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Prospective investigation of positron emission tomography in lung nodules.
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1998
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Solitary pulmonary nodules are frequently detected on chest radiographs and CT, and biopsies are commonly performed to evaluate them. The study aimed to determine whether FDG‑PET could noninvasively differentiate benign from malignant nodules, potentially obviating invasive biopsies. In a prospective multicenter trial of 89 patients with indeterminate nodules, FDG‑PET scans were performed and analyzed using standardized uptake values and visual scoring, with results compared to pathology. FDG‑PET achieved 92 % sensitivity and 90 % specificity using SUV, with visual analysis yielding 98 % sensitivity and 69 % specificity; for nodules ≤1.5 cm, SUV sensitivity was 80 % and specificity 95 %, while visual sensitivity was 100 % and specificity 74 %, demonstrating accurate characterization and potential to reduce biopsies.
Solitary pulmonary nodules (SPNs) are commonly identified by chest radiographs and computed tomography (CT). Biopsies are often performed to evaluate the nodules further. An accurate, noninvasive diagnostic test could avoid the morbidity and costs of invasive tissue sampling. We evaluated the ability of fluorine-18 deoxyglucose positron emission tomography (FDG-PET) to discriminate between benign and malignant pulmonary nodules in a prospective, multicenter trial.Eighty-nine patients who had newly identified indeterminate SPNs on chest radiographs and CT were evaluated with FDG-PET. PET data were analyzed semiquantitatively by calculating standardized uptake values (SUVs) as an index of FDG accumulation and also by a visual scoring method. PET results were compared with pathology results.Sixty SPNs were malignant and 29 were benign. Using SUV data, PET had an overall sensitivity and specificity for detection of malignant nodules of 92% and 90%. Visual analysis provided a slightly higher, but not statistically significant, sensitivity of 98% and lower specificity of 69%. For SPNs < or = 1.5 cm (34 of 89), the sensitivity and specificity of SUV and visual analysis were 80% and 95% and 100% and 74%, respectively.FDG-PET can accurately characterize indeterminate SPNs. PET imaging provides a noninvasive method to evaluate indeterminate SPNs, which can reduce the need for invasive tissue biopsy.