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Incremental Value of Integrated FDG-PET/CT in Evaluating Indeterminate Solitary Pulmonary Nodule for Malignancy

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Abstract

Objectives

The objective of this study was to evaluate the increased diagnostic benefit of integrated positron emission tomography/computed tomography (PET/CT) interpretation in evaluating solitary pulmonary nodules for malignancy.

Methods

One hundred seventeen patients (67 men and 50 women; mean age ± SD, 61.7 ± 13.6 years, range, 31–86 years) with indeterminate solitary pulmonary nodules and no previous history of malignancy were analyzed. PET/CT was performed with an integrated PET/CT scanner (Siemens Biograph BGO duo) 1 h after an intravenous injection of 370 MBq (10 mCi) 18F-fluorodeoxyglucose. Patients fasted for 6 h before imaging. PET was interpreted alone or combined with CT and was graded according to a five-point scale. A malignant diagnosis was based on histological findings or a clinical and radiological follow-up after at least 24 months. The diagnostic performances of PET alone and integrated PET/CT interpretation were evaluated using discriminant analysis.

Results

PET alone correctly classified 85% of nodules and integrated PET/CT interpretation increased the correct classification to 89%, with similar sensitivity and specificity of 88% and 89%, respectively. False-positive PET results mainly resulted from granulomatous disorders. Four (50%) of the eight cases deemed indeterminate on PET alone were resolved with combined PET/CT interpretation.

Conclusions

Although the benefit attributable to the CT component was limited when integrated PET/CT was used, PET and CT acted synergistically to significantly increase the diagnostic veracity for PET-indeterminate nodules.

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References

  1. Leef JL 3rd, Klein JS (2002) The solitary pulmonary nodule. Radiol Clin North Am 40:123–143 ix

    Article  PubMed  Google Scholar 

  2. Ooi GC, Khong PL, Yau YY (2004) Advances in imaging of the solitary pulmonary nodule. Hong Kong Med J 10:107–116

    CAS  PubMed  Google Scholar 

  3. Yankelevitz DF, Gupta R, Zhao B, Henschke CI (1999) Small pulmonary nodules: evaluation with repeat CT—preliminary experience. Radiology 212:561–566

    CAS  PubMed  Google Scholar 

  4. Gurney JW (1993) Determining the likelihood of malignancy in solitary pulmonary nodules with Bayesian analysis. Part I. Theory. Radiology 186:405–413

    CAS  PubMed  Google Scholar 

  5. Tan BB, Flaherty KR, Kazerooni EA, Iannettoni MD (2003) The solitary pulmonary nodule. Chest 123:89S–96S

    Article  PubMed  Google Scholar 

  6. Bogot NR, Shaham D (2000) Semi-invasive and invasive procedures for the diagnosis and staging of lung cancer. II. Bronchoscopic and surgical procedures. Radiol Clin North Am 38:535–544

    Article  CAS  PubMed  Google Scholar 

  7. Larscheid RC, Thorpe PE, Scott WJ (1998) Percutaneous transthoracic needle aspiration biopsy: a comprehensive review of its current role in the diagnosis and treatment of lung tumors. Chest 114:704–709

    Article  CAS  PubMed  Google Scholar 

  8. Ciriaco P, Negri G, Puglisi A, Nicoletti R, Del Maschio A, Zannini P (2004) Video-assisted thoracoscopic surgery for pulmonary nodules: rationale for preoperative computed tomography-guided hookwire localization. Eur J Cardiothorac Surg 25:429–433

    Article  PubMed  Google Scholar 

  9. The National Health Insurance Statistics. Bureau of National Health Insurance, Taiwan; 2007. http://www.doh.gov.tw/statistic/data

  10. Ost D, Fein A (2000) Evaluation and management of the solitary pulmonary nodule. Am J Respir Crit Care Med 162:782–787

