Japanese Journal of Clinical Oncology 31:51-54 (2001)
© 2001 Foundation for Promotion of Cancer Research
Differentiation of Radiographically Indeterminate Solitary Pulmonary Nodules with [18F]Fluoro-2-deoxyglucose Positron Emission Tomography
1Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, 2Department of Nuclear Medicine, Far Eastern Memorial Hospital and Institute of Biomedical Engineering, College of Electrical Engineering, National Taiwan University, Taipei, 3Department of Nuclear Medicine, Show-Chwan Memorial Hospital, Chunghua, 4Department of Radiology, Jen-Ai Hospital, Taichung and 5Department of Nuclear Medicine, National Taiwan University Hospital, Taipei, Taiwan
Background: The purpose of this preliminary study was to evaluate the efficacy of positron emission tomography (PET) with [18F]fluoro-2-deoxyglucose (FDG) for differentiating benign from malignant solitary pulmonary nodules.
Methods: Twenty-six patients (12 females, 14 males, age 27–79 years) with radiographically indeterminate solitary pulmonary nodules underwent FDG-PET and the findings were compared with the results of pathological examination of biopsy samples. FDG activity in the lesion was expressed as the ratio of lesion-to-background counts (L/B ratio) for semiquantitative analysis.
Results: The mean L/B ratio of malignant lesions (8.81 3.71, n = 20) was not significantly higher than that of benign lesions (4.71 3.00, n = 6) (p = 1.00). Using a cut-off L/B ratio of 5.0 for malignancy, FDG-PET correctly detected 19 true positive and three true negative cases, but failed to detect three false positive (two abscesses and one cryptococcus) cases and one false negative (adenocarcinoma) case. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 95, 50, 86, 75 and 85%, respectively.
Conclusions: FDG-PET is a sensitive modality for detecting malignancy, but is not specific enough. Benign lung lesion with active inflammation could demonstrate high FDG uptake, making it difficult to differentiate from malignancy. In the future, we will increase the case numbers to evaluate further the utility of FDG-PET for differentiating radiographically indeterminate solitary pulmonary nodules.
+ For reprints and all correspondence: Chia-Hung Kao, Department of Nuclear Medicine, Taichung Veterans General Hospital, 160 Taichung Harbor Road, Section 3, Taichung 407, Taiwan. E-mail: kaoch@vghtc.vghtc.gov.tw
Abbreviations: PET, positron emission tomography; FDG, [18F]fluoro-2-deoxyglucose; L/B, lesion-to-background counts; CT, computed tomography; MRI, magnetic resonance imaging
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