Two surgical cases of small pulmonary nodules in which preoperative FDG-PET was carried out for differentiating between malignant and benign diseases

DOI IR IR (HANDLE) 4 Citations 16 References Open Access
  • Sakai Mitsuaki
    Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Kato Hideyuki
    Department of Thoracic Surgery, Tsukuba University Hospital
  • Ito Hiromichi
    Department of Thoracic Surgery, Tsukuba University Hospital
  • Ozawa Yuichiro
    Department of Thoracic Surgery, Tsukuba University Hospital
  • Yamamoto Tatsuo
    Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Ishikawa Shigemi
    Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Onizuka Masataka
    Department of Surgery, Institute of Clinical Medicine, University of Tsukuba
  • Sakakibara Yuzuru
    Department of Surgery, Institute of Clinical Medicine, University of Tsukuba

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  • ＣＴによる良悪性鑑別が難しい末梢肺の結節性病変に対しＦＤＧ集積を診断の一助に手術を施行した２例

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In cases of patients with small pulmonary nodules it is occasionally difficult to differentiate between malignant and benign diseases using CT. The sensitivity and specificity of FDG-PET in differentiating between lung cancer and benign disease are higher than those of CT, but previous studies have shown instances of false negative malignant tumor and false positive benign results. We report two cases of peripheral small pulmonary nodules in which preoperative FDG-PET was performed to identify the pathological characteristics of the lesions. Case 1 was a 58-year-old man with an abnormal shadow 20mm in size at left S9. Chest CT demonstrated an irregularly shaped fibrous shadow with a small nodule around the bulla. We suspected inflammation based upon the CT. FDG-PET showed an accumulation with an SUV of 2.6 corresponding to the lesion, indicating a possible malignancy. We initially performed a left upper wedge resection. Intraoperative diagnosis was squamous cell carcinoma. We performed a left lower lobectomy and mediastinal lymph node dissection. Case 2 was a 31-year-old man with a small nodular shadow 15mm in diameter with accompanying spicula and ground-glass opacity at the left S1+2. CT examination led us to suspect small adenocarcinoma. FDG-PET showed an accumulation with an SUV of 2.3 corresponding to the lesion. We performed a left upper wedge resection. Pathological diagnosis was pulmonary tuberculoma. For case 1, FDG-PET provided useful information for the preoperative diagnosis of lung cancer. However, we could not exclude lung cancer from the differential diagnosis by FDG-PET in case 2, because small adenocarcinoma could show an accumulation with an SUV of less than 2.5.

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