From the Guidelines
Yes, you can order a whole-body PET-CT scan for lung cancer workup, as it is the most sensitive technique for detecting extracranial metastatic disease, unexpected additional primary malignancies, and recurrence, as supported by the study published in the Journal of Thoracic Oncology 1. The use of whole-body PET-CT scans in lung cancer staging has been shown to improve the accuracy of T3 and T4 staging and delineation of tumors associated with atelectasis, making it a valuable tool in the workup of lung cancer. Some key points to consider when ordering a whole-body PET-CT scan include:
- The scan combines functional imaging (PET) with anatomical detail (CT) to detect cancer cells throughout the body based on their higher glucose metabolism.
- The procedure involves injecting a radioactive glucose tracer (usually F-18 FDG), waiting about an hour for uptake, then performing the scan which takes 20-30 minutes.
- Insurance coverage generally requires a confirmed or strongly suspected cancer diagnosis with appropriate documentation.
- While PET-CT is excellent for detecting metastatic disease, it should be part of a comprehensive evaluation that includes pulmonary function tests and possibly tissue sampling to guide treatment decisions, as recommended by the American College of Chest Physicians evidence-based clinical practice guidelines 1.
- Some limitations of PET-CT scans include false positives from inflammation and infection, and potential false negatives in slow-growing tumors. It is also important to note that the clinical evaluation tool, including a thorough history and physical examination, remains the best predictor of distant metastatic disease, and that tissue sampling is often required to confirm suspected metastasis, as stated in the guidelines published in Chest 1.
From the Research
Whole Body PET CT Scan for Lung Cancer Workup
- The use of whole-body PET/CT scans in the workup and management of patients with lung cancer has greatly increased in recent decades 2.
- Whole-body examinations using integrated (18)F-FDG-PET/CT have been shown to reduce the side effects of futile invasive procedures and reduce additional costly staging procedures 3.
- PET/CT is a whole-body non-invasive imaging procedure that has been increasingly used for the assessment of lung cancer patients, with added value to CT mainly related to a more accurate staging of nodal and metastatic sites and to the evaluation of the response to therapy 4.
Indications for Whole Body PET CT Scan
- The main indication for whole-body PET/CT scan is the staging of patients with lung cancer, as it allows for precise pretherapeutic staging and also posttreatment restaging according to the TNM criteria 3.
- Whole-body PET/CT scan is also useful in the characterization of indeterminate pulmonary nodules and in the evaluation of the response to therapy 2.
Benefits of Whole Body PET CT Scan
- The accuracy of whole-body PET/CT scan has been shown to be greater than that of conventional modalities in some scenarios, making it a valuable noninvasive method for the investigation of lung cancer 2.
- Whole-body PET/CT scan can provide useful data during the characterization of indeterminate pulmonary nodules and in the staging of lung cancer 5, 4.