What causes false-negative PET findings for solid-type lung cancer?

doi:10.1016/j.lungcan.2012.10.018

Lung Cancer

Volume 79, Issue 2, February 2013, Pages 132-136

https://doi.org/10.1016/j.lungcan.2012.10.018 Get rights and content

Abstract

Background

To investigate possible causes for false-negative findings on PET scans for solid-type lung cancers, we retrospectively compared PET findings to clinical and pathological features using multivariate analysis.

Methods

We reviewed PET/CT records, clinical records, preoperative thin-section CT images, and postoperative pathological records and selected only solid-type primary lung cancers with lesions ≤40 mm in diameter that had been definitively diagnosed by surgical resection. PET images with SUVmax of ≥2.5 were considered PET-positive. Logistic regression analysis was used to identify independent predictors of PET-positive or negative among five factors: body weight, blood glucose level, lesion size, location, and histological classification.

Results

A total of 187 solid-type primary lung cancers were selected. Forty lesions (21.4%) were judged as PET-negative and 147 lesions (78.6%) were judged as PET-positive. Multivariate logistic analysis for the 187 lesions revealed that lesion size (p < 0.001) and histological tumour type (p < 0.001) were significant factors for determining whether PET findings were negative.

Conclusions

Among solid-type lung cancers, lesion size and histopathological findings were significantly associated with FDG uptake. In particular, it warrants attention that lesions ≤2 cm and bronchioloalveolar carcinoma and well-differentiated adenocarcinoma have a tendency for negative PET findings.

Introduction

¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) is an essential tool in current lung cancer practice. FDG-PET is not only useful for staging, evaluating therapeutic effects, and for observation, it is also useful for differentiating localized pulmonary lesions. Numerous studies have shown that FDG-PET has a high sensitivity for malignant tumours because most lung cancers have increased FDG uptake [1], [2], [3], [4], [5].

However, several studies have reported false-negative PET results for patients with primary lung cancers [1], [6], [7], [8], [9], [10]. It has been shown that several factors affect the maximum standardized uptake values (SUVmax) on PET images. These include body weight, blood glucose concentration, lesion size, respiratory motion, and lesion histological type [11], [12], [13], [14], [15], [16], [17]. Regarding the cancer cell type, bronchioloalveolar carcinoma and well-differentiated adenocarcinoma are more likely to have negative PET findings and often show pathognomonic ground-glass opacity (GGO) on thin-section CT images [7], [8], [9], [18]. Thus, even though PET scan findings may be negative, radiologists can diagnose these GGO type cancers based on thin-section CT findings. However, in clinical practice, solid-type lung cancers that do not show GGO on thin-section CT results can also show false-negative PET findings.

To our knowledge, little data have been published regarding the clinical significance of false-negative PET results for solid-type lung cancers. For example, are there any features that are different between PET positive and negative findings for solid-type cancers? What is the cause of a false-negative finding for a solid-type lung cancer? Thus, this study retrospectively compared the PET findings of solid-type lung cancers to their clinical and pathological features using multivariate analysis.

Section snippets

Materials and methods

This retrospective study was approved by our Institutional Review Board.

Results

A total of 178 patients were included: 125 males and 53 females; age range: 34–87 years; median age: 69 years. These patients had a total of 187 solid-type primary lung cancers that were selected (9 patients each had two simultaneous lesion). The patients’ characteristics are summarized in Table 1.

Forty-seven lesions (25.1%) were located in basal segments (S7–S10) of bilateral lower lobes and 140 lesions (74.9%) were located in other segments. Twelve lesions (6.4%) were not visually identified

Discussion

This retrospective study established that there were statistically significant differences between PET-negative and PET-positive solid-type lung cancers. The primary factors associated with negative findings on PET were the lesion size and histopathological findings. It is worth noting that lesion sizes of ≤2 cm and adenocarcinomas (i.e., BACs and W/D ACs) exhibited tendencies for negative findings on PET even though they appeared as solid-types on thin-section CT images. In contrast, tumour

Conflict of interest

None of the authors have any conflicts of interest associated with this study.

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Citation Excerpt :
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What causes false-negative PET findings for solid-type lung cancer?

Abstract

Background

Methods

Results

Conclusions

Introduction

Section snippets

Materials and methods

Results

Discussion

Conflict of interest

Ann Thorac Surg

Am J Med Sci

Lung Cancer

Lung Cancer

Eur J Radiol

J Thorac Oncol

The utility of the nonattenuation corrected 18F-FDG PET images in the characterization of solitary pulmonary lesions

Nucl Med Commun

Relation between nodule size and 18F-FDG-PET SUV for malignant and benign pulmonary nodules

J Hematol Oncol

Comparison of [(18)F]FDG PET and (201)Tl SPECT in evaluation of pulmonary nodules

J Nucl Med

Risk stratification of solitary pulmonary nodules by means of PET using (18)F-fluorodeoxyglucose and SUV quantification

Eur J Nucl Med Mol Imaging

False-negative findings for primary lung tumors on FDG positron emission tomography: staging and prognostic implications

AJR Am J Roentgenol

Fluorine-18-FDG. PET imaging is negative in bronchioloalveolar lung carcinoma

J Nucl Med

Focal parenchymal lung lesions showing a potential of false-positive and false-negative interpretations on integrated PET/CT

AJR Am J Roentgenol

Positron emission tomography in lung cancer

Gen Thorac Cardiovasc Surg