18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review

Ung, Yee C.; Maziak, Donna E.; Vanderveen, J A; Smith, Christopher A.; Gulenchyn, Karen Y.; Lacchetti, Christina; Evans, William K.

doi:10.1093/jnci/djm232

Cited by 127 publications

(91 citation statements)

References 79 publications

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“…Also, nodules that presented with pure ground-glass opacities were more likely to be malignant, in a rate of about 59 to 73%. 10 Since this case not only had a nodule that close to 2 cm and showed ground-glass opacities, the chance for malignancy was high. The established prognostic criteria for the diagnosis of malignancy in similar tumors include any combination of the following: infiltrative growth, marked hypercellularity nuclear enlargement and hyperchromasia, high mitotic activity, atypical mitotic figures, and coagulative necrosis.…”

Section: Discussionmentioning

confidence: 88%

Clear Cell “Sugar” Tumor of the Lung: Benign or Malignant?

Olivencia‐Yurvati

Rodriguez

2015

International Surgery

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Clear cell ''sugar'' tumors of the lung are rare pulmonary tumors. This case study illustrates a patient who was found to have a persistent nodule in the left-upper lobe of the lung. Positron emission tomographic scanning showed mild-moderate 18-fluorodeoxyglucose uptake. Based on these findings, a video-assisted resection of the tumor was undertaken. The mass was identified histologically, as a clear cell ''sugar'' tumor of the lung. This case report discusses the benign versus malignant nature of this rare tumor.Key words: Clear cell sugar tumor -Rare tumor -Lung tumor -Incidentaloma L ung cancer is one of the leading causes of cancer death in industrialized countries. Early discovery is an important factor for survivability. With only a limited number of cases reported, 1 clear cell (sugar) lung tumors are extraordinarily rare. These particular lung tumors have been described as benign neoplasms that have a considerable amount of intracellular glycogen among other diagnostic features. The characteristic presence of such a high amount of glycogen has led to these tumors as often being referred to as simply, sugar tumors of the lung. The purpose of this report is to add to other reported cases of this rare pulmonary lesion, through a comprehensive literature review. The goals are to inform physicians of this rare entity, and to discuss how these tumors can be confused with malignant tumors. CaseA 39-year-old, well-developed female presented with evidence of a persistent nodule located in the left-upper lobe of the lung. A whole body positron emission tomographic/computed tomography (PET/CT) showed the nodule measuring approximately 1.1 cm 3 1.0 cm in size along with persistent ground glass type infiltrate. The 18-fluorodeoxyglucose uptake was positive. The nodule was also shown to be changing with serial films, with an increase in size. The structural exam was normal except for paravertebral tissue fullness around T2 to T5. It was recommended that she undergo videoassisted thoracoscopic resection of the lesion. A wedge resection was carried out and the lesion was successfully removed alongside normal surrounding parenchyma. Frozen sections showed evidence of inflammatory cells surrounding the nodule, but no evidence of malignancy. During the operation, both the lesion and the lung parenchyma were opened and aerobic, anaerobic, and acid-fast cultures were obtained. The rest of the lung appeared healthy with no pleural effusions or any other abnormalities. The operation was well-tolerated and the patient recovered completely and continued to do well on postsurgical cardiothoracic surgical clinic visits. Final pathology was consistent with benign sugar tumor (Fig.

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Section: Discussionmentioning

confidence: 88%

Clear Cell “Sugar” Tumor of the Lung: Benign or Malignant?

Olivencia‐Yurvati

Rodriguez

2015

International Surgery

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“…[25][26][27] Matthies et al 28 Single-time-point PET (at time point 1) with a threshold SUV of 2.5 reached a sensitivity of 80% and a specificity of 94%; DP imaging (with a threshold value of 10% increase between scan 1 and scan 2) had a sensitivity of 100% and a specificity of 89%, respectively. In particular, 4 of 20 of malignant nodules had SUVs Ͻ2.5 on scan 1, whereas 2 lesions with a high likelihood of benign etiology showing increase Ͼ10% of their SUVs over time had very low uptake (0.43 and 0.63, respectively) on scan 1.…”

