| 1. To analyze the results of multiple primary cancer (MPC) including lung cancer by 18F-FDG PET/CT retrospectively. Additionally, analyze the clinical feature and imaging manifestation.2. To sumarize the diagnosis procedure of multiple primary cancer. Patients and MethodAccording to Warren and Gates'3 standards of MPC, we collected 45 MPC patients for retrospective analysis in our PET center from Sep 2004 to Dec 2009. The final diagnoses were all confirmed by pathology of biopsy or surgery. All the patients were scanned by Siemens Biograph Sensation 16 and Siemens Biograph 64HD PET/CT with 18F-FDG. All the patients took scans 1h after injection and delayed scans 2-3h after injection. The images were separately read by 2 experienced nuclear medical doctors. They described CT imaging manifestation and FDG metabolism. Then they determined the nature of the disease and located it precisely by fused image. Lesions should be documented in number, size, shape and FDG uptake, etc. Patients with lung cancer as first primary cancer were grouped in the First Primary Lung Cancer (FPLC). Patients with lung cancer as second primary cancer were grouped in the Second Primary Lung Cancer (SPLC). The data was statistically analyzed by Excel and SPSS15.0.Result①The incidence of MPC was 1.55%.②The most common second primary cancer was lung cancer in FPLC. It was followed by pancreas cancer. The most common first cancer was breast cancer in SPLC. It was followed by colorectal cancer and gastric cancer. The most common pathology of multiple lung cancer was adencarcinoma.③The male to female ratio was 1.25:1 in MPC. Gender was no significant difference in FPLC and SPLC (χ2=0.54, P>0.05).④Age of onset of first primary cancer was 27-79 years old, and the average was 55.8 years old. Age of onset of second lung cancer was 40～84 years old, and the average was 62.1 years old. Both of them got to the top in 60～70-year-old group. There was no significant difference of age between first primary cancer and second primary cancer in both FPLC and SPLC (t=1.985, 1.646, P>0.05).⑤11 patients (24.4%) were synchronous multiple primary cancer(SMPC).34 patients (75.6%) were metachronous multiple primary cancer (MMPC). The shortest interval of MMPC was 8 months. The longest was 31 years. The average was 76.1 months. The longest interval in FPLC was 372 months and the average was 76.6 months. The longest interval in SPLC was 144 months and the average was 29.7 months. There was significant difference between FPLC and SPLC (t=1.818,P=0.041<0.05).⑥45 MPC patients all took 71 PET/CT scan.1 first primary cancer was found.19 second primary cancer were detected, and 3 out of 19 were double primary lung cancer (DPLC).5 SMPC were diagnosed, including 2 DPLC. The rest 20 were follow-up after the treatment of MPC.⑦The SUVmax of the only first lung cancer was 3.6 and the delayed SUVmax was 3.5.⑧Second primary cancer were detected by PET/CT in 24 scans.19 out of 24 were confirmed MMPC in the follow-up of first primary cancer.16 patients (84.21%) had single lesions. They located in lung(13/16,81.25%), pancreas (2/16,12.5%), colon (1/16,6.25%). SUVmax of 15 second primary solitary pulmonary nodule was 1.3～22.9,the average was 6.5.⑨CT imaging manifestation of the 22 FDG uptake focus include no sign (1),one sign(7),two signs(8),three signs(3),four signs(1). Each lesion had 1.9 signs on average.ConclusionDiagnosis procedure of MPC is as followed:①The incidence of MPC is 1.55%.②Patients above 60 years old take high risk.③hen lesions locate in uncommon or rare metastasis location, the possibility of MPC should be paid attention.④Other imaging examiniation or serologic examination or other serum tumor markers should be taken to help diagnosis.⑤Suspected lesions with FDG uptake should have biopsy or surgery for pathological results. Then we can make reasonable clinical treatment to improve survival time.
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