Integrated Imaging of Non-small Cell Lung Cancer Recurrence: CT and PET-CT Findings, Possible Pitfalls and Risk of Recurrence Criteria

Overview

Journal Eur Radiol

Specialty Radiology

Date 2011 Oct 5

PMID 21969110

Citations 11

Authors

Andrea Caulo

Saeed Mirsadraee

Fabio Maggi

Lucia Leccisotti

Edwin J R van Beek

Lorenzo Bonomo

Affiliations

Soon will be listed here.

Abstract

Objectives: To review the role of imaging in the diagnosis of recurrent disease in previously treated non-small cell lung cancer (NSCLC) and discuss the imaging pitfalls.

Methods: A comprehensive review of published literature on CT and PET imaging of NSCLC recurrence was performed. Diagnostic and prognostic values are discussed. Representative imaging examples are illustrated.

Results: Up to 30% of NSCLC recurrences present as loco-regional, involving treated hemithorax and ipsilateral lymph nodes, while 70% present as metachronous distant metastases. CT and PET-CT play an important role in the early detection of recurrence; indications for imaging vary depending on pathological features.

Conclusion: Imaging plays a central role in the identification of recurrence and may predict prognosis.

Key Points: Lung cancer recurs after surgery in 30% to 75% of patients. CT and PET-CT are crucial in identification of loco-regional recurrence. Knowledge of potential pitfalls is essential, especially for parenchymal or nodal recurrence. CT can diagnose metastases but further examinations (PET-CT, MRI) are often needed. Morphological and functional imaging criteria may help in predicting recurrence.

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References

Vansteenkiste J, Dooms C, De Leyn P . The multidisciplinarity of stage III non-small cell lung cancer. Eur J Cancer. 2009; 45 Suppl 1:92-105. DOI: 10.1016/S0959-8049(09)70021-8. View

Suh R, Wallace A, Sheehan R, Heinze S, Goldin J . Unresectable pulmonary malignancies: CT-guided percutaneous radiofrequency ablation--preliminary results. Radiology. 2003; 229(3):821-9. DOI: 10.1148/radiol.2293021756. View

Rami-Porta R, Gonzalez-Pont G . Remediastinoscopy after induction chemotherapy in non-small cell lung cancer. Ann Thorac Surg. 2000; 70(2):391-5. DOI: 10.1016/s0003-4975(00)01437-5. View

De Wever W, Vankan Y, Stroobants S, Verschakelen J . Detection of extrapulmonary lesions with integrated PET/CT in the staging of lung cancer. Eur Respir J. 2007; 29(5):995-1002. DOI: 10.1183/09031936.00119106. View

Trovo M, Linda A, El Naqa I, Javidan-Nejad C, Bradley J . Early and late lung radiographic injury following stereotactic body radiation therapy (SBRT). Lung Cancer. 2009; 69(1):77-85. DOI: 10.1016/j.lungcan.2009.09.006. View

Virgo K, Johnson F, Naunheim K . Follow-up of patients with thoracic malignancies. Surg Oncol Clin N Am. 1999; 8(2):355-69. View

Hishida T, Nagai K, Yoshida J, Nishimura M, Ishii G, Iwasaki M . Is surgical resection indicated for a solitary non-small cell lung cancer recurrence?. J Thorac Cardiovasc Surg. 2006; 131(4):838-42. DOI: 10.1016/j.jtcvs.2005.11.028. View

Seo J, Im J, Goo J, Chung M, Kim M . Atypical pulmonary metastases: spectrum of radiologic findings. Radiographics. 2001; 21(2):403-17. DOI: 10.1148/radiographics.21.2.g01mr17403. View

Jang K, Lee K, Shim Y, Han D, Kim H, Kwon O . The rates and CT patterns of locoregional recurrence after resection surgery of lung cancer: correlation with histopathology and tumor staging. J Thorac Imaging. 2003; 18(4):225-30. DOI: 10.1097/00005382-200310000-00003. View

10.

Onishi Y, Ohno Y, Koyama H, Nogami M, Takenaka D, Matsumoto K . Non-small cell carcinoma: comparison of postoperative intra- and extrathoracic recurrence assessment capability of qualitatively and/or quantitatively assessed FDG-PET/CT and standard radiological examinations. Eur J Radiol. 2010; 79(3):473-9. DOI: 10.1016/j.ejrad.2010.04.027. View

11.

Bryant A, Cerfolio R . Differences in epidemiology, histology, and survival between cigarette smokers and never-smokers who develop non-small cell lung cancer. Chest. 2007; 132(1):185-92. DOI: 10.1378/chest.07-0442. View

12.

Blake M, Slattery J, Kalra M, Halpern E, Fischman A, Mueller P . Adrenal lesions: characterization with fused PET/CT image in patients with proved or suspected malignancy--initial experience. Radiology. 2006; 238(3):970-7. DOI: 10.1148/radiol.2383042164. View

13.

Goldstraw P, Crowley J, Chansky K, Giroux D, Groome P, Rami-Porta R . The IASLC Lung Cancer Staging Project: proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM Classification of malignant tumours. J Thorac Oncol. 2007; 2(8):706-14. DOI: 10.1097/JTO.0b013e31812f3c1a. View

14.

De Leyn P, Vansteenkiste J, Cuypers P, Deneffe G, Van Raemdonck D, Coosemans W . Role of cervical mediastinoscopy in staging of non-small cell lung cancer without enlarged mediastinal lymph nodes on CT scan. Eur J Cardiothorac Surg. 1998; 12(5):706-12. DOI: 10.1016/s1010-7940(97)00253-4. View

15.

Singnurkar A, Solomon S, Gonen M, Larson S, Schoder H . 18F-FDG PET/CT for the prediction and detection of local recurrence after radiofrequency ablation of malignant lung lesions. J Nucl Med. 2010; 51(12):1833-40. DOI: 10.2967/jnumed.110.076778. View

16.

Detterbeck F, Jantz M, Wallace M, Vansteenkiste J, Silvestri G . Invasive mediastinal staging of lung cancer: ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007; 132(3 Suppl):202S-220S. DOI: 10.1378/chest.07-1362. View

17.

Mayo-Smith W, Boland G, Noto R, Lee M . State-of-the-art adrenal imaging. Radiographics. 2001; 21(4):995-1012. DOI: 10.1148/radiographics.21.4.g01jl21995. View

18.

Maeda R, Yoshida J, Ishii G, Hishida T, Aokage K, Nishimura M . Long-term survival and risk factors for recurrence in stage I non-small cell lung cancer patients with tumors up to 3 cm in maximum dimension. Chest. 2010; 138(2):357-62. DOI: 10.1378/chest.09-3046. View

19.

Takeda S, Fukai S, Komatsu H, Nemoto E, Nakamura K, Murakami M . Impact of large tumor size on survival after resection of pathologically node negative (pN0) non-small cell lung cancer. Ann Thorac Surg. 2005; 79(4):1142-6. DOI: 10.1016/j.athoracsur.2004.09.062. View

20.

Al-Kattan K, Sepsas E, Fountain S, Townsend E . Disease recurrence after resection for stage I lung cancer. Eur J Cardiothorac Surg. 1997; 12(3):380-4. DOI: 10.1016/s1010-7940(97)00198-x. View