FDG uptake at the bronchial stump after curative lobectomy for non-small cell lung cancer.
OBJECTIVE
Focal areas of FDG uptake may occur at the bronchial stump following curative lobectomy for non-small-cell lung carcinoma (NSCLC), even in the absence of suspicious CT changes. The purpose of our study was to investigate the significance of such PET/CT findings.


METHODS
FDG-PET/CT scans performed in 54 patients after lobectomy for NSCLC were reviewed. The presence of focal areas of FDG uptake at the bronchial stump, associated CT abnormalities, SUVmax, and normalized SUV (SUVnorm = SUVmax/mean liver SUV) were recorded. Final diagnosis was based on biopsy or imaging follow-up.


RESULTS
Focal areas of FDG uptake at the bronchial stump were detected in 30 patients (56 %). Mean SUVmax was 4.0 ± 1.9 (range; 2.2-12.1) and mean SUVnorm was 1.8 ± 0.8 (range; 0.9-4.5). Biopsy showed recurrence in two patients. In these patients, SUVnorm was respectively 4.4 and 4.5 (with SUVmax of 8.8 and 12.1), whereas SUVnorm was lower than 4.0 in those without recurrence, with mean SUVnorm of 1.6 ± 0.5 (range; 0.9-3.4) and mean SUVmax of 3.6 ± 0.9 (range; 2.2-5.8). The CT component of the PET/CT revealed ill-defined peribronchial soft tissue opacity only in both patients with recurrence.


CONCLUSIONS
FDG uptake at the bronchial stump is a frequent finding after pulmonary lobectomy. Moderate levels of FDG uptake (i.e., SUVnorm < 4.0) without corresponding abnormal CT findings might be a dual criterion for diagnosing benign post-surgical changes.
Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium. caroline.keyzer@erasme.ulb.ac.be.
Caroline
C
Keyzer
Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
Florence
F
Corbusier
Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
Eirini
E
Kyratzi
Department of Thoracic Surgery, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
Youri
Y
Sokolow
Department of Radiology, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
Pierre Alain
PA
Gevenois
Department of Nuclear Medicine, Hôpital Erasme, Université libre de Bruxelles, Route de Lennik 808, B-1070, Brussels, Belgium.
Serge
S
Goldman
D000368:Aged; D001980:Bronchi / Q000000981:diagnostic imaging* / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D000072078:Positron Emission Tomography Computed Tomography; D011184:Postoperative Period; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
Bronchial stump; Lobectomy; Non-small-cell lung cancer; PET/CT; Recurrence; SUV