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Improved Detection of Second Primary Cancer Using Integrated [¹⁸F] Fluorodeoxyglucose Positron Emission Tomography and Computed Tomography for Initial Tumor Staging

From the Departments of Nuclear Medicine, Radiology, Medicine, Thoracic Surgery, and Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Address reprint requests to Byung-Tae Kim, MD, Department of Nuclear Medicine, Samsung Medical Center, 50 Ilwon-dong, Kangnam-ku 135-710 Seoul Republic of Korea; e-mail: btnm.kim{at}samsung.com

PURPOSE: This study evaluated prospectively the value of integrated whole-body positron emission tomography and computed tomography (PET/CT) using [¹⁸F] fluorodeoxyglucose (FDG) in detecting a second primary cancer at the time of the initial staging in comparison with a conventional staging work-up (CSW).

METHODS: The participants were 547 patients diagnosed with cancer who underwent FDG PET/CT imaging for the initial staging. An additional diagnostic evaluation was performed when there were abnormal findings indicative of a second primary cancer on either PET/CT or CSW considering the site and the biologic behavior of the alleged primary tumor.

RESULTS: A total of 27 second primary malignant tumors were identified in 26 of the 547 patients (4.8%). FDG PET/CT found 45 lesions indicative of a second primary cancer, of which 24 lesions were proved to be a second primary cancer, seven were clinically unexpected metastases, and 14 lesions were benign. Therefore, sensitivity and positive predictive value of FDG PET/CT in detecting a second primary cancer or an unexpected metastasis were 91% (31 of 34) and 69% (31 of 45), respectively. In contrast, CSW could not identify 16 second primary cancers and one metastatic lesion.

CONCLUSION: FDG PET/CT at the time of the initial staging is useful for screening a second primary cancer with a high sensitivity. An additional diagnostic work-up is essential when abnormal findings, which are indicative of a second primary cancer, are obtained on PET/CT images to rule out the presence of either a second primary cancer or an unexpected metastasis.

Presented in part at the Annual Meeting of the Society of Nuclear Medicine, Philadelphia, PA, June 19-23, 2004.

Supported by Grant No. 02-PJ3-PG6-EV06-0002 from the Korea Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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