Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer

Kamilla Bredlund Caspersen, Nikoletta Giannoutsou, Oke Gerke, Abass Alavi, Poul Flemming Høilund-Carlsen, Søren Hess

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

PURPOSE: Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician's discretion. Being a sensitive non-invasive whole-body imaging modality 18F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18F-FDG-PET/CT in SSD using long-term follow-up as reference.

METHODS: We retrospectively studied results obtained in all SSD patients referred for 18F-FDG-PET/CT at a single institution in 2010-2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from 6 months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsy-confirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis.

RESULTS: Ninety-three patients, aged 67 years (range 25-89) were included and followed for up to 7.3 years (median 6). Of these, 21 [22.6% (95% CI 15.3-32.1)] turned out to have cancer. With 18F-FDG-PET/CT, the sensitivity was 81.0% (95% CI 60.0-92.3), specificity 76.4% (95% CI 65.4-84.7), positive predictive value 50% (95% CI 34.1-65.9), and negative predictive value 93.2% (95% CI 83.8-97.3). Five patients with negative scans were subsequently diagnosed with cancer.

CONCLUSION: Cancer prevalence is substantial among patients with SSD. 18F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18F-FDG-PET/CT in SSD.

Original languageEnglish
JournalAnnals of Nuclear Medicine
Volume33
Issue number3
Pages (from-to)184-192
ISSN0914-7187
DOIs
Publication statusPublished - 25. Mar 2019

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Fluorodeoxyglucose F18
Neoplasms
Whole Body Imaging

Keywords

  • FDG
  • Occult cancer
  • PET/CT
  • Suspected serious disease

Cite this

@article{3305b0bc7b1d4f5abcbf413db7ccd997,
title = "Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer",
abstract = "PURPOSE: Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician's discretion. Being a sensitive non-invasive whole-body imaging modality 18F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18F-FDG-PET/CT in SSD using long-term follow-up as reference.METHODS: We retrospectively studied results obtained in all SSD patients referred for 18F-FDG-PET/CT at a single institution in 2010-2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from 6 months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsy-confirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis.RESULTS: Ninety-three patients, aged 67 years (range 25-89) were included and followed for up to 7.3 years (median 6). Of these, 21 [22.6{\%} (95{\%} CI 15.3-32.1)] turned out to have cancer. With 18F-FDG-PET/CT, the sensitivity was 81.0{\%} (95{\%} CI 60.0-92.3), specificity 76.4{\%} (95{\%} CI 65.4-84.7), positive predictive value 50{\%} (95{\%} CI 34.1-65.9), and negative predictive value 93.2{\%} (95{\%} CI 83.8-97.3). Five patients with negative scans were subsequently diagnosed with cancer.CONCLUSION: Cancer prevalence is substantial among patients with SSD. 18F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18F-FDG-PET/CT in SSD.",
keywords = "FDG, Occult cancer, PET/CT, Suspected serious disease",
author = "Caspersen, {Kamilla Bredlund} and Nikoletta Giannoutsou and Oke Gerke and Abass Alavi and H{\o}ilund-Carlsen, {Poul Flemming} and S{\o}ren Hess",
year = "2019",
month = "3",
day = "25",
doi = "10.1007/s12149-018-01322-9",
language = "English",
volume = "33",
pages = "184--192",
journal = "Annals of Nuclear Medicine",
issn = "0914-7187",
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}

Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer. / Caspersen, Kamilla Bredlund; Giannoutsou, Nikoletta; Gerke, Oke; Alavi, Abass; Høilund-Carlsen, Poul Flemming; Hess, Søren.

In: Annals of Nuclear Medicine, Vol. 33, No. 3, 25.03.2019, p. 184-192.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Clinical value of 18F-FDG-PET/CT in suspected serious disease with special emphasis on occult cancer

AU - Caspersen, Kamilla Bredlund

AU - Giannoutsou, Nikoletta

AU - Gerke, Oke

AU - Alavi, Abass

AU - Høilund-Carlsen, Poul Flemming

AU - Hess, Søren

PY - 2019/3/25

Y1 - 2019/3/25

N2 - PURPOSE: Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician's discretion. Being a sensitive non-invasive whole-body imaging modality 18F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18F-FDG-PET/CT in SSD using long-term follow-up as reference.METHODS: We retrospectively studied results obtained in all SSD patients referred for 18F-FDG-PET/CT at a single institution in 2010-2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from 6 months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsy-confirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis.RESULTS: Ninety-three patients, aged 67 years (range 25-89) were included and followed for up to 7.3 years (median 6). Of these, 21 [22.6% (95% CI 15.3-32.1)] turned out to have cancer. With 18F-FDG-PET/CT, the sensitivity was 81.0% (95% CI 60.0-92.3), specificity 76.4% (95% CI 65.4-84.7), positive predictive value 50% (95% CI 34.1-65.9), and negative predictive value 93.2% (95% CI 83.8-97.3). Five patients with negative scans were subsequently diagnosed with cancer.CONCLUSION: Cancer prevalence is substantial among patients with SSD. 18F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18F-FDG-PET/CT in SSD.

AB - PURPOSE: Suspected serious disease (SSD) is a disease designation often given to patients with one or more non-specific symptoms of severe disease that could be due to cancer; the optimal diagnostic strategy is largely left to the clinician's discretion. Being a sensitive non-invasive whole-body imaging modality 18F-FDG-PET/CT may have a potential role in this cancer-prevalent group of patients to confirm or refute suspected malignancy. We aimed to investigate the diagnostic value of 18F-FDG-PET/CT in SSD using long-term follow-up as reference.METHODS: We retrospectively studied results obtained in all SSD patients referred for 18F-FDG-PET/CT at a single institution in 2010-2011 retrieving the following clinical data in all patients: journal entries, examinations, and evaluations made from 6 months before the scan and until the latest recorded entry. A true positive PET scan was a positive scan with a subsequently biopsy-confirmed diagnosis of cancer in the same target organ, whereas a false positive scan had no subsequent cancer diagnosis. A true negative PET scan was a negative scan without a cancer diagnosis during follow-up, whereas a false negative PET scan was one with a subsequently confirmed cancer diagnosis.RESULTS: Ninety-three patients, aged 67 years (range 25-89) were included and followed for up to 7.3 years (median 6). Of these, 21 [22.6% (95% CI 15.3-32.1)] turned out to have cancer. With 18F-FDG-PET/CT, the sensitivity was 81.0% (95% CI 60.0-92.3), specificity 76.4% (95% CI 65.4-84.7), positive predictive value 50% (95% CI 34.1-65.9), and negative predictive value 93.2% (95% CI 83.8-97.3). Five patients with negative scans were subsequently diagnosed with cancer.CONCLUSION: Cancer prevalence is substantial among patients with SSD. 18F-FDG-PET/CT is a promising option in this setting, in particular because a high negative predictive value equals a low incidence of cancer during follow-up. Further studies are needed to establish the role of 18F-FDG-PET/CT in SSD.

KW - FDG

KW - Occult cancer

KW - PET/CT

KW - Suspected serious disease

U2 - 10.1007/s12149-018-01322-9

DO - 10.1007/s12149-018-01322-9

M3 - Journal article

VL - 33

SP - 184

EP - 192

JO - Annals of Nuclear Medicine

JF - Annals of Nuclear Medicine

SN - 0914-7187

IS - 3

ER -