Abstract
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.
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