Diagnostic Yield of 18F-FDG PET After Lung Transplantation: A Single-center, Retrospective Cohort Study

Abstract

Take Home Message:The diagnostic yield of 18 F-FDG PET for malignancy in lung transplant recipients is high.

Imaging in Lung Transplantation: So Near and Yet So Far

“…Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 91.4%, 82.3%, 75.3%, and 94.2% respectively. 5 These findings are comparable to earlier retrospective studies that investigated the clinical utility of 18 F-FDG PET/CT in diagnosing malignancy in SOTs; however, in these prior studies LTRs were underrepresented compared with other SOTs. 3 This topic is of clinical interest given LTRs are at a 3–5-fold increased risk of malignancy compared with the general population and early diagnosis could have huge clinical implications.…”

“…3,4 In the current issue of Transplantation, Van Rompaey and colleagues report high diagnostic yield of 18 F-FDG PET and PET/CT for malignancy in LTRs. 5 In this single-center, retrospective, observational study, the major indication for 18 F-FDG PET/CT referral was malignancy, followed by CLAD with restrictive allograft syndrome (RAS) phenotype, and infection/inflammation not otherwise specified. 5 Due to the large number of referrals for malignancy (80.8%), the analysis primarily focuses on the diagnostic performance of 18 F-FDG PET/CT in malignancy.…”

“…3 While the high sensitivity and negative predictive value is no surprise and is consistent with findings in nontransplant populations, 6 it drives home the point that 18 F-FDG PET is an attractive diagnostic tool to "rule-out" malignancy in LTRs in the right clinical context. 3,5 The greatest limitation of this study acknowledged by the authors is that it has a single-center, retrospective design over a period of time, which may or may not have been subject to different diagnostic or therapeutic strategies. Given these limitations, prospective studies are needed to further elucidate these findings and delineate the value of 18 F-FDG PET/CT scans for evaluating different sizes and phenotypes of pulmonary abnormalities (solid, subsolid, and ground glass) as well as for distribution of lesions in LTRs.…”

“…5 In this single-center, retrospective, observational study, the major indication for 18 F-FDG PET/CT referral was malignancy, followed by CLAD with restrictive allograft syndrome (RAS) phenotype, and infection/inflammation not otherwise specified. 5 Due to the large number of referrals for malignancy (80.8%), the analysis primarily focuses on the diagnostic performance of 18 F-FDG PET/CT in malignancy. Sensitivity, specificity, positive predictive value, and negative predictive value for malignancy were 91.4%, 82.3%, 75.3%, and 94.2% respectively.…”

“…While the high sensitivity and negative predictive value is no surprise and is consistent with findings in nontransplant populations, 6 it drives home the point that 18 F-FDG PET is an attractive diagnostic tool to “rule-out” malignancy in LTRs in the right clinical context. 3,5…”