alexa Indeterminate pulmonary nodules on CT images in breast cancer patient: the additional value of 18F-FDG PET CT.


Journal of Cancer Science & Therapy

Author(s): Evangelista L, Panunzio A, Cervino AR, Vinante L, AlNahhas A,

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Abstract AIM: To assess the potential role of 18F-Fluorodeoxiglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) in characterizing indeterminate lung nodules detected at CT scan in patients previously treated for a breast cancer (BC). MATERIALS AND METHODS: Twenty-nine consecutive BC patients (28 females, mean age 65 ± 12 years) with evidence of indeterminate lung nodules at contrast-enhanced CT (CECT) scan (lesions with axial diameter ≥8 mm) were retrospectively analysed: all patients underwent 18F-FDG PET/CT within a mean 2 ± 1 months from CECT imaging. PET/CT was considered positive in the presence of abnormal FDG uptake in the pulmonary nodules and/or in other organs. The nature of lung nodules was defined at histopathology and/or imaging follow-up. RESULTS: Fourteen (48\%) patients showed negative and 15 (52\%) positive PET/CT scan in the lungs: of these 15 patients, 7 (47\%) had pathologic FDG-uptake in lungs only, whereas 8 (53\%) showed abnormal FDG-uptake also in sites different from lungs. At histology and/or imaging follow-up, five (17\%) patients were considered positive for BC lung metastases while in seven (24\%) a second cancer was diagnosed. In this subset of patients, the sensitivity and specificity for FDG PET/CT in revealing lung lesions were 17\% and 100\%, respectively, for nodules <8 mm in diameter, and 77\% and 85\%, respectively, for nodules with diameter ≥8 mm. The therapeutic planning was changed to surgery in seven patients, chemotherapy in one patient and continued hormonal therapy in five. The inclusion of PET/CT in the diagnostic algorithm of the evaluated patients helped avoid unnecessary over-treatment in 12 of 29 patients. CONCLUSION: FDG PET/CT appears useful in characterizing indeterminate lung nodules found at CECT scan in BC patients, with a sensitivity that is proportional to nodule size. In addition, PET/CT helped in avoiding over-treatment in a significant proportion of patients. © 2012 The Authors. Journal of Medical Imaging and Radiation Oncology © 2012 The Royal Australian and New Zealand College of Radiologists. This article was published in J Med Imaging Radiat Oncol and referenced in Journal of Cancer Science & Therapy

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