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Seeking a Home for a PET, Part 2*: Defining the Appropriate Place for Positron Emission Tomography Imaging in the Staging of Patients With Suspected Lung Cancer

Frank C. Detterbeck, MD, FCCP; Steven Falen, MD, PhD; M. Patricia Rivera, MD, FCCP; Jan S. Halle, MD; Mark A. Socinski, MD, FCCP
Author and Funding Information

Affiliations: *From the Division of Cardiothoracic Surgery, Department of Surgery (Dr. Detterbeck); Department of Radiology (Dr. Falen); Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine (Dr. Rivera); Department of Radiation Oncology (Dr. Halle); and Division of Medical Oncology, Department of Internal Medicine (Dr. Socinski), University of North Carolina at Chapel Hill, Chapel Hill, NC.,  Members of the Multidisciplinary Thoracic Oncology Program, University of North Carolina, Chapel Hill, NC.

Correspondence to: Frank C. Detterbeck, MD, FCCP, Division of Cardiothoracic Surgery, Medical School Wing C, Room 354 CB# 7065, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7065; e-mail: fdetter@med.unc.edu



Chest. 2004;125(6):2300-2308. doi:10.1378/chest.125.6.2300
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In patients who have a high likelihood of having lung cancer, there is little role for positron emission tomography (PET) imaging for diagnosis of the primary lesion. The primary impact of PET imaging is in extrathoracic staging, but it should not replace a clinical evaluation by a physician experienced in lung cancer. PET imaging is most useful for confirmation of the presumed extrathoracic stage in patients with intermediate stages of lung cancer. The role of PET imaging is limited in patients with strong clinical signs of metastatic disease, or in patients with a clinical stage I lung cancer and a negative clinical evaluation. With regard to intrathoracic staging, PET imaging has a definite role in communities in which mediastinoscopy is not available, whereas the impact is limited in institutions in which invasive mediastinal staging is available. The data suggest that a positive PET result in the mediastinum should be confirmed by biopsy. A mediastinoscopy is also reasonable in patients with clinical stage III lung cancer who have no mediastinal PET uptake. It is unclear and controversial whether a biopsy is needed in patients with clinical stage II lung cancer who have no PET uptake in the mediastinum.


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