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The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer

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

Abstract

Purpose

To evaluate whether PET/low-dose CT (ldCT) using 18F-fluorodeoxyglucose (FDG) improves characterization of indeterminate single pulmonary nodules (SPNs) in patients at high risk of lung cancer.

Methods

Retrospective analysis of 307 patients who underwent FDG-PET/CT for indeterminate SPNs identified 93 (70 men, age range 46–90 years) at high risk of lung cancer (age >40 years, minimum 10 pack-year smokers). SPNs were evaluated for the presence and intensity of FDG avidity and ldCT patterns. The performance of visual and semiquantitative FDG-PET/ldCT algorithms for characterization of SPNs was compared to that of ldCT. Incongruent FDG-PET and ldCT patterns were analyzed for significance in further patient management.

Results

Malignancy was diagnosed in 38% patients. FDG avidity defined 33 SPNs as true-positive (TP) and 2 as false-negative (FN) (malignant), and 41 as true-negative (TN) and 17 as false-positive (FP) (benign). For SUVmax of 2.2 (by ROC analysis) there were 27 TP, 8 FN, 48 TN and 10 FP SPNs. LdCT defined 34 TP, 1 FN, 28 TN and 30 FP lesions. Of the FP lesions on ldCT, 60% were FDG-negative. Visual PET/ldCT analysis had a sensitivity of 94%, a specificity of 70%, an accuracy of 80%, a positive predictive value (PPV) of 66%, and a negative predictive value (NPV) of 95% as compared to 77%, 83%, 81%, 73%, 86% for semiquantitative PET/ldCT and 97%, 48%, 66%, 53%, 96% for ldCT, respectively. Both PET/ldCT algorithms had statistically significantly higher specificity and accuracy than ldCT. Semiquantitative analysis showed significantly higher PPV and lower sensitivity and NPV than found with ldCT.

Conclusion

A single screening procedure encompassing FDG-PET and ldCT may improve screening for lung cancer in high-risk patients. The significantly improved specificity may potentially reduce FP ldCT results and further unnecessary invasive procedures.

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Acknowledgments

The authors express their gratitude to Drs. Einat Even-Sapir and Ada Tamir for critical review of the paper and their many useful suggestions.

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Authors and Affiliations

  1. Department of Nuclear Medicine, Ramban Health Care Campus, Technion, Israel Institute of Technology, POB 9602, Haifa, 31096, Israel

    Olga Kagna, Zohar Keidar, Rachel Bar-Shalom & Ora Israel

  2. Department of Pulmonary Medicine, Ramban Health Care Campus, Technion, Israel Institute of Technology, Haifa, Israel

    Anna Solomonov, Oren Fruchter & Mordechai Yigla

  3. Department of Diagnostic Imaging, Ramban Health Care Campus, Technion, Israel Institute of Technology, Haifa, Israel

    Luda Guralnik

  4. Bruce and Ruth Rappaport School of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Zohar Keidar, Rachel Bar-Shalom, Mordechai Yigla & Ora Israel

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  1. Olga Kagna
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  2. Anna Solomonov
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  3. Zohar Keidar
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Correspondence to Olga Kagna.

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Kagna, O., Solomonov, A., Keidar, Z. et al. The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer. Eur J Nucl Med Mol Imaging 36, 997–1004 (2009). https://doi.org/10.1007/s00259-009-1061-9

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  • DOI: https://doi.org/10.1007/s00259-009-1061-9

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