Source: Annual Congress 2006 - Sarcoidosis
Disease area: Interstitial lung diseases, Thoracic oncology

Abstract

Background: Integrated FDG-PET/CT scan has been recently introduced in the diagnostic work-up of suspected thoracic malignancies. Differential diagnosis between malignant lymphoma, lung cancer and sarcoidosis can be very difficult. Aim of this study was to examine the findings of sarcoidosis on integrated PET/CT, which has not been done before.
Methods: We studied 5 patients (pts) (48 ± 6 y., 4 men) with mediastinal lymph node enlargement suggestive of malignant lymphoma, small cell lung cancer or sarcoidosis.
Results: Maximum lesion size of mediastinal lymph nodes ranged from 16 to 39 mm in diameter. All of those enlarged lymph nodes were not calcified and considered as possibly malignant with respect to CT findings. Histologic specimen were obtained by mediastinoscopy (n = 2) or bronchoscopy (n = 3) with a definite diagnosis confirming sarcoidosis. Maximum FDG standard uptake value (SUV) in lymph nodes was 8.8 ± 3.6 (range 3.8 – 13.9). Three pts showed pulmonary involvement of sarcoidosis with small intrapulmonary nodules. In one pt the nodules were FDG negative. In two pts the nodules were FDG positive with a SUV of 2.9 and 10.7. None of the pts had clinical extrathoracic manifestations of sarcoidosis and none of them showed extrathoracic increased FDG-uptake.
Conclusions: Sarcoidosis can be a pitfall in PET/CT imaging, which may lead to false positive results of malignancy. Increased FDG-uptake in mediastinal lymph nodes is often comparable to malignant lymphoma or lymph nodes metastases. Therefore histological confirmation of the lesions by mediastinoscopy or bronchoscopic biopsy should be mandatory, except for pts in whom sarcoidosis could be accurately confirmed by other diagnostic methods.

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Citations should be made in the following way:
C. Kropf, A. Buck, S. Pauls, C. Schumann, F. Mottaghy, V. Hombach, S. Reske, S. Krueger (Ulm, Germany). Use of integrated FDG PET/CT imaging in sarcoidosis. Eur Respir J 2006; 28: Suppl. 50, 3135

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