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Lung Cancer
Image:
68 year old man with history of right apical lung nodule. PET study demonstrates intense
FDG uptake in area of the nodule suggestive of lung cancer.
Lung Cancer, Initial Staging
Study Background:
A 52 year old male with large Pancoast-type lung tumor. The CT showed the tumor extending
into the paraspinal space, an enlarged left adrenal gland, suspicious for metastasis, and
erosion of the left first and second ribs. The PET study was performed as part of the initial
staging diagnostic work-up.
PET Imaging:
Seventy minutes after the injection of 733 MBq of 18F-FDG, images of the neck and torso
were obtained with a GE Advance tomograph (7 minutes emission, 3 minutes transmission
data per bed position). Data were reconstructed using an OSEM algorithm and segmented
attenuation correction. The PET study confirms invasive spread of the tumor into the spine
and ribs, as well as increased metabolism in the left adrenal gland, consistent with
metastasis. In addition, the PET scan demonstrates uptake in the right adrenal gland and
the left seventh and eighth ribs, also suggestive of metastatic disease.
Discussion:
Pancoast-type lung cancer is relatively rare, accounting for less than 5% of all non-small cell
cancers of the lung. Due to its location and invasive nature, complete surgical resection is
difficult. Accurate staging is therefore essential to the assessment of surgical and treatment
options and estimation of life expectancy. Importantly, PET can be useful in confirming
distant metastases, thereby sparing patients of further tissue sampling procedures.
Reference:
Detterbeck FC, Jones DR, Kernstine KH, et al. Lung cancer. Special treatment issues.
Chest, Jan 2003, 123(1 Suppl) p244S-258S
Alifano M, D'Aiuto M, Magdeleinat P, et al. Surgical treatment of superior sulcus
tumors: results and prognostic factors. Chest, Sep 2003, 124(3) p996-1003
Images courtesy of:
Williams County Community Hospital, Bryan OH
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