ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
The role of FDG-PET in the evaluation of solitary pulmonary nodules
Yavuz Narin1, Muammer Urhan1, Ayşe Mavi2, Z Farrokh Dehdashti3, Barry A. Siegel3
1Division of Nuclear Medicine, GATA Haydarpaşa Training Hospital, İstanbul
2Department of Radiology, Division of Nuclear Medicine, Medicine Faculty of Yeditepe University, Istanbul
3Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
Background: We investigated the clinical role of fluorine- 18-deoxyglucose positron emission tomography (FDGPET) in the initial management of patients with an indeterminate solitary pulmonary nodule (SPN).

Methods: A total of 158 patients (83 males, 75 females; mean age 64 years; range 32 to 91 years) underwent FDG-PET to reveal the metabolic activity of an SPN, <3 cm in size, incidentally detected on a chest X-ray or computed tomography. The findings were correlated with those of (i) histology after lobectomy in 43 patients (27.2%) and transthoracic or open biopsy in 97 patients (61.4%), (ii) bronchial washing in two patients (1.3%), or (iii) clinical follow-up for a period of time not less than six months in 16 patients (10.1%).

Results: Malignancy was documented in 119 nodules (75.3%), being primary lung cancer in 115, and metastatic lesions in four patients. FDG-PET revealed malignant disease successfully in 115 patients. PET scanning was false positive in four patients whose definitive diagnoses were histoplasmosis, granuloma, tuberculosis, and histiocytosis with organizing pneumonia, respectively. FDG-PET was also concluded to be false positive in two patients because no malignancy was noted histologically after performing transthoracic needleaspiration biopsy. FDG-PET yielded a true negative result in 33 patients. It was false negative in four patients with bronchoalveolar carcinoma (n=2) and adenocarcinoma (n=2). The sensitivity, specificity, negative-positive predictive value, and accuracy of FDG-PET were 96.6%, 84.6%, 89.2%-95.0% and 93.7%, respectively.

Conclusion: In the evaluation of an indeterminate SPN, FDG-PET can be used as a noninvasive diagnostic alternative with no risk or complications, that may otherwise necessitate more invasive surgical interventions.

Keywords : Diagnosis, differential; fluorodeoxyglucose F18/diagnostic use; lung neoplasms/diagnosis/imaging; tomography, emission- computed.
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