Incidental Detection of a Small Cell Lung Cancer by 18F-Choline PET/CT Performed for Recurrent Hyperparathyroidism After Parathyroidectomy

Jacquet-Francillon, Nicolas; Granjon, D.; Casteillo, François; Prévôt, Nathalie; Habouzit, V.

doi:10.1097/rlu.0000000000003246

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…Table 3 shows the significant differences between the subgroups of lesions: adenomas, hyperplasias, and other diagnoses only proven histologically. Differential diagnoses were normal parathyroids, one lymph node metastasis from a small cell lung cancer ( 26 ), and benign lymph nodes. Hyperfunctional glands had a higher SUV max ( p = 0.0085) and a higher liver ratio ( p = 0.0002) than differential diagnosis.…”

Section: Resultsmentioning

confidence: 99%

Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study)

Jacquet-Francillon

Morelec²,

Germain³

et al. 2022

Front. Med.

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Objective[18F]Fluorocholine positron emission tomography/computed tomography (PET/CT) is used frequently in addition to [99mTc]Tc-Sestamibi scintigraphy and ultrasonography for the location of hyperfunctioning parathyroid glands. The aim of this study is to evaluate the performance of quantitative criteria in [18F]fluorocholine PET/CT for localization of hyperfunctioning parathyroid glands. The secondary objective is to highlight a correlation between the detection rate of [18F]fluorocholine PET/CT and serum parathyroid hormone (PTH) level.Materials and methodsIn two academic centers, we retrospectively included patients with biological hyperparathyroidism (HPT) and who had [18F]fluorocholine PET/CT. After a visual analysis, to measure the overall performance of [18F]fluorocholine PET/CT, a blind reading was carried out with standardized measurements of maximum standardized uptake value (SUVmax), liver ratio, thyroid ratio, and size ratio. We analyzed the quantitative criteria of [18F]fluorocholine PET/CT compared to the histological results, in particular to identify differences between adenomas and hyperplasias. We compared the performance of each quantitative criterion to the overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of [18F]fluorocholine PET/CT. The detection rate of hyperfunctioning parathyroid glands was calculated in subgroups of serum PTH level.ResultsThe quantitative criteria in [18F]fluorocholine PET/CT were measured for 120 patients (135 lesions). The areas under the receiver operating characteristic (ROC) curve representing SUVmax and liver ratio were significantly increased. The optimal cut-off values represented by the maximum Youden index was >4.12 for SUVmax and >27.4 for liver ratio. Beyond certain threshold values of SUVmax (>4.12) or liver ratio (>38.1), all the lesions were histologically proven adenomas. SUVmax and liver ratio were significantly higher for adenomas than for hyperplasias and differential diagnosis (p = 0.0085 and p = 0.0002). The positivity of [18F]fluorocholine PET/CT was correlated with PTH level. Detection rates were 55.56, 75.56, and 87.5%, respectively, for serum PTH < 70, 70 to 120, and >120 ng/ml.ConclusionSemi-quantitative measurements (SUVmax and liver ratio) should be considered as additional tools in interpretation of [18F]fluorocholine PET/CT. These quantitative parameters have lower overall performance but higher specificity than overall visual analysis in identifying an adenoma. Above certain threshold values, all lesions are adenomas. [18F]fluorocholine PET/CT confirms excellent performance for the detection of hyperfunctional parathyroids. For serum PTH levels < 70 ng/ml, the detection rate of [18F]fluorocholine PET/CT is strongly decreased.

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Section: Resultsmentioning

confidence: 99%

Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study)

Jacquet-Francillon

Morelec²,

Germain³

et al. 2022

Front. Med.

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“…Serum PTHrP correction upon pancreatic tumor removal might prove a useful prognostic marker in some of these cases [ 172 ]. Exceptionally, persistent hypercalcemia in patients who underwent surgery for primary hyperparathyroidism might not be a recurrent or persistent hyperparathyroidism but hypercalcemia of malignancy [ 173 ].…”

