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Performance of Integrated FDG-PET/CT for Differentiating Benign and Malignant Lung Lesions -Results from a Large Prospective Clinical Trial

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An Erratum to this article was published on 26 February 2008

Abstract

Purpose

The purpose of the study was to evaluate prospectively whether integrated 2-deoxy-2-[18F]fluoro-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) is more accurate for determination of malignancy in newly diagnosed pulmonary lesions compared to separate interpretation of CT and FDG-PET.

Procedures

Two hundred and seventy-six patients with newly diagnosed lung lesions underwent FDG-PET/CT. Helical CT, FDG-PET, and FDG-PET/CT were interpreted separately to determine the performance of each imaging modality. Histopathology served as reference in all patients, and in further 60 patients, a benign lesion was verified at follow-up (mean follow-up of 1,040 days).

Results

Histology revealed malignant lung tumors in 216 of 276 patients. With PET and PET/CT, a significantly lower number of lesions were classified as equivocal compared to CT alone (p < 0.001). Assuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity, and accuracy for CT was 94, 75, and 90%, for PET 97, 83, and 94% (p = 0.021), and for PET/CT 96, 87, and 94% (p = 0.010). Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 99, 37, and 86%, for PET 99, 77, and 94% (p < 0.001), and for PET/CT 98, 68, and 92% (p = 0.002). PET and PET/CT showed the highest concordance (K = 0.912; confidence interval 0.866–0.958). In lesions less than or equal to 3 cm, there was a significant difference in the performance of PET alone and multidetector row CT as well as PET/CT and multidetector row CT (p = 0.007), irrespective if equivocal findings were judged as malignant or benign.

Conclusion

For differentiation of benign from malignant lung lesions, integrated FDG-PET/CT imaging was significantly more accurate than CT but not FDG-PET. The addition of metabolic imaging (FDG-PET) to morphological imaging (CT) leads to an increase in specificity and significantly reduced equivocal findings and is therefore recommended to further specify newly diagnosed lung lesions.

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Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany

    Sandra Pauls & Andreas K. Buck

  2. Department of Nuclear Medicine, University of Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany

    Gisela Halter, Rainer Muche, Susanne Gerstner, Ludger Sunder-Plassmann & Sven N. Reske

  3. Department of Thoracic Surgery, University of Ulm, Steinhövelstr. 9, 89075, Ulm, Germany

    Felix M. Mottaghy & Peter Möller

  4. Institute of Biometrics, University of Ulm, Schwabstr. 13, 89075, Ulm, Germany

    Christina Bluemel & Stefan Krüger

  5. Department of Internal Medicine II, University of Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany

    Gerhard Glatting

  6. Department of Pathology, University of Ulm, Robert-Koch-Strasse 8, 89081, Ulm, Germany

    Hans-Jürgen Brambs

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  1. Sandra Pauls
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Corresponding author

Correspondence to Sandra Pauls.

Additional information

Sandra Pauls and Andreas K. Buck equally contributed.

An erratum to this article can be found at http://dx.doi.org/10.1007/s11307-008-0135-6

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Pauls, S., Buck, A.K., Halter, G. et al. 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 (2008). https://doi.org/10.1007/s11307-007-0129-9

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  • DOI: https://doi.org/10.1007/s11307-007-0129-9

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