Skip to main content

Advertisement

SpringerLink
Log in

Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary

  • Systematic Review
  • Published:
Clinical and Translational Imaging Aims and scope Submit manuscript

Abstract

Purpose

Several meta-analyses and systematic reviews have reported data about the prevalence and the malignancy risk of focal incidental uptake detected by 18F-FDG PET (FIU). This review aims to summarize the published evidence-based data about the most common sites, prevalence and malignancy risk of FIU, to derive schematic estimates in this setting.

Methods

A comprehensive computer literature search of meta-analyses or systematic reviews regarding FIU and published in PubMed/MEDLINE and/or Cochrane library database through June 2017 was carried out.

Results

Twelve articles were discussed in our summary and different organs were evaluated. The pooled prevalence of FIU ranged, respectively, from 1.6 to 3.6% for colon–rectum, from 1 to 2.46% for thyroid, being 0.4% for breast, 1.8% for prostate and 0.6% for parotid. Despite that, the pooled risk of malignancy considering histology as reference standard was quite high in all organs evaluated in the summary, except for parotid gland. In fact, it ranged from 61.5 to 76% for FIU in the colon–rectum (including both premalignant and malignant lesions), from 33.2 to 37% for FIU in the thyroid gland, and it was 60 and 62%, respectively, for breast and prostate FIU. For parotid FIU pathologically proven the pooled risk of malignancy was only 20.4%.

Conclusions

Our summary showed that the most frequent sites of FIUs are colon and thyroid according to literature data. The risk of malignancy is quite high for FIU in colon-rectum, thyroid, breast and prostate especially when histologically analyzed. Beyond the localization, when FIU are detected further investigation is warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Lumbreras B, Donat L, Hernandez-Aguado I (2010) Incidental findings in imaging diagnostic tests: a systematic review. Br J Radiol 83:276–289

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Kapoor A, Morris T, Rebello R (2011) Guidelines for the management of the incidentally discovered adrenal mass. Can Urol Assoc J 5:241–247

    Article  PubMed  PubMed Central  Google Scholar 

  3. Corrigan AJ, Schleyer PJ, Cook GJ (2015) Pitfalls and artifacts in the use of PET/CT in oncology imaging. Semin Nucl Med 45:481–499

    Article  PubMed  Google Scholar 

  4. Ballinger JR (2015) Pitfalls and limitations of SPECT, PET, and therapeutic radiopharmaceuticals. Semin Nucl Med 45:470–478

    Article  PubMed  Google Scholar 

  5. Bertagna F, Treglia G, Piccardo A, Giovannini E, Bosio G, Biasiotto G, el Bahij K, Maroldi R, Giubbini R (2013) FDG-PET/CT thyroid incidentalomas: a wide retrospective analysis in three Italian centers on the significance of focal uptake and SUV value. Endocrine 43:678–685

    Article  CAS  PubMed  Google Scholar 

  6. Gill RS, Perry T, Abele JT, Bédard EL, Schiller D (2012) The clinical significance of incidental intra-abdominal findings on positron emission tomography performed to investigate pulmonary nodules. World J Surg Oncol 10:25

    Article  PubMed  PubMed Central  Google Scholar 

  7. Magee AL, Dashevsky BZ, Jahangir K, Kulkarni K (2017) Incidental focal uptake in the breast and axilla on FDG PET: clinical considerations and differential diagnosis. Clin Imaging 45:96–104

    Article  PubMed  Google Scholar 

  8. Treglia G, Calcagni ML, Rufini V, Leccisotti L, Meduri GM, Spitilli MG, Dambra DP, De Gaetano AM, Giordano A (2012) Clinical significance of incidental focal colorectal 18F-fluoro- deoxyglucose uptake: our experience and a review of the literature. Colorectal Dis 14:174–180

