Assessing the Potential Usefulness of FDG LAFOV-PET for Oncological Staging: An Evaluation of Lesion Number and Uptake

Background/Objectives: In many cases, the detection of a single lesion could revolutionise patient clinical management; not all localisations, especially those with a low uptake and, consequently, a low Tumour-to-Background Ratio (TBR), are readily detectable using [18F]F-FDG PET/CT. LAFOV-PET offers a potential enhancement in lesion detection, but the proportion of patients who would benefit from its use has yet to be determined. With the present analysis, we aimed to assess which clinical contexts the enhancement in lesion detection could affect the most. Methods: This retrospective study included 764 patients who underwent [18F]F-FDG PET/CT between January and April 2024. Data were obtained through a review of PET/CT reports. Inclusion criteria comprised patients who attended our centre for cancer pathologies or masses of undetermined nature (MUNs) in a staging setting, excluding patients who had undergone a prior [18F]F-FDG PET/CT scan or who had received therapy for any cancer pathology. This analysis focused on the total number of lesions identified, as well as the SUVmax of the lesion with the highest uptake. We analysed the proportion of patients who were within the range of number of lesions between 1 and 2, as well as who had an SUVmax of the lesion with the highest uptake between 2 and 5, either in the whole patient population or in the pathologies with a larger numerosity in the present study. Results: Among the 862 scans analysed, 289 (34%) were found to be negative, while 573 (66%) presented at least one localisation. In total, 4.5% of patients presented both a lesion number of between 1 and 2 and an SUVmax of the lesion with the highest uptake between 2 and 5. Among the malignancies that were the most common in the analysed population, a higher-than-average proportion of patients meeting these criteria were found in melanoma (6.2%), breast cancer (5.9%), and multiple myeloma (4.8%) patients. Conversely, the conditions that presented a lower proportion of patients in this range were suffering from MUNs (4.0%), lung cancer (2.1%), head–neck cancer (2.1%), suspected lymphoma (2.0%), and colon cancer (0.0%). Conclusions: Our analysis shows that almost 1 in 20 patients evaluated at oncological staging with [18F]F-FDG PET/CT could benefit from the increased diagnostic sensitivity offered by LAFOV-PET scanners. These data, although preliminary, support the need for future prospective controlled studies to confirm the actual clinical impact of implementing LAFOV-PET in current practice.