الفهرس 
Anatomy of the Lungs
Bronchopulmonary segmentsOnly 14 pages are availabe for public view
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Abstract
Lung cancer is the leading cause of cancer-related deaths for both men and women across the developed world. Despite tremendous efforts to treat this cancer, the overall 5-year survival for all stages is low (15%), as most patients present at an advanced stage when curative treatment is no longer an option. Although the majority of patients present at an advanced stage, those with early-stage lung cancer can be treated with a potentially curative intent. Thus, the early diagnosis as well as appropriate radiological staging cannot be overemphasized.
Before the emergence of FDG-PET/CT, radiological assessment and staging of lung cancer was mainly based on CT examination as well as bone scan. After development of PET and PET/CT machines, this modality rapidly proved its efficiency and is now recommended by the NCCN guidelines Our study was done on 50 patients and intended to evaluate the added value of PET/CT in bronchogenic carcinoma patients in initial staging (group A: 25 patients) and follow up (group B: 25 patients). The results revealed in group A, a change of N staging in 32% of patients, 4% change in T staging and 56% change in M staging compared to CT alone. In group B, response assessment was changed in 12 patients (48%) compared to CT alone.The added value of PET/CT exam in initial staging (group A) in T-stage assessment was accurately identifying the true size of primary mass when it is surrounded by collapsed lobe or distal consolidation. In N-stage, it has the ability of PET/CT to detect the metastatic subcentimetric normal sized lymph nodes. In M stage, it detected metastatic lesions all over the body accurately as in liver, adrenal, pleura or bone (except brain).
The added value in follow up of patients (group B) was the early and accurate assessment of metabolic response before any change in size or appearance in CT exam.
Despite the overall great benefits, PET/CT also shows few limitations and pitfalls as increased metabolic activity in lung inflammatory conditions as sarcoidosis and radiation pneumonitis or infective conditions as pneumonia or abscess. Also one of the sources of false positive results are benign adrenal lesions as functioning adenomas or hyperplasia that show increased activity. Our results show the great advantage of PET/CT in initial staging of bronchogenic carcinoma, which is also recommended by the NCCN guidelines. We also recommend doing PET/CT in follow up studies as it gives an early and accurate metabolic response assessment before any CT changes, leading to early modification of therapy or confirmation of its efficiency.Finally, FDG-PET/CT proved itself as useful, efficient and reliable tool of investigation in initial staging and follow up of lung cancer patients.