Solitary pulmonary nodule and 18F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations

Mosmann, Marcos Pretto; Borba, Marcelle Alves; Macedo, Francisco Pires Negromonte de; Liguori, Adriano de Araújo Lima; Neto, Arthur Villarim; Lima, Kênio Costa de

doi:10.1590/0100-3984.2014.0087

Cited by 14 publications

(14 citation statements)

References 30 publications

(33 reference statements)

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“…To this regard, a recent cost-effectiveness analysis by Lopci et al demonstrated that, despite a higher average cost for outpatient's diagnostics, the implementation of 18 F-FDG PET/CT in the workup of undetermined lung nodules results in reduced unnecessary harm and costs related to inpatient's procedures [22]. ese findings are in line with those of previous cost-effectiveness analyses which reported that the additional information gained from 18 F-FDG PET or PET/CT in the characterization of SPNs is worth the cost in the context of proper medical indications [23,24]. erefore, it is expected that 18 F-FDG PET/CT is reported in the list of approved procedures for the investigation of SPNs in several countries [24].…”

Section: Discussionsupporting

confidence: 81%

Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Lococo

Muoio

Chiappetta

et al. 2020

Contrast Media & Molecular Imaging

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Purpose. Several meta-analyses have reported data about the diagnostic performance of positron emission tomography or positron emission tomography/computed tomography (PET or PET/CT) with different radiotracers in patients with suspicious lung cancer (LC) or pleural tumours (PT). This review article aims at providing an overview on the recent evidence-based data in this setting. Methods. A comprehensive literature search of meta-analyses published in PubMed/MEDLINE and Cochrane Library database from January 2010 through March 2020 about the diagnostic performance of PET or PET/CT with different radiotracers in patients with suspicious LC or PT was performed. This combination of keywords was used: (A) “PET” OR “positron emission tomography” AND (B) “lung” OR “pulmonary” OR “pleur∗” AND (C) meta-analysis. Only meta-analyses on PET or PET/CT in patients with suspicious LC or PT were selected. Results. We have summarized the diagnostic performance of PET or PET/CT with fluorine-18 fluorodeoxyglucose (18F-FDG) and other radiotracers taking into account 17 meta-analyses. Evidence-based data demonstrated a good diagnostic performance of 18F-FDG PET or PET/CT for the characterization of solitary pulmonary nodules (SPNs) or pleural lesions with overall higher sensitivity than specificity. Evidence-based data do not support the routine use of dual time point (DTP) 18F-FDG PET/CT or fluorine-18 fluorothymidine (18F-FLT) PET/CT in the differential diagnosis of SPNs. Even if 18F-FDG PET/CT has high sensitivity and specificity as a selective screening modality for LC, its role in this setting remains unknown. Conclusions. Evidence-based data about the diagnostic performance of PET/CT with different radiotracers for suspicious LC or PT are increasing, with good diagnostic performance of 18F-FDG PET/CT. More prospective multicenter studies and cost-effectiveness analyses are warranted.

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Section: Discussionsupporting

confidence: 81%

Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Lococo

Muoio

Chiappetta

et al. 2020

Contrast Media & Molecular Imaging

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“…2 Positron emission tomography/CT is sometimes used to evaluate larger, higher-risk pulmonary nodules. 5 PRACTICE | FIVE THINGS TO KNOW ABOUT ...…”

Section: Chest Ct Is Useful For Following Pulmonary Nodulesmentioning

confidence: 99%

Pulmonary nodules as incidental findings

Simon

Zukotynski

Naeger

2018

CMAJ

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About 30% of all chest computed tomography (CT) scans contain one or more pulmonary nodules. 1 Larger nodules can also be seen on chest radiographs. 2 2 Most pulmonary nodules are benign The most common cause of a pulmonary nodule is a previous infection. Other benign entities include active infection and hamartomas. 2 Malignant disease (both primary and metastatic) is less common, although it is the possibility of malignant disease that drives the need for follow-up. Even in smokers-those at highest risk for lung cancer-nodules are usually benign; in the National Lung Screening Trial, 96% of all nodules (and 93% of nodules ≥ 6 mm) were benign. 3 3 Patient and nodule risk factors are important for determining the next step The recently updated Fleischner Society guideline for management of incidental pulmonary nodules recommends assessing patient risk factors, such as smoking history, exposures and family history, as well as nodule risk factors, such as size, density, multiplicity, morphology and growth. 4

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“…Advances in CT have increased detection of pulmonary nodules, most of which are too small to biopsy or to be characterized by PET/CT and definitive diagnosis is only established by surgery [5,6]. In this clinical context, it is common practice to recommend a 3-month FU CT for a new pulmonary nodule; however there is no agreement on how long the nodule should be monitored if it remains unchanged or if there is small increase in size on FU.…”

Section: Introductionmentioning

confidence: 99%

The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT

Soliman

Petrella

Tyrrell

et al. 2019

European Journal of Radiology Open

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ObjectiveThis study aims to determine an appropriate timeline to monitor indeterminate pulmonary nodules (IPN) in melanoma patients to confirm metastatic origin.Materials and Methods588 clinically non-metastatic melanoma patients underwent curative intent surgery during 3 years. Patients with baseline chest CT and at least one follow-up (FU) CT were retrospectively analyzed to assess for IPN. Patients with definitely benign nodules, metastases and non-melanoma malignancies were excluded. Change in volume from first to FU CT, initial diameter (D1) and volume (V1), distance from pleura, peripheral and perifissural location, density and clinical stage were evaluated. Nodules were volumetrically measured on CTs and were considered metastases if they increased in size between two CTs or if increase was accompanied by multiple new nodules or extrapulmonary metastases.Results148 patients were included. Two out of 243 baseline IPN detected in 70 patients, increased significantly in volume in 3 and 5 months and were proven metastases. During FU, 86% of 40 interval IPN detected in 28 patients, were proven metastases. Interval nodule (p < 0.0001, HR:243,CI:[57.32,1033.74]), 3-month volume change (OR:1.023,CI:[1.014,1.033]), V1 (OR:1.006,CI:[1.003,1.009]), D1 (OR:1.424,CI:[1.23,1.648]), distance from pleura (OR:1.03,CI:[1.003,1.059]), and combined stage IIC + III (OR:11.29,CI:[1.514,84.174]), were associated with increased risk for metastasis. 43%, 72% and 94% of patients with IPN were confirmed with metastases in the first FU CT at 3, 6 and 12 months respectively.ConclusionBaseline IPN are most likely benign, while interval IPN are high risk for metastasis. Absence of volume increase of IPN within 6 months excluded metastasis in most patients.

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Solitary pulmonary nodule and 18F-FDG PET/CT. Part 2: accuracy, cost-effectiveness, and current recommendations

Cited by 14 publications

References 30 publications

Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Diagnostic Performance of PET or PET/CT with Different Radiotracers in Patients with Suspicious Lung Cancer or Pleural Tumours according to Published Meta-Analyses

Pulmonary nodules as incidental findings

The clinical significance of indeterminate pulmonary nodules in melanoma patients at baseline and during follow-up chest CT

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