    Article  CAS  PubMed  Google Scholar 

  9. Basu S, Houseni M, Alavi A (2008) Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 29:367–373

    Article  CAS  PubMed  Google Scholar 

  10. Han EJ, Ho J, Choi WH, Yoo IR, Chung SK (2010) Significance of incidental focal uptake in prostate on 18-fluoro-2-deoxyglucose positron emission tomography CT images. Br J Radiol 83:915–920

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Israel O, Yefremov N, Bar-Shalom R, Kagana O, Frenkel A, Keidar Z, Fischer D (2005) PET/CT detection of unexpected gastrointestinal foci of 18F-FDG uptake: incidence, localization patterns, and clinical significance. J Nucl Med 46:758–762

    PubMed  Google Scholar 

  12. Grassi I, Castellucci P, Nanni C, Ghedini P, Ambrosini V, Allegri V, Montini GC, Guidalotti PL, Fanti S (2014) Incidentally detected increased FDG uptake in bowel and its correlation with hystopathological data: our experience in a case series study. Curr Radiopharm 7:107–114

    Article  CAS  PubMed  Google Scholar 

  13. Agrawal K, Weaver J, Ngu R, Krishnamurthy Mohan H (2015) Clinical significance of patterns of incidental thyroid uptake at (18)F-FDG PET/CT. Clin Radiol 70:536–543

    Article  CAS  PubMed  Google Scholar 

  14. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012

    Article  PubMed  Google Scholar 

  15. Sadeghi R, Treglia G (2017) Systematic reviews and meta-analyses of diagnostic studies: a practical guideline. Clin Transl Imaging 5:83–87

    Article  Google Scholar 

  16. Treglia G, Bertagna F, Sadeghi R, Verburg FA, Ceriani L, Giovanella L (2013) Focal thyroid incidental uptake detected by 18F-Fluorodeoxyglucose positron emission tomography: meta-analysis on prevalence and malignancy risk. Nuklearmedizin 52:130–136

    Article  CAS  PubMed  Google Scholar 

  17. Qu N, Zhang L, Lu ZW, Wei WJ, Zhang Y, Ji QH (2014) Risk of malignancy in focal thyroid lesions identified by (18) F-fluorodeoxyglucose positron emission tomography or positron emission tomography/computed tomography: evidence from a large series of studies. Tumour Biol 35:6139–6147

    Article  CAS  PubMed  Google Scholar 

  18. Nayan S, Ramakrishna J, Gupta MK (2014) The proportion of malignancy in incidental thyroid lesions on 18-FDG PET study: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 151:190–200

    Article  PubMed  Google Scholar 

  19. Shie P, Cardarelli R, Sprawls K, Fulda KG, Taur A (2009) Systematic review: prevalence of malignant incidental thyroid nodules identified on fluorine-18 fluorodeoxyglucose positron emission tomography. Nucl Med Commun 30:742–748

    Article  PubMed  Google Scholar 

  20. Bertagna F, Treglia G, Piccardo A, Giubbini R (2012) Diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas. J Clin Endocrinol Metab 97:3866–3875

    Article  CAS  PubMed  Google Scholar 

  21. Soelberg KK, Bonnema SJ, Brix TH, Hegedus L (2012) Risk of malignancy in thyroid incidentalomas detected by 18F-fluorodeoxyglucose positron emission tomography: a systematic review. Thyroid 22:918–925

    Article  CAS  PubMed  Google Scholar 

  22. Treglia G, Taralli S, Salsano M, Muoio B, Sadeghi R, Giovanella L (2014) Prevalence and malignancy risk of focal colorectal incidental uptake detected by (18)F-FDG-PET or PET/CT: a meta-analysis. Radiol Oncol 48:99–104

    Article  PubMed  PubMed Central  Google Scholar 

  23. Shie P (2011) Incidental focal hypermetabolic colorectal lesions identified by positron emission tomography: prevalence of malignancy. Abdom Imaging 36:165–169

    Article  PubMed  Google Scholar 

  24. Kousgaard SJ, Thorlacius-Ussing O (2017) Incidental colorectal FDG uptake on PET/CT scan and lesions observed during subsequent colonoscopy: a systematic review. Tech Coloproctol. doi:10.1007/s10151-017-1652-6

