What are the second-line imaging modalities for the evaluation of non-small cell lung cancer (NSCLC)?

Updated: Aug 27, 2019
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Eugene C Lin, MD  more...
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Invariably, other investigations, such as CT scanning, are required for better delineation of the abnormality detected on plain radiographs. CT can also be helpful in excluding a benign lesion and in preoperative staging. CT of the chest is an important informative tool that helps in detailed imaging of the primary tumor and its anatomic relationship to other structures, and it provides information with respect to the size of mediastinal lymph nodes and the status of the pleural space. However, CT criteria for adenopathy are based on size alone and do not always accurately reflect the presence or absence of tumor metastases. CT can best be thought of as a technique that provides a roadmap for more accurate surgical staging. [12, 13, 14]

The roles of MRI and positron emission tomography (PET) scan are not as well defined. MRI may be superior to CT in the assessment of the chest wall invasion by apical tumors. The use of PET scanning is expanding rapidly. The National Comprehensive Cancer Network (NCCN) guidelines for NSCLC find PET/CT imaging useful prior to biopsy to help identify the biopsy site that will confer the highest stage. [15]  

PET scanning may be useful in the assessment of solitary pulmonary lung nodules. Several studies indicate that PET scanning appears to be valuable in deciding whether a nodule is benign or malignant, as well as in staging locoregional and distant metastatic disease. [16, 17] In some centers, PET/CT scanners are available to allow more precise anatomic localization. [12, 13, 18]

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