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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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Metastatic lung nodule from mucinous carcinoma of the left breast.A. Gadolinium-enhanded MR shows a well enhancing lobulating mass.B. FDG-PET fusion CT shows a nodular lesion in the right lower lung without increased FDG uptake (arrow).
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Figure 16: Metastatic lung nodule from mucinous carcinoma of the left breast.A. Gadolinium-enhanded MR shows a well enhancing lobulating mass.B. FDG-PET fusion CT shows a nodular lesion in the right lower lung without increased FDG uptake (arrow).

Mentions: Metastasis of tumors with a mucinous component can result in low FDG uptake (18). The relative cellularity of tumors is important in the detection of disease using FDG PET. Consequently, low cellularity in these tumors caused by the presence of mucin results in lower FDG uptake (19). For example, lung metastasis of a mucinous carcinoma of the breast (Fig. 16) may not show high FDG uptake. Other metastatic tumors such as mucinous adenocarcinomas of gastrointestinal origin can also show false negative findings in PET scans. Also, a metastatic mass from a renal cell carcinoma (20) (Fig. 17), and some invasive ductal and lobular breast carcinomas (21) are well reported to result in false negative findings.


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)

Metastatic lung nodule from mucinous carcinoma of the left breast.A. Gadolinium-enhanded MR shows a well enhancing lobulating mass.B. FDG-PET fusion CT shows a nodular lesion in the right lower lung without increased FDG uptake (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 16: Metastatic lung nodule from mucinous carcinoma of the left breast.A. Gadolinium-enhanded MR shows a well enhancing lobulating mass.B. FDG-PET fusion CT shows a nodular lesion in the right lower lung without increased FDG uptake (arrow).
Mentions: Metastasis of tumors with a mucinous component can result in low FDG uptake (18). The relative cellularity of tumors is important in the detection of disease using FDG PET. Consequently, low cellularity in these tumors caused by the presence of mucin results in lower FDG uptake (19). For example, lung metastasis of a mucinous carcinoma of the breast (Fig. 16) may not show high FDG uptake. Other metastatic tumors such as mucinous adenocarcinomas of gastrointestinal origin can also show false negative findings in PET scans. Also, a metastatic mass from a renal cell carcinoma (20) (Fig. 17), and some invasive ductal and lobular breast carcinomas (21) are well reported to result in false negative findings.

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