    PubMed  Google Scholar 

  25. Bertagna F, Treglia G, Orlando E, Dognini L, Giovanella L, Sadeghi R, Giubbini R (2014) Prevalence and clinical significance of incidental F18-FDG breast uptake: a systematic review and meta-analysis. Jpn J Radiol 32:59–68

    Article  CAS  PubMed  Google Scholar 

  26. Bertagna F, Sadeghi R, Giovanella L, Treglia G (2014) Incidental uptake of 18F-fluorodeoxyglucose in the prostate gland. Systematic review and meta-analysis on prevalence and risk of malignancy. Nuklearmedizin 53:249–258

    Article  CAS  PubMed  Google Scholar 

  27. Treglia G, Bertagna F, Sadeghi R, Muoio B, Giovanella L (2015) Prevalence and risk of malignancy of focal incidental uptake detected by fluorine-18-fluorodeoxyglucose positron emission tomography in the parotid gland: a meta-analysis. Eur Arch Otorhinolaryngol 272:3617–3626

    Article  PubMed  Google Scholar 

  28. Ooh SH, Jung SA, Kim SE, Kim HI, Lee MJ, Tae CH et al (2012) The clinical meaning of benign colon uptake in 18 FDG PET: comparison with Colonscopic findings. Clin Endosc 45:145–150

    Article  Google Scholar 

  29. Tatlidil R, Jadvar H, Bading JR, Conti PS (2002) Incidental colonic fluorodeoxyglucose uptake: correlation with colonoscopic and histopathologic findings. Radiology 224:783–787

    Article  PubMed  Google Scholar 

  30. Isobe K, Hata Y, Sakaguchi S, Takai Y, Shibuya K, Takagi K et al (2010) The role of positron emission tomography in the detection of incidental gastrointestinal tract lesions in patients examined for lung cancer. Nihon Kokyuki Gakkai Zasshi 48:482–487

    PubMed  Google Scholar 

  31. Chopra A, Ford A, De Noronha R, Matthews S (2012) Incidental findings on positron emission tomography/CT scans performed in the investigation of lung cancer. Br J Radiol 85:e229–e237

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. van Hoeij FB, Keijsers RG, Loffeld BC, Dun G, Stadhouders PH, Weusten BL (2015) Incidental colonic focal FDG uptake on PET/CT: can the maximum standardized uptake value (SUVmax) guide us in the timing of colonoscopy? Eur J Nucl Med Mol Imaging 42:66–71

    Article  PubMed  Google Scholar 

  33. Seivert M, Plomteux O, Colard A, Leclercq P, Gauthier D, Houbiers G et al (2014) Endoscopic findings in case of incidental colonic uptake in PET-CT how to improve PET-CT specificity? Acta Gastroenterol Belg 77:413–417

    PubMed  Google Scholar 

  34. Jin J, McHenry CR (2012) Thyroid incidentaloma. Best Pract Res Clin Endocrinol Metab 26:83–96

    Article  PubMed  Google Scholar 

  35. Yasuda S, Shohtsu A, Ide M, Takagi S, Takahashi W, Suzuki Y et al (1998) Chronic thyroiditis: diffuse uptake of FDG at PET. Radiology 207:775–778

    Article  CAS  PubMed  Google Scholar 

  36. Boerner AR, Voth E, Theissen P, Wienhard K, Wagner R, Schicha H (1998) Glucose metabolism of the thyroid in Graves’s disease measured by F-18-fluoro-deoxyglucose positron emission tomography. Thyroid 8:765–772

    Article  CAS  PubMed  Google Scholar 

  37. Kroiss A, Uprimny C, Virgolini IJ (2016) Thyroid carcinoma detected by incidental (18)F-FDG uptake in a patient with progressive cerebellar syndrome. Endocrine 51:199–200

