Malignant disease as an incidental finding at 18F-FDG-PET/CT scanning in patients with granulomatous lung disease

Huber, H; Hodolič, Marina; Stelzmüller, Ingrid; Wunn, Rainer; Hatzl, Margit; Fellner, Franz A.; Lamprecht, Bernd; Rubello, Domenico; Colletti, Patrick M.; Gabriel, Michael

doi:10.1097/mnm.0000000000000274

Cited by 12 publications

(4 citation statements)

References 37 publications

(32 reference statements)

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“…The 18 F-FDG uptake which represents the levels of cellular glucose metabolism in inflammatory and oncological diseases shares the similar mechanism and is mediated by the glucose transporters GLUT1-5 (21,22). In active inflammation and granulomatous diseases, such as tuberculosis and sarcoidosis, increased 18 F-FDG accumulation appears in cells due to the expression of glucose transporters, especially GLUT1 in activated leucocytes, macrophages, and T lymphocytes (23)(24)(25).…”

Section: Discussionmentioning

confidence: 99%

Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Lin

Ling

Zheng

et al. 2021

Quant Imaging Med Surg

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Background: The aim of this study was to investigate the value of visual assessment of 18 F-fluorodeoxyglucose ( 18 F-FDG) metabolic spatial distribution (V-FMSD) in the diagnosis of indeterminate pulmonary nodules and masses with high 18 F-FDG uptake.Methods: A total of 301 patients with indeterminate pulmonary nodules or masses who underwent 18 F-FDG positron emission tomography/computed tomography (PET/CT) imaging were retrospectively studied. The characteristics of 18 F-FDG metabolic spatial distribution (FMSD) in the proximal and distal regions of the lesions were visually analyzed using a 5-point scoring system. The sensitivity, specificity, accuracy, and area under receiver operating characteristic curve (AUC) were compared between V-FMSD and conventional PET/CT methods for the diagnosis of hypermetabolic indeterminate pulmonary nodules and masses.Results: The V-FMSD results showed that 180 (92.8%) malignant lesions had a score of ≥3 and 78 (72.9%) benign lesions had a score of ≤2. This indicated that the FMSD in the proximal region of malignant lesions was significantly higher than that of the distal region, and the FMSD in the proximal region of benign lesions was significantly lower than that of the distal region. V-FMSD had a specificity of 72.9%, which was markedly higher than those of the maximum standard uptake value (SUV max ; 0%, P<0.001) and the retention index (RI; 26.2%, P<0.001). The AUC of V-FMSD was 0.886, which was significantly larger than those of the SUV max (0.626, P<0.001), RI (0.670, P<0.001), and PET/CT (0.788, P<0.05).Conclusions: Our study found that pulmonary benign and malignant lesions have distinct FMSD characteristics. V-FMSD can therefore be used as a novel auxiliary marker to improve the diagnostic accuracy of hypermetabolic indeterminate pulmonary nodules and masses.

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Section: Discussionmentioning

confidence: 99%

Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Lin

Ling

Zheng

et al. 2021

Quant Imaging Med Surg

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“…Patients who live in areas endemic for fungal disease may have granulomatous disease; the false-positive rate for PET/CT is higher for granulomas. 223–225 Solitary pulmonary nodules pose unique challenges. 215,226–230 Nodule risk calculators have been published, which may be helpful when assessing solitary pulmonary nodules.…”

Section: Accuracy Of Ldct Protocols and Imaging Modalitiesmentioning

confidence: 99%

Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology

Wood

Kazerooni

Baum

et al. 2018

J Natl Compr Canc Netw

457

255

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Lung cancer is the leading cause of cancer-related mortality in the United States and worldwide. Early detection of lung cancer is an important opportunity for decreasing mortality. Data support using low-dose computed tomography (LDCT) of the chest to screen select patients who are at high risk for lung cancer. Lung screening is covered under the Affordable Care Act for individuals with high-risk factors. The Centers for Medicare & Medicaid Services (CMS) covers annual screening LDCT for appropriate Medicare beneficiaries at high risk for lung cancer if they also receive counseling and participate in shared decision-making before screening. The complete version of the NCCN Guidelines for Lung Cancer Screening provides recommendations for initial and subsequent LDCT screening and provides more detail about LDCT screening. This manuscript focuses on identifying patients at high risk for lung cancer who are candidates for LDCT of the chest and on evaluating initial screening findings.

