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differentiated adenocarcinomas (4.63 ±1.86) (p = 0.031). No
significant differenceswere apparent in average size among these
three histologk@types. Conclusion: A correlatlon was observed
between FDG uptake and the degree of cell dffferentuatkn in
adenocarcinoma of the lung. FDG PET may show negative results
for BAG.
Key Words: PET; fiuorine-18-fluorodeoxyglucose; bronchioloalveo
lar lung carcinoma
J NuciMed1998 39.1O16-1OZ@
PETwith18F-fluorodeoxyglucose(FDG)mayplayavaluable
role in delineating viable tumor tissue due to FDG PET's ability
to detect a tumor's increased glucose metabolism. It is known
that malignant tumorstend to show higher metabolic demands
than normal tissues. Recent articles have indicated FDG PET's
value in diagnosing human lung cancer (1—7).FDG PET has a
sensitivity and specificity of 93% and 88%, respectively, for
detecting malignancy in indeterminate solitary pulmonary nod
ules (7). However, wide variations in glucose consumption exist
among individuals depending on the type of neoplasm. In cases
of malignant lung neoplasms,few negative results of malig
nancy have been reported using FDG PET (4,5,8). Negative
results have occurred in patients with bronchioloalveolar lung
carcinomas (BACs) (4,8). BAC is a form of peripheral lung
adenocarcinomagrowing as a single layer of malignant cells
along the walls of terminal airways (9). It is known that the
tumor growth rate for BACs is lower than that for non-BAC
The goals of our study were to eStabliShPET accuracy wfth 18F-
fluorodeoxyglucose(FDG)in findinglOcalizedformations of bronchi
oloalveolarlung carcinoma (BAG)and to investigatethe correlation
between FDG uptake and the degree of cell differentiation in
adenocarcinoma of the lung. Materials: Twenty-nine patients wfth
30 adenocarcinomasof the lung (7 bronchioloalveolarlungcarcino
mas, 9 well differentiated,2 well-moderately differentiated,11 mod
erately differentiated and 1 poorly d@1ferentiated)were studied. ,@Jl
patients underwent thoracotomies within 4 wk after the FDG PET
study. For qual@abveana@,sis,the degree of FDG actMty in the
tumors was visually scored using a five-point grading system: 0 =
same to background activity, 1 = less than mediastinalblood-pool
activity, 2 = same to mediastinal blood-pool activity, 3 = slightly
greater than mediastinal blood-pool activity and 4 = substantially
greater than mediastinal blood-pool actlvfty. Foci of activity with
Grades 2-4 were consideredtumors. For semk@uantitativeanalysis,
standardized uptake values (SUV)were calculated. Results In 7
BAGs,4 lesions(57%) showednegativeresultson FOG PET,while
in 23 non-BAGs,only 1 lesion (4%),which was a well-differentiated
adenocarcinoma showed a negative result. BAGs' mean visual
score (1.43 ±1.27)was significantly lower than that of non-BAGs
(3.17 ±1.03)(p = 0.001).The BAGs'mean SUV (1.36 ±0.821)was
significantly lower than that of well-differentiated adenocarcinomas
(2.92 ±1.28) (p = 0.014); the mean SUV of well-differentiated
adenocarcinomas was significantly lower than that of moderately
Received May 2, 1997; accepted Sep. 4, 1997.
For correspondence or reprints contact: Kotaro Higashi, MD, Department of Radiol
ogy, Kanazawa Medkal University, 1-1, Daigaku, Uchinada, Kahoku-gun, Ishikawa,
920-02, Japan.
1016 THEJOURNALOFNUCLEARMEDICINE•Vol. 39 •No. 6 •June 1998
Fluorine-18-FDG PET Imaging Is Negative in
Bronchioloalveolar Lung Carcinoma
Kotaro Higashi, Yoshimichi Ueda, HiroyasuSeki, Kokichi Yuasa,ManabuOguchi, Tetsuhiko Noguchi, Mitsuru Taniguchi,
Hisao Tonami, Tetsuro Okimura and Itaru Yamamoto
Departments ofRadiology, Internal Medicine, Pathology and Thoracic Surgery, Kanazawa Medical University, Kahoku-gun,
Ishikawa; and Department ofRadiology, Kanazawa Cardiovascular Hospital, Kahoku-gun, Ishikawa, Japan
