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Journal of Clinical Oncology, Vol 16, 1075-1084, Copyright © 1998 by American Society of Clinical Oncology

ARTICLES

Prospective investigation of positron emission tomography in lung nodules

VJ Lowe, JW Fletcher, L Gobar, M Lawson, P Kirchner, P Valk, J Karis, K Hubner, D Delbeke, EV Heiberg, EF Patz and RE Coleman
Department of Nuclear Medicine, St Louis University Health Sciences Center, MO 63110-0250, USA. lowe@nucmed.slu.edu

PURPOSE: Solitary pulmonary nodules (SPNs) are commonly identified by chest radiographs and computed tomography (CT). Biopsies are often performed to evaluate the nodules further. An accurate, noninvasive diagnostic test could avoid the morbidity and costs of invasive tissue sampling. We evaluated the ability of fluorine-18 deoxyglucose positron emission tomography (FDG-PET) to discriminate between benign and malignant pulmonary nodules in a prospective, multicenter trial. METHODS: Eighty-nine patients who had newly identified indeterminate SPNs on chest radiographs and CT were evaluated with FDG-PET. PET data were analyzed semiquantitatively by calculating standardized uptake values (SUVs) as an index of FDG accumulation and also by a visual scoring method. PET results were compared with pathology results. RESULTS: Sixty SPNs were malignant and 29 were benign. Using SUV data, PET had an overall sensitivity and specificity for detection of malignant nodules of 92% and 90%. Visual analysis provided a slightly higher, but not statistically significant, sensitivity of 98% and lower specificity of 69%. For SPNs < or = 1.5 cm (34 of 89), the sensitivity and specificity of SUV and visual analysis were 80% and 95% and 100% and 74%, respectively. CONCLUSION: FDG-PET can accurately characterize indeterminate SPNs. PET imaging provides a noninvasive method to evaluate indeterminate SPNs, which can reduce the need for invasive tissue biopsy.
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A. Imdahl, S. Jenkner, I. Brink, E. Nitzsche, E. Stoelben, E. Moser, and J. Hasse
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S. S. Gambhir, J. Czernin, J. Schwimmer, D. H. S. Silverman, R. E. Coleman, and M. E. Phelps
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J.F. Vansteenkiste and S.G. Stroobants
The role of positron emission tomography with 18F-fluoro-2-deoxy-D-glucose in respiratory oncology
Eur. Respir. J., April 1, 2001; 17(4): 802 - 820.
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H.-P. Hauber, K. H. Bohuslavizki, C. H. Lund, A. Fritscher-Ravens, A. Meyer, and A. Pforte
Positron Emission Tomography in the Staging of Small-Cell Lung Cancer : A Preliminary Study
Chest, March 1, 2001; 119(3): 950 - 954.
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M. K. Gould, C. C. Maclean, W. G. Kuschner, C. E. Rydzak, and D. K. Owens
Accuracy of Positron Emission Tomography for Diagnosis of Pulmonary Nodules and Mass Lesions: A Meta-analysis
JAMA, February 21, 2001; 285(7): 914 - 924.
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V. Kalff, R. J. Hicks, M. P. MacManus, D. S. Binns, A. F. McKenzie, R. E. Ware, A. Hogg, and D. L. Ball
Clinical Impact of 18F Fluorodeoxyglucose Positron Emission Tomography in Patients With Non-Small-Cell Lung Cancer: A Prospective Study
J. Clin. Oncol., January 1, 2001; 19(1): 111 - 118.
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V. Bousson, J.-L. Moretti, P. Weinmann, N. Safi, F. Tamgac, C. Groiselle, V. de Beco, Y. Hillali, D. Valeyre, and J.-L. Breau
Assessment of Malignancy in Pulmonary Lesions: FDG Dual-Head Coincidence Gamma Camera Imaging in Association with Serum Tumor Marker Measurement
J. Nucl. Med., November 1, 2000; 41(11): 1801 - 1807.
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E. F. Patz Jr
1999 Plenary Session: Friday Imaging Symposium : Evaluation of Focal Pulmonary Abnormalities with FDG PET
RadioGraphics, July 1, 2000; 20(4): 1182 - 1185.
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J. Blum, H. Handmaker, J. Lister-James, and N. Rinne
A Multicenter Trial With a Somatostatin Analog 99mTc Depreotide in the Evaluation of Solitary Pulmonary Nodules
Chest, May 1, 2000; 117(5): 1232 - 1238.
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S. J. Swensen, R. W. Viggiano, D. E. Midthun, N. L. Muller, A. Sherrick, K. Yamashita, D. P. Naidich, E. F. Patz, T. E. Hartman, J. R. Muhm, et al.
Lung Nodule Enhancement at CT: Multicenter Study1
Radiology, January 1, 2000; 214(1): 73 - 80.
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J. J. Erasmus, H. P. McAdams, and J. E. Connolly
Solitary Pulmonary Nodules: Part II. Evaluation of the Indeterminate Nodule
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K. N. Ganjoo, R. J. Chan, M. Sharma, and L. H. Einhorn
Positron Emission Tomography Scans in the Evaluation of Postchemotherapy Residual Masses in Patients With Seminoma
J. Clin. Oncol., November 1, 1999; 17(11): 3457 - 3460.
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Y. Sugawara, K. R. Zasadny, A. W. Neuhoff, and R. L. Wahl
Reevaluation of the Standardized Uptake Value for FDG: Variations with Body Weight and Methods for Correction
Radiology, November 1, 1999; 213(2): 521 - 525.
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E. M. Marom, H. P. McAdams, J. J. Erasmus, P. C. Goodman, D. K. Culhane, R. E. Coleman, J. E. Herndon, and E. F. Patz Jr
Staging Non-Small Cell Lung Cancer with Whole-Body PET
Radiology, September 1, 1999; 212(3): 803 - 809.
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R. E. Coleman, C. M. Laymon, and T. G. Turkington
FDG Imaging of Lung Nodules: A Phantom Study Comparing SPECT, Camera-based PET, and Dedicated PET
Radiology, March 1, 1999; 210(3): 823 - 828.
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J. E. Blum, H. Handmaker, and N. A. Rinne
The Utility of a Somatostatin-Type Receptor Binding Peptide Radiopharmaceutical (P829) in the Evaluation of Solitary Pulmonary Nodules
Chest, January 1, 1999; 115(1): 224 - 232.
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P. D. Shreve, Y. Anzai, and R. L. Wahl
Pitfalls in Oncologic Diagnosis with FDG PET Imaging: Physiologic and Benign Variants
RadioGraphics, January 1, 1999; 19(1): 61 - 77.
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V. J Lowe and K. S Naunheim
Current role of positron emission tomography in thoracic oncology
Thorax, August 1, 1998; 53(8): 703 - 712.
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V. J. Lowe and K. S. Naunheim
Positron Emission Tomography in Lung Cancer
Ann. Thorac. Surg., June 1, 1998; 65(6): 1821 - 1829.
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