Marco Spadafora1,2, Leonardo Pace3, Laura Evangelista4, Luigi Mansi5, Francesco Del Prete6, Giorgio Saladini4, Paolo Miletto6, Stefano Fanti7, Silvana Del Vecchio8, Luca Guerra9, Giovanna Pepe10, Giuseppina Peluso11, Emanuele Nicolai12, Giovanni Storto13, Marco Ferdeghini14, Alessandro Giordano15, Mohsen Farsad16, Orazio Schillaci17,18, Cesare Gridelli19, Alberto Cuocolo8. 1. Struttura Complessa di Medicina Nucleare, Ospedale del Mare, Napoli, Italy. spamar@libero.it. 2. Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy. spamar@libero.it. 3. Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy. 4. SSD Medicina Nucleare e Imaging Molecolare, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy. 5. Centro Interuniversitario di Ricerca per lo Sviluppo Sostenibile, Napoli-Roma, Italy. 6. Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy. 7. Servizio di Medicina Nucleare, Policlinico S. Orsola Malpighi, Università degli Studi di Bologna, Bologna, Italy. 8. Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy. 9. Unità di Medicina Nucleare, Ospedale San Gerardo, Università di Milano Bicocca, Monza, Italy. 10. Unità di Medicina Nucleare, Cancer Center, Humanitas Research Hospital, Rozzano, Milano, Italy. 11. Unità di Medicina Nucleare, Dipartimento delle Immagini, Medicina Futura IOS, Acerra, Napoli, Italy. 12. Unità di Medicina Nucleare, Dipartimento delle Immagini, SDN-IRCCS, Napoli, Italy. 13. Unità di Medicina Nucleare, Centro di Riferimento Oncologico della Basilicata-IRCCS, Rionero in Vulture, Potenza, Italy. 14. Unità di Medicina Nucleare, Dipartimento delle Immagini, Ospedale Universitario Integrato di Verona, Verona, Italy. 15. Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy. 16. Dipartimento di Medicina Nucleare, Ospedale di Bolzano, Bolzano, Italy. 17. Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy. 18. Servizio di Medicina Nucleare, IRCCS-Neuromed, Pozzilli, Isernia, Italy. 19. Divisione di Oncologia Medica, Ospedale San Giuseppe Moscati, Avellino, Italy.
Abstract
PURPOSE: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. METHODS: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. RESULTS: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. CONCLUSION: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.
PURPOSE: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. METHODS: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. RESULTS: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. CONCLUSION: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.
Authors: Heber MacMahon; John H M Austin; Gordon Gamsu; Christian J Herold; James R Jett; David P Naidich; Edward F Patz; Stephen J Swensen Journal: Radiology Date: 2005-11 Impact factor: 11.105
Authors: Dominique Delbeke; R Edward Coleman; Milton J Guiberteau; Manuel L Brown; Henry D Royal; Barry A Siegel; David W Townsend; Lincoln L Berland; J Anthony Parker; Karl Hubner; Michael G Stabin; George Zubal; Marc Kachelriess; Valerie Cronin; Scott Holbrook Journal: J Nucl Med Date: 2006-05 Impact factor: 10.057