[18F]FDG PET/CT: Lung Nodule Evaluation in Patients Affected by Renal Cell Carcinoma

Author:

Airò Farulla Lighea Simona12,Travaini Laura Lavinia1ORCID,Cuomo Mariarosaria12,Galetta Domenico23ORCID,Mattana Francesco1,Frassoni Samuele4ORCID,Buonsanti Giuseppe1,Muraglia Lorenzo1ORCID,Zuccotti Giulia Anna12,Bagnardi Vincenzo4,Spaggiari Lorenzo23,Ceci Francesco12

Affiliation:

1. Division of Nuclear Medicine, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy

2. Department of Oncology and Hemato-Oncology, University of Milan, 20141 Milan, Italy

3. Division of Thoracic Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy

4. Department of Statistics and Quantitative Methods, University of Milan-Bicocca, 20141 Milan, Italy

Abstract

Renal Cell Carcinoma (RCC) is generally characterized by low-FDG avidity, and [18F]FDG-PET/CT is not recommended to stage the primary tumor. However, its role to assess metastases is still unclear. The aim of this study was to evaluate the diagnostic accuracy of [18F]FDG-PET/CT in correctly identifying RCC lung metastases using histology as the standard of truth. The records of 350 patients affected by RCC were retrospectively analyzed. The inclusion criteria were: (a) biopsy- or histologically proven RCC; (b) Computed Tomography (CT) evidence of at least one lung nodule; (c) [18F]FDG-PET/CT performed prior to lung surgery; (d) lung surgery with histological analysis of surgical specimens; (e) complete follow-up available. A per-lesion analysis was performed, and diagnostic accuracy was reported as sensitivity and specificity, using histology as the standard of truth. [18F]FDG-PET/CT semiquantitative parameters (Standardized Uptake Value [SUVmax], Metabolic Tumor Volume [MTV] and Total Lesion Glycolysis [TLG]) were collected for each lesion. Sixty-seven patients with a total of 107 lesions were included: lung metastases from RCC were detected in 57 cases (53.3%), while 50 lesions (46.7%) were related to other lung malignancies. Applying a cut-off of SUVmax ≥ 2, the sensitivity and the specificity of [18F]FDG-PET/CT in detecting RCC lung metastases were 33.3% (95% CI: 21.4–47.1%) and 26% (95%CI: 14.6–40.3%), respectively. Although the analysis demonstrated a suboptimal diagnostic accuracy of [18F]FDG-PET/CT in discriminating between lung metastases from RCC and other malignancies, a semiquantitative analysis that also includes volumetric parameters (MTV and TLG) could support the correct interpretation of [18F]FDG-PET/CT images.

Funder

European Institute of Oncology Foundation

Publisher

MDPI AG

Subject

Radiology, Nuclear Medicine and imaging

Reference19 articles.

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