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The sensitivity of ¹⁸F-fluorodeoxyglucose positron emission tomography in the evaluation of metastatic pulmonary nodules

^a Division of General Thoracic Surgery, Department of Surgery, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, United States
^b Division of Nuclear Medicine, Department of Radiology, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, United States

Received 6 June 2008; received in revised form 28 August 2008; accepted 8 September 2008.

^_* Corresponding author. Tel.: +1 507 284 1517; fax: +1 507 284 0058. (Email: allen.mark{at}mayo.edu).

Objective: Pulmonary metastasectomy is beneficial in select patients. The sensitivity of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) for pulmonary metastasis is unknown. The aims of the study were to determine the accuracy of FDG-PET in detecting pulmonary metastasis and identify factors affecting sensitivity. Methods: All patients undergoing metastasectomy from September 2002 through December 2006 who had both chest computed tomography (CT) and FDG-PET scans or a fused CT/FDG-PET within 6 weeks prior to surgery were reviewed. Univariate and multivariate analysis were performed to determine predictors of positivity. Results: There were 83 patients (41 men, 42 women) who had 104 resections. Median age was 61 years (range, 32–87). In total 154 nodules were resected; 1 nodule in 47 patients and multiple in 36. Histopathology was adenocarcinoma in 94 nodules, sarcoma in 18, squamous cell carcinoma in 15, renal cell carcinoma in 7 and other in 20. At least one nodule was FDG-PET positive in 68 patients (81.9%). True positive FDG-PET was found in 104 nodules (67.5%) while 50 were false negative (32.5%). Multivariate analysis revealed tumor diameter and grade correlated with increased sensitivity of FDG-PET. Conclusion: FDG-PET is positive in only 67.5% of metastatic pulmonary nodules. Nodule size and grade affect the sensitivity of FDG-PET for metastatic pulmonary nodules. FDG-PET is not a sensitive test in the evaluation of patients considered for pulmonary metastasectomy. Moreover, a negative FDG-PET should not be used to rule out metastatic disease.

Key Words: Pulmonary metastases • Positron emission tomography • Screening

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