PET\/CT is an integral component of lung cancer staging, and its use is recommended by leading international guidelines, including the NCCN (National Comprehensive Cancer Network). The scan facilitates a comprehensive assessment of disease extent and the selection of appropriate treatment tactics.<\/p>\n
Despite modern advances in diagnosis and treatment, lung cancer remains one of the leading causes of cancer-related mortality worldwide. Inaccurate staging can lead to unnecessary surgical intervention, incorrect definition of the target volume for radiation therapy, delays in systemic treatment, or the selection of inappropriate treatment for the patient.<\/p>\n
Unfortunately, performing a PET\/CT scan is not accessible to all patients. In Georgia, PET\/CT scans within state programs are only accessible to a limited category of patients, while in other cases, the cost of the scan is covered by the patient. As a result, staging and treatment planning often occur without PET\/CT, making it difficult to fully incorporate international recommendations into clinical practice.<\/p>\n
Principles of <\/strong>\u00a0PET\/CT and Types of PET\/CT<\/strong><\/p>\n PET\/CT scans are performed using various radiopharmaceuticals (radiotracers), each serving to evaluate specific biological processes.<\/p>\n PET\/CT is the most widely used scan. It simultaneously provides information on both the anatomical structure of tissues and their functional activity. CT shows structural changes, whereas PET evaluates the metabolic activity of tissues using \u00a0(FDG). Malignant tumor cells consume glucose more actively, allowing PET to detect metabolically active tumor foci that may not be clearly visible on anatomical imaging alone. Combined evaluation of anatomical and metabolic information allows for accurate detection of the primary tumor, regional lymph nodes, and distant metastases.<\/p>\n In Georgia, only \u00a0PET\/CT is routinely available in clinical practice, serving as the main method for the diagnosis and management of oncological diseases. Additionally, PSMA PET\/CT is performed at select medical centers for prostate cancer diagnosis, while PET\/CT scans using other radiotracers are currently not implemented in routine clinical practice in Georgia.<\/p>\n Accurate Staging: The First Step Toward Optimal Treatment<\/strong><\/p>\n Accurate TNM staging forms the basis for choosing an optimal treatment strategy. In this context, PET\/CT imaging plays a crucial role in identifying mediastinal lymph nodes and distant metastases, as the obtained data can substantially change the clinical stage of the disease and therapeutic tactics.<\/p>\n A scientific review published in 2025 in the journal Seminars in Nuclear Medicine<\/em> presents the role of PET\/CT in lung cancer staging. According to available data, the sensitivity of PET\/CT in detecting lymph node involvement in patients with non-small cell lung cancer (NSCLC) is approximately 85%, while specificity is 84%.<\/p>\n The clinical significance of PET\/CT was clearly demonstrated by Fischer et al. in the randomized PLUS trial, which involved 189 patients with potentially operable non-small cell lung cancer. In the PET\/CT group, thoracotomy was performed in 60 patients, of which the intervention proved to be futile in 21 cases (35%). In the traditional staging group, thoracotomy was performed in 73 patients and was futile in 38 cases (52%). The study results showed that the use of PET\/CT aids in the proper selection of patients for surgical treatment and reduces the number of unnecessary surgical interventions.<\/p>\n Despite the high diagnostic accuracy of PET\/CT, suspicious mediastinal lymph nodes still require morphological (histological\/cytological) confirmation. This is due to the fact that in certain cases, increased FDG uptake may be related to inflammatory or infectious processes rather than tumor infiltration.<\/p>\n The Role of PET\/CT in Treatment Planning<\/strong><\/p>\n PET\/CT is particularly important in radiation oncology, as the scan allows for accurate determination of target volumes for the primary tumor and involved lymph nodes.<\/p>\n Its important role was confirmed in the multicenter, randomized PET-Plan trial, which showed that \u00a0PET\/CT facilitates accurate target volume definition. This allows the radiation dose to be distributed more precisely to tumor-affected areas while minimizing impact on healthy tissue. In the PET\/CT-based group, the risk of local and regional progression was significantly lower compared to the standard approach (14% vs. 29% at one year), with no observed increase in treatment-related toxicity. The study results confirm the efficacy and safety of PET\/CT-based target volume definition when planning radiation therapy for non-small cell lung cancer.<\/p>\n These data are very important for the reality in Georgia, as due to limited financial accessibility to PET\/CT imaging, pre-treatment scanning cannot always be performed. Consequently, radiation therapy planning relies solely on anatomical imaging (e.g., CT\/MRI). This limits a full assessment of tumor and lymph node spread and increases the risk of incorrectly defining the radiation target area.<\/p>\n PET\/CT in Assessing Treatment Response and Follow-up<\/strong><\/p>\n In the post-treatment period, PET\/CT plays a critical role in identifying residual or recurrent disease, helping differentiate active tumor tissue from post-therapeutic changes. It must be noted that inflammatory reactions also cause increased FDG uptake. Therefore, to avoid diagnostic errors, it is essential to evaluate the clinical context and perform the scan within optimal timeframes.<\/p>\n Why PET\/CT Should Become a Routinely Accessible Standard in Lung Cancer Management in Georgia<\/strong><\/p>\n The discussed medical evidence clearly demonstrates that PET\/CT scanning is an irreplaceable gold standard in managing oncological diseases – especially lung, head and neck, prostate, breast, and neuroendocrine tumors. Despite this, in the Georgian reality, this method is not yet included in the routine state coverage system, creating a significant financial barrier for patients.<\/p>\n Due to high costs, treatment planning in clinical practice often relies solely on traditional, anatomical visualization (CT\/MRI). This approach increases the risk of error, leading to inaccurate disease staging, unnecessary invasive surgeries, target area volume errors in radiation therapy, and delayed medical treatment.<\/p>\n From a clinical and economic perspective, routine coverage of PET\/CT is not an extra expense for the healthcare budget, but rather a wise reallocation of resources: accurate diagnosis and early staging directly reduce indirect and direct costs for the healthcare system by avoiding futile invasive procedures and the inappropriate prescription of expensive drug therapies (chemo\/immunotherapy). Accordingly, the gradual integration of PET\/CT imaging and innovative radiotracers into universal healthcare programs is a critically necessary step for implementing evidence-based medical practice, improving treatment quality, and increasing patient Overall Survival (OS) rates.<\/p>\n\n