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Annals of Nuclear Medicine

, Volume 32, Issue 7, pp 492–498 | Cite as

Is 18F-FDG PET/CT useful for the differential diagnosis of solitary pulmonary nodules in patients with idiopathic pulmonary fibrosis?

  • Suk Hyun Lee
  • Changhwan Sung
  • Hyo Sang Lee
  • Hee-young Yoon
  • Soo-Jong Kim
  • Jungsu S. Oh
  • Jin Woo Song
  • Mi Young Kim
  • Jin-Sook RyuEmail author
Original Article

Abstract

Objective

Idiopathic pulmonary fibrosis (IPF) is associated with an increased incidence of lung cancer, but patients with IPF often have poor pulmonary function and are vulnerable to pneumothorax and so using an invasive procedure to diagnose a single nodule detected on chest CT risks a critical adverse outcome. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is recognized to be useful for differentiating between benign and malignant solitary pulmonary nodules (SPN) in patients without IPF, but its diagnostic accuracy has not been investigated in patients with IPF. In this study, therefore, we investigated whether 18F-FDG PET/CT is useful for the differential diagnosis of SPNs in patients with IPF.

Methods

From the IPF patient cohort of our institution, we retrospectively reviewed 55 patients (54 men, 1 woman; age 67.8 ± 7.6 years) with an SPN sized 8–30 mm (mean 18.5 ± 5.7 mm) who underwent chest CT followed by 18F-FDG PET/CT between April 2004 and March 2016. The 18F-FDG uptake of the SPN was analyzed visually and semiquantitatively, and these determinations were compared with the final diagnosis obtained by pathology (n = 52) or imaging follow-up (n = 3).

Results

The final diagnoses showed that 41 (75%) of the SPNs were malignant (21 squamous cell carcinomas, 9 adenocarcinomas, 5 small-cell carcinomas, 4 mixed-type carcinomas, 1 large-cell neuroendocrine carcinoma, and 1 sarcoid carcinoma) and 14 (25%) were benign. The determination of malignant SPNs by visual analysis of the PET/CT images had a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 98, 86, 95, and 92%, respectively. The semiquantitative analysis using a maximum standardized uptake value of 2.0 as the cut-off had a sensitivity, specificity, PPV, and NPV of 95, 93, 98, and 87%, respectively.

Conclusions

18F-FDG PET/CT is useful for differentiating benign and malignant SPNs in patients with IPF, as it is for patients without IPF.

Keywords

18F-fluorodeoxyglucose Positron emission tomography Lung cancer Solitary pulmonary nodule Idiopathic pulmonary fibrosis 

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Copyright information

© The Japanese Society of Nuclear Medicine 2018

Authors and Affiliations

  • Suk Hyun Lee
    • 1
  • Changhwan Sung
    • 2
  • Hyo Sang Lee
    • 3
  • Hee-young Yoon
    • 4
  • Soo-Jong Kim
    • 2
  • Jungsu S. Oh
    • 2
  • Jin Woo Song
    • 4
  • Mi Young Kim
    • 5
  • Jin-Sook Ryu
    • 2
    Email author
  1. 1.Department of Nuclear Medicine, Severance HospitalYonsei University College of MedicineSeoulSouth Korea
  2. 2.Department of Nuclear Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  3. 3.Department of Nuclear Medicine, Gangneung Asan HospitalUniversity of Ulsan College of MedicineGangneungSouth Korea
  4. 4.Department of Pulmonary and Critical Care Medicine, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea
  5. 5.Department of Radiology and Research Institute of Radiology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulSouth Korea

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