Nuclear Medicine and Molecular Imaging

The Korean Society of Nuclear Medicine (대한핵의학회)
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Incidental Benign Parotid Lesions on FDG-PET: Prevalence and Clinico-pathologic Findings

FDG-PET 검사시 우연히 발견한 양성 이하선 병변: 유병율과 임상 및 병리 소견

  • Lim, Il-Han (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital) ;
  • Lee, Won-Woo (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital) ;
  • Chung, Jin-Haeng (Department of Pathology, Seoul National University College of Medicine, Seoul National University Bundang Hospital) ;
  • Park, So-Yeon (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital) ;
  • Kim, Sang-Hee (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital) ;
  • Kim, Yu-Kyeong (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital) ;
  • Kim, Sang-Eun (Department of Nuclear Medicine, Seoul National University College of Medicien, Seoul National University Bundang Hospital)
  • 임일한 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과) ;
  • 이원우 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과) ;
  • 정진행 (서울대학교 의과대학, 분당서울대학교병원, 병리학과) ;
  • 박소연 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과) ;
  • 김상희 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과) ;
  • 김유경 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과) ;
  • 김상은 (서울대학교 의과대학, 분당서울대학교병원, 핵의학과)
  • Published : 2007.10.31
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Abstract

Purpose: Incidental parotid lesions on F-18 FDG-PET can mimic distant metastasis of underlying malignancy. The prevalence and the clinico-pathologic findings of PET positive parotid lesions have not been known. We investigated how often incidental parotid lesions are found on clinical FDG-PET studies and what the clinico-pathologic characteristics of those parotid lesions are in the present study. Materials and Methods: We retrospectively reviewed 3,344 cases of FDG-PET which had been obtained in our hospital from May 2003 to Dec 2006. The indications of FDG-PET were: evaluation of known/suspected cancer (n= 3,212) or screening of cancer in healthy subjects (n=132). Incidental parotid lesion on FDG-PET was defined as an un-expected FDG uptake in one of parotid glands which was not primary target lesion of current FDG-PET. FDG uptake was represented by maximum standardized uptake value (maxSUV). Final diagnosis was made by pathologic analysis or clinical follow-up assessment. Results: Fifteen (0.45% = 15/3,344) incidental parotid lesions were found and they were all benign lesions. The maxSUV ranged from 1.7 to 8.6 (mean${\pm}$s.d. = $3.7{\pm}1.9$). Final diagnoses of the incidental parotid lesions were; Warthin's tumor (n=2), pleomorphic adenoma (n=1), other un-specified benign lesion (n=1), and benign lesions under bases of imaging studies (n=3) and of clinical follow-up (n=8). Conclusion: All of incidentally found parotid lesions in clinical FDG-PET studies were confirmed as benign lesions with prevalence of 0.45%. Close follow up using PET or CT might be a reasonable approach for determining the nature of incidentally found parotid lesions.

목적 : FDG-PET을 시행하였을 때 이하선에서 우연히 발견되는 FDG 섭취병변은 원발암의 원격 전이로 오인될 수 있다. 이러한 이하선의 우연한 FDG 섭취병변에 대한 유병률과 임상-병리학적 소견에 관한 연구는 아직 시행되지 않았다. 본 연구에서는 FDG-PET검사시 우연히 발견된 이하선 FDG 섭취병변의 유병률과 악성위험도를 평가하였다. 대상 및 방법 : 본 병원에서 2003년 5월부터 2006년 12월까지 FDG-PET을 시행한 3,344명의 환자가 대상이었다. 이중 3,212명은 암이 알려져 있거나 암이 의심되어 FDG-PET을 시행하였으며, 132명은 암 조기 검진 목적으로 FDG-PET을 시행하였다. 이하선의 우연한 FDG 섭취병변은 이하선이 현재 FDG-PET을 실시한 관심병소가 아니면서 육안적으로 평가하였을 때 반대편 이하선보다 FDG 섭취가 국소적으로 증가되어 있는 경우로 정의하였다. FDG 섭취 정도는 최대 SUV값 (maxSUV)으로 제시하였다. 최종 진단은 병리학적 검사소견이나 임상적인 추적관찰결과를 토대로 하였다. 결과 : 15명 (0.45% = 15/3,344)의 환자에서 이하선의 우연한 FDG 섭취병변이 관찰되었으며, 이들은 모두 양성병변을 시사하는 소견을 나타내었다. MaxSUV의 범위는 1.7 에서 8.6(평균${\pm}$표준편차=$3.7{\pm}1.9$) 이었다. 최종 진단은 2명이 Warthin 종양, 1명이 pleomorphic adenoma, 다른 1명은 비특이적 양성 병변, 3명의 환자는 영상검사 추적결과 유의한 변화가 관찰되지 않았고, 8명의 환자는 임상적 추적관찰에서 유의한 변화가 관찰되지 않았다. 결론 : 본 연구에서 FDG-PET 검사시 우연히 이하선에 FDG 섭취를 보이는 병변이 0.45%의 유병률로 나타났으며 모두 양성병변을 시사하는 소견을 나타냈다. 우연히 이하선에 FDG 섭취를 보이는 병변이 발견될 경우 PET이나 CT를 이용한 면밀한 영상검사로 추적관찰을 하는 것이 병변의 진단을 위한 합리적인 접근방법이라고 생각된다.

Keywords

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