FDG-PET/CT Incidental Detection of Cancer in Patients Investigated for Infective Endocarditis

Abstract

Background: Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is an imaging technique largely used in the management of infective endocarditis and in the detection and staging of cancer. We evaluate our experience of incidental cancer detection by PET/CT during IE investigations and follow-up. Methods and Findings: Between 2009 and 2018, our center, which includes an "endocarditis team," managed 750 patients with IE in a prospective cohort. PET/CT became available in 2011 and was performed in 451 patients. Incidental diagnosis of cancer by PET/CT was observed in 36 patients and confirmed in 34 of them (7.5%) (colorectal n = 17; lung n = 7; lymphoma n = 2; melanoma n = 2; ovarian n = 2; prostate n = 1; bladder n = 1; ear, nose, and throat n = 1; brain n = 1). A significant association has been found between colorectal cancer and Streptococcus gallolyticus and/or Enterococcus faecalis [12/26 vs. 6/33 for other cancers, p = 0.025, odds ratio = 3.86 (1.19-12.47)]. Two patients had a negative PET/CT (a colon cancer and a bladder cancer), and two patients, with positive PET/CT, had a benign colorectal tumor. PET/CT had a sensitivity of 94-100% for the diagnosis of cancer in this patient. Conclusions: Whole-body PET/CT confirmed the high incidence of cancer in patients with IE and could now be proposed in these cases.

Cardiac Devices Infection

“…Patients with endocarditis, with or without cardiac devices, are known to be at a higher risk for malignancies [80]. In a recent study assessing occult cancer detected in patients with suspected endocarditis with or without cardiac devices, FDG PET/CT was useful in detecting occult cancers, including colorectal cancer, lung cancer, prostate cancer, among others [81]. During FDG PET/CT image interpretation, attention must, therefore, be paid not only to finding suggestive of device infection, septic embolism, and portal of entry of infection, but also to findings that may suggest occult malignancy.…”

Systematic Evaluation of Imaging Features of Early Bladder Cancer Using Computed Tomography Performed before Pathologic Diagnosis

“…Over 80 million CT scans are performed annually in the United States, of which approximately 40% are abdominopelvic CTs [21]. This represents a significant opportunity for bladder tumor detection, as there is extensive recent literature reporting incidental bladder tumor detection on imaging performed for alternative indications, such as colorectal cancer screening, spinal cord injury, and aortic/peripheral vascular disease [22][23][24][25][26][27][28][29][30][31]. These series illustrate incidentally detected bladder cancer as intraluminal masses or areas of focal wall thickening on cross-sectional imaging [32].…”