Laura Evangelista1, Alberto Cuocolo2, Leonardo Pace3, Luigi Mansi4, Silvana Del Vecchio2, Paolo Miletto5, Silvia Sanfilippo6, Sara Pellegrino2, Luca Guerra7, Giovanna Pepe8, Giuseppina Peluso9, Marco Salvatore10, Rosj Galicchio11, Michele Zuffante12, Salvatore Annunziata13, Mohsen Farsad14, Agostino Chiaravalloti15,16, Marco Spadafora5,17. 1. SSD Medicina Nucleare e Imaging Molecolare, Istituto Oncologico Veneto IOV - IRCCS, Padova, Italy. laura.evangelista@iov.veneto.it. 2. Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy. 3. Dipartimento di Medicina, Chirurgia e Odontoiatria "Scuola Medica Salernitana", Università degli Studi di Salerno, Salerno, Italy. 4. Centro Interuniversitario di Ricerca per lo Sviluppo Sostenibile, Napoli-Roma, Italy. 5. Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy. 6. Servizio di Medicina Nucleare, Policlinico S. Orsola Malpighi, Università degli Studi di Bologna, Bologna, Italy. 7. Unità di Medicina Nucleare, Ospedale San Gerardo, Università di Milano Bicocca, Monza, Italy. 8. Unità di Medicina Nucleare, Cancer Center, Ospedale Humanitas, Rozzano, Milano, Italy. 9. Unità di Medicina Nucleare, Dipartimento delle Immagini, Medicina Futura IOS, Acerra, Napoli, Italy. 10. Unità di Medicina Nucleare, Dipartimento delle Immagini, SDN-IRCCS, Napoli, Italy. 11. Centro di Riferimento Oncologico della Basilicata-IRCCS, Potenza, Italy. 12. Unità di Medicina Nucleare, Dipartimento delle Immagini, Ospedale Universitario Integrato di Verona, Verona, Italy. 13. Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy. 14. Dipartimento di Medicina Nucleare, Ospedale di Bolzano, Bolzano, Italy. 15. Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy. 16. Servizio di Medicina Nucleare, IRCCS Neuromed, Pozzilli, IS, Italy. 17. Struttura Complessa di Medicina Nucleare, Ospedale del Mare, Napoli, Italy.
Abstract
PURPOSE: The aim of this study was to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy. METHODS: FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference. RESULTS: SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%. CONCLUSION: Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.
PURPOSE: The aim of this study was to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy. METHODS:FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference. RESULTS: SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%. CONCLUSION: Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.
Entities:
Keywords:
Diagnosis; FDG-PET/CT; Likelihood of malignancy; Performance; Single pulmonary nodule
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: David M Hansell; Alexander A Bankier; Heber MacMahon; Theresa C McLoud; Nestor L Müller; Jacques Remy Journal: Radiology Date: 2008-01-14 Impact factor: 11.105
Authors: M Dabrowska; R Krenke; P Korczynski; M Maskey-Warzechowska; M Zukowska; J Kunikowska; T Orłowski; R Chazan Journal: Medicine (Baltimore) Date: 2015-04 Impact factor: 1.889
Authors: Jörg van den Hoff; Liane Oehme; Georg Schramm; Jens Maus; Alexandr Lougovski; Jan Petr; Bettina Beuthien-Baumann; Frank Hofheinz Journal: EJNMMI Res Date: 2013-11-23 Impact factor: 3.138
Authors: Frank Hofheinz; Jörg van den Hoff; Ingo G Steffen; Alexandr Lougovski; Kilian Ego; Holger Amthauer; Ivayla Apostolova Journal: EJNMMI Res Date: 2016-06-22 Impact factor: 3.138
Authors: Marco Spadafora; Laura Evangelista; Salvatore Fiordoro; Francesco Porcaro; Marilena Sicignano; Luigi Mansi Journal: Curr Radiopharm Date: 2020