The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review
<b>Background/Objectives</b>: Pulmonary lymphangitic carcinomatosis (PLC) is a rare, aggressive manifestation of metastatic cancer characterized by lymphatic infiltration of the lungs, typically indicating advanced disease and poor prognosis. <b>Methods</b>: This comprehensiv...
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MDPI AG
2025-06-01
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| author | Francesco Dondi Pietro Bellini Michela Cossandi Luca Camoni Roberto Rinaldi Gian Luca Viganò Francesco Bertagna |
| author_facet | Francesco Dondi Pietro Bellini Michela Cossandi Luca Camoni Roberto Rinaldi Gian Luca Viganò Francesco Bertagna |
| author_sort | Francesco Dondi |
| collection | DOAJ |
| description | <b>Background/Objectives</b>: Pulmonary lymphangitic carcinomatosis (PLC) is a rare, aggressive manifestation of metastatic cancer characterized by lymphatic infiltration of the lungs, typically indicating advanced disease and poor prognosis. <b>Methods</b>: This comprehensive narrative review evaluates the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) imaging in assessing PLC. <b>Results</b>: Current evidence demonstrates that [18F]FDG PET/CT achieves high diagnostic accuracy, with sensitivity and specificity ranging from 86 to 97% and 84 to 100%, respectively, particularly when employing semiquantitative metrics such as peritumoral standardized uptake value (SUVmax) thresholds (e.g., ≥2.1). PET/CT surpasses high-resolution computed tomography (HRCT) in distinguishing PLC from mimics like pulmonary sarcoidosis by identifying distinct metabolic patterns: bronchovascular hypermetabolism in PLC versus subpleural nodular uptake in sarcoidosis. Prognostically, metabolic tumor burden (e.g., SUVmax × involved lobes) and novel cPLC classifications (localized to the ipsilateral or contralateral lung) independently predict progression-free survival. However, challenges persist, including non-specific tracer uptake in inflammatory conditions and variability in SUV measurements due to technical factors. Emerging digital PET/CT systems, with enhanced spatial resolution, may improve the detection of focal PLC and reduce false negatives. While [18F]FDG PET/CT is invaluable for whole-body staging, therapeutic monitoring and biopsy guidance, the standardization of protocols and multicenter validation of prognostic models are critical for clinical integration. Future research should explore novel tracers (e.g., PSMA for prostate cancer-related PLC) and machine learning approaches to refine diagnostic and prognostic accuracy. <b>Conclusions</b>: This review underscores the role and the transformative potential of [18F]FDG PET/CT in PLC management while advocating for rigorous standardization to maximize its clinical utility. |
| format | Article |
| id | doaj-art-9e89681a05d845b4b1ca3fe33480fe8e |
| institution | Kabale University |
| issn | 2075-4418 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj-art-9e89681a05d845b4b1ca3fe33480fe8e2025-08-20T03:28:37ZengMDPI AGDiagnostics2075-44182025-06-011513162610.3390/diagnostics15131626The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature ReviewFrancesco Dondi0Pietro Bellini1Michela Cossandi2Luca Camoni3Roberto Rinaldi4Gian Luca Viganò5Francesco Bertagna6Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, ItalyNuclear Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyNuclear Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyNuclear Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyNuclear Medicine, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyClinical Engineering, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyDepartment of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy<b>Background/Objectives</b>: Pulmonary lymphangitic carcinomatosis (PLC) is a rare, aggressive manifestation of metastatic cancer characterized by lymphatic infiltration of the lungs, typically indicating advanced disease and poor prognosis. <b>Methods</b>: This comprehensive narrative review evaluates the role of [18F]fluorodeoxyglucose ([18F]FDG) positron emission tomography (PET) imaging in assessing PLC. <b>Results</b>: Current evidence demonstrates that [18F]FDG PET/CT achieves high diagnostic accuracy, with sensitivity and specificity ranging from 86 to 97% and 84 to 100%, respectively, particularly when employing semiquantitative metrics such as peritumoral standardized uptake value (SUVmax) thresholds (e.g., ≥2.1). PET/CT surpasses high-resolution computed tomography (HRCT) in distinguishing PLC from mimics like pulmonary sarcoidosis by identifying distinct metabolic patterns: bronchovascular hypermetabolism in PLC versus subpleural nodular uptake in sarcoidosis. Prognostically, metabolic tumor burden (e.g., SUVmax × involved lobes) and novel cPLC classifications (localized to the ipsilateral or contralateral lung) independently predict progression-free survival. However, challenges persist, including non-specific tracer uptake in inflammatory conditions and variability in SUV measurements due to technical factors. Emerging digital PET/CT systems, with enhanced spatial resolution, may improve the detection of focal PLC and reduce false negatives. While [18F]FDG PET/CT is invaluable for whole-body staging, therapeutic monitoring and biopsy guidance, the standardization of protocols and multicenter validation of prognostic models are critical for clinical integration. Future research should explore novel tracers (e.g., PSMA for prostate cancer-related PLC) and machine learning approaches to refine diagnostic and prognostic accuracy. <b>Conclusions</b>: This review underscores the role and the transformative potential of [18F]FDG PET/CT in PLC management while advocating for rigorous standardization to maximize its clinical utility.https://www.mdpi.com/2075-4418/15/13/1626pulmonary lymphangitic carcinomatosisPLClymphangitic carcinomatosis positron emission tomographyPET/CTPET[18F]FDG |
| spellingShingle | Francesco Dondi Pietro Bellini Michela Cossandi Luca Camoni Roberto Rinaldi Gian Luca Viganò Francesco Bertagna The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review Diagnostics pulmonary lymphangitic carcinomatosis PLC lymphangitic carcinomatosis positron emission tomography PET/CT PET [18F]FDG |
| title | The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review |
| title_full | The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review |
| title_fullStr | The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review |
| title_full_unstemmed | The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review |
| title_short | The Role of [18F]FDG PET Imaging for the Assessment of Pulmonary Lymphangitic Carcinomatosis: A Comprehensive Narrative Literature Review |
| title_sort | role of 18f fdg pet imaging for the assessment of pulmonary lymphangitic carcinomatosis a comprehensive narrative literature review |
| topic | pulmonary lymphangitic carcinomatosis PLC lymphangitic carcinomatosis positron emission tomography PET/CT PET [18F]FDG |
| url | https://www.mdpi.com/2075-4418/15/13/1626 |
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