CT with Histopathologic Correlation of FDG Uptake in a Patient with Pulmonary Granuloma and Pleural Plaque Caused by Remote Talc Pleurodesis

Nguyen, Minh; Varma, Vijay; Perez, Rafael L.; Schuster, David M.

doi:10.2214/ajr.182.1.1820092

Cited by 14 publications

(8 citation statements)

References 7 publications

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“…We believe that FDG uptake in the tumor bed following a previous liver resection is not specific for tumor recurrence, especially if the CEA levels are normal. Nguyen et al demonstrated that FDG uptake may be high in various granulomatous lesions,23 possibly explaining the FP results along resection margins. Therefore, biopsy or follow-up should be considered in these cases.…”

Section: Discussionmentioning

confidence: 99%

The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

Lubezky

Metser

Geva

et al. 2007

Journal of Gastrointestinal Surgery

148

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BackgroundRecent data confirmed the importance of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) in the selection of patients with colorectal hepatic metastases for surgery. Neoadjuvant chemotherapy before hepatic resection in selected cases may improve outcome. The influence of chemotherapy on the sensitivity of FDG-PET and CT in detecting liver metastases is not known.MethodsPatients were assigned to either neoadjuvant treatment or immediate hepatic resection according to resectability, risk of recurrence, extrahepatic disease, and patient preference. Two-thirds of them underwent FDG-PET/CT before chemotherapy; all underwent preoperative contrast-enhanced CT and FDG-PET/CT. Those without extensive extrahepatic disease underwent open exploration and resection of all the metastases according to original imaging findings. Operative and pathological findings were compared to imaging results.ResultsTwenty-seven patients (33 lesions) underwent immediate hepatic resection (group 1), and 48 patients (122 lesions) received preoperative neoadjuvant chemotherapy (group 2). Sensitivity of FDG-PET and CT in detecting colorectal (CR) metastases was significantly higher in group 1 than in group 2 (FDG-PET: 93.3 vs 49%, P < 0.0001; CT: 87.5 vs 65.3, P = 0.038). CT had a higher sensitivity than FDG-PET in detecting CR metastases following neoadjuvant therapy (65.3 vs 49%, P < 0.0001). Sensitivity of FDG-PET, but not of CT, was lower in group 2 patients whose chemotherapy included bevacizumab compared to patients who did not receive bevacizumab (39 vs 59%, P = 0.068).ConclusionsFDG-PET/CT sensitivity is lowered by neoadjuvant chemotherapy. CT is more sensitive than FDG-PET in detecting CR metastases following neoadjuvant therapy. Surgical decision-making requires information from multiple imaging modalities and pretreatment findings. Baseline FDG-PET and CT before neoadjuvant therapy are mandatory.

show abstract

Section: Discussionmentioning

confidence: 99%

The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

Lubezky

Metser

Geva

et al. 2007

Journal of Gastrointestinal Surgery

148

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“…Some authors have suggested that the talc is absorbed through the pleura into the systemic circulation. In the rat model, it is deposited into the coronary arteries, meninges and pulmonary arteries [4]. Another suggested possibility includes talc entering into the parietal pleural lymphatics, the mediastinal lymph nodes, and the thoracic duct, to access the systemic venous circulation; this leads to deposits in the peripheral lung [4].…”

Section: Discussionmentioning

confidence: 99%

“…The most common differential diagnosis of FDG avid lesions includes infection versus neoplastic lesions. However, a false-positive FDG uptake can occur with granulomas, inflammatory processes, infectious disease, postradiation pneumonitis, fibrosis, or talc pleurodesis [4]. The mechanism of FDG-uptake in association with talc pleurodesis has been a focus of interest in several studies.…”

Section: Discussionmentioning

confidence: 99%

Lung Nodule with Increasing Fluorodeoxyglucose Uptake in a Patient with a History of Lung Carcinoma and Talc Pleurodesis Evaluated by EBUS-TBNA On-Site Assessment

Kurian

2017

Acta Cytologica

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Background: Fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) scan is an indicator of potential malignancy or infection. Patients with a history of talc pleurodesis can develop pleural or lung parenchymal nodules/talcomas. In these patients, talc-associated (non-malignancy-related) FDG uptake may occur over years. Case Report: A 66-year-old female presented with a past medical history significant for resected non-small-cell lung cancer and was treated with chemotherapy/radiation. The referring physician indicated that she subsequently developed benign pleural effusions and had talc pleurodesis to limit recurrence. The patient was referred to our institution for endobronchial ultrasound-guided transbronchial fine-needle aspiration (EBUS-TBNA) due to a new left upper lobe nodule with increasing FDG uptake on follow-up interval PET performed at the referring institution. On-site cytologic evaluation showed no evidence of malignancy, but found refractile foreign material, consistent with the presence of talc particles. Conclusion: This case presents the importance of cytologic recognition of talc particles during on-site evaluation and discusses the phenomenon of increasing PET-FDG uptake associated with talc pleurodesis.

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“…This diagnostic dilemma becomes even greater, when pulmonary parenchymal nodules develop because of talc-particle absorption through the pleura, with avid 18 F-FDG uptake. 9 Because 18 F-FDG is not a malignancy-specific agent, the use of 18 F-FDG-PET/CT imaging can lead to misinterpretation and false upstaging in patients with history of TP. It has been reported that somatostatin receptors (SSTRs) are expressed and upregulated on human macrophages, [21][22][23] suggesting the potential role of PET/CT using 68 Ga-DOTA-conjugated peptides (SST analogues) for evaluation of sites of talc-induced inflammation.…”

Section: Figurementioning

confidence: 99%

Talc Pleurodesis With Intense 18F-FDG Activity But No 68Ga-DOTA-TATE Activity on PET/CT

Papadakis¹,

Millo²,

Bağcı³

et al. 2015

Clinical Nuclear Medicine

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Talc pleurodesis (TP) is a technique, widely employed in the management of patients with persistent pleural effusions or pneumothoraces not amenable to other treatment options. It is well documented, that talc deposits produce areas of highly increased 18F-FDG uptake, due to talc-induced inflammation. We present a case of a patient with history of TP who was evaluated with both 18F-FDG and 68Ga-DOTA-TATE. The hypermetabolic area seen on 18F-FDG-PET-CT in the region of talc placement, showed no uptake by 68Ga-DOTA-TATE, suggesting the potential role of 68Ga-DOTA-TATE-PET-CT in elucidating 18F-FDG-postitive lesions in patients with history of both neuroendocrine malignancy and TP.

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CT with Histopathologic Correlation of FDG Uptake in a Patient with Pulmonary Granuloma and Pleural Plaque Caused by Remote Talc Pleurodesis

Cited by 14 publications

References 7 publications

The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

The Role and Limitations of 18-Fluoro-2-deoxy-d-glucose Positron Emission Tomography (FDG-PET) Scan and Computerized Tomography (CT) in Restaging Patients with Hepatic Colorectal Metastases Following Neoadjuvant Chemotherapy: Comparison with Operative and Pathological Findings

Lung Nodule with Increasing Fluorodeoxyglucose Uptake in a Patient with a History of Lung Carcinoma and Talc Pleurodesis Evaluated by EBUS-TBNA On-Site Assessment

Talc Pleurodesis With Intense 18F-FDG Activity But No 68Ga-DOTA-TATE Activity on PET/CT

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