Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with 18F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study

Abstract

Purpose: To evaluate the role of 18 F-fluorodeoxyglucose positron emission tomography (FDG-PET) in radiologically occult preinvasive lesions and lung cancer in the central airways. Experimental Design:Twenty-two patients with 24 preinvasive lesions and early squamous cell cancer (SCC) being occult on high-resolution computed tomography were studied. All lesions were diagnosed based on histology sampled using autofluorescence bronchoscopy. FDG-PET findings were correlated with WHO histologic classification. FDG-PET was considered truepositive when the final diagnosis was SCC and true-negative when the lesions were classified as severe dysplasia or less. Results: FDG-PET was true-positive in 8 of 11and true-negative in 11of 13 cases corresponding with a sensitivity of 73% [95% confidence interval (CI), 0.43-0.91] and specificity of 85% (95% CI, 0.57-0.97). Positive and negative predictive values were 80% (95% CI, 0.48-0.96) and 79% (95% CI, 0.52-0.93), respectively. Conclusions: Our very preliminary data suggest that FDG-PET might be useful for the evaluation of early central airway lesions, being positive in most SCC and negative in cases of severe dysplasia. Validation in a larger multicenter study is needed.

Virtual positron emission tomography/computed tomography-bronchoscopy: possibilities, advantages and limitations of clinical application

“…Therefore, virtual PET/CT-bronchoscopy will improve diagnostic accuracy in the diagnosis of endotracheal and endobronchial diseases. This is also supported by Pasic et al [18], who suggested that 18 F-FDG PET might be useful for the evaluation of early central airway lung cancer that cannot be visualized with highresolution CT. 18 F-FDG PET imaging has become an accepted and valuable diagnostic imaging tool for patients with cancer. Kamel et al [19] reported that 18 F-FDG PET has a major impact on the management of treatment for patients with small cell lung cancer (SCLC).…”

Usefulness of FDG PET/CT in determining benign from malignant endobronchial obstruction

“…However, most of these studies have focused on solitary pulmonary nodules (SPN) or evaluated the FDG uptake of the malignant lesion itself only. Although there have been a few studies on the FDG uptake in evaluation of central airway lesions [28][29][30][31][32][33], to our knowledge, there have been no reports evaluating the FDG uptake pattern at the obstruction site in patients with endobronchial lesions with distal atelectasis.…”

Early Detection of Lung Cancer

“…In a retrospective series of 20 PET-negative lesions of less than 1 cm at CT, Nomori et al [42 ]reported 8 (40%) malignant tumours, while in 64 non-small cell lung cancers of 2 cm or less, Port et al [43 ]observed 29 (45%) false-negative results, mostly in BACs. On the other hand, a pilot study on 22 patients showed promising results with preinvasive lesions and occult cancer of central airways with an overall accuracy of 79% [44]. …”