Patterns of FDG uptake in post-thoracotomy surgical scars in patients with lung cancer

Increased (18)F-fluorodeoxyglucose ((18)F-FDG) uptake can occur in surgical scars. This study assesses the incidence, patterns and natural history of (18)F-FDG uptake in post-thoracotomy scars of non-small cell lung cancer (NSCLC) patients. 73 (18)F-FDG-PET/CT studies performed after resection of NSCLC in 61 patients (49 men, 12 women; mean age, 66.7 years) were retrospectively reviewed for the presence, pattern and intensity (maximum standardized uptake value (SUV(max))) of (18)F-FDG uptake in sites of previous thoracotomy. Increased (18)F-FDG uptake in surgical scars was found in 61% of studies (43/70) (average SUV(max), 3.6); 3 patients with recurrence at the surgical scar were excluded from the analysis of the characteristics of physiological FDG uptake in scars over time. The average time from surgery was 14.4 months in patients with, and 43.8 months in patients without, scar uptake (p<0.0002). Increased uptake was seen in 14/14 studies (100%) at 1-3 months, in 12/13 studies (92%) at 3-12 months, and in 17/43 studies (40%) at more than 12 months after surgery in patients with no evidence of disease on follow-up. (18)F-FDG uptake was diffuse in 67% of studies (29/43). Tumour recurrence in the scar was found in three studies, showing focally increased uptake (average SUV(max), 9.1 ) at 3-8 months after thoracotomy. In conclusion, increased (18)F-FDG uptake in post-thoracotomy surgical scars is mainly diffuse, and decreases in incidence and intensity with time, with 60% of studies showing no scar uptake at more than 12 months after surgery. Focally intense scar uptake should be evaluated for suspected recurrence.