Section: Lung Cancermentioning

confidence: 99%

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Schillaci

2012

Seminars in Nuclear Medicine

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Positron emission tomography (PET) and positron emission tomography/computed tomography imaging with fluorodeoxyglucose (FDG) are widely used as a powerful evaluation modality in oncological nuclear medicine not only for detecting tumors but also for staging and for therapy monitoring. Nevertheless, there are numerous causes of FDG uptake in benign processes seen on PET images. In fact, the degree of FDG uptake is related to the cellular metabolic rate and the number of glucose transporters. FDG accumulation in tumors is due, in part, to an increased number of glucose transporters in malignant cells. However, FDG is not specific for neoplasms: a similar situation exists in inflammation; activated inflammatory cells demonstrate increased expression of glucose transporters. Therefore, there is growing interest in improving the specificity of FDG-PET in patients with cancer. Preliminary studies showed that in several neoplasms, the uptake of FDG continues to increase for hours after radiopharmaceutical injection, and this difference in the time course of FDG uptake could be useful to improve the accuracy of PET to distinguish benign lesions from malignant ones. Also in experimental cultures, dual-point acquisition (early at 40-60 minutes postinjection and delayed at 90-270 minutes) demonstrated that it is able to differentiate inflammatory from neoplastic tissue. In general, inflammatory tissue is expected to reduce FDG uptake as the time goes by, whereas the uptake in the neoplastic lesions is supposed to be increasing. There is evidence in the recent literature of the clinical usefulness of dual-time-point FDG-PET imaging in a wide variety of malignancies, including those of head and neck, lung, breast, gallbladder, cervix, liver, and in brain tumors. A lesion is likely to be malignant if the standard uptake value increases over time, whereas it is likely to be benign if the standard uptake value is stable or decreases. It is worth noting that in many of these studies, dual-time-point PET improved not only the specificity but also the sensitivity in assessing breast, pulmonary, liver, and other tumors because of increased lesion-to-background ratio, as a consequence of FDG washout from the surrounding normal tissues and increasing neoplastic uptake. Semin Nucl Med 42:267-280

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“…[3][4][5] The determination of malignant lesions with FDG-PET is based on increased glucose metabolism. 6) The standardized uptake value (SUV) of FDG-PET is a semiquantitative simplified measurement of FDG accumulation rate in tissues and the maximum SUV (SUV max ) in the target lesion is widely used because of its simplicity.…”

Section: Introductionmentioning

confidence: 99%

Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography can Predict the Tumor Malignancy of Small Peripheral Lung Cancer

Kosaka

Yamaki

Tanaka

et al. 2014

Ann Thorac Cardiovasc Surg

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Purpose: Recent advances in image diagnostic technology have enhanced the discovery of peripheral small size lung cancers. Here, we examined the utility of 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for the evaluation of grade of tumor malignant potency. Methods: Seventy-nine patients with peripheral small lung cancers (≤2 cm) who underwent surgical resections and preoperative FDG-PET were enrolled. The correlations between the maximum standardized uptake value (SUV max ) and various clinicopathological features related to tumor invasiveness, nodal metastasis, and recurrence were analyzed. Results: The median SUV max of all tumors was 2.4 (range, 0-16.1). The SUV max was significantly higher in patients with vascular invasion (5.6 ± 3.5 vs. 2.4 ± 2.4; P <0.0001), lymphatic invasion (4.9 ± 3.7 vs. 2.7 ± 2.6; P = 0.0029), lymph node metastasis (6.1 ± 4.4 vs. 3.0 ± 2.7; P = 0.0022), and recurrences (5.8 ± 3.3 vs. 3.1 ± 3.1; P = 0.0219). Patients with SUV max ≥2.5 had a significantly higher incidence rate of vascular invasion (56% vs. 7%; P <0.0001), lymphatic invasion (51% vs. 15%; P = 0.0006), lymph node metastasis (26% vs. 3%; P = 0.0033), and recurrence (18% vs. 3%; P = 0.0289). The patients with SUV max ≥1.5 also had a significantly higher incidence of vascular invasion, lymphatic invasion, lymph node metastasis, and recurrence. It is particularly worth noting that patients with SUV max <1.5 had no vascular invasion, lymph node metastasis, or recurrence. Conclusion: Preoperative SUV max of peripheral small lung cancers were significantly associated with tumor malignancy.

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18Fluorodeoxyglucose Positron Emission Tomography in the Diagnosis and Staging of Lung Cancer: A Systematic Review

Cited by 127 publications

References 79 publications

Clear Cell “Sugar” Tumor of the Lung: Benign or Malignant?

Clear Cell “Sugar” Tumor of the Lung: Benign or Malignant?

Use of Dual-Point Fluorodeoxyglucose Imaging to Enhance Sensitivity and Specificity

Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography can Predict the Tumor Malignancy of Small Peripheral Lung Cancer

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