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The Utility of Fluorodeoxyglucose Positron Emission Tomography in the Evaluation of Carcinoid Tumors Presenting as Pulmonary Nodules^*

^* From the Division of Pulmonary and Critical Care Medicine (Dr. Daniels), Division of Radiology, Department of Nuclear Medicine (Dr. Lowe), Division of Anatomic Pathology (Dr. Aubry), Division of General Thoracic Surgery (Dr. Allen), and Division of Medical Oncology (Dr. Jett), Mayo Clinic, Rochester, MN.

Correspondences to: Craig E. Daniels, MD, Division of Pulmonary and Critical Care Medicine, Desk East 18, Mayo Clinic, 200 First St SW, Rochester, MN 55905; e-mail: daniels.craig{at}mayo.edu

Abstract

Background: Fluorodeoxyglucose positron emission tomography (FDG-PET) is sensitive for detection of neoplastic solitary pulmonary nodules but may have decreased sensitivity for detection of carcinoid tumors. Our purpose was to determine the sensitivity of FDG-PET to detect pulmonary carcinoid tumors.

Methods: We performed a retrospective review of our institutional results regarding FDG-PET in the setting of thoracic carcinoid neoplasms. We identified 16 patients with a pathologic diagnosis of bronchial carcinoid who had an antecedent FDG-PET (from 2000 to 2004). All patients but one presented with pulmonary nodule(s).

Results: Sixteen patients had a diagnosis of carcinoid tumor, typical in 11 patients and atypical in 5 patients. The mean greatest pathologic dimension was 2.08 cm (range, 1.0 to 8.3 cm). Overall positron emission tomography (PET) sensitivity was 75% (12 true-positive and 4 false-negative results). The mean (± SD) size of carcinoids with false-negative PET results was not significantly different from carcinoids with true-positive results (1.6 ± 0.81 cm and 2.35 ± 1.87 cm, p = 0.54). Fifteen of 16 patients were staged pathologically, and positive nodes were found in 2 of these patients. PET lymph node staging agreed with pathologic staging in one stage 4 patient with positive lymph nodes and distant metastasis, but PET results were false negative in the other patient who had N2 with micrometastatic disease; stage IIIA.

Conclusions: FDG-PET imaging is useful for evaluation of typical and atypical thoracic carcinoid tumors. Although overall PET sensitivity for detection of carcinoid tumors is somewhat reduced as compared to non-small cell lung cancer, it is much higher than prior reports suggest.

Key Words: carcinoid • positron emission tomography • sensitivity • solitary pulmonary nodule • thoracic neoplasm

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