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.
