Significance of ¹⁸F-fluorocholine PET/CT positive pulmonary lesions in prostate cancer patients

Summary

Aim: To assess the frequency and the significance of incidental pulmonary lesions with ¹⁸F-fluorocholine (¹⁸F-FCH) PET/CT in prostate cancer (PCa) patients. Patients, methods: 225 consecutive PCa patients referred for ¹⁸F-FCH PET/CT (median age 68 years) were retrospectively evaluated for the presence of lesions in the lungs: 173 referred for restaging and 52 for initial staging regarding their high risk of extra prostatic extension. The final diagnosis was based on histopathological or on clinical and radiological follow-up. Results: 13 patients had ¹⁸F-FCH positive pulmonary and 8 patients malignant lesions: 5 patients (38%) had a primary lung cancer (2 squamous cell carcinomas, 1 papillary adenocarcinoma, 1 typical pulmonary carcinoid, 1 bronchioloalveolar carcinoma) and 3 patients (23%) PCa metastases. Benign lesions were found in 5 subjects (38%). SUVmax and maximum diameter were neither significantly different in primary and metastatic tumors nor between malignant and benign lesions. Conclusions: Although our results suggest that incidental uptake in the lungs in PCa patients are nonspecific, their detection may have a significant impact on patient management knowing that more than 60% represent malignant diseas.

Zusammenfassung

Ziel: Untersuchung der Häufigkeit und Bedeutung von zufällig in der PET/CT mit ¹⁸F-Fluorcholin (¹⁸F-FCH) entdeckten Lungenrundherde bei Patienten mit Prostatakarzinom (PCa). Patienten, Methoden: 225 konsekutive ¹⁸F-FCH-PET/CT von PCa-Patienten (medianes Alter 68 Jahre) wurden retrospektiv auf das Vorhandensein von Lungenläsionen analysiert: Verdacht auf PCa-Rezidiv in 173 Fällen und initiales Staging bei hohem Risiko auf extra- prostatisches Wachstum in 52 Fällen. Die definitive Diagnose wurde histopathologisch oder aufgrund des klinischen und radiologischen Verlaufs erstellt. Ergebnisse: Bei 13 Patienten fanden sich ¹⁸F-FCH-positive Lungenbefunde, davon 8 mit maligner Histologie: 5 Patienten (38%) hatten primäre Lungentumore (2 Plattenepithelkarzinome, 1 papilläres Adenokarzinom, 1 typisches Lungenkarzinoid, 1 bronchioalveoläres Karzinom), bei 3 Patienten (23%) wurden PCa-Metastasen gefunden. Benigne Befunde wurden bei 5 Patienten (38%) erhoben. SUVmax und maximaler Durchmesser zeigten weder zwischen primären und metastatischen Lungenläsionen noch zwischen malignen und benignen Befunden signifikante Unterschiede. Schlussfolgerung: Obwohl unsere Resultate suggerieren, dass akzidentelle Lungenanreicherung von Fluorcholin bei PCa-Patienten unspezifisch ist, kann deren Nachweis einen signifikanten Einfluss auf das Management der Patienten haben unter Berücksichtigung der Tatsache, dass mehr als 60% der Befunde maligne sind.

Keywords

¹⁸F-Fluorocholine - PET/CT - pulmonary metastases - prostate cancer - lung cancer

Schlüsselwörter

¹⁸F-Fluorcholin - PET/CT - Lungenmetastasen - Prostatakrebs - Lungenkrebs

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