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The clinical value of F-18 FDG PET/CT in differentiating malignant from benign lesions in pneumoconiosis patients

  • Nuclear Medicine
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

We reviewed PET/CT findings of pneumoconiosis and determined the ability of PET/CT to differentiate lung cancer from progressive massive fibrosis (PMF), and metastatic lymph nodes (LNs) from underlying reactive LN hyperplasia.

Methods

This was a retrospective study of patients with pneumoconiosis and suspected lung cancer. Maximum standardized uptake value (SUVmax), long- and short-axis diameters (DL and DS), ratio of DL to DS (DL/S), and Hounsfield unit (HU) from the lung mass and mediastinal LNs were measured. The cutoff values of each parameter were obtained by ROC analysis, and we evaluated the diagnostic sensitivity.

Results

Forty-nine pneumoconiosis patients were included. Eighty-three lung masses were detected, of which 42 were confirmed as lung cancer (23 squamous cell carcinomas, 12 adenocarcinomas, and 7 small cell carcinomas) and 41 were PMF. There were significant differences between lung cancer and PMF in terms of SUVmax, DS, DL/S, and HU (all p < 0.05). The sensitivity, specificity, and accuracy for diagnosis of lung cancer were 81.0%, 73.2%, and 77.1%, respectively, with an SUVmax cutoff value of 7.4; and 92.8%, 87.8%, and 90.4%, respectively, with a HU cutoff value of 45.5. Among the 40 LNs with available pathological results, 7 were metastatic. Metastatic LNs showed higher SUVmax, larger DS, and lower HU than benign lesions (all p < 0.05). The sensitivity, specificity, and accuracy for predicting metastatic LNs by PET/CT were 85.7%, 93.9%, and 92.5%, respectively.

Conclusion

By applying PET and CT parameters in combination, the accuracy for differentiating malignant from benign lesions could be increased. PET/CT can play a central role in the discrimination of lung cancer and PMF.

Key Points

• Lung cancer showed significantly higher SUVmax than PMF.

• Lung cancer showed similar D L but longer D S , resulting in a smaller D L/S than PMF.

• SUVmax demonstrated additive value in differentiating lung cancer from PMF, compared with HU alone.

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Abbreviations

CT:

Computed tomography

D L :

Long-axis diameter

D L/S :

Ratio of long- to short-axis diameter

D S :

Short-axis diameter

FDG:

Fluorodeoxyglucose

HU:

Hounsfield unit

LN:

Lymph node

NPV:

Negative predictive value

PET:

Positron emission tomography

PMF:

Progressive massive fibrosis

PPV:

Positive predictive value

ROC:

Receiver operating characteristic

SUVmax:

Maximum standardized uptake value

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Eun Kyoung Choi and Hye Lim Park contributed equally to this work.

Authors and Affiliations

  1. Division of Nuclear Medicine, Department of Radiology, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Eun Kyoung Choi

  2. Division of Nuclear Medicine, Department of Radiology, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Hye Lim Park

  3. Division of Nuclear Medicine, Department of Radiology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, South Korea

    Ie Ryung Yoo

  4. Division of Pulmonology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea

    Seung Joon Kim & Young Kyoon Kim

Authors
  1. Eun Kyoung Choi
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  2. Hye Lim Park
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Correspondence to Ie Ryung Yoo.

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The scientific guarantor of this publication is Ie Ryung Yoo.

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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

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Written informed consent was waived by the Institutional Review Board.

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• retrospective

• observational

• performed at one institution

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Choi, E.K., Park, H.L., Yoo, I.R. et al. The clinical value of F-18 FDG PET/CT in differentiating malignant from benign lesions in pneumoconiosis patients. Eur Radiol 30, 442–451 (2020). https://doi.org/10.1007/s00330-019-06342-1

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  • DOI: https://doi.org/10.1007/s00330-019-06342-1

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