title: Indeterminate pulmonary nodules on CT images in breast cancer patient: the additional value of 18F-FDG PET/CT.
abstract: OBJECTIVE
  To assess the potential role of 18F-Fluorodeoxiglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) in characterizing indeterminate lung nodules detected at CT scan in patients previously treated for a breast cancer (BC).
  
  
  METHODS
  Twenty-nine consecutive BC patients (28 females, mean age 65 ± 12 years) with evidence of indeterminate lung nodules at contrast-enhanced CT (CECT) scan (lesions with axial diameter ≥8 mm) were retrospectively analysed: all patients underwent 18F-FDG PET/CT within a mean 2 ± 1 months from CECT imaging. PET/CT was considered positive in the presence of abnormal FDG uptake in the pulmonary nodules and/or in other organs. The nature of lung nodules was defined at histopathology and/or imaging follow-up.
  
  
  RESULTS
  Fourteen (48%) patients showed negative and 15 (52%) positive PET/CT scan in the lungs: of these 15 patients, 7 (47%) had pathologic FDG-uptake in lungs only, whereas 8 (53%) showed abnormal FDG-uptake also in sites different from lungs. At histology and/or imaging follow-up, five (17%) patients were considered positive for BC lung metastases while in seven (24%) a second cancer was diagnosed. In this subset of patients, the sensitivity and specificity for FDG PET/CT in revealing lung lesions were 17% and 100%, respectively, for nodules <8 mm in diameter, and 77% and 85%, respectively, for nodules with diameter ≥8 mm. The therapeutic planning was changed to surgery in seven patients, chemotherapy in one patient and continued hormonal therapy in five. The inclusion of PET/CT in the diagnostic algorithm of the evaluated patients helped avoid unnecessary over-treatment in 12 of 29 patients.
  
  
  CONCLUSIONS
  FDG PET/CT appears useful in characterizing indeterminate lung nodules found at CECT scan in BC patients, with a sensitivity that is proportional to nodule size. In addition, PET/CT helped in avoiding over-treatment in a significant proportion of patients.
authors.affiliation: Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Evangelista
authors.forename: Annalori
authors.initials: A
authors.lastname: Panunzio
authors.forename: Anna Rita
authors.initials: AR
authors.lastname: Cervino
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Vinante
authors.forename: Adil
authors.initials: A
authors.lastname: Al-Nahhas
authors.forename: Domenico
authors.initials: D
authors.lastname: Rubello
authors.forename: Pier Carlo
authors.initials: PC
authors.lastname: Muzzio
authors.forename: Roberta
authors.initials: R
authors.lastname: Polverosi
mesh_terms: D000368:Aged; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008327:Mammography / Q000379:methods*; D064847:Multimodal Imaging / Q000379:methods*; D055613:Multiple Pulmonary Nodules / Q000175:diagnosis*; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18