Society of University SurgeonIncidental PET/CT findings in the cancer patient: How should they be managed?
Section snippets
Methods
A query of our prospectively acquired database of nuclear medicine was performed to identify all patients that had undergone PET imaging. From January 2005 to December 2008, 2,219 patients underwent a total of 3814 PET or PET/CT scans. Of the 2,219 patients, 272 patients were identified to have incidental findings on PET or PET/CT concerning for a possible second primary malignancy. An Institutional Review Board-approved, retrospective study was initiated to abstract additional patient data.
Results
Of the 272 patients, 128 were males and 144 were females. The median age of primary tumor diagnosis was 61 (SD 14) years with a range of 19–93 years. The sites of the primary tumors included head and neck (n = 53;20%), lung (n = 51; 19%), colorectal (n = 29; 11%), breast (n = 25; 9%), lymphoma (n = 27; 10%), gynecologic organs (n = 21; 8%), genitourinary organs (21; 8%), unknown primary (2; 1 %).
Almost half (49%, 133/272) underwent an invasive procedure with biopsy of the abnormal finding.
Discussion
PET imaging has become an important resource in the management of the cancer patient. PET can upstage a solid organ malignancy and potentially alter the treatment algorithm.9, 22 However, it is not uncommon for incidental findings to be uncovered on PET that are consistent with a possible second primary tumor,16, 17, 18, 23, 24 The physician, patient, or a multi-disciplinary team is often challenged with the dilemma to determine not only the relevance of the finding, but also the timing and
References (31)
- et al.
Utility of PET, CT, and EUS to identify pathologic responders in esophageal cancer
Ann Thorac Surg
(2004) - et al.
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)
Eur J Cancer
(2009) - et al.
Mediastinal lymph node sampling following positron emission tomography with fluorodeoxyglucose imaging in lung cancer staging
Chest
(2001) - et al.
Accuracy and cost-effectiveness of [18F]-2-fluoro-deoxy-D-glucose-positron emission tomography scan in potentially resectable non-small cell lung cancer
Chest
(2004) - et al.
Normal physiological and benign pathological variants of 18-fluoro-2-deoxyglucose positron-emission tomography scanning: potential for error in interpretation
Semin Nucl Med
(1996) - et al.
Pitfalls and artifacts in 18FDG PET and PET/CT oncologic imaging
Semin Nucl Med
(2004) - et al.
Whole-body dual-modality PET/CT and whole-body MRI for tumor staging in oncology
JAMA
(2003) - et al.
New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada
J Natl Cancer Inst
(2000) Oncological applications of FDG PET imaging
J Nucl Med
(1999)- et al.
Integrated FDG-PET/CT compared with intravenous contrast-enhanced CT for evaluation of metastatic regional lymph nodes in patients with resectable early stage esophageal cancer
Ann Nucl Med
(2009)
Recommendations on the use of 18F-FDG PET in oncology
J Nucl Med
Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: the feasibility of integrated (18)F-FDG PET/CT
Lung Cancer
Oncological applications of positron emission tomography with fluorine-18 fluorodeoxyglucose
Eur J Nucl Med
PET-CT fusion imaging in differentiating physiologic from pathologic FDG uptake
Radiographics
Imaging of malignant bone involvement by morphologic, scintigraphic, and hybrid modalities
J Nucl Med
Cited by (72)
Parotid gland incidentalomas: A single-institution experience
2022, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryDetection of extraoral primary cancers by positron emission tomography/computed tomography in patients with oral squamous cell carcinoma
2020, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :There has been limited research describing detection rates for EPCs in patients with oral cancer.1 In our study, the rate of detection with PET/CT was 3.8%, which is consistent with the detection rate of 0.5%-4.8% reported for cancers of the head and neck.4-6 Regarding organs where second or third primary tumors developed, 11 (32.4%) carcinomas arose in the upper gastrointestinal tract, including the esophagus (8) and gastric mucosa (3), which supports the concept of field cancerization described by Slaughter et al.8 The floor of the mouth has been reported to have a high probability of complications involving EPCs in the upper gastrointestinal tract, compared with cancers in other subsites.9
Incidence and Economic Impact of Incidental Findings on <sup>18</sup>F-FDG PET/CT Imaging
2018, Canadian Association of Radiologists JournalIncidental detection of colorectal lesions by FDG PET/CT scans in melanoma patients
2017, European Journal of Surgical OncologyCitation Excerpt :On the one hand, Agress et al. [6] found that the referring physician was also focused on the primary disease and that often follow-up of the incidental PET finding was a relatively low priority. Wang et al. [11] and Beatty et al. [13] also found that follow-up evaluation was not recommended except when confirmation of malignancy would significantly alter curative potential. Evens-Sapir et al. [5] declared that there was a direct association between the incentive of the referring physician to evaluate a focal lesion and the decision of whether to treat the lesion if it was found to be malignant.