The Role of PET in Lung Cancer from a Surgeon’s Perspective

PET has been widely adopted and remains the most cost-effective investigation in clinical staging of non-small cell lung cancer. Minimal access thoracic surgeons pinned their hopes on this new non-invasive technique to stage the mediastinum. PET can be blinded to adenocarcinoma in the lung or in mediastinal nodes in 10-15% of cases. Faced with low sensitivity of PET, Multidisciplinary treating clinicians have to accept these limitations when constructing clinical pathways, and adjuvant therapy should be based on pathological staging by invasive techniques (mediastinoscopy, EBUS, operative Systematic Nodal Dissection). PET helps direct those biopsies and finds unsuspected extra-thoracic metastases in 7% of patients. Relying on PET staging alone can lead to significant over staging, denial of curative resection, stage migration and misleading survival statistics. Review Article