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Objective <p>Primary lung carcinoid tumors are well-differentiated malignant neuroendocrine neoplasms classified as typical carcinoids (low grade) and atypical carcinoids (intermediate grade), accounting for 0.5–5% of all lung cancers. Differentiating these tumors from other lung pathologies, particularly hamartomas—common benign lung tumors—can be challenging due to overlapping radiological features. This study aimed to evaluate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in distinguishing pulmonary carcinoids from hamartomas and to explore the relationship between FDG metabolism and tumor growth rates.</p> Methods <p>We conducted a retrospective analysis of 146 patients diagnosed with carcinoid tumors (<i>n</i> = 61) or hamartomas (<i>n</i> = 85) after surgical resection or biopsy between April 2019 and May 2024. Patients with solitary pulmonary nodules under clinical follow-up were excluded. FDG PET/CT scans were performed using standardized imaging protocols, and metabolic parameters, including the maximum standardized uptake value (SUVmax), were measured. Statistical analyses were done to assess correlations and diagnostic performance.</p> Results <p>The study population had a mean age of 57.2&#xa0;years, with significant differences in nodule size and SUVmax values between carcinoids and hamartomas. Carcinoids demonstrated higher SUVmax (mean 4.02) compared to hamartomas (mean 1.34), with an optimal cutoff value of 1.73 for distinguishing between the two, yielding a sensitivity of 86.9% and a specificity of 77.6%. VDTs differed significantly, with atypical carcinoids having shorter doubling times than hamartomas. Notably, no significant correlations were found between SUVmax and mitotic activity or Ki-67 levels, although necrosis showed a significant relationship with SUVmax.</p> Conclusions <p>The findings underscore the importance of FDG PET/CT in differentiating pulmonary carcinoids from hamartomas, with implications for clinical management and treatment strategies. The study also suggests that existing mitotic criteria in pathological classification may need reevaluation to improve the differentiation of these tumors.</p>

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Distinguishing between carcinoid tumors and hamartomas: the diagnostıc value of FDG PET/CT

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年11月18日

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  • Resit Akyel,
  • Senar Gunenc,
  • Kaan Akcay,
  • Mehmet Turker,
  • Erdogan Cetinkaya,
  • Muhammed Mustafa Atci

摘要

Objective

Primary lung carcinoid tumors are well-differentiated malignant neuroendocrine neoplasms classified as typical carcinoids (low grade) and atypical carcinoids (intermediate grade), accounting for 0.5–5% of all lung cancers. Differentiating these tumors from other lung pathologies, particularly hamartomas—common benign lung tumors—can be challenging due to overlapping radiological features. This study aimed to evaluate the role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in distinguishing pulmonary carcinoids from hamartomas and to explore the relationship between FDG metabolism and tumor growth rates.

Methods

We conducted a retrospective analysis of 146 patients diagnosed with carcinoid tumors (n = 61) or hamartomas (n = 85) after surgical resection or biopsy between April 2019 and May 2024. Patients with solitary pulmonary nodules under clinical follow-up were excluded. FDG PET/CT scans were performed using standardized imaging protocols, and metabolic parameters, including the maximum standardized uptake value (SUVmax), were measured. Statistical analyses were done to assess correlations and diagnostic performance.

Results

The study population had a mean age of 57.2 years, with significant differences in nodule size and SUVmax values between carcinoids and hamartomas. Carcinoids demonstrated higher SUVmax (mean 4.02) compared to hamartomas (mean 1.34), with an optimal cutoff value of 1.73 for distinguishing between the two, yielding a sensitivity of 86.9% and a specificity of 77.6%. VDTs differed significantly, with atypical carcinoids having shorter doubling times than hamartomas. Notably, no significant correlations were found between SUVmax and mitotic activity or Ki-67 levels, although necrosis showed a significant relationship with SUVmax.

Conclusions

The findings underscore the importance of FDG PET/CT in differentiating pulmonary carcinoids from hamartomas, with implications for clinical management and treatment strategies. The study also suggests that existing mitotic criteria in pathological classification may need reevaluation to improve the differentiation of these tumors.