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False positive and false negative FDG-PET scans in various thoracic diseases.

Chang JM, Lee HJ, Goo JM, Lee HY, Lee JJ, Chung JK, Im JG - Korean J Radiol (2006 Jan-Mar)

Bottom Line: Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is being used more and more to differentiate benign from malignant focal lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT).However, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported.Furthermore, in diseases located near the physiologic uptake sites (heart, bladder, kidney, and liver), FDG-PET should be complemented with other imaging modalities to confirm results and to minimize false negative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is being used more and more to differentiate benign from malignant focal lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT). However, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported. Infectious diseases (mycobacterial, fungal, bacterial infection), sarcoidosis, radiation pneumonitis and post-operative surgical conditions have shown intense uptake on PET scan. On the other hand, tumors with low glycolytic activity such as adenomas, bronchioloalveolar carcinomas, carcinoid tumors, low grade lymphomas and small sized tumors have revealed false negative findings on PET scan. Furthermore, in diseases located near the physiologic uptake sites (heart, bladder, kidney, and liver), FDG-PET should be complemented with other imaging modalities to confirm results and to minimize false negative findings. Familiarity with these false positive and negative findings will help radiologists interpret PET scans more accurately and also will help to determine the significance of the findings. In this review, we illustrate false positive and negative findings of PET scan in a variety of diseases.

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Bronchioloalveolar carcinoma in a 75-year-old male.A. Contrast-enhanced CT shows a cavitary lesion in the left lower lobe (arrow).B. Transverse FDG-PET image of the transverse scan shows subtle uptake (arrow) in the left lower lobe with a maximum standardized uptake value of 1.7.
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Figure 13: Bronchioloalveolar carcinoma in a 75-year-old male.A. Contrast-enhanced CT shows a cavitary lesion in the left lower lobe (arrow).B. Transverse FDG-PET image of the transverse scan shows subtle uptake (arrow) in the left lower lobe with a maximum standardized uptake value of 1.7.

Mentions: Bronchioloalveolar carcinomas appear as areas of ground-glass opacity, nodules, masses, or areas of ground-glass opacity plus consolidation, on high-resolution CT scans. On pathologic examination, bronchioloalveolar carcinomas are well differentiated, having moderate degrees of nuclear atypism, mild degrees of mitotic figure, desmoplasia, and necrosis. These mild degrees of atypism, mitosis, and desmoplasia may be the causes of lower peak SUVs than those of other lung carcinomas. Several reports (18) have revealed lower FDG uptake in BAC than adenocarcinomas in the lungs. Thus, bronchioloalveolar carcinomas can be potential causes of false negative findings of malignancy on FDG PET scans (Fig. 13). Furthermore, mucinous bronchioloalveolar cell carcinomas, which often contain abundant mucin, exhibit significantly lower peak SUVs compared with those of squamous cell carcinomas, adenocarcinomas, and other cell types. In such cases, not only histologic grade, but also the amount of mucin component in the tumor (Fig. 14) is closely related with FDG-uptake (18).


False positive and false negative FDG-PET scans in various thoracic diseases.

Chang JM, Lee HJ, Goo JM, Lee HY, Lee JJ, Chung JK, Im JG - Korean J Radiol (2006 Jan-Mar)

Bronchioloalveolar carcinoma in a 75-year-old male.A. Contrast-enhanced CT shows a cavitary lesion in the left lower lobe (arrow).B. Transverse FDG-PET image of the transverse scan shows subtle uptake (arrow) in the left lower lobe with a maximum standardized uptake value of 1.7.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2667579&req=5

Figure 13: Bronchioloalveolar carcinoma in a 75-year-old male.A. Contrast-enhanced CT shows a cavitary lesion in the left lower lobe (arrow).B. Transverse FDG-PET image of the transverse scan shows subtle uptake (arrow) in the left lower lobe with a maximum standardized uptake value of 1.7.
Mentions: Bronchioloalveolar carcinomas appear as areas of ground-glass opacity, nodules, masses, or areas of ground-glass opacity plus consolidation, on high-resolution CT scans. On pathologic examination, bronchioloalveolar carcinomas are well differentiated, having moderate degrees of nuclear atypism, mild degrees of mitotic figure, desmoplasia, and necrosis. These mild degrees of atypism, mitosis, and desmoplasia may be the causes of lower peak SUVs than those of other lung carcinomas. Several reports (18) have revealed lower FDG uptake in BAC than adenocarcinomas in the lungs. Thus, bronchioloalveolar carcinomas can be potential causes of false negative findings of malignancy on FDG PET scans (Fig. 13). Furthermore, mucinous bronchioloalveolar cell carcinomas, which often contain abundant mucin, exhibit significantly lower peak SUVs compared with those of squamous cell carcinomas, adenocarcinomas, and other cell types. In such cases, not only histologic grade, but also the amount of mucin component in the tumor (Fig. 14) is closely related with FDG-uptake (18).

Bottom Line: Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is being used more and more to differentiate benign from malignant focal lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT).However, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported.Furthermore, in diseases located near the physiologic uptake sites (heart, bladder, kidney, and liver), FDG-PET should be complemented with other imaging modalities to confirm results and to minimize false negative findings.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Seoul National University Hospital, Seoul, Korea.

ABSTRACT
Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is being used more and more to differentiate benign from malignant focal lesions and it has been shown to be more efficacious than conventional chest computed tomography (CT). However, FDG is not a cancer-specific agent, and false positive findings in benign diseases have been reported. Infectious diseases (mycobacterial, fungal, bacterial infection), sarcoidosis, radiation pneumonitis and post-operative surgical conditions have shown intense uptake on PET scan. On the other hand, tumors with low glycolytic activity such as adenomas, bronchioloalveolar carcinomas, carcinoid tumors, low grade lymphomas and small sized tumors have revealed false negative findings on PET scan. Furthermore, in diseases located near the physiologic uptake sites (heart, bladder, kidney, and liver), FDG-PET should be complemented with other imaging modalities to confirm results and to minimize false negative findings. Familiarity with these false positive and negative findings will help radiologists interpret PET scans more accurately and also will help to determine the significance of the findings. In this review, we illustrate false positive and negative findings of PET scan in a variety of diseases.

Show MeSH
Related in: MedlinePlus