Staging, staging procedures, and prognostic factors

The guidelines of both the European Society of Thoracic Surgeons (ESTS)1 and the American College of Chest Physicians (ACCP)2 recommend the use of [18F]- fluorodeoxyglucose (18-FDG) positron emission tomography (18-FDG-PET) in the work-up of patients with (suspected) lung cancer. The tracer 18-FDG visualizes glucose metabolism and, as a result, does not solely visualize tracer uptake in malignant tissues.3,4 In order to improve the specificity of PET, which ranges between 40 and 100%,5 alternative tracers have been tested.6–8 Cell proliferation can be visualized by a nucleoside analog 3′-deoxy-3′-18F-fluorothymidine (18-FLT).8 The specificity for 18-FLT was reported to be as high as 93% (95% confidence interval (CI) 0.74-0.99), which was not significantly better than by 18-FDG (78%, 95% CI 0.57-0.91). The reported high specificity of 18-FLT was at the expense of a significantly lower sensitivity when compared with 18-FDG (67 % for 18-FLT versus 94 % for 18-FDG).8