Impact of EBUS-TBNA on PET-CT Imaging of Mediastinal Nodes

TY - JOUR

T1 - Impact of EBUS-TBNA on PET-CT Imaging of Mediastinal Nodes

AU - Sivapalan, Pradeesh

AU - Naur, Therese Maria Henriette

AU - Colella, Sara

AU - Richter Larsen, Klaus

AU - Konge, Lars

AU - Frost Clementsen, Paul

PY - 2017

Y1 - 2017

N2 - BACKGROUND: Positron emission tomography-computed tomography (PET-CT) with fluorine-18-fluorodeoxyglucose has a high sensitivity in detecting malignancy in patients suspected of lung cancer but a low specificity as inflammatory reactions can also result in metabolic activity. Furthermore, it is assumed that invasive pulmonary procedures with biopsies from benign lesions can induce metabolic activity resulting in false-positive results. However, this hypothesis lacks solid evidence. We aimed to evaluate how often endobronchial ultrasound (EBUS) with biopsies from benign lesions are followed by false-positive results.METHODS: Patients with suspected or proven lung cancer admitted for invasive pulmonary procedures in a 6-year period were retrospectively reviewed. Patients who had at least 1 nonmalignant mediastinal lymph node (MLN) biopsied 1 to 13 days before PET-CT were included. The number of false-positive and true-negative results shortly after EBUS biopsy of nonmalignant MLN was reviewed.RESULTS: Of 1025 patients, 216 patients were referred for PET-CT 1 to 13 days after biopsy. Of these, 107 patients had at least 1 MLN biopsied. From a total of 198 biopsied MLNs, we found 62% without metabolic activity (benign) and 38% with metabolic activity. In 5% the metabolic activity could be explained by an infection or inflammatory disorder, in 15% no cytologic follow-up was available, in 1% malignancy was confirmed at follow-up, and in 3% the patients were not possible to follow-up. In the remaining 14%, no other reasonable explanation for the metabolic activity was found other than the biopsy.CONCLUSIONS: EBUS with biopsy do not necessarily result in PET activity. Therefore, PET-positive results should always be taken seriously, even when PET is performed shortly after biopsies.

AB - BACKGROUND: Positron emission tomography-computed tomography (PET-CT) with fluorine-18-fluorodeoxyglucose has a high sensitivity in detecting malignancy in patients suspected of lung cancer but a low specificity as inflammatory reactions can also result in metabolic activity. Furthermore, it is assumed that invasive pulmonary procedures with biopsies from benign lesions can induce metabolic activity resulting in false-positive results. However, this hypothesis lacks solid evidence. We aimed to evaluate how often endobronchial ultrasound (EBUS) with biopsies from benign lesions are followed by false-positive results.METHODS: Patients with suspected or proven lung cancer admitted for invasive pulmonary procedures in a 6-year period were retrospectively reviewed. Patients who had at least 1 nonmalignant mediastinal lymph node (MLN) biopsied 1 to 13 days before PET-CT were included. The number of false-positive and true-negative results shortly after EBUS biopsy of nonmalignant MLN was reviewed.RESULTS: Of 1025 patients, 216 patients were referred for PET-CT 1 to 13 days after biopsy. Of these, 107 patients had at least 1 MLN biopsied. From a total of 198 biopsied MLNs, we found 62% without metabolic activity (benign) and 38% with metabolic activity. In 5% the metabolic activity could be explained by an infection or inflammatory disorder, in 15% no cytologic follow-up was available, in 1% malignancy was confirmed at follow-up, and in 3% the patients were not possible to follow-up. In the remaining 14%, no other reasonable explanation for the metabolic activity was found other than the biopsy.CONCLUSIONS: EBUS with biopsy do not necessarily result in PET activity. Therefore, PET-positive results should always be taken seriously, even when PET is performed shortly after biopsies.

KW - Biopsy, Fine-Needle

KW - Denmark

KW - False Positive Reactions

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Lung Neoplasms/diagnostic imaging

KW - Lymph Nodes/diagnostic imaging

KW - Lymphatic Metastasis

KW - Mediastinum/diagnostic imaging

KW - Neoplasm Staging

KW - Positron Emission Tomography Computed Tomography

KW - Retrospective Studies

KW - Ultrasonography, Interventional

U2 - 10.1097/LBR.0000000000000373

DO - 10.1097/LBR.0000000000000373

M3 - Journal article

C2 - 28696964

SN - 1944-6586

VL - 24

SP - 188

EP - 192

JO - Journal of Bronchology & Interventional Pulmonology

JF - Journal of Bronchology & Interventional Pulmonology

IS - 3

ER -