    CAS  PubMed  Google Scholar 

  11. Marten K, Grabbe E (2003) The challenge of the solitary pulmonary nodule: diagnostic assessment with multislice spiral CT. Clin Imaging 27:156–161

    Article  PubMed  Google Scholar 

  12. Hung GU, Shiau YC, Tsai SC, Ho YJ, Kao CH, Yen RF (2001) Differentiation of radiographically indeterminate solitary pulmonary nodules with. Jpn J Clin Oncol 31:51–54

    Article  CAS  PubMed  Google Scholar 

  13. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK (2001) Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 285:914–924

    Article  CAS  PubMed  Google Scholar 

  14. Kapucu LO, Meltzer CC, Townsend DW, Keenan RJ, Luketich JD (1998) Fluorine-18-fluorodeoxyglucose uptake in pneumonia. J Nucl Med 39:1267–1269

    CAS  PubMed  Google Scholar 

  15. Lewis PJ, Salama A (1994) Uptake of fluorine-18-fluorodeoxyglucose in sarcoidosis. J Nucl Med 35:1647–1649

    CAS  PubMed  Google Scholar 

  16. Higashi K, Ueda Y, Seki H et al (1998) Fluorine-18-FDG PET imaging is negative in bronchioloalveolar lung carcinoma. J Nucl Med 39:1016–1020

    CAS  PubMed  Google Scholar 

  17. Erasmus JJ, McAdams HP, Patz EF Jr, Coleman RE, Ahuja V, Goodman PC (1998) Evaluation of primary pulmonary carcinoid tumors using FDG PET. AJR Am J Roentgenol 170:1369–1373

    CAS  PubMed  Google Scholar 

  18. Nakamoto Y, Senda M, Okada T et al (2008) Software-based fusion of PET and CT images for suspected recurrent lung cancer. Mol Imaging Biol 10:147–153

    Article  PubMed  Google Scholar 

  19. Pauls S, Buck AK, Halter G et al (2008) Performance of integrated FDG-PET/CT for differentiating benign and malignant lung lesions—results from a large prospective clinical trial. Mol Imaging Biol 10:121–128

    Article  PubMed  Google Scholar 

  20. Kim SK, Allen-Auerbach M, Goldin J et al (2007) Accuracy of PET/CT in characterization of solitary pulmonary lesions. J Nucl Med 48:214–220

    PubMed  Google Scholar 

  21. von Schulthess GK (2004) Positron emission tomography versus positron emission tomography/computed tomography: from “unclear” to “new-clear” medicine. Mol Imaging Biol 6:183–187

    Article  Google Scholar 

  22. Dewan NA, Shehan CJ, Reeb SD, Gobar LS, Scott WJ, Ryschon K (1997) Likelihood of malignancy in a solitary pulmonary nodule: comparison of Bayesian analysis and results of FDG-PET scan. Chest 112:416–422

    Article  CAS  PubMed  Google Scholar 

  23. Anzai Y, Carroll WR, Quint DJ et al (1996) Recurrence of head and neck cancer after surgery or irradiation: prospective comparison of 2-deoxy-2-[F-18]fluoro-D-glucose PET and MR imaging diagnoses. Radiology 200:135–141

    CAS  PubMed  Google Scholar 

  24. Winer-Muram HT (2006) The solitary pulmonary nodule. Radiology 239:34–49

    Article  PubMed  Google Scholar 

  25. Keidar Z, Haim N, Guralnik L et al (2004) PET/CT using 18F-FDG in suspected lung cancer recurrence: diagnostic value and impact on patient management. J Nucl Med 45:1640–1646

    PubMed  Google Scholar 

  26. Hashimoto Y, Tsujikawa T, Kondo C et al (2006) Accuracy of PET for diagnosis of solid pulmonary lesions with 18F-FDG uptake below the standardized uptake value of 2.5. J Nucl Med 47:426–431

