FDG is not only a cancer specific imaging agent, false positive results may be observed with benign diseases. False positive results are commonly observed in areas of active inflammation or infection (Gupta et al., 20000), with a reported false positive rate of 13% and false negative rate of 9% (Alavi et al., 2002).
Not all that lights up on a PET scan can or should be considered malignancy, and clinical context can become even more pertinent. Inflammatory cells, sarcoidosis, and other thoracic etiologies such as silicone-induced granuloma, can cause PET scans to light up, giving false positives [3,4,5].
PET/CT is the most useful test for determining the stage of cancer. It is more accurate than any other test in finding local or metastatic tumors. Although PET can't detect microscopic cells, it can detect clusters of tumor cells that metastasized, or spread, to other tissues or organs.
The retrospective study by Leblanc et al. including 125 patients with cervical cancer in stage IB2 –IIA with negative pre-operative CT scans or MRI, FDG PET or PET/CT showed a sensitivity of 33% in PA lymph nodes detection with false negative rate of 67% [10].
The diagnostic accuracy of PET-CT was 93.5%, and the false positive rate was 6.50%. Among the false positive patients, inflammatory pseudotumor (42.86%) and tuberculoma (36.74%) were the most pathological types.
PET has been reported to have a sensitivity of 97–100% and a specificity of 62–100% in the detection of recurrent tumours. Scans are most reliable 6 months to 1 year after completion of therapy. Before that time, hypermetabolic inflammatory changes may result in false-positive studies.
Tumors with low activity are well-known major causes of false negative findings. This can be easily understood considering the FDG PET is metabolic imaging using the activity of lesion. Another major cause of false negative findings for malignancy is tumor size.
PET scanning can give false results if chemical balances within the body are not normal. Specifically, test results of diabetic patients or patients who have eaten within a few hours prior to the examination can be adversely affected because of altered blood sugar or blood insulin levels.
18F-Fluorodeoxy glucose positron emission tomography‒computed tomography (18F-FDG-PET) can detect malignant lymph nodes of even normal size, thus overcoming one of the major limitations of CT.
No, a PET scan cannot provide a conclusive diagnosis regarding whether a tumour is benign or malignant.
The bright spot in the chest, seen best on the PET and PET-CT scans, is lung cancer. Cancer cells show up as bright spots on PET scans because they have a higher metabolic rate than do typical cells.
A PET scan can help to: show up a cancer. find out how big it is and whether it has spread (stage a cancer) show whether a lump is cancer or not.
Not all cancers show up on a PET scan. PET scan results are often used with other imaging and lab test results. Other tests are often needed to find out whether an area that collected a lot of radioactive material is non-cancerous (benign) or cancerous (malignant).
PET scans do not diagnose cancer; they only show areas of abnormal uptake of the tracer material. Other diseases can produce "hot spots," such as infection.
When the scan lights up brightly, it means there is metabolic activity. Most aggressive cancers light up brightly, but the caveat is inflammation in the body also lights up because inflammatory cells are also metabolically active. That's why we need to verify the scan results with a needle biopsy.
In general, PET scans may be used to evaluate organs and/or tissues for the presence of disease or other conditions. PET may also be used to evaluate the function of organs, such as the heart or brain. The most common use of PET is in the detection of cancer and the evaluation of cancer treatment.
If a lesion is identified by a PET scan, it may need to undergo a biopsy to determine benign nature versus malignancy. The reported sensitivity and specificity varies greatly among studies, and, in many instances, there is a lack of histologic confirmation.
However, PET scans are more accurate in detecting larger and more aggressive tumors than they are in locating tumors that are smaller than 8 mm a pinky nail (or half of a thumb nail) and/or less aggressive cancers.
CT scans are more accurate than PET scans, but PET scans can be used to diagnose cancer at an early stage. Both scans are painless and take about 30 minutes to complete. If you're unsure which scan is right for you, be sure to talk to your doctor about PET and CT protocols.
Disadvantages of PET
Because radionuclides used in PET give off radiation for only a short time, PET can be done only if the radionuclide is produced at a nearby location and can be obtained quickly. PET is relatively expensive and not widely available.
Because PET scans read your sugar metabolism, eating sugar could affect the results of your scan. It's also important that you don't exercise for 24 hours before your PET scan. That's because exercise affects the radiotracer's reading and could cause the results to be inaccurate.
In cancer cells, there is an overproduction of glucose transporters and, as a result, increased FDG uptake. However, not all PET-positive lesions are cancer, and in many instances, PET findings can be false positive."
What happens after a PET scan? After the test, you can go about your day unless your doctor gives you other instructions. However, because radioactive material will remain in your body for about 12 hours, you'll want to limit your contact with both pregnant women and infants during this time.
However, PET scans should be interpreted by an experienced radiologist since areas of inflammation, infection, or recent surgery or trauma can also show up bright on a PET scan and do not indicate a cancer.