Differential uptake of TI-201 by small-cell lung cancer in a patient with pneumoconiosis-related pulmonary nodules

A 68-year-old man with pneumoconiosis was thought to have small-cell lung c ancer based on the results of a biopsy of a bone tumor, Three pulmonary nod ules were observed on a chest radiograph. Compared with a chest radiograph taken 4 months earlier, one of the nodules had grown, It was difficult to d ifferentiate this nodule from pneumoconiosis-related benign pulmonary nodul es from the appearance on the chest radiograph and CT. Ga-67 scintigraphy a nd Tl-201 lung SPECT were performed to characterize these nodules. Tl-201 S PECT showed differential high uptake in the enlarged nodule, whereas Ga-67 scintigraphy showed equally intense uptake in all these nodules. Transbronc hial biopsy of the nodule that showed high Tl-201 uptake revealed cancer ce ll nests against a background of interstitial fibrosis. The pathologic diag nosis was small-cell lung cancer that had developed in lung scar tissue, Th is case suggests the utility of Tl-201 in scintigraphic assessments of pneu moconiosis-related pulmonary nodules when lung cancer is suspected.