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[Positron emission tomography (PET) with [18F]-FDG in bronchopulmonary cancer and its impact on medical decision at the time of diagnosis, staging, or recurrence evaluation].

Clinical usefulness of [18F]-FDG imaging, performed by means of a dedicated or a "hybrid" PET machine, has been recognised in France since November 1998. Among the clinical indications, three major clinical settings of lung cancer have been included: characterisation, staging and detection of recurrences. After a brief presentation of the PET scintigraphic imaging modality, authors report on the experience of the nuclear medicine team of Hôspital Tenon and summarise the results in literature. For tumour characterisation, a recent meta-analysis obtained a 96% sensitivity, a 73% specificity, a 91% positive predictive value and a 90% negative predictive value, the performances being better for lesions greater than 1 cm. For staging, an increase greater than 15% both in sensitivity and specificity has been observed with dedicated or "hybrid" PET versus CT for N staging. Detection of distant metastases was also more accurate using [18F]-FDG. A similar increase was observed in the detection of recurrence, in accordance with our study; some authors described even better results. A better anatomical delineation of the lesions detected with FDG can be achieved by means of image fusion with CT; this technique is likely to develop as a routine tool in the near future. Finally, FDG imaging led to modification of patient's management in 37% of the cases according to a recent meta-analysis versus 53% of the cases in our retrospective survey concerning the first year of installation of a dedicated PET machine. This rate was equal with dedicated PET and with CDET. In 46% of the cases an inter-modality change occurred, and in 7% an intra-modality change consisting mainly in adaptation of the surgical procedure. As soon as the FDG examination became available, its clinical impact, in the French medical context, appeared to reach the highest values that were published internationally.