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1 School of Medicine, Duke University, Durham, NC 27710.
2 Department of Radiology, Duke University Medical Center, Box 3803, Durham, NC
27710.
OBJECTIVE. The aim of this study was to determine the stage and outcome of patients with primary lung tumors who had a negative finding on a FDG positron emission tomography (PET) study at the time of diagnosis.
MATERIALS AND METHODS. A total of 3,912 patients between November 1994 and August 2002 underwent thoracic or whole-body PET performed at our institution for evaluation of a pulmonary abnormality suspicious for lung cancer. We identified 20 patients with a biopsy-proven primary lung tumor and a negative PET study at the time of presentation. Surgical, pathologic, radiographic imaging, and clinical follow-up information were reviewed to confirm the histology, stage, and outcome.
RESULTS. Tumor histology included adenocarcinoma (n = 7, 35%), bronchioalveolar cell carcinoma (n = 6, 30%), carcinoid (n = 3, 15%), squamous cell carcinoma (n = 2, 10%), otherwise unspecified non–small cell lung cancer (n = 1, 5%), and sarcomatoid neoplasm (n = 1, 5%). One patient with bronchioalveolar cell carcinoma had multifocal stage IV disease, and all other patients were stage IA (n = 14, 70%) or stage IB (n = 5, 25%). Eighteen (90%) of the 20 patients underwent curative surgical resection. No patient is known to have tumor recurrence after resection, and three (17%) of the 18 patients are known to be living and free of disease 5 years after surgery.
CONCLUSION. With the exception of bronchioalveolar cell carcinoma and carcinoid, newly diagnosed lung cancers with negative PET findings are usually early-stage diseases and are associated with a favorable prognosis, suggesting that indeterminate pulmonary nodules, which are PET-negative, can be managed conservatively with serial radiographic studies to monitor for signs of growth. These findings warrant further study and should be confirmed with sufficient follow-up in a large cohort of patients with PET-negative lung lesions.
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