Metformin as a strategy against false positives in ¹⁸F-FDG PET/CT due to inflammation

Lung cancer is the leading cause of cancer-related deaths globally. Despite recent improvements in incidence and mortality rates, the prognosis of lung cancer remains dire.¹⁸F-FDG PET/CT plays a vital role in diagnosing, staging, and monitoring the therapeutic efficacy of lung cancer. However, the high glucose metabolism in inflammatory lesions, driven by macrophage activation, aggregation, and the release of inflammatory factors, is a primary source of false-positive results in FDG PET/CT oncology. This significantly diminishes the specificity and accuracy of PET/CT in diagnosing and staging lung cancer.Here we show FoxO1 plays a role in glucose metabolism in macrophages.We found that metformin regulated FoxO1 expression in macrophages, regulated the expression of inflammatory mediators and apoptosis of macrophages, thus reducing inflammatory glucose metabolism and improving the diagnostic accuracy of ¹⁸F-FDG PET/CT in lung cancer.We anticipate that our study could provide a credible approach to improve tumor diagnostic accuracy with PET/CT.