Abstract
Purpose
Febrile neutropenia (FNP) is a frequent complication of cancer care and evaluation often fails to identify a cause. [18 F]FDG PET/CT has the potential to identify inflammatory and infectious foci, but its potential role as an investigation for persistent FNP has not previously been explored. The aim of this study was to prospectively evaluate the clinical utility of FDG PET/CT in patients with cancer and severe neutropenia and five or more days of persistent fever despite antibiotic therapy.
Methods
Adult patients with a diagnosis of an underlying malignancy and persistent FNP (temperature ≥38°C and neutrophil count <500 cells/μl for 5 days) underwent FDG PET/CT as an adjunct to conventional evaluation and management.
Results
The study group comprised 20 patients with FNP who fulfilled the eligibility criteria and underwent FDG PET/CT in addition to conventional evaluation. The median neutrophil count on the day of the FDG PET/CT scan was 30 cells/μl (range 0–730 cells/μl). Conventional evaluation identified 14 distinct sites of infection, 13 (93 %) of which were also identified by FDG PET/CT, including all deep tissue infections. FDG PET/CT identified 9 additional likely infection sites, 8 of which were subsequently confirmed as “true positives” by further investigations. FDG PET/CT was deemed to be of ‘high’ clinical impact in 15 of the 20 patients (75 %).
Conclusion
This study supports the utility of FDG PET/CT scanning in severely neutropenic patients with five or more days of fever. Further evaluation of the contribution of FDG PET/CT in the management of FNP across a range of underlying malignancies is required.
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References
Hughes WT, Armstrong D, Bodey GP, Bow EJ, Brown AE, Calandra T, et al. 2002 guidelines for the use of antimicrobial agents in neutropenic patients with cancer. Clin Infect Dis. 2002;34:730–51.
Pizzo PA. Management of fever in patients with cancer and treatment-induced neutropenia. N Engl J Med. 1993;328:1323–32.
Paul M, Yahav D, Fraser A, Leibovici L. Empirical antibiotic monotherapy for febrile neutropenia: systematic review and meta-analysis of randomized controlled trials. J Antimicrob Chemother 2006;57:176–89.
Ruhnke M, Bohme A, Buchheidt D, Cornely O, Donhuijsen K, Einsele H, et al. Diagnosis of invasive fungal infections in hematology and oncology – guidelines from the Infectious Diseases Working Party in Haematology and Oncology of the German Society for Haematology and Oncology (AGIHO). Ann Oncol. 2012;23:823–33.
Einsele H, Loeffler J. Contribution of new diagnostic approaches to antifungal treatment plans in high-risk haematology patients. Clin Microbiol Infect. 2008;14 Suppl 4:37–45.
Barnes PD, Marr KA. Risks, diagnosis and outcomes of invasive fungal infections in haematopoietic stem cell transplant recipients. Br J Haematol. 2007;139(4):519–31.
Strauss LG. Fluorine-18 deoxyglucose and false-positive results: a major problem in the diagnostics of oncological patients. Eur J Nucl Med. 1996;23(10):1409–15.
Bleeker-Rovers CP, Vos FJ, Corstens FH, Oyen WJ. Imaging of infectious diseases using [18F]fluorodeoxyglucose PET. Q J Nucl Med Mol Imaging. 2008;52(1):17–29.
Mahfouz T, Miceli MH, Saghafifar F, Stroud S, Jones-Jackson L, Walker R, et al. 18F-fluorodeoxyglucose positron emission tomography contributes to the diagnosis and management of infections in patients with multiple myeloma: a study of 165 infectious episodes. J Clin Oncol. 2005;23(31):7857–63.
Miceli MH, Jones-Jackson LB, Walker RC, Talamo G, Barlogie B, Anaissie EJ. Diagnosis of infection of implantable central venous catheters by [18F]fluorodeoxyglucose positron emission tomography. Nucl Med Commun. 2004;25(8):813–8.
Miceli M, Atoui R, Walker R, Mahfouz T, Mirza N, Diaz J, et al. Diagnosis of deep septic thrombophlebitis in cancer patients by fluorine-18 fluorodeoxyglucose positron emission tomography scanning: a preliminary report. J Clin Oncol. 2004;22:1949–56.
Ho AY, Pagliuca A, Maisey MN, Mufti GJ. Positron emission scanning with 18-FDG in the diagnosis of deep fungal infections. Br J Haematol. 1998;101(2):392–3.
Hot A, Maunoury C, Poiree S, Lanternier F, Viard JP, Loulergue P, et al. Diagnostic contribution of the positron emission scanning with 18F-FDG for invasive fungal infections. Clin Microbiol Infect. 2011;17:409–17.
Xu B, Shi P, Wu H, Guo X, Wang Q, Zhou S. Utility of FDG PET/CT in guiding antifungal therapy in acute leukemia patients with chronic disseminated candidiasis. Clin Nucl Med. 2010;35(8):567–70.
Connell CA, Corry J, Milner AD, Hogg A, Hicks RJ, Rischin D, et al. Clinical impact of, prognostic stratification by, F-18 FDG PET/CT in head and neck mucosal squamous cell carcinoma. Head Neck. 2007;29(11):986–95.
Bleeker-Rovers CP, Vos FJ, van der Graaf WT, Oyen WJ. Nuclear medicine imaging of infection in cancer patients (with emphasis on FDG-PET). Oncologist. 2011;16(7):980–91.
Ruf J, Oeser C, Amthauer H. Clinical role of anti-granulocyte MoAb versus radiolabeled white blood cells. Q J Nucl Med Mol Imaging. 2010;54(6):599–616.
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Guy, S.D., Tramontana, A.R., Worth, L.J. et al. Use of FDG PET/CT for investigation of febrile neutropenia: evaluation in high-risk cancer patients. Eur J Nucl Med Mol Imaging 39, 1348–1355 (2012). https://doi.org/10.1007/s00259-012-2143-7
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DOI: https://doi.org/10.1007/s00259-012-2143-7