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Detection of Unexpected Additional Primary Malignancies with PET/CT

¹ Division of Nuclear Medicine, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Medical Institutions, Baltimore, Maryland

This study evaluated the yield of whole-body ¹⁸F-FDG PET/CT for the detection of unexpected ¹⁸F-FDG-avid additional primary malignant tumors in patients being evaluated by PET/CT for known or suspected malignances. Methods: Reports from whole-body ¹⁸F-FDG PET/CT scans from June 2001 to June 2003 were reviewed, and 1,912 patients (924 men and 988 women; mean age ± SD, 58.9 ± 13.9 y) who had been scanned for known or suspected malignant lesions were included in this study. The sites of known or suspected primary tumors included lung (28.6%), colon or rectum (12.4%), head or neck (12.1%), lymph nodes (10.9%), breast (7.6%), gynecologic organs (7.1%), genitourinary organs (4.2%), esophagus (3.6%), skin (melanoma) (3.5%), pancreas (2.5%), bone or soft tissue (2.2%), and other sites (5.4%). Lesions that were newly discovered on PET/CT, had not been previously detected by other modalities, and were atypical in location for metastases on the PET/CT study were interpreted as suggestive of a new primary malignant tumor. These abnormalities were compared with the final diagnosis obtained from the medical records, including pathologic reports. Results: PET-positive lesions suggestive of new primary malignant tumors were found in 79 (4.1%) of 1,912 patients. In 22 (1.2%) of 1,912 patients, these lesions were pathologically proven to be malignant. Proven sites were lung (7 lesions), thyroid (6 lesions), colon (4 lesions), breast (2 lesions), esophagus (2 lesions), bile duct (1 lesion), and head and neck other than thyroid (1 lesion). Two new lesions in the lung and the thyroid were proven malignant in 1 patient. In 17 patients, the treatment plan was changed and the new lesion was surgically resected after the PET/CT examination. In 10 patients, PET was falsely positive after pathologic assessment. False-positive sites included thyroid (5 lesions), uterus (2 lesions), head and neck other than thyroid (2 lesions), and lung (1 lesion). In 8 patients, the PET-positive lesions were considered benign after clinical follow-up of at least 8 mo. In 39 patients, the follow-up record was not yet available and the final diagnosis of the detected lesion has not yet been resolved. Conclusion: Whole-body PET/CT detected new, unexpected ¹⁸F-FDG-avid primary malignant tumors in at least 1.2% of patients with cancer.

Key Words: additional primary malignancy • PET/CT • ¹⁸F-FDG

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