Is PET/CT Useful in Detecting Pneumocystis jirovecii Colonization in Patients with Primary Lung Cancer?
5 affiliations
- 1Department of Surgery, 4th Military Clinical Hospital, 50-981 Wroclaw, Poland
- 2Student Research Club No. 180, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland
- 3Department ofBiology and Medical Parasitology, Faculty of Medicine, Wroclaw Medical University, 50-368 Wroclaw, Poland
- 4Division of Clinical Pathology, Department of Clinical and Experimental Pathology, Wroclaw Medical University, 50-368 Wroclaw, Poland
- 5Department of Clinical Surgical Sciences, Wroclaw University of Science and Technology, 50-376 Wroclaw, Poland
Abstract
Background/Objectives: Pneumocystis jirovecii colonization induces persistent low-grade pulmonary inflammation, which may alter fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT). We aimed to evaluate whether asymptomatic infection influences the maximum standardized uptake value (SUVmax) or clinicopathological parameters of primary lung cancer. Methods: In this prospective single-center observational study, 107 consecutive patients undergoing surgical resection for primary lung cancer were enrolled. Preoperative FDG PET/CT scans were obtained within four weeks prior to surgery. Intraoperative respiratory secretions and lung tissue samples were analyzed for P. jirovecii, using nested polymerase chain reaction (nested-PCR) targeting the mitochondrial large subunit rRNA gene. Propensity score matching (PSM) adjusting for age, sex, and body mass index was performed across 1:1, 1:2, and 1:3 matching models. Results: Pneumocystis jirovecii colonization was confirmed in 12 of 107 patients (11.21%). In the unadjusted cohort, no significant differences in primary lesion SUVmax were identified between positive and negative patients (10.38 ± 6.50 vs. 8.86 ± 6.58, p = 0.411), nor across matched models (1:1: p = 0.555; 1:2: p = 0.951; 1:3: p = 0.926). Following PSM, patients without colonization exhibited significantly larger maximum tumor diameters in both 1:2 (30.71 ± 19.23 vs. 18.25 ± 6.63 mm, p = 0.035) and 1:3 matching models (29.08 ± 17.47 vs. 18.25 ± 6.63 mm, p = 0.035). Conclusions: We did not find any association between P. jirovecii colonization and preoperative metabolic tumor staging on FDG PET/CT. However, asymptomatic carriage was associated with smaller primary tumor dimensions following propensity adjustment in 1:2 and 1:3 matching models, warranting further exploration of host–fungal interactions within the pulmonary tumor microenvironment.
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BibTeX
@article{nowicki2026petct,
title = {{Is PET/CT Useful in Detecting Pneumocystis jirovecii Colonization in Patients with Primary Lung Cancer?}},
author = {Maciej Nowicki and Ignacy Ilski and Jan Żywica and Igor Szczurek and Magdalena Szydłowicz and Błażej Łukianowski and Mariusz Chabowski},
journal = {Cancers},
year = {2026},
month = oct,
doi = {10.3390/cancers18203274},
url = {https://www.mdpi.com/2072-6694/18/20/3274},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Is PET/CT Useful in Detecting Pneumocystis jirovecii Colonization in Patients with Primary Lung Cancer?
AU - Maciej Nowicki
AU - Ignacy Ilski
AU - Jan Żywica
AU - Igor Szczurek
AU - Magdalena Szydłowicz
AU - Błażej Łukianowski
AU - Mariusz Chabowski
PY - 2026
DA - 2026/10/01
JO - Cancers
DO - 10.3390/cancers18203274
UR - https://www.mdpi.com/2072-6694/18/20/3274
AB - Background/Objectives: Pneumocystis jirovecii colonization induces persistent low-grade pulmonary inflammation, which may alter fluorodeoxyglucose (FDG) uptake in positron emission tomography/computed tomography (PET/CT). We aimed to evaluate whether asymptomatic infection influences the maximum standardized uptake value (SUVmax) or clinicopathological parameters of primary lung cancer. Methods: In this prospective single-center observational study, 107 consecutive patients undergoing surgical resection for primary lung cancer were enrolled. Preoperative FDG PET/CT scans were obtained within four weeks prior to surgery. Intraoperative respiratory secretions and lung tissue samples were analyzed for P. jirovecii, using nested polymerase chain reaction (nested-PCR) targeting the mitochondrial large subunit rRNA gene. Propensity score matching (PSM) adjusting for age, sex, and body mass index was performed across 1:1, 1:2, and 1:3 matching models. Results: Pneumocystis jirovecii colonization was confirmed in 12 of 107 patients (11.21%). In the unadjusted cohort, no significant differences in primary lesion SUVmax were identified between positive and negative patients (10.38 ± 6.50 vs. 8.86 ± 6.58, p = 0.411), nor across matched models (1:1: p = 0.555; 1:2: p = 0.951; 1:3: p = 0.926). Following PSM, patients without colonization exhibited significantly larger maximum tumor diameters in both 1:2 (30.71 ± 19.23 vs. 18.25 ± 6.63 mm, p = 0.035) and 1:3 matching models (29.08 ± 17.47 vs. 18.25 ± 6.63 mm, p = 0.035). Conclusions: We did not find any association between P. jirovecii colonization and preoperative metabolic tumor staging on FDG PET/CT. However, asymptomatic carriage was associated with smaller primary tumor dimensions following propensity adjustment in 1:2 and 1:3 matching models, warranting further exploration of host–fungal interactions within the pulmonary tumor microenvironment.
SN - 2072-6694
ER -