Patterns of abnormal FDG uptake by various histological types of non-small cell lung cancer at initial staging by PET

Abstract

The aim of this study was to identify useful patterns of abnormal fluorine-18 fluorodeoxyglucose (FDG) uptake by different types of non-small cell (NSC) lung cancer and to assess their clinical implications. One hundred and three sequential patients with newly diagnosed, pathology-proven NSC lung cancer were included. FDG positron emission tomography (PET) images were acquired using a dedicated PET scanner. There were 35 squamous cell carcinomas (SQC), 17 large cell cancers (LGC), 38 adenocarcinomas (ADC), 1 bronchioloalveolar carcinoma (BAC) and 12 non-classified NSC cancers. PET images were categorized into detectable patterns of necrotic center in the primary tumor, satellite lesions (T4), hilar lymph nodes (N1), and N2, N3, and M1 lesions by visual interpretation of PET images for SQC, LGC, and ADC (n=90; BAC and non-classified NSC cancers were excluded). The PET lesions were correlated with surgical pathology and with CT findings in inoperable cases. Necrosis was more commonly present in the primary tumors of LGC (53%) and SQC (43%) than in those of ADC (26%) (P<0.0001 and <0.01, respectively). The frequencies of nodal uptake in ADC, SQC and LGC were similar (71%, 60%, and 59%, respectively). However, M1 lesions were present significantly more often in LGC (41%) and ADC (34%) than in SQC (3%) (both P<0.0001). Significantly more surgically inoperable cases were found by PET (T4, N3, M1) in ADC (50%) and LGC (41%) than in SQC (26%) (P<0.001 and <0.02, respectively). Our results suggest a wide variation of PET findings for different types of NSC lung cancer. Identification of these patterns is useful in clinical PET interpretation, in that knowledge of the most probable association between the PET patterns and the histological types will facilitate initial staging and planning of management.

The rim sign: FDG-PET/CT pattern of pulmonary infarction

“…Nevertheless, in this study, the eight pulmonary infarctions exhibited a slight, thin and continuous FDG uptake in all cases, with a median SUV max value of 3.6, which is close to those reported previously [5]. Tumors with central necrosis or lung abscess typically appear as round masses with stronger and thicker FDG uptake [12, 13]. …”

Hounsfield units upon PET/CT are useful in evaluating metastatic regional lymph nodes in patients with oesophageal squamous cell carcinoma

“…Histological tumour types were squamous cell carcinoma in 17 of the 19 patients and adenocarcinoma in two. A previous study had concluded that standard uptake values (SUV) for PET show wide variations for different histological types [7]; thus, we excluded the two patients who had oesophageal adenocarcinoma. Accordingly, we analysed the data from 17 patients with squamous cell carcinoma of the oesophagus.…”

FDG PET: advantages for staging the mediastinum?

“…Lung-cancer cells are characterised by an increased cellular uptake of glucose and a higher rate of glycolysis when compared to normal cells [2]. The glucose analog F-18-fluoro-deoxy-glucose (FDG) undergoes the same cellular uptake as glucose but, after phosphorylation, is not further metabolised and becomes trapped within the cells.…”