The value of positron emission tomography in early detection of lung cancer in high-risk population: a systematic review

Background: Early detection trials with chest radiography and sputum cytology were ineffective in decreasing lung cancer mortality. The advent of low-dose spiral chest computed tomography (LDCT) provided clinicians with a new tool that could be with early diagnosis; however, this also raised significant concerns regarding the systematic use of LDCT with its high false-positive rate for benign nodules. At this time, there is limited information about the true role of PET (positron emission tomography) for early detection of lung cancer. Methods: We used systematic methods, including Preferred Reporting Items for Systematic reviews and Meta-Analyses statement, to identify relevant studies, assess study eligibility, evaluate study methodological quality, and summarize findings regarding diagnostic accuracy and outcome. Results: In total, only seven eligible studies were selected from 82 potentially relevant studies. The sensitivity of 18F-FDG-PET for the detection of T1 lung cancers ranged between 68% and 95%. The rate of detection tended to be lower for carcinoid tumors, adenocarcinoma and bronchoalveolar cell carcinomas. FDG-PET using SUV (standardized uptake value) level can predict the outcome of the screening detected lung cancer. A combination of FDG-PET and LDCT may improve screening for lung cancer in high-risk patients. Conclusions: PET or PET/CT may be used as a useful tool for early detection of lung cancer in high-risk population based on the existing information. However, there is still limited information with regards to evidence of survival benefits from PET screening in high-risk patients. Please cite this paper as: Chang C-Y, Chang S-J, Chang S-C and Yuan M-K. The value of positron emission tomography in early detection of lung cancer in high-risk population: a systematic review. Clin Respir J 2013; 7: 16.