False-Negative Findings for Primary Lung Tumors on FDG Positron Emission Tomography: Staging and Prognostic Implications

• Published in: American journal of roentgenology (1976) Vol. 182; no. 5; pp. 1129 - 1132
• Main Authors: Cheran, Sendhil Kumar, Nielsen, Nathan D, Patz, Edward F., Jr
• Format: Journal Article
• Language: English
• Published: Leesburg, VA Am Roentgen Ray Soc 01.05.2004; American Roentgen Ray Society
• Subjects: Adult; Aged; Biological and medical sciences; False Negative Reactions; Female; Fluorodeoxyglucose F18; Humans; Investigative techniques, diagnostic techniques (general aspects); Lung Neoplasms - diagnostic imaging; Lung Neoplasms - pathology; Male; Medical sciences; Middle Aged; Neoplasm Staging; Prognosis; Radiopharmaceuticals; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Tomography, Emission-Computed; Radionuclide study; Nuclear medicine; Prognosis; False negative; Radiology; Positron emission tomography; Lung tumor; Emission tomography
• ISSN: 0361-803X; 1546-3141
• DOI: 10.2214/ajr.182.5.1821129

The aim of this study was to determine the stage and outcome of patients with primary lung tumors who had a negative finding on a FDG positron emission tomography (PET) study at the time of diagnosis. A total of 3912 patients between November 1994 and August 2002 underwent thoracic or whole-body PET performed at our institution for evaluation of a pulmonary abnormality suspicious for lung cancer. We identified 20 patients with a biopsy-proven primary lung tumor and a negative PET study at the time of presentation. Surgical, pathologic, radiographic imaging, and clinical follow-up information were reviewed to confirm the histology, stage, and outcome. Tumor histology included adenocarcinoma (n = 7, 35%), bronchioalveolar cell carcinoma (n = 6, 30%), carcinoid (n = 3, 15%), squamous cell carcinoma (n = 2, 10%), otherwise unspecified non-small cell lung cancer (n = 1, 5%), and sarcomatoid neoplasm (n = 1, 5%). One patient with bronchioalveolar cell carcinoma had multifocal stage IV disease, and all other patients were stage IA (n = 14, 70%) or stage IB (n = 5, 25%). Eighteen (90%) of the 20 patients underwent curative surgical resection. No patient is known to have tumor recurrence after resection, and three (17%) of the 18 patients are known to be living and free of disease 5 years after surgery. With the exception of bronchioalveolar cell carcinoma and carcinoid, newly diagnosed lung cancers with negative PET findings are usually early-stage diseases and are associated with a favorable prognosis, suggesting that indeterminate pulmonary nodules, which are PET-negative, can be managed conservatively with serial radiographic studies to monitor for signs of growth. These findings warrant further study and should be confirmed with sufficient follow-up in a large cohort of patients with PET-negative lung lesions.