Molecular Imaging and Biology

, Volume 10, Issue 2, pp 121–128

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

  • Sandra Pauls
  • Andreas K. Buck
  • Gisela Halter
  • Felix M. Mottaghy
  • Rainer Muche
  • Christina Bluemel
  • Susanne Gerstner
  • Stefan Krüger
  • Gerhard Glatting
  • Ludger Sunder-Plassmann
  • Peter Möller
  • Hans-Jürgen Brambs
  • Sven N. Reske
Research Article

DOI: 10.1007/s11307-007-0129-9

Cite this article as:
Pauls, S., Buck, A.K., Halter, G. et al. Mol Imaging Biol (2008) 10: 121. doi:10.1007/s11307-007-0129-9

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.

Key words

NSCLC PET/CT PET MDCT Lung tumor 

Copyright information

© Academy of Molecular Imaging 2007

Authors and Affiliations

  • Sandra Pauls
    • 1
  • Andreas K. Buck
    • 1
  • Gisela Halter
    • 2
  • Felix M. Mottaghy
    • 3
  • Rainer Muche
    • 2
  • Christina Bluemel
    • 4
  • Susanne Gerstner
    • 2
  • Stefan Krüger
    • 4
  • Gerhard Glatting
    • 5
  • Ludger Sunder-Plassmann
    • 2
  • Peter Möller
    • 3
  • Hans-Jürgen Brambs
    • 6
  • Sven N. Reske
    • 2
  1. 1.Department of Diagnostic and Interventional RadiologyUniversity of UlmUlmGermany
  2. 2.Department of Nuclear MedicineUniversity of UlmUlmGermany
  3. 3.Department of Thoracic SurgeryUniversity of UlmUlmGermany
  4. 4.Institute of BiometricsUniversity of UlmUlmGermany
  5. 5.Department of Internal Medicine IIUniversity of UlmUlmGermany
  6. 6.Department of PathologyUniversity of UlmUlmGermany

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