    Article  CAS  PubMed  Google Scholar 

  38. Haugen BR, Alexander EK, Bible KC, Doherty GM, Mandel SJ, Nikiforov YE et al (2016) 2015 American Thyroid Association Management Guidelines for adult patients with thyroid nodules and differentiated thyroid cancer: the american thyroid association guidelines task force on thyroid nodules and differentiated thyroid cancer. Thyroid 26:1–133

    Article  PubMed  PubMed Central  Google Scholar 

  39. Yang Z, Hu S, Cheng J, Xu J, Shi W, Zhu B et al (2014) Prevalence and risk of cancer of incidental uptake in prostate identified by fluorine-18fluorodeoxyglucose positron emission tomography/computed tomography. Clin Imaging 38:470–474

    Article  PubMed  Google Scholar 

  40. Bhosale P, Balachandran A, Vikram R, Viswanathan C, Macapinlac H, Rohren E et al (2013) What is the clinical significance of FDG unexpected uptake in the prostate in patients undergoing PET/CT for other malignancies? Int J Mol Imaging 2013:476–786

    Article  Google Scholar 

  41. Cho SK, Choi JY, Yoo J, Cheon M, Lee JY, Hyun SH et al (2011) Incidental focal 18F-FDG uptake in the prostate: clinical significance and differential diagnostic criteria. Nucl Med Mol Imaging 45:192–196

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  42. Basu S, Houseni M, Alavi A (2008) Significance of incidental fluorodeoxyglucose uptake in the parotid glands and its impact on patient management. Nucl Med Commun 29:367–373

    Article  CAS  PubMed  Google Scholar 

  43. Sreeja C, Shahela T, Aesha S, Satish MK (2014) Taxonomy of salivary gland neoplasm. J Clin Diagn Res 8:291–293

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Bertagna F, Nicolai P, Maroldi R, Mattavelli D, Bertoli M, Giubbini R et al (2015) Diagnostic role of (18)F-FDG-PET or PET/CT in salivary gland tumors: a systematic review. Rev Esp Med Nucl Imagen Mol 34:295–302

    CAS  PubMed  Google Scholar 

  45. Toriihara A, Nakamura S, Kubota K, Makino T, Okochi K, Shibuya H (2013) Can dual-time-point 18F-FDG PET/CT differentiate malignant salivary gland tumors from benign tumors? AJR Am J Roentgenol 201:639–644

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

All authors have made substantial contributions to all of the following: (1) the conception and design of the study, acquisition of data, analysis and interpretation of data, (2) drafting and revising the article; (3) final approval of the submitted version.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona and Lugano, Via Ospedale, 12, 6500, Bellinzona, Switzerland

    Adriana Tamburello, Giorgio Treglia & Luca Giovanella

  2. Health Technology Assessment Unit, General Directorate, Ente Ospedaliero Cantonale, Bellinzona, Switzerland

    Giorgio Treglia

  3. Department of Nuclear Medicine and Molecular Imaging, CHUV University Hospital, Lausanne, Switzerland

    Giorgio Treglia

  4. Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy

    Domenico Albano & Francesco Bertagna

Authors
  1. Adriana Tamburello
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giorgio Treglia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Domenico Albano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Francesco Bertagna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Luca Giovanella
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

A Tamburello: literature search and review, content planning and manuscript writing. G. Treglia: literature search and review, manuscript writing and language editing. D. Albano: manuscript editing. F. Bertagna:manuscript editing. L. Giovanella: manuscript editing.

Corresponding author

Correspondence to Giorgio Treglia.

Ethics declarations

Conflict of interest

All authors (Adriana Tamburello, Giorgio Treglia, Domenico Albano, Francesco Bertagna and Luca Giovanella) declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Additional information

Adriana Tamburello and Giorgio Treglia share the first authorship.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Tamburello, A., Treglia, G., Albano, D. et al. Prevalence and clinical significance of focal incidental 18F-FDG uptake in different organs: an evidence-based summary. Clin Transl Imaging 5, 525–532 (2017). https://doi.org/10.1007/s40336-017-0253-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40336-017-0253-8

Keywords

Search

Navigation