Evaluation of PET-CT imaging as a Prognostic Tool in pulmonary nodules
DOI:
https://doi.org/10.5281/zenodo.22814229Keywords:
PET-CT, pulmonary nodule, SUVmax, prognosis, non-small cell lung cancerAbstract
Background: Fluorodeoxyglucose PET-CT is well established as a diagnostic tool for characterizing indeterminate pulmonary nodules, but its role once malignancy is confirmed, as a predictor of patient outcome, has received comparatively less synthesis.
Objective: This review synthesizes the published evidence on FDG-PET-CT as a prognostic tool in pulmonary nodules and early-stage lung cancer, focusing on standardized uptake value, volumetric and radiomic parameters, diagnostic pitfalls that complicate prognostic interpretation, and serial imaging during treatment.
Methods: We synthesized diagnostic-accuracy meta-analyses, surgical and multicenter cohort studies, systematic reviews from the European Lung Cancer Working Party, and treatment-response imaging trials addressing FDG-PET-CT in pulmonary nodule and non-small cell lung cancer prognosis.
Findings: Primary tumor SUVmax is a reproducible, stage-independent predictor of survival, while region-dependent false positives from granulomatous disease and false negatives in well-differentiated histologies complicate naive interpretation of uptake as risk; volumetric and radiomic signatures add discrimination beyond SUVmax alone, and serial imaging during treatment extends prognostic assessment through therapy.
Conclusions: FDG-PET-CT is a genuine prognostic instrument in pulmonary nodules when quantitative and volumetric parameters are interpreted alongside clinical probability and diagnostic context, supporting a layered approach treating each scan as input into ongoing risk stratification.
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