title: Ensuring the right PET scan for the right patient.
abstract: Guidelines issued by the National Institute for Clinical Excellence (NICE) in the England and Wales recommend that rapid access to (18)F-deoxyglucose positron emission tomography (FDG-PET) is made available to all appropriate patients with non-small-cell lung cancer (NSCLC). The clinical evidence for the benefits of PET scanning in NSCLC is substantial, showing that PET has high accuracy, sensitivity and specificity for disease staging, as well as pre-therapeutic assessment in candidates for surgery and radical radiotherapy. Moreover, PET scanning can provide important information to assist in radiotherapy treatment planning, and has also been shown to correlate with responses to treatment and overall outcomes. If the government cancer waiting time targets are to be met, rapid referral from primary to secondary healthcare is essential, as is early diagnostic referral within secondary and tertiary care for techniques such as PET. Studies are also required to explore new areas in which PET may be of benefit, such as surveillance studies in high-risk patients to allow early diagnosis and optimal treatment, while PET scanning to identify treatment non-responders may help optimise therapy, with benefits both for patients and healthcare resource use. Further studies are needed into other forms of lung cancer, including small-cell lung cancer and mesothelioma. In conclusion, PET scanning has the potential to improve the diagnosis and management of lung cancer for many patients. Further studies and refinement of guidelines and procedures will maximise the benefit of this important technique.
authors.affiliation: Department of Respiratory Medicine, University College Hospital, UCLH NHS Foundation Trust, London WC1E 6AU, United Kingdom. stephen.spiro@uclh.org
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Spiro
authors.forename: John
authors.initials: J
authors.lastname: Buscombe
authors.forename: Gary
authors.initials: G
authors.lastname: Cook
authors.forename: Tim
authors.initials: T
authors.lastname: Eisen
authors.forename: Fergus
authors.initials: F
authors.lastname: Gleeson
authors.forename: Mary
authors.initials: M
authors.lastname: O'Brien
authors.forename: Michael D
authors.initials: MD
authors.lastname: Peake
authors.forename: Nicholas P
authors.initials: NP
authors.lastname: Rowell
authors.forename: Richard
authors.initials: R
authors.lastname: Seymour
mesh_terms: D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D018288:Carcinoma, Small Cell / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D049268:Positron-Emission Tomography / Q000191:economics; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012017:Referral and Consultation; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18