Section: Discussionmentioning

confidence: 99%

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

Carsote,

Nistor,

Gheorghe

et al. 2024

IJMS

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We aimed to provide an in-depth analysis with respect to three turning points in pancreas involvement in primary hyperparathyroidism (PHP): hypercalcemia-induced pancreatitis (HCa-P), MEN1 (multiple endocrine neoplasia)-related neuroendocrine tumors (NETs), and insulin resistance (IR). This was a comprehensive review conducted via a PubMed search between January 2020 and January 2024. HCa-P (n = 9 studies, N = 1375) involved as a starting point parathyroid NETs (n = 7) or pancreatitis (n = 2, N = 167). Case report-focused analysis (N = 27) showed five cases of pregnancy PHP-HCa-P and three reports of parathyroid carcinoma (female/male ratio of 2/1, ages of 34 in women, men of 56). MEN1-NET studies (n = 7) included MEN1-related insulinomas (n = 2) or MEN1-associated PHP (n = 2) or analyses of genetic profile (n = 3), for a total of 877 MEN1 subjects. In MEN1 insulinomas (N = 77), the rate of associated PHP was 78%. Recurrence after parathyroidectomy (N = 585 with PHP) was higher after less-than-subtotal versus subtotal parathyroidectomy (68% versus 45%, p < 0.001); re-do surgery was 26% depending on surgery for pancreatic NETs (found in 82% of PHP patients). MEN1 pathogenic variants in exon 10 represented an independent risk factor for PHP recurrence. A single pediatric study in MEN1 (N = 80) revealed the following: a PHP rate of 80% and pancreatic NET rate of 35% and 35 underlying germline MEN1 pathogenic variants (and 3/35 of them were newly detected). The co-occurrence of genetic anomalies included the following: CDC73 gene variant, glucokinase regulatory protein gene pathogenic variant (c.151C>T, p.Arg51*), and CAH-X syndrome. IR/metabolic feature-focused analysis identified (n = 10, N = 1010) a heterogeneous spectrum: approximately one-third of adults might have had prediabetes, almost half displayed some level of IR as reflected by HOMA-IR > 2.6, and serum calcium was positively correlated with HOMA-IR. Vitamin D deficiency was associated with a higher rate of metabolic syndrome (n = 1). Normocalcemic and mildly symptomatic hyperparathyroidism (n = 6, N = 193) was associated with a higher fasting glucose and some improvement after parathyroidectomy. This multilayer pancreas/parathyroid analysis highlighted a complex panel of connections from pathogenic factors, including biochemical, molecular, genetic, and metabolic factors, to a clinical multidisciplinary panel.

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“…In particular, for lung cancers, it has been demonstrated that the uptake of [ 18 F]fluorocholine is correlated with the proliferation of tumor cells; furthermore, the [ 18 F]fluorocholine uptake mechanism is related to the overexpression of choline kinase and phosphorylcholine-cytidyl transferase in lung tumors [ 6 ]. A previous case reported the incidental detection of SCLC by [ 18 F]fluorocholine PET/CT performed for a non-oncological indication (primary hyperparathyroidism) [ 7 ]. Our case demonstrated that coexisting tumors such as HCC and SCLC showing increased cell membrane turnover can be detected by radiolabeled choline PET/CT.…”

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Two Birds with One Stone: Hepatocellular Carcinoma and Small Cell Lung Cancer Imaged with [18F]Fluorocholine Positron Emission Tomography/Computed Tomography

2023

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We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [18F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [18F]fluorocholine PET/CT showed increased radiopharmaceutical uptake in a liver lesion corresponding to the known HCC. Furthermore, a right pulmonary hilar lesion suspicious for metastatic spread of HCC showed increased radiopharmaceutical uptake. Surprisingly, the histological assessment of the thoracic lesion demonstrated the presence of small cell lung cancer (SCLC). The patient underwent treatment with radiation therapy and chemotherapy for the SCLC and selective internal radiation therapy (SIRT) for the HCC. The patient died after one year due to progressive SCLC. This case demonstrates that coexisting tumors showing increased cell membrane turnover, including SCLC, can be detected by [18F]fluorocholine PET/CT. In our case, [18F]fluorocholine PET/CT findings influenced the patient management in terms of histological verification and different treatment of the detected lesions.

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Incidental Detection of a Small Cell Lung Cancer by 18F-Choline PET/CT Performed for Recurrent Hyperparathyroidism After Parathyroidectomy

Cited by 6 publications

References 9 publications

Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study)

Performance of quantitative measurements in [18F]fluorocholine positron emission tomography/computed tomography for parathyroid imaging (P2TH study)

Turning Points in Cross-Disciplinary Perspective of Primary Hyperparathyroidism and Pancreas Involvements: Hypercalcemia-Induced Pancreatitis, MEN1 Gene-Related Tumors, and Insulin Resistance

Two Birds with One Stone: Hepatocellular Carcinoma and Small Cell Lung Cancer Imaged with [18F]Fluorocholine Positron Emission Tomography/Computed Tomography

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