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Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy.

Methods

FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference.

Results

SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%.

Conclusion

Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.

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Acknowledgments

We thank Christina A. Drace, Istituto Oncologico Veneto-IRCCS, Padova, Italia, for assistance in writing this manuscript.

Author information

Authors and Affiliations

  1. SSD Medicina Nucleare e Imaging Molecolare, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy

    Laura Evangelista

  2. Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy

    Alberto Cuocolo, Silvana Del Vecchio & Sara Pellegrino

  3. Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”, Università degli Studi di Salerno, Salerno, Italy

    Leonardo Pace

  4. Centro Interuniversitario di Ricerca per lo Sviluppo Sostenibile, Napoli-Roma, Italy

    Luigi Mansi

  5. Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy

    Paolo Miletto & Marco Spadafora

  6. Servizio di Medicina Nucleare, Policlinico S. Orsola Malpighi, Università degli Studi di Bologna, Bologna, Italy

    Silvia Sanfilippo

  7. Unità di Medicina Nucleare, Ospedale San Gerardo, Università di Milano Bicocca, Monza, Italy

    Luca Guerra

  8. Unità di Medicina Nucleare, Cancer Center, Ospedale Humanitas, Rozzano, Milano, Italy

    Giovanna Pepe

  9. Unità di Medicina Nucleare, Dipartimento delle Immagini, Medicina Futura IOS, Acerra, Napoli, Italy

    Giuseppina Peluso

  10. Unità di Medicina Nucleare, Dipartimento delle Immagini, SDN-IRCCS, Napoli, Italy

    Marco Salvatore

  11. Centro di Riferimento Oncologico della Basilicata-IRCCS, Potenza, Italy

    Rosj Galicchio

  12. Unità di Medicina Nucleare, Dipartimento delle Immagini, Ospedale Universitario Integrato di Verona, Verona, Italy

    Michele Zuffante

  13. Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy

    Salvatore Annunziata

  14. Dipartimento di Medicina Nucleare, Ospedale di Bolzano, Bolzano, Italy

    Mohsen Farsad

  15. Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy

    Agostino Chiaravalloti

  16. Servizio di Medicina Nucleare, IRCCS Neuromed, Pozzilli, IS, Italy

    Agostino Chiaravalloti

  17. Struttura Complessa di Medicina Nucleare, Ospedale del Mare, Napoli, Italy

    Marco Spadafora

Authors
  1. Laura Evangelista
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  2. Alberto Cuocolo
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  3. Leonardo Pace
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  4. Luigi Mansi
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  5. Silvana Del Vecchio
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  6. Paolo Miletto
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  7. Silvia Sanfilippo
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  8. Sara Pellegrino
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  9. Luca Guerra
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  10. Giovanna Pepe
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  11. Giuseppina Peluso
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  12. Marco Salvatore
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  13. Rosj Galicchio
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  14. Michele Zuffante
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  15. Salvatore Annunziata
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  16. Mohsen Farsad
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  17. Agostino Chiaravalloti
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  18. Marco Spadafora
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Corresponding author

Correspondence to Laura Evangelista.

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Conflict of interest

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

ITALIAN in title = Italian Tailored Assessment of Lung Indeterminate Accidental Nodule

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Evangelista, L., Cuocolo, A., Pace, L. et al. Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial. Eur J Nucl Med Mol Imaging 45, 1898–1907 (2018). https://doi.org/10.1007/s00259-018-4016-1

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  • DOI: https://doi.org/10.1007/s00259-018-4016-1

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