Additional Primary Tumors Detected Incidentally on FDG PET/CT at Staging in Patients with First Diagnosis of NSCLC: Frequency, Impact on Patient Management and Survival

Abstract

We aimed to assess the frequency of additional primary malignancies detected incidentally on [18F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) at staging in NSCLC patients. Moreover, their impact on patient management and survival was assessed. Consecutive NSCLC patients with available staging FDG-PET/CT between 2020 and 2021 were retrospectively enrolled. We reported whether further investigations of suspicious findings presumably not related to NSCLC were recommended and performed after FDG-PET/CT. Any additional imaging, surgery or multimodal management was considered as an impact on patient management. Patient survival was defined using overall survival OS and progression-free survival PFS. A total of 125 NSCLC patients were included, while 26 findings in 26 different patients were suspicious for an additional malignancy on FDG-PET/CT at staging. The most frequent anatomical site was the colon. A total of 54.2% of all additional suspicious lesions turned out to be malignant. Almost every malignant finding had an impact on patient management. No significant differences were found between NSCLC patients with suspicious findings versus no suspicious findings with regards to their survival. FDG-PET/CT performed for staging might be a valuable tool to identify additional primary tumors in NSCLC patients. Identification of additional primary tumors might have substantial implications for patient management. An early detection together with interdisciplinary patient management could prevent a worsening of survival compared to patients with NSCLC only.

PET/CT in leukemia: utility and future directions

“…NHL [105]. The incidental identification of solid tumors alongside leukemic malignancies has also been previously documented [106].…”

“…have documented the valuable utility of [ 18 F]FDG PET/CT in individuals diagnosed with synchronous HCL and NHL [105]. The incidental identification of solid tumors alongside leukemic malignancies has also been previously documented [106].…”

Predictive Value of Total Metabolic Tumor Burden Prior to Treatment in NSCLC Patients Treated with Immune Checkpoint Inhibition

“…The 2-deoxy-2-[ 18 F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is a non-invasive hybrid imaging modality, which captures metabolic and morphological features of a tumor in the same modality [15]. FDG-PET/CT has been an integral part of staging, detection of additional primary tumors at staging and treatment response assessment in NSCLC patients [16,17]. Metabolic parameters on FDG-PET/CT, such as maximum/mean standardized uptake value (SUVmax/SUVmean), metabolic tumor volume (MTV) or total lesion glycolysis (TLG) have been the subjects of recent, innovative and partly contradictory investigations regarding their abilities to predict patient response, but also new patterns of response to ICIs, such as pseudo-or hyper-progression, have been observed .…”