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Clinical relevance of imaging proliferative activity in lung nodules

European Journal of Nuclear Medicine and Molecular Imaging volume 32, pages 525–533 (2005)Cite this article

Abstract

Purpose

Recently, the thymidine analogue 3′-deoxy-3′[18F]fluorothymidine (FLT) has been introduced for imaging proliferation with positron emission tomography (PET). In this prospective study, we examined the accuracy of FLT for differentiation of benign from malignant lung lesions and for tumour staging.

Methods

A total of 47 patients with newly diagnosed pulmonary nodules on chest CT suspicious for malignancy were examined with FLT-PET in addition to routine staging procedures. A total of 43 patients also underwent 2-[18F]fluoro-2-deoxy-D-glucose (FDG) PET imaging. Within 2 weeks, patients underwent resective surgery or core biopsy of the pulmonary lesion.

Results

Histopathology revealed malignant lung tumours in 32 patients (20 non-small cell lung cancer, 1 small cell lung cancer, 1 pulmonary carcinoid, 1 non-Hodgkin’s lymphoma, nine metastases from extrapulmonary tumours) and benign lesions in 15 patients. Increased FLT uptake was exclusively related to malignant tumours. FLT-PET was false negative in two patients with non-small cell lung cancer, in the patient with a pulmonary carcinoid and in three patients with lung metastases. The sensitivity of FLT-PET for detection of lung cancer was 90%, the specificity 100% and the accuracy 94%. Fifteen out of 21 patients with lung cancer had mediastinal lymph node metastases. FLT-PET was true positive in 7/15 patients, resulting in a sensitivity of 53% for N-staging (specificity 100%, accuracy 67%). Clinical TNM stage was correctly identified in 67% (20/30) patients, compared to 85% (23/27) with FDG-PET.

Conclusion

FLT-PET has a high specificity for the detection of malignant lung tumours. Compared with FDG, FLT-PET is less accurate for N-staging in patients with lung cancer and for detection of lung metastases. FLT-PET therefore cannot be recommended for staging of lung cancer.

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Author information

Affiliations

  1. Department of Nuclear Medicine, University of Ulm, Robert-Koch-Strasse 8, 89081, Ulm, Germany

    Andreas K. Buck, Holger Schirrmeister, Clemens Kratochwil, Andreas Wahl, Gerhard Glatting, Felix M. Mottaghy, Bernd Neumaier & Sven N. Reske

  2. Department of Internal Medicine II—Pulmonary Medicine, University of Ulm, Ulm, Germany

    Martin Hetzel

  3. Department of Thoracic Surgery, University of Ulm, Ulm, Germany

    Gisela Halter

  4. Department of Pathology, University of Ulm, Ulm, Germany

    Peter Möller & Torsten Mattfeldt

Authors
  1. Andreas K. Buck
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  2. Martin Hetzel
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  3. Holger Schirrmeister
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  4. Gisela Halter
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  7. Andreas Wahl
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  11. Bernd Neumaier
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  12. Sven N. Reske
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Correspondence to Andreas K. Buck.

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Buck, A.K., Hetzel, M., Schirrmeister, H. et al. Clinical relevance of imaging proliferative activity in lung nodules. Eur J Nucl Med Mol Imaging 32, 525–533 (2005). https://doi.org/10.1007/s00259-004-1706-7

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  • DOI: https://doi.org/10.1007/s00259-004-1706-7

Keywords

  • PET
  • [18F]FLT
  • [18F]FDG
  • Lung nodules
  • Staging