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Clinical significance of small pulmonary nodules with little or no 18F-FDG uptake on PET/CT images of lung cancer patients

¹ Radiology, The Catholic University of Korea, Seoul, South Korea

225

Objectives: Small indeterminate pulmonary nodules with little or no 18F-FDG uptake present as diagnostic challenge on PET/CT images of lung cancer patients, and this study evaluates the significance of these nodules.

Methods: 817 PET/CT studies of lung cancer patients from November 2003 to April 2007 were reviewed. In 43 patients, in addition to the primary tumor, there were pulmonary nodules less than 1 cm in diameter showing little or no 18F-FDG uptake. Nodules with findings indicative of benign nature or malignancy were excluded. All 43 cases had pathologic confirmation or clinical follow-up with enhanced chest CT. The 43 cases were subdivided into four categories: (1) number of nodules (solitary or multiple); (2) presence or absence of other accompanying benign lung abnormalities; (3) presence or absence of perceptible FDG uptake; (4) and location of the nodule (same lobe, ipsilateral lung, or contralateral lung). The incidence of malignancy was calculated for each group of the four categories.

Results: Of the 43 cases, 5 (11.6%) were confirmed to be malignant nodules. No statistically meaningful difference was noted between the solitary and multiple nodule groups (4.2% versus 21.1%), the groups with and without accompanying lung lesions (8.3% vs. 12.9%), the faint FDG uptake group and imperceptible group (16.7% vs. 10.8%), or the groups by the site of nodule (same lobe 7.7%, ipsilateral lung 14.3%, contralateral lung 12.5%).

Conclusions: Small lung nodules with no or faint FDG uptake in lung cancer patients were malignant in over 11% of the cases. Thus, when small indeterminate pulmonary nodules are present in lung cancer patients close follow-up is mandatory, regardless of their number, presence of accompanying benign lesion, degree of FDG uptake, or location.

This Article Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Han, E. j. Articles by Chung, S. K. PubMed Articles by Han, E. j. Articles by Chung, S. K.