Publication: La PET-TAC en la estadificación ganglionar prequirúrgica y tras el tratamiento de inducción del carcinoma de pulmón de células no pequeñas
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2017-02-07
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Universidad Complutense de Madrid
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Abstract
El cáncer de pulmón es la primera causa de muerte por cáncer en el mundo. En el año 2012, se diagnosticaron más de 1,8 millones de nuevos casos y se produjeron 1,6 millones de muertes por esta causa, lo que refleja la alta letalidad de este tumor. El 80%-87% son carcinomas de células no pequeñas (CPCNP), incluyen fundamentalmente los subtipos histológicos de adenocarcinoma, carcinoma epidermoide o de células escamosas y carcinoma de células grandes. El 15-20% restante son carcinomas de células pequeñas (CPCP). La supervivencia media a los 5 años en Europa es del 12-14%. Es fundamental realizar una estadificación precisa y detallada de la enfermedad para seleccionar el tratamiento más adecuado y poder predecir el pronóstico. En los pacientes con CPCNP que no tienen metástasis a distancia, el factor más importante que influye en la decisión terapéutica es la afectación ganglionar mediastínica, pues nos permite diferenciar pacientes con tumores resecables en estadios iniciales de la enfermedad (estadios I y II), de pacientes con tumores potencialmente resecables en estadio IIIA, del resto de pacientes en estadio III inoperables. La Tomografía Computarizada (TC) es la técnica de imagen más utilizada en la estadificación del CPCNP. Aporta una excelente información anatómica y morfológica del tumor primario y de la infiltración de las estructuras vecinas, pero tiene una sensibilidad limitada en la estadificación ganglionar pues el único criterio utilizado es el tamaño del ganglio. Su sensibilidad es del 51%-70% y la especificidad del 61%-86%...
Lung cancer is the leading cause of death in the world. In 2012 more than 1.8 million new causes were diagnosed and 1.6 million patients died of this disease, indicating its aggressiveness. The most frequent type is non-small lung cancer (NSCLC), which comprises 80%-87% of lung cancer cases and includes adenocarcinoma, squamous cell carcinoma and large-cell carcinoma subtypes. The remaining 15%-20% correspond to small-cell lung cancer (SCLC). Five-year overall survival in Europe is 12%-14%. Accurate staging is key to be able to take the most appropriate management decisions based on staging and prognosis. In patients with NSCLC without distant metastases, the most important factor when deciding the optimal management approach is the presence or absence of mediastinal lymphadenopathies as it will differentiate initial stages (I, II), locally advanced disease but potentially resectable (IIIA) or inoperable patients (IIIB, IV). CT is the imaging technique most frequently used for staging NSCLC. It provides excellent anatomic and morphological information of the primary tumour and of the infiltration of the neighboring structures, but it has a limited sensitivity for N staging, as the only criteria is the size of the lymph node. Sensitivity (Se) of CT is 51%-70% and specificity (Sp) 61%-86%. FDG PET supplies metabolic information which improves its diagnostic performance compared to CT, especially regarding N staging. Several meta-analysis have described Se between 79% and 90% and Sp between 89% and 91% for differentiating N0-1 stages from N2-3 stages...
Lung cancer is the leading cause of death in the world. In 2012 more than 1.8 million new causes were diagnosed and 1.6 million patients died of this disease, indicating its aggressiveness. The most frequent type is non-small lung cancer (NSCLC), which comprises 80%-87% of lung cancer cases and includes adenocarcinoma, squamous cell carcinoma and large-cell carcinoma subtypes. The remaining 15%-20% correspond to small-cell lung cancer (SCLC). Five-year overall survival in Europe is 12%-14%. Accurate staging is key to be able to take the most appropriate management decisions based on staging and prognosis. In patients with NSCLC without distant metastases, the most important factor when deciding the optimal management approach is the presence or absence of mediastinal lymphadenopathies as it will differentiate initial stages (I, II), locally advanced disease but potentially resectable (IIIA) or inoperable patients (IIIB, IV). CT is the imaging technique most frequently used for staging NSCLC. It provides excellent anatomic and morphological information of the primary tumour and of the infiltration of the neighboring structures, but it has a limited sensitivity for N staging, as the only criteria is the size of the lymph node. Sensitivity (Se) of CT is 51%-70% and specificity (Sp) 61%-86%. FDG PET supplies metabolic information which improves its diagnostic performance compared to CT, especially regarding N staging. Several meta-analysis have described Se between 79% and 90% and Sp between 89% and 91% for differentiating N0-1 stages from N2-3 stages...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Radiología y Medicina Física, leída el 20/01/2016