The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigat
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WORLD JOURNAL OF SURGICAL ONCOLOGY
RESEARCH
Open Access
The clinical significance of incidental intraabdominal findings on positron emission tomography performed to investigate pulmonary nodules Richdeep S Gill1*, Troy Perry1, Jonathan T Abele2, Eric LR Bédard1,3† and Daniel Schiller1,3†
Abstract Background: Lung cancer is a common cause of cancer-related death. Staging typically includes positron emission tomography (PET) scanning, in which18F-fluoro-2-dexoy-D-glucose (FDG) is taken up by cells proportional to metabolic activity, thus aiding in differentiating benign and malignant pulmonary nodules. Uptake of FDG can also occur in the abdomen. The clinical significance of incidental intraabdominal FDG uptake in the setting of pulmonary nodules is not well established. Our objective was to report on the clinical significance of incidental intra-abdominal FDG activity in the setting of lung cancer. Methods: Fifteen hundred FDG-PET reports for studies performed for lung cancer were retrospectively reviewed for the presence of incidental FDG-positive intraabdominal findings. Patient charts with positive findings were then reviewed and information extracted. Results: Twenty-five patients (25/1500) demonstrated incidental intraabdominal FDG uptake thought to be significant (1.7%) with a mean patient age of 71 years. Colonic uptake was most common (n = 17) with 9 (52%) being investigated further. Of these 9 cases, a diagnosis of malignancy was made in 3 patients, pre-malignant adenomas in 2 patients, a benign lipoma in 1 patient and no abnormal findings in the remaining patients. 8 patients were not investigated further (3 diagnosed with metastatic lung cancer and 2 were of advanced age) secondary to poor prognosis. Conclusion: Incidental abdominal findings in the colon on FDG-PET scan for work-up of pulmonary nodules need to be further investigated by colonoscopy. Keywords: Pulmonary nodules, incidental intraabdominal findings, PET scan, lung cancer, colon cancer, adenoma
Background Lung cancer is the most common cause of cancer-related deaths worldwide. Staging typically uses imaging techniques such as chest radiography, computed tomography (CT), and occasionally magnetic resonance imaging (MRI). In the last decade, use of positron emission tomography (PET) has been increasingly employed to improve both the staging of lung cancer and the assessment of patients with pulmonary nodules (Figure 1) [1-3]. Cells in * Correspondence: [email protected] † Contributed equally 1 Department of Surgery, University of Alberta, Edmonton, Alberta, Canada Full list of author information is available at the end of the article
a malignant tumor undergo glycolysis at an increased rate, and hence have greater cellular uptake of glucose [4]. 18 F-fluoro-2-dexoy-D-glucose (FDG) is a glucose analog that undergoes the same mechanism of uptake as glucose but becomes trapped within the tumor cell. FDG emits a positron, which can ultimately be imaged making it a good tracer for metabolic activity [5,6]. Uptake of FDG can also occur in ot
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