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Detection of unexpected additional primary malignancies with PET/CT
Takayoshi Ishimori1, Pavni V Patel, Richard L Wahl
1Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, 601 N. Caroline Street, Baltimore, MD 21287, USA.
Summary
Whole-body positron emission tomography/computed tomography (PET/CT) identified new, unexpected malignant tumors in 1.2% of cancer patients. This imaging technique aids in detecting additional primary cancers, influencing treatment plans.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiology
Background:
- Whole-body (18)F-FDG PET/CT is utilized for evaluating known or suspected malignancies.
- Detecting unexpected additional primary malignant tumors can significantly impact patient management.
Purpose of the Study:
- To assess the diagnostic yield of whole-body (18)F-FDG PET/CT in identifying unexpected primary malignant tumors.
- To determine the incidence of new primary malignancies detected incidentally during PET/CT scans for other cancer evaluations.
Main Methods:
- A retrospective review of 1,912 whole-body (18)F-FDG PET/CT scans performed between June 2001 and June 2003.
- Inclusion criteria involved patients scanned for known or suspected malignant lesions.
- Newly discovered, atypical lesions not detected by other modalities were interpreted as potential new primary tumors and compared with final diagnoses.
Main Results:
- Seventy-nine patients (4.1%) showed PET-positive lesions suggestive of new primary malignant tumors.
- Pathological confirmation of malignancy was established in 22 patients (1.2%).
- Proven new primary sites included lung, thyroid, colon, breast, esophagus, bile duct, and head and neck.
- Treatment plans were altered in 17 patients due to the new findings, with surgical resection of the new lesion.
- False-positive findings occurred in 10 patients, and 8 lesions were deemed benign after follow-up.
Conclusions:
- Whole-body (18)F-FDG PET/CT is effective in detecting new, unexpected primary malignant tumors.
- The incidence of pathologically proven new primary malignancies detected by PET/CT was at least 1.2%.
- These findings underscore the value of whole-body PET/CT in comprehensive cancer staging and management.