The Ulutas Medical Journal p-ISSN 2149-0430 e-ISSN 2149-388X

The Ulutas Medical Journal · ISSN 2149-0430 (print), 2149-388X (online) · https://www.ulutasmedicaljournal.com/?mno=258465

Letter to the Editor · Open access

The Situations Which May Cause False-Negative Results in Oncological FDG-PET/CT Practice

  • Sevin Ayaz1
  1. Department of Medical Imaging Techniques, Toros University, Vocational School ROR
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Abstract

To the Editor, It is important to have a thorough knowledge about the conditions or situations which may lead to insufficient fluorine-18 fluorodeoxyglucose (FDG) uptake and false-negative results, particularly in oncological FDG-positron emission tomography/computed tomography (PET/CT) practice. Small tumor or metastatic lymph node dimensions (1, 2), necrotic areas within the tumor, high levels of blood glucose and insulin (3) may be the causes of false-negative FDG-PET/CT findings. In suspicious cases with unexpectedly low FDG affinity, history of corticosteroid treatment with increased doses, radiation therapy and chemotherapy should be questioned (3, 4). Well-differentiated forms of various malignancies such as hepatocellular carcinoma, some cases of genitourinary tract carcinomas including prostate cancer (3), some cases of ovarian cancer (5), various neuroendocrine tumours and malignancies of the thyroid gland (3), some head and neck squamous cell carcinomas without a known primary (6), some cases of esophageal carcinoma (7), some subtypes/cases of bronchioloalveolar carcinomas (8, 9), some cases of multiple myeloma (10), various metastatic bone tumours (particularly the sclerotic ones) (11), some cases of lobular breast carcinomas, as well as some low-grade malignancies (e.g. some central nervous system tumours and some sarcomas), lymphoma, and malignancies including high amounts of mucin may present with low FDG uptake (3). In order to overcome this diagnostically challenging situation, it is mandatory to evaluate the plain CT components of FDG-PET/CT images meticulously. But since this may not give sufficient data in some patients, the images which have readily or previously been obtained by other tools such as plain radiography, fluoroscopy, ultrasonography, mammography, contrast enhanced CT and magnetic resonance imaging should be evaluated at the same setting. Also, all the clinical and laboratory findings should be correlated with FDG-PET/CT findings. In indeterminate cases, the diagnosis should be verified by biopsy in appropriate patients.

Full text

It is important to have a thorough knowledge about the conditions or situations which may lead to insufficient fluorine-18 fluorodeoxyglucose (FDG) uptake and false negative results, particularly in oncological FDG-positron emission tomography / computed tomography (PET/CT) practice. Small tumour or metastatic lymph node dimensions (1, 2), necrotic areas within the tumour, high levels of blood glocose and insulin (3) may be the causes of false-negative FDG-PET/CT findings. In suspicious cases with unexpectedly low FDG affinity, history of corticosteroid treatment with increased doses, radiation therapy and chemotherapy should be questioned (3, 4). Well-differentiated forms of various malignancies such as hepatocellular carcinoma, some cases of genitourinary tract carcinomas including prostate cancer (3), some cases of ovarian cancer (5),variousneuroendocrine tumours and malignancies of the thyroid gland (3), some head and neck squamous cell carcinomas without a known primary (6), some cases of esophageal carcinoma (7), some subtypes/cases of bronchioloalveolar carcinomas (8, 9), some cases of multiple myeloma (10), various metastatic bone tumours (particularly the sclerotic ones) (11), some cases of lobular breast carcinomas, as well as some low-grade malignancies (e.g.some central nervous system tumours and some sarcomas), lymphoma, and malignancies including high amounts of mucin may present with low FDG uptake (3).

In order to overcome this diagnostically challenging situation, it is mandatory to evaluate the plain CT components of FDG-PET/CT images meticulously. But since this may not give sufficient data in some patients, the images which have readily or previously been obtained by other tools such as plain radiography, fluoroscopy, ultrasonography, mammography, contrast enhanced CT and magnetic resonance imaging should be evaluated at the same setting. Also, all the clinical and laboratory findings should be correlated with FDG-PET/CT findings. In indeterminate cases, the diagnosis should be verified by biopsy in appropriate patients.

Declarations

Author contributions (CRediT)
All authors contributed equally to all 14 CRediT roles (Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing).
Funding

Funding information was not reported in the published version of this article.

Conflicts of interest
A conflict of interest statement was not reported in the published version of this article.
Ethics approval
Ethics approval details were not reported in the published version of this article.
Data availability
Data sharing is not applicable to this article as no new data were created or analysed in this study.

References (11)

10 of 11 references are linked to their DOI.

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How to cite this article

Ayaz S. The Situations Which May Cause False-Negative Results in Oncological FDG-PET/CT Practice. Ulutas Med J. 2017;3(1):23-24. doi:10.5455/umj.20170213045950

Ayaz, S. (2017). The Situations Which May Cause False-Negative Results in Oncological FDG-PET/CT Practice. The Ulutas Medical Journal, 3(1), 23–24. https://doi.org/10.5455/umj.20170213045950

Ayaz, S. (2017) 'The Situations Which May Cause False-Negative Results in Oncological FDG-PET/CT Practice', The Ulutas Medical Journal, 3(1), pp. 23–24. doi: 10.5455/umj.20170213045950.

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