Prospective Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Radiol. Oct 28, 2021; 13(10): 344-353
Published online Oct 28, 2021. doi: 10.4329/wjr.v13.i10.344
Shoulder adhesive capsulitis in cancer patients undergoing positron emission tomography - computed tomography and the association with shoulder pain
Daichi Hayashi, Elaine Gould, Robert Shroyer, Eric van Staalduinen, Jie Yang, Musa Mufti, Mingqian Huang
Daichi Hayashi, Elaine Gould, Robert Shroyer, Eric van Staalduinen, Musa Mufti, Mingqian Huang, Department of Radiology, State University of New York at Stony Brook, Stony Brook, NY 11794, United States
Jie Yang, Department of Family, Population and Preventive Medicine, Stony Brook Medicine, Stony Brook, NY 11794, United States
Author contributions: Hayashi D, Gould E and Huang M designed the research study; Hayashi D, Gould E, Shroyer R, van Staalduinen E, Mufti M and Huang M performed the research including data collection and electronic medical record review; Gould E, Shroyer R and Huang M interpreted positron emission tomography - computed tomography images; Yang J performed the statistical analyses; Hayashi D analyzed results and wrote the manuscript; all authors have read, edited and approved the final manuscript.
Institutional review board statement: Our prospective study received Institutional Review Board approval at our institution (Protocol# 2015-3396-R2).
Clinical trial registration statement: Our study is not a clinical trial. Therefore, there is no Clinical Trial Registration Statement applicable to this submission.
Informed consent statement: Written informed consent was obtained from all patients.
Conflict-of-interest statement: All authors have nothing to disclose.
Data sharing statement: Patient data are not available for sharing for protection of patient confidentiality and anonymity. No additional data are available.
CONSORT 2010 statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Daichi Hayashi, MD, PhD, Associate Professor, Department of Radiology, State University of New York at Stony Brook, HSC Level 4, Room 120, Stony Brook, NY 11794, United States. daichi.hayashi@stonybrookmedicine.edu
Received: March 13, 2021
Peer-review started: March 13, 2021
First decision: July 31, 2021
Revised: August 3, 2021
Accepted: September 14, 2021
Article in press: September 14, 2021
Published online: October 28, 2021
Processing time: 226 Days and 21.7 Hours
ARTICLE HIGHLIGHTS
Research background

Adhesive capsulitis of the shoulder is a relatively common condition that can develop and possibly predate diagnosis of cancer in patients undergoing treatment. The presence of adhesive capsulitis may explain the presence of shoulder pain or stiffness in cancer patients, which can be incidentally diagnosed on Positron emission tomography - computed tomography (PET-CT).

Research motivation

Since PET-CT imaging is routinely performed as a follow-up study in cancer patients after therapy, being aware of PET-CT findings to suggest shoulder adhesive capsulitis may help to alert clinicians for the diagnosis of unsuspected shoulder capsulitis and avoid potential misdiagnosis of cancer progression.

Research objectives

To: (1) Evaluate the frequency of shoulder capsulitis in cancer patients undergoing PET-CT; (2) Determine if there is correlation between cancer type/treatment regimen and frequency of adhesive capsulitis; (3) Evaluate if metabolic activities in the rotator interval are different between symptomatic and asymptomatic patients. We assessed if Standard Uptake Values (SUVs) are different between symptomatic and asymptomatic patients in both shoulders.

Research methods

In this prospective study, patients answered a questionnaire regarding shoulder pain/stiffness at the time of PET-CT study, between March 2015 and April 2019. Patterns of shoulder capsule 18F-fluorodeoxyglucose (FDG) uptake were noted. SUVmax and SUVmean values were measured at the rotator interval (RI) and deltoid muscle in bilateral shoulders. Wilcoxon rank sum tests were used to compare unadjusted marginal differences for age, SUV measurements between symptomatic and asymptomatic patients. Multiple linear regression models were used to examine the relationship between right or left shoulder SUV measurements and symptom status, after adjusting for covariates.

Research results

200 right shoulders and 200 Left shoulders were included in our study. No significant difference was noted between symptomatic and asymptomatic patients in terms of age, gender, proportion of patients who had surgical therapy and radiation therapy. In both shoulders, SUVmax and SUVmean were higher in symptomatic shoulders than asymptomatic shoulders (Left SUVmax 2.0 vs 1.6, SUVmean 1.6 vs 1.3, both P < 0.002; Right SUVmax 2.2 vs 1.8, SUVmean 1.8 vs 1.5, both P < 0.01). For lung cancer patients, bilateral RI SUVmax and SUVmean values were higher in symptomatic shoulders than asymptomatic shoulders.

Research conclusions

In symptomatic patients metabolic activities in the RI were higher than asymptomatic patients. Adhesive capsulitis should be considered in cancer patients with shoulder pain or stiffness and positive FDG uptake in the RI, as it may allow for therapy in earlier stages of disease to improve outcomes.

Research perspectives

Future studies may endeavor to perform radiomics research (texture analysis) on the PET-CT images.