Cell Lung Tumours

  • Non-Small-Cell Lung Carcinoma

  • Non-Small-Cell Lung Carcinomas

  • Non-Small-Cell Lung Cancer

  • Non-Small-Cell Lung Cancers

  • Non-Small-Cell Lung Neoplasm

  • Non-Small-Cell Lung Neoplasms

  • Non-Small-Cell Lung Tumor

  • Non-Small-Cell Lung Tumors

  • Non-Small-Cell Lung Tumour

  • Non-Small-Cell Lung Tumours

  • Nonsmall Cell Lung Cancer

  • Nonsmall Cell Lung Cancers

  • Nonsmall Cell Lung Carcinoma

  • Nonsmall Cell Lung Carcinomas

  • NonSmall Cell Lung Neoplasm

  • NonSmall Cell Lung Neoplasms

  • NonSmall Cell Lung Tumor

  • NonSmall Cell Lung Tumors

  • NonSmall Cell Lung Tumour

  • NonSmall Cell Lung Tumours

  • Non-Small Cell Lung Carcinoma

  • Non-Small Cell Lung Carcinomas

  • Non-Small Cell Lung Cancer

  • Non-Small Cell Lung Cancers

  • Non-Small Cell Lung Neoplasm

  • Non-Small Cell Lung Neoplasms

  • Non-Small Cell Lung Tumor

  • Non-Small Cell Lung Tumors

  • Non-Small Cell Lung Tumour

  • Non-Small Cell Lung Tumours


PET synonyms:

  • Positron Emission Tomography and Computed Tomography

  • X-Ray Computed Tomography and Positron-Emission Tomography

  • X Ray Computed Tomography and Positron Emission Tomography

  • PET and CT

  • Hybrid Pet and CT

  • Integrated PET CT

  • Positron Emission Tomography

  • PET Scan

  • PET Scans

  • Positron-Emission Tomography

  • “Positron Emission Tomographies”

  • “Positron Emission Tomographic”

  • “PET” AND “CT”

  • PET/CT

  • PET

  • “petscan”

  • “petscans”

  • “petscanning”

  • “pet scanning”

  • Fluorodeoxyglucose F18

  • Fluorodeoxy Glucose

  • Fludeoxyglucose F18

  • Fluorodeoxyglucose F 18

  • Fludeoxyglucose F 18

  • Fluorine-18-fluorodeoxyglucose

  • Fluorine 18 fluorodeoxyglucose

  • Fluorine-18-Fludeoxyglucose

  • Fluorine 18 Fludeoxyglucose

  • 18F Fludeoxyglucose

  • 18-F Fludeoxyglucose

  • 18F Fluorodeoxyglucose

  • 18-F Fluorodeoxyglucose

  • 18F-Fluorodeoxyglucose

  • F-18 Fluorodeoxyglucose

  • F-18 Fludeoxyglucose

  • F18 Fludeoxyglucose

  • F18 Fluorodeoxyglucose

  • 18FDG

  • 18-FDG

  • 18 FDG

  • 18F FDG

  • 18-F-FDG

  • 18F-FDG

  • F18 FDG

  • F-18-FDG

  • F-18 FDG

  • F 18 FDG

  • FDG




  • 2-Fluoro-2-deoxy-D-glucose

  • 2 Fluoro 2 deoxy D glucose

  • 2-Fluoro-2-deoxyglucose

  • 2 Fluoro 2 deoxyglucoses

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Madsen, P.H., Holdgaard, P.C., Christensen, J.B. et al. Clinical utility of F-18 FDG PET-CT in the initial evaluation of lung cancer. Eur J Nucl Med Mol Imaging 43, 2084–2097 (2016).

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