Abstract
Purpose
Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician’s discretion. Being a sensitive non-invasive whole-body imaging modality 18F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18F-FDG-PET/CT in SSD using long-term follow-up as reference.
Methods
We retrospectively studied results obtained in all SSD patients referred for 18F-FDG-PET/CT at a single institution in 2010–2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from 6 months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsy-confirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis.
Results
Ninety-three patients, aged 67 years (range 25–89) were included and followed for up to 7.3 years (median 6). Of these, 21 [22.6% (95% CI 15.3–32.1)] turned out to have cancer. With 18F-FDG-PET/CT, the sensitivity was 81.0% (95% CI 60.0–92.3), specificity 76.4% (95% CI 65.4–84.7), positive predictive value 50% (95% CI 34.1–65.9), and negative predictive value 93.2% (95% CI 83.8–97.3). Five patients with negative scans were subsequently diagnosed with cancer.
Conclusion
Cancer prevalence is substantial among patients with SSD. 18F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18F-FDG-PET/CT in SSD.
Similar content being viewed by others
References
Danish Board of Health. Diagnostisk pakkeforløb for patienter med uspecifikke symptomer på alvorlig sygdom som kunne være kræft. Copenhagen: Danish Board of Health; 2016.
Bislev LS, Bruun BJ, Gregersen S, Knudsen ST. Prevalence of cancer in Danish patients referred to a fast-track diagnostic pathway is substantial. Dan Med J 2015;62(9):A5138.
Ingeman ML, Christensen MB, Bro F, Knudsen ST, Vedsted P. The Danish cancer pathway for patients with serious non-specific symptoms and signs of cancer-a cross-sectional study of patient characteristics and cancer probability. BMC cancer. 2015;15:421.
Lebech AM, Gaardsting A, Loft A, Graff J, Markova E, Bertelsen AK, et al. Whole-body (18)F-FDG PET/CT is superior to CT as first-line diagnostic imaging in patients referred with serious nonspecific symptoms or signs of cancer: a randomized prospective study of 200 patients. J Nucl Med. 2017;58(7):1058–64.
Fredberg U, Vedsted P. [Organisation of diagnosing patients with unspecific cancer symptoms]. Ugeskr Laeger. 2011;173(24):1718–21.
Kristensen SB, Hess S, Petersen H, Høilund-Carlsen PF. Clinical value of FDG-PET/CT in suspected paraneoplastic syndromes: a retrospective analysis of 137 patients. Eur J Nucl Med Mol Imaging. 2015;42:2056–64.
Hess S, Alavi A, Basu S. PET-based personalized management of infectious and inflammatory disorders. PET Clin. 2016;11(3):351–61.
Griffeth LK. Use of PET/CT scanning in cancer patients: technical and practical considerations. Proc (Bayl Univ Med Cent). 2005;18(4):321–30.
Tind S, Vestergaard S, Farahani ZA, Hess S. Positron emission tomography/computer tomography in gastrointestinal malignancies: current potential and challenges. Minerva Chir. 2017;72(5):397–415.
Hess S, Blomberg BA, Zhu HJ, Høilund-Carlsen PF, Alavi A. The pivotal role of FDG-PET/CT in modern medicine. Acad Radiol. 2014;21(2):232–49.
Farwell MD, Pryma DA, Mankoff DA. PET/CT imaging in cancer: current applications and future directions. Cancer. 2014;120(22):3433–45.
Boellaard R, Delgado-Bolton R, Oyen WJ, Giammarile F, Tatsch K, Eschner W, et al. FDG PET/CT: EANM procedure guidelines for tumour imaging: version 2.0. Eur J Nucl Med Mol Imaging. 2015;42(2):328–54.
Frary EC, Hess S, Gerke O, Laustrup H. 18F-fluoro-deoxy-glucose positron emission tomography combined with computed tomography can reliably rule-out infection and cancer in patients with anti-neutrophil cytoplasmic antibody-associated vasculitis suspected of disease relapse. Medicine (Baltimore). 2017;96(30):e7613.
Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.
Segtnan EA, Hess S, Grupe P, Høilund-Carlsen PF. F-fluorodeoxyglucose PET/computed tomography for primary brain tumors. PET Clin. 2015;10(1):59–73.
Valls L, Badve C, Avril S, Herrmann K, Faulhaber P, O’Donnell J, et al. FDG-PET imaging in hematological malignancies. Blood Rev. 2016;30(4):317–31.
Wong SS, Yu WL, Wang K, Ahuja AT. Efficacy of 18F-FDG PET/CT in investigation of elevated CEA without known primary malignancy. Indian J Radiol Imaging. 2016;26(3):405–10.
Terauchi T, Murano T, Daisaki H, Kanou D, Shoda H, Kakinuma R, et al. Evaluation of whole-body cancer screening using 18F-2-deoxy-2-fluoro-D-glucose positron emission tomography: a preliminary report. Ann Nucl Med. 2008;22(5):379–85.
Nishizawa S, Kojima S, Teramukai S, Inubushi M, Kodama H, Maeda Y, et al. Prospective evaluation of whole-body cancer screening with multiple modalities including [18F]fluorodeoxyglucose positron emission tomography in a healthy population: a preliminary report. J Clin Oncol. 2009;27(11):1767–73.
Sekine T, Barbosa FG, Sah BR, Mader CE, Delso G, Burger IA, et al. PET/MR outperforms PET/CT in suspected occult tumors. Clin Nucl Med. 2017;42(2):e88–95.
Acknowledgements
The authors acknowledge Eivind Antonsen Segtnan, BSc., PhD candidate, for guidance, advice, and moral support, and the secretary Bente Stillingsborg for invaluable help with data retrieval.
Funding
There are no financial disclosures; this work received no funding.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
All authors declare that they have no conflicts of interest.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors; only retrospective data was included.
Rights and permissions
About this article
Cite this article
Caspersen, K.B., Giannoutsou, N., Gerke, O. et al. Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer. Ann Nucl Med 33, 184–192 (2019). https://doi.org/10.1007/s12149-018-01322-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12149-018-01322-9