BACKGROUND: Solitary pulmonary nodules detected during follow-up in patients with previous cancer history have a high probability of malignancy being either a metachronous lung cancer or a metastasis. This distinction represents a crucial issue in the perspective of "personalized medicine", implying different treatments and prognosis. Aim - to evaluate the role of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in distinguishing whether solitary pulmonary nodules are metachronous cancers or metastases and the relationship between the nodule's characteristics and their nature. METHODS: From a single-institution database, we retrospectively selected all patients with a previous cancer history who performed 18F-FDG PET/CT to evaluate pulmonary nodules detected during follow-up, ranging from 5mm to 40mm, and histologically diagnosed as malignant. RESULTS: Between September 2009 and August 2017, 127 patients (80 males; mean age=70.2±8.5years) with 127 malignant nodules were included: 103/127 (81%) metachronous cancers, 24/127 (19%) metastases. In both groups, PET/CT provided good and equivalent detection rate of malignancy (81% vs 83%). No differences between metachronous cancers and metastases were found in: patient's age (70.3±8.1years vs 69.5±9.7years), gender (males=63.1% vs 62.5%), interval between previous cancer diagnosis and nodules' detection (median time=4years vs 4.5years), location (right-lung=55% vs 54%; upper-lobes=64% vs 67%; central-site=31% vs 25%), size (median size=17mm vs 19.5mm), 18F-FDG standardized uptake value (median SUVmax=5.2 vs 5.9). CONCLUSIONS: In oncological patients, despite its high detection rate, 18F-FDG PET/CT, as well as any other clinico-anatomical features, cannot distinguish whether a malignant solitary pulmonary nodule is a metachronous lung cancer or a metastasis, supporting the need of histological differential diagnosis.
Taralli, S., Scolozzi, V., Triumbari, E. K. A., Carleo, F., Di Martino, M., De Massimi, A. R., Ricciardi, S., Cardillo, G., Calcagni, M. L., Is 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography useful to discriminate metachronous lung cancer from metastasis in patients with oncological history?, <<THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING>>, 2019; (17): 44-51. [doi:10.23736/S1824-4785.19.03140-6] [http://hdl.handle.net/10807/139735]
Is 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography useful to discriminate metachronous lung cancer from metastasis in patients with oncological history?
Triumbari, Elizabeth Katherine Anna;Calcagni, Maria Lucia
2019
Abstract
BACKGROUND: Solitary pulmonary nodules detected during follow-up in patients with previous cancer history have a high probability of malignancy being either a metachronous lung cancer or a metastasis. This distinction represents a crucial issue in the perspective of "personalized medicine", implying different treatments and prognosis. Aim - to evaluate the role of 18F-Fluorodeoxyglucose (18F-FDG) Positron Emission Tomography/Computed Tomography (PET/CT) in distinguishing whether solitary pulmonary nodules are metachronous cancers or metastases and the relationship between the nodule's characteristics and their nature. METHODS: From a single-institution database, we retrospectively selected all patients with a previous cancer history who performed 18F-FDG PET/CT to evaluate pulmonary nodules detected during follow-up, ranging from 5mm to 40mm, and histologically diagnosed as malignant. RESULTS: Between September 2009 and August 2017, 127 patients (80 males; mean age=70.2±8.5years) with 127 malignant nodules were included: 103/127 (81%) metachronous cancers, 24/127 (19%) metastases. In both groups, PET/CT provided good and equivalent detection rate of malignancy (81% vs 83%). No differences between metachronous cancers and metastases were found in: patient's age (70.3±8.1years vs 69.5±9.7years), gender (males=63.1% vs 62.5%), interval between previous cancer diagnosis and nodules' detection (median time=4years vs 4.5years), location (right-lung=55% vs 54%; upper-lobes=64% vs 67%; central-site=31% vs 25%), size (median size=17mm vs 19.5mm), 18F-FDG standardized uptake value (median SUVmax=5.2 vs 5.9). CONCLUSIONS: In oncological patients, despite its high detection rate, 18F-FDG PET/CT, as well as any other clinico-anatomical features, cannot distinguish whether a malignant solitary pulmonary nodule is a metachronous lung cancer or a metastasis, supporting the need of histological differential diagnosis.
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