    PubMed  Google Scholar 

  27. Kernstine KH, Grannis FW Jr, Rotter AJ (2005) Is there a role for PET in the evaluation of subcentimeter pulmonary nodules? Semin Thorac Cardiovasc Surg 17:110–114

    Article  PubMed  Google Scholar 

  28. Goudarzi B, Jacene HA, Wahl RL (2008) Diagnosis and differentiation of bronchioloalveolar carcinoma from adenocarcinoma with bronchioloalveolar components with metabolic and anatomic characteristics using PET/CT. J Nucl Med 49:1585–1592

    Article  PubMed  Google Scholar 

  29. Munden RF, Hess KR (2001) “Ditzels” on chest CT: survey of members of the Society of Thoracic Radiology. AJR Am J Roentgenol 176:1363–1369

    CAS  PubMed  Google Scholar 

  30. Christensen JA, Nathan MA, Mullan BP, Hartman TE, Swensen SJ, Lowe VJ (2006) Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT. AJR Am J Roentgenol 187:1361–1367

    Article  PubMed  Google Scholar 

  31. Wormanns D, Diederich S (2004) Characterization of small pulmonary nodules by CT. Eur Radiol 14:1380–1391

    PubMed  Google Scholar 

  32. Lowe VJ, Fletcher JW, Gobar L et al (1998) Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 16:1075–1084

    CAS  PubMed  Google Scholar 

  33. Gollub MJ, Hong R, Sarasohn DM, Akhurst T (2007) Limitations of CT during PET/CT. J Nucl Med 48:1583–1591

    Article  PubMed  Google Scholar 

  34. Chen CJ, Lee BF, Yao WJ et al (2008) Dual-phase 18F-FDG PET in the diagnosis of pulmonary nodules with an initial standard uptake value less than 2.5. AJR Am J Roentgenol 191:475–479

    Article  PubMed  Google Scholar 

  35. Hamberg LM, Hunter GJ, Alpert NM, Choi NC, Babich JW, Fischman AJ (1994) The dose uptake ratio as an index of glucose metabolism: useful parameter or oversimplification? J Nucl Med 35:1308–1312

    CAS  PubMed  Google Scholar 

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Acknowledgment

This work has been supported by the National Science Council, R.O.C. NSC 95-2314-B016011 and TSGH- C95-38. The authors thank Ta-Wei Tzeng and En-Shih Chen for his technical support.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Tri-Service General Hospital, National Defense Medical Center, 325, Section 2, Cheng-Kung Road, Taipei, 114, Taiwan

    Chih-Yung Chang, Cheng-Yi Cheng & Wen-Sheng Huang

  2. Department of Thoracic Surgery, Tri-Service General Hospital, Taipei, Taiwan

    Ching Tzao & Shih-Chun Lee

  3. Department of Radiology, Tri-Service General Hospital, Taipei, Taiwan

    Chang-Hsien Liu

  4. School of Public Health, National Defense Medical Center, Taipei, Taiwan

    Chih-Hung Ku

  5. Department of Nuclear Medicine, Chung Shan Medical University Hospital, 110, Section 1, Chien-Kuo N. Road, Taichung, 402, Taiwan

    Jong-Kang Lee

  6. Department of Nuclear Medicine, William Beaumont Hospital, Royal Oak, MI, USA

    Ching-Yee Oliver Wong

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  1. Chih-Yung Chang
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  2. Ching Tzao
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  5. Chang-Hsien Liu
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  6. Wen-Sheng Huang
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Corresponding authors

Correspondence to Wen-Sheng Huang or Jong-Kang Lee.

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Chang, CY., Tzao, C., Lee, SC. et al. Incremental Value of Integrated FDG-PET/CT in Evaluating Indeterminate Solitary Pulmonary Nodule for Malignancy. Mol Imaging Biol 12, 204–209 (2010). https://doi.org/10.1007/s11307-009-0241-0

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  • DOI: https://doi.org/10.1007/s11307-009-0241-0

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