J Clin Oncol 1998 Mar;16(3):1075-84
Prospective investigation of positron emission tomography in lung
nodules.
Lowe VJ, Fletcher JW, Gobar L, Lawson M, Kirchner P, Valk P, Karis J, Hubner K, Delbeke D,
Heiberg EV, Patz EF, Coleman RE.
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.
PMID: 9508193
