Yuko Oya,Hiroaki  Kuroda,Hiroshi  Iwata,Keita  Nakanishi,Noriaki Sakakura,Toyoaki  Hida ,Yukinori  Sakao,Yusuke  Sugita,Yusuke Takahashi,
Presurgical heterogeneity of lung <sup>18</sup>FDG-PET uptake predicts acute exacerbation of interstitial lung disease following pulmonary resection in patients with smoke exposures
Journal of Surgical Oncology
2019
2674-3000
http://dx.doi.org/10.31487/j.JSO.2019.02.08
https://www.sciencerepository.org/presurgical-heterogeneity-of-lung-18fdg-pet-uptake-predicts-acute-exacerbation-of-interstitial-lung-disease-following-pulmonary-resection-in-patients-with-smoke-exposures_JSO-2019-2-108 
Abstract: Objectives: Acute exacerbation of interstitial lung disease (AEILD) is a severe complication after
pulmonary resection. This study investigates whether 2-[18]-fluoro-2-deoxy-D-glucose (18F-FDG) uptake
on positron emission tomography (PET) in ILD areas is a predictor of AEILD.
Methods: We enrolled 200 non-small cell lung cancer (NSCLC) patients with smoke exposures. Ten (5.0%)
developed AEILD of whom seven were diagnosed as severe AEILD requiring medication. Patients were
classified into either heterogeneity (HET, presence of ILD and non-ILD areas) or homogeneity (HOM, only
non-ILD) according to the 18F-FDG uptake at diaphragm level.
Results: The average maximum 18F-FDG uptake by NSCLC and in non-ILD was in HOM comparable to
that in HET (p = 0.86 and p = 0.14, respectively); however; it was 2.8-fold higher in ILD than in non-ILD
within HET (p < 0.01). Multivariate analyses revealed that only HET was independent factors for AEILD
and severe AEILD (p < 0.01, and p = 0.03, respectively). Among HET, honeycombing or a triad of
reticulation, consolidation, and ground-glass attenuation on high-resolution computed tomography (n = 21)
associated with higher complication rate regarding AEILD and worse prognosis (both p < 0.01).
Conclusions: Presurgical 18F-FDG uptake on normal lung areas may predict AEILD in smoke exposures.
Synopsis: Heterogeneity consisted of normal lung area and interstitial lung disease area according to 18FFDG uptake. The average maximum 18F-FDG uptake was 2.8-fold higher in interstitial lung area than in
normal area within heterogeneity. honeycombing or plenty of distinctive findings of interstitial lung disease
on high-resolution computed tomography associated with higher complication rate regarding acute
exacerbation of interstitial lung disease and worse prognosis.Keywords: Positron emission tomography, non-small cell lung cancer, interstitial lung disease, pulmonary resection, honeycombing