Abstract
Background: Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is an imaging technique largely used in the management of infective endocarditis and in the detection and staging of cancer. We evaluate our experience of incidental cancer detection by PET/CT during IE investigations and follow-up.Methods and Findings: Between 2009 and 2018, our center, which includes an “endocarditis team,” managed 750 patients with IE in a prospective cohort. PET/CT became available in 2011 and was performed in 451 patients. Incidental diagnosis of cancer by PET/CT was observed in 36 patients and confirmed in 34 of them (7.5%) (colorectal n = 17; lung n = 7; lymphoma n = 2; melanoma n = 2; ovarian n = 2; prostate n = 1; bladder n = 1; ear, nose, and throat n = 1; brain n = 1). A significant association has been found between colorectal cancer and Streptococcus gallolyticus and/or Enterococcus faecalis [12/26 vs. 6/33 for other cancers, p = 0.025, odds ratio = 3.86 (1.19–12.47)]. Two patients had a negative PET/CT (a colon cancer and a bladder cancer), and two patients, with positive PET/CT, had a benign colorectal tumor. PET/CT had a sensitivity of 94–100% for the diagnosis of cancer in this patient.Conclusions: Whole-body PET/CT confirmed the high incidence of cancer in patients with IE and could now be proposed in these cases.
Highlights
Cancer in patients with infective endocarditis (IE) is not rare [1] and constitutes a special risk group with higher mortality [2]
The aim of this study is to evaluate our experience of IE and cancer association, incidentally discovered by positron emission tomography/computed tomography (PET/CT) examination performed for IE workup or follow-up
The study reported a total of 70 patients (9%) whose cancer was discovered at the time of IE management or follow-up (Figure 1)
Summary
Cancer in patients with infective endocarditis (IE) is not rare [1] and constitutes a special risk group with higher mortality [2]. Colorectal, prostate, and lung represent half of the overall burden of cancer in Europe [3]. The incidence of IE is around 1.5–11.6 cases per 100,000 people [4]. Over the past 40 years, the median age of IE patients has increased. The incidence of IE in the elderly increased 5-fold for the diagnosis of colorectal cancer compared to lung, breast, or prostate cancer [5]. Fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is an imaging technique largely used in the management of infective endocarditis and in the detection and staging of cancer. We evaluate our experience of incidental cancer detection by PET/CT during IE investigations and follow-up
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