Glucose utilizationin vivo by human pulmonary neoplasms

Neoplastic tissue in general shows a high rate of glucose consumption under both anaerobic and aerobic conditions. Using positron emission tomography (PET) we measured the rate of uptake of the glucose analogue 1sfluoro-2-deoxy-D-glucose ("FDG) in 12 patients with carcinoma of the lung. The tumor types were six squamous cell, two large cell, two oat cell, one adenocarcinoma, and one undifferentiated carcinoma. In each patient a transaxial plane was selected that contained the bulk of the tumor tissue. Regional density and blood volume were measured. Following the intravenous injection of "FDG, the rates of uptake in the tumor and normal lung tissue were assessed from sequential scans over 1 hour. In each patient the rate of uptake of "FDG in the tumor tissue was significantly increased relative to normal lung tissue. For the group the rate of uptake by the tumor was 211.4 +- 69.4 m1/100 g/hr (mean 2 SD) compared to 31.9 k 13.2 in the contralateral lung (P < 0.05). The tumor-to-normal tissue ratio of 6.6 (range, 2.7 to 14.6) was higher than previously reported ratios for brain and liver tumors. In contrast to brain tumors there was little correlation between tumor type and rate of "FDG uptake. Measurements of glucose metabolism taken in vivo in human pulmonary tumors may lead to advances in screening, staging, and therapy. Cancer 60:2682-2689, 1987. HlRTY YEARS AGO, Warburg demonstrated abnorT mal glucose metabolism in neoplastic tissue in vitro. I Compared to normal hepatic tissue, rapidly growing, poorly differentiated hepatic tumors showed increased glycolysis and lactate production despite the presence of abundant oxygen, resulting in high rates of glucose consumption. The mechanism of this increased glucose consumption probably depends on the type of tissue and may be due to increased glucose transport through the cell membrane2 or an enhanced capacity for glycolysis because of increased activity of the key glycolytic en~ymes.~ This differential metabolic property of neoplastic tissue has been used by several investigators to detect malignancy. Recent studies have been performed using the