Clinical Endocrinology
Clinical Endocrinology
5 years ago

An assessment of 18F-FDG PET/CT for thoracic screening and risk stratification of Pulmonary Nodules in Multiple Endocrine Neoplasia Type 1

Alvin So, Richard Hodgson, John Burgess, Owen Pointon
Context Bronchopulmonary neuroendocrine tumours (bpNETs) and thymic carcinoid (ThC) are features of Multiple Endocrine Neoplasia Type 1 (MEN 1) and surveillance guidelines recommend periodic thoracic imaging. The optimal thoracic imaging modality and screening frequency remains uncertain as does the prognosis of small lung nodules when identified. Objectives To evaluate fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for identification and prognostic assessment of thoracic lesions in MEN 1. Design Retrospective observational study. Setting and participants Fifty consecutive MEN 1 patients undergoing screening with 18F-FDG PET/CT at a tertiary referral hospital between July 2011 and December 2016. Interventions 18F-FDG PET/CT. Outcome measures Pulmonary and thymic lesion prevalence, size, functional characteristics and behaviour. Results Thirteen patients (26.0%) exhibited pulmonary nodules with multiple nodules identified in nine (18.0%). An asymptomatic 31mm FDG avid ThC was identified in one patient (2%). Of the 13 patients with pulmonary nodules, four (8.0%) exhibited 13 FDG-avid nodules (mean size 10.1±9.1mm), and nine (18.0%) demonstrated 26 non-FDG avid nodules (mean size 6.9±5.8mm). All FDG-avid lesions increased in size versus 11 (42.3%) non-FDG avid lesions (p=0.0004). For FDG avid and non-avid nodules, the median doubling time was 24.2 months (IQR 11.4 - 40.7) and 48.6 months (IQR 37.0 – 72.2) respectively. Nodule resection was undertaken in two patients, typical bronchial carcinoid diagnosed in one (FDG non-avid) and metastatic renal cell carcinoma in the second (FDG avid). Conclusion Thoracic imaging with 18F-FDG PET/CT effectively identifies pulmonary nodules and ThC. FDG-avid pulmonary lesions are significantly more likely to progress than non-avid lesions. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/cen.13573

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