Diagnostic efficacy of PET-FDG imaging in solitary pulmonary nodules. Potential role in evaluation and management.

BACKGROUND Positron emission tomography (PET), a new noninvasive imaging modality, utilizing 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG), has demonstrated increased FDG uptake in lung tumors. OBJECTIVE To determine the diagnostic efficacy of PET-FDG imaging in differentiating benign from malignant solitary pulmonary nodules. PATIENT SELECTION A prospective study of 30 patients who presented with indeterminate solitary pulmonary nodules less than 3 cm in size based on chest radiograph and computed tomographic (CT) scan. SETTING Two tertiary care medical centers in Omaha, Neb: Creighton University Medical Center and the Omaha Veterans Administration Medical Center. MEASUREMENTS Positron emission tomographic imaging of the lung was performed 1 h after intravenous injection of 10 mCi of F-18-FDG. Qualitative analysis of the images was performed independently by two observers by visual identification of the areas of increased FDG uptake in the lung nodules. Semiquantitative analysis was performed using computation of differential uptake ratio (DUR). Histologic specimens were obtained in 29 patients (thoracotomy 20, transthoracic needle aspiration biopsy 8, bronchoscopy 1). RESULTS Positron emission tomographic imaging correctly identified 27 of 30 pulmonary nodules. Diagnostic accuracy was high with sensitivity of 95 percent and specificity of 80 percent. The positive and negative predictive value of PET imaging for solitary pulmonary nodules was 90 percent and 89 percent, respectively. The DUR values were significantly higher for malignant nodules (mean +/- SD, 5.55 +/- 2.79) than benign nodules (mean +/- SD, 0.95 +/- 0.99) (p < 0.001). There was one false-negative result in a patient with a 1-cm nodule identified as a scar adenocarcinoma. There were two false-positive cases and both had caseating granulomas with active inflammation and Histoplasma organisms. CONCLUSION PET-FDG imaging of the lung, a new noninvasive diagnostic test, has a high degree of accuracy in differentiating benign from malignant pulmonary nodules. PET-FDG imaging could complement CT scanning in the evaluation and treatment of patients with solitary pulmonary nodules.

[1]  H. Woodard,et al.  Expression of Tissue Isotope Distribution , 1975 .

[2]  Levin Dc,et al.  Flexible Fiberoptic Bronchoscopy and Fluoroscopically Guided Transbronchial Biopsy in the Management of Solitary Pulmonary Nodules , 1982 .

[3]  E A Zerhouni,et al.  The Solitary Pulmonary Nodule: Assessment, Diagnosis, and Management , 1987 .

[4]  S. Swensen,et al.  Clinical strategies for solitary pulmonary nodule. , 1992, Annual review of medicine.

[5]  W. E. Miller,et al.  Transthoracic needle biopsy: accuracy and complications in relation to location and type of lesion. , 1980, Mayo Clinic proceedings.

[6]  G. Lillington,et al.  Management of solitary pulmonary nodules. , 1991, Disease-a-month : DM.

[7]  D J Conces,et al.  Thoracic needle biopsy. Improved results utilizing a team approach. , 1987, Chest.

[8]  L G Strauss,et al.  The applications of PET in clinical oncology. , 1991, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[9]  G. Lillington.  Hazards of transthoracic needle biopsy of the lung. , 1989, The Annals of thoracic surgery.

[10]  C. Caskey,et al.  The solitary pulmonary nodule. , 1990, Seminars in roentgenology.

[11]  R A Brooks,et al.  Glucose utilization of cerebral gliomas measured by [18F] fluorodeoxyglucose and positron emission tomography , 1982, Neurology.

[12]  D. Hnatowich,et al.  Albumin microspheres labeled with Ga-67 by chelation: concise communication. , 1981, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[13]  T Jones,et al.  Glucose utilization in vivo by human pulmonary neoplasms , 1987, Cancer.

[14]  W. Seed,et al.  Interpretation of negative results in fine needle aspiration of discrete pulmonary lesions. , 1986, Thorax.

[15]  R. Wahl,et al.  18F‐2‐deoxy‐2‐fluoro‐D‐glucose uptake into human tumor xenografts. Feasibility studies for cancer imaging with positron‐emission tomography , 1991, Cancer.

[16]  W. Black,et al.  The clinical outcome of needle aspirations of the lung when cancer is not diagnosed. , 1986, The Annals of thoracic surgery.

[17]  S S Sagel,et al.  CT of the pulmonary nodule: a cooperative study. , 1986, Radiology.

[18]  R Iwata,et al.  Differential diagnosis of lung tumor with positron emission tomography: a prospective study. , 1990, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[19]  T. Rice,et al.  Solitary pulmonary nodule. , 1988, Cleveland Clinic journal of medicine.

[20]  A. Deutsch,et al.  Flexible fiberoptic bronchoscopy and percutaneous needle lung aspiration for evaluating the solitary pulmonary nodule. , 1982, Chest.

[21]  K. Sugimachi,et al.  Strategy for lymphadenectomy in lung cancer three centimeters or less in diameter. , 1990, The Annals of thoracic surgery.

[22]  S. Swensen,et al.  An integrated approach to evaluation of the solitary pulmonary nodule. , 1990, Mayo Clinic proceedings.

[23]  J. Sunderland,et al.  Solitary pulmonary nodules: detection of malignancy with PET with 2-[F-18]-fluoro-2-deoxy-D-glucose. , 1992, Radiology.

[24]  E. Fishman,et al.  Solitary pulmonary nodules: CT assessment. , 1986, Radiology.

[25]  J. R. Muhm,et al.  Solitary pulmonary nodules: evaluation with a CT reference phantom. , 1989, Radiology.

[26]  Lillington Ga.  Pulmonary nodules: solitary and multiple. , 1982, Clinics in chest medicine.

[27]  S. Cummings,et al.  Estimating the probability of malignancy in solitary pulmonary nodules. A Bayesian approach. , 1986, The American review of respiratory disease.

[28]  M Hatanaka,et al.  Transport of sugars in tumor cell membranes. , 1974, Biochimica et biophysica acta.

[29]  M. Levine,et al.  Transthoracic needle aspiration biopsy following negative fiberoptic bronchoscopy in solitary pulmonary nodules. , 1988, Chest.

[30]  W F Taylor,et al.  Survival of patients surgically treated for stage I lung cancer. , 1981, The Journal of thoracic and cardiovascular surgery.