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“…Generally, the malignant lesions have higher SUVmax than the benign ones, which are consistent with our findings. However, due to the high expression of glucose transporters in activated leucocytes, T-lymphocytes and macrophages (18)(19)(20), increased 2-[ 18 F]FDG uptake can be found in a large proportion of activated inflammation and granulomatous diseases, such as tuberculosis, cryptococcosis, sarcoidosis and so on (21)(22)(23). Then, the value of SUVmax in differentiating malignant and benign lesions is limited.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of intratumoral 2-[18F]FDG metabolic spatial distribution in hypermetabolic pulmonary lesions in PET/CT

Jiang

Xue

Lin

et al. 2022

Quant Imaging Med Surg

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Background: The purpose of this study was to evaluate the value of quantitative assessment of intratumoral 2-deoxy-2-[ 18 F]fluoro-D-glucose (2-[ 18 F]FDG) metabolic spatial distribution (Q-FMSD) in differentiating pulmonary lesions with high 2-[ 18 F]FDG uptake. Methods:In this retrospective study, a total of 564 patients with pulmonary lesions who underwent 2-[ 18 F] FDG positron emission tomography/computed tomography (PET/CT) examination were analyzed. The maximum standard uptake value (SUVmax) of the proximal (pSUVmax) and distal (dSUVmax) regions of the lesions were measured, respectively. Then, Q-FMSD was obtained by the ratio of pSUVmax to dSUVmax.The diagnostic performance and area under receiver operating characteristic curve (AUC) were compared between Q-FMSD and conventional PET/CT methods for the diagnosis of pulmonary lesions with high 2-[ 18 F]FDG uptake.Results: The malignant tumors presented significantly higher Q-FMSD values than the benign lesions (1.11 vs. 0.94, P<0.001), which indicated that the 2-[ 18 F]FDG uptake in the proximal region was significantly higher than that of distal region in malignant lesions when compared with benign ones. For distinguishing hypermetabolic pulmonary malignant and benign lesions, the sensitivity, specificity and accuracy of Q-FMSD were 96.9%, 83.2% and 92.7%, respectively. Compared with other traditional methods, Q-FMSD presented significantly higher specificity than visual PET/CT (61.8%, P<0.001), retention index (RI) (33.8%, P<0.001) and SUVmax (11.0%, P<0.001). The AUC of Q-FMSD was 0.920, which was obviously larger than that of the SUVmax (0.587, P<0.001), RI (0.701, P<0.001), and visual PET/CT (0.781, P<0.001).Conclusions: Q-FMSD provides a simply and quantitative indicator for differentiating hypermetabolic pulmonary lesions with higher diagnostic performance than conventional PET/CT methods. Therefore, Q-FMSD should be recommended as a new promising marker to improve the diagnostic performance of hypermetabolic pulmonary lesions in clinical practice.

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Malignant disease as an incidental finding at 18F-FDG-PET/CT scanning in patients with granulomatous lung disease

Cited by 12 publications

References 37 publications

Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Characterization of 18F-fluorodeoxyglucose metabolic spatial distribution improves the differential diagnosis of indeterminate pulmonary nodules and masses with high fluorodeoxyglucose uptake

Lung Cancer Screening, Version 3.2018, NCCN Clinical Practice Guidelines in Oncology

Quantitative assessment of intratumoral 2-[18F]FDG metabolic spatial distribution in hypermetabolic pulmonary lesions in PET/CT

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