Accuracy of FDG-PET to Diagnose Lung Cancer in a Region of Endemic Granulomatous Disease

Deppen, Stephen A.; Putnam, Joe B.; Andrade, Gabriela M.; Speroff, Theodore; Nesbitt, Jonathan C.; Lambright, Eric S.; Massion, Pierre P.; Walker, R.; Grogan, Eric L.

doi:10.1016/j.athoracsur.2011.02.052

Cited by 91 publications

(81 citation statements)

References 26 publications

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“…The lower specificity of PET-CT in the study by Deppen et al (sensitivity 89%, specificity 40%) was caused by the fact that many examined patients had pulmonary granulomas, which increased the number of false positive results [5]. Nomori et al showed lower sensitivity of PET-CT (38%) because their study also concerned ground-glass opacity lesions (established on computed tomography), which corresponded to neoplastic foci with little marker uptake [6].…”

Section: Discussionmentioning

confidence: 86%

Accuracy of FDG PET/CT in the Evaluation of Solitary Pulmonary Lesions—Own Experience

Opoka¹,

Kunikowska

Podgajny³

et al. 2014

Advances in Respiratory Medicine

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Introduction: In recent years, positron emission tomography (PET) has been increasingly applied in the diagnosis of neoplastic lung diseases. In contrast to conventional imaging studies, PET-CT enables the visualisation of not only the morphology of the suspicious lesion, but also its metabolism. The aim of the present study was to investigate the role of PET-CT in the initial assessment of patients with indeterminate solitary pulmonary lesions. Material and methods: The study was conducted on a group of 82 patients with indeterminate lung nodule diagnosed at the National Institute of Tuberculosis and Lung Diseases in the period from January 2008 to May 2011. CT and PET-CT were performed in all of the patients. Histological or cytological examination of the biopsy specimens obtained from bronchoscopy, mediastinoscopy and intraoperatively were the reference tests. Results: Malignancy was documented in 40 patients (48.8%). Histopathological analysis of all tumours revealed 12 cases of squamous cell carcinoma, 18 cases of adenocarcinoma and 1 case of carcinoid, whereas in 9 patients the diagnosis of "non-small cell cancer not otherwise specified" was made. All lesions except one were of solid character on chest CT. SUV max values exceeding 2.5 were found in 38 cancer patients (true positives, TP). The mean value of SUV max was 9.1 (1-26.8). Forty-two lesions were documented as benign (51.2%). SUV max values equal to or less than 2.5 were found in 37 patients (true negatives, TN). The mean value of SUV max in this group was 1.9 (0.5-8.6). The diagnostic value of PET-CT SUV max exceeding 2.5 in the prediction of neoplastic origin of solitary pulmonary lesions was: sensitivity -95% (95% CI 84-99%), specificity -88% (95% CI 75-95%) and accuracy -91.5% (95% CI 83-96%). Positive predictive value (PPV) was 88.4% (95% CI 76-95%), and negative predictive value (NPV) was 94.8% (95% CI 83-99%). False negative results concerned two patients, with final diagnosis of carcinoid and adenocarcinoma; false positive results were obtained in 5 patients with various inflammatory lesions. Conclusions: In the present study, PET-CT appeared to have high sensitivity (95%), but lower specificity (88%) for predicting the malignant character of solitary pulmonary lesions. Overall diagnostic value of PET-CT SUV max > 2.5 was high -PPV was 88.4%, NPV was 94.8%. In the authors' opinion, the PET-CT value may increase when clinical data as well as other radiological documentation (with retrospective assessment) are taken into consideration.Key words: solitary pulmonary nodule, lung cancer, PET-CT, fluorodeoxyglucose Pneumonol. Alergol. Pol. 2014; 82: 198-205 Streszczenie Wstęp: W ostatnich latach w diagnostyce raka płuca coraz szersze zastosowanie znajduje pozytonowa tomografia emisyjna (PET). W odróżnieniu od klasycznych metod obrazowania PET-CT daje możliwość uwidocznienia nie tylko morfologii, ale także metabolizmu podejrzanego ogniska. Celem pracy była ocena przydatności metody PET-CT w ocenie charakteru zmiany ogniskowej w płucu. Mate...

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Section: Discussionmentioning

confidence: 86%

Accuracy of FDG PET/CT in the Evaluation of Solitary Pulmonary Lesions—Own Experience

Opoka¹,

Kunikowska

Podgajny³

et al. 2014

Advances in Respiratory Medicine

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“…2). 18 F-FDG is the most routinely used radiolabeled compound for PET imaging [25,26]. Cells experiencing high glycolytic activities phosphorylate FDG.…”

Section: Imaging and Lung Cancermentioning

confidence: 99%

Image-guided drug delivery in lung cancer

Wiedmann

Sadhukha

Hammer

et al. 2012

Drug Deliv. and Transl. Res.

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Lung cancer continues to be the number one cause of cancer-related deaths in the USA. Early identification of the disease, availability of more effective drugs, and improved delivery of such drugs specifically to cancer cells are needed to decrease lung cancer-associated morbidity and mortality. The concept of image-guided drug delivery (IGDD), which envisions the utilization of imaging techniques for quantitative assessments of tumor-targeted drug delivery and therapeutic response, has the potential to make a significant impact in lung cancer. While the anatomic and physiological features of the lung pose distinct problems for imaging drug delivery, several new techniques are emerging that have the potential to overcome these problems. X-ray is a routinely used technique for diagnosing lung cancer; however, positron emission tomography (PET) and magnetic resonance imaging (MRI) are complementary approaches. PET- and MRI-based techniques (such as functional MRI) offer the possibility of imaging the delivery of specific molecules to cancer tissues in the lung. This paper reviews fundamentals of imaging with an emphasis on MRI and to some extent PET, since it will be argued that these techniques are the most promising for development in IGDD for lung cancer. Finally, key literature contributions will be highlighted, which exemplify the current successes in this area.

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“…In patients with a history of cancer, a rate of up to 90% malignancy in newly detected SPL has been reported [3]. Currently, positron emission tomography (PET) [4] is the most specific radio-diagnostic tool, but false-positive results in nonmalignant pulmonary lesions such as inflammatory lesions and granulomatous diseases limit its clinical value [5,6,7]. However, histologic proof of SPL should be standard prior to any treatment.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Computed Tomography-Guided Biopsy and Radiofrequency Ablation of Solitary Pulmonary Malignancy in High-Risk Patients

et al. 2012

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Background: In recent years experience has been accumulated in percutaneous radiofrequency ablation (RFA) of lung malignancies in nonsurgical patients. Objectives: In this study, we retrospectively evaluated a simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions. Methods: CT-guided transthoracic core needle biopsy of solitary pulmonary lesions suspicious for malignancy was performed and histology was proven based on immediate frozen sections. RFA probes were placed into the pulmonary tumors under CT guidance and the ablation was performed subsequently. The procedure-related morbidity was analyzed. Follow-up included a CT scan and pulmonary function parameters. Results: A total of 33 CT-guided biopsies and subsequent RFA within a single procedure were performed. Morbidity of CT-guided biopsy included pulmonary hemorrhage (24%) and a mild pneumothorax (12%) without need for further interventions. The RFA procedure was not aggravated by the previous biopsy. The rate of pneumothorax requiring chest tube following RFA was 21%. Local tumor control was achieved in 77% with a median follow-up of 12 months. The morbidity of the CT-guided biopsy had no statistical impact on the local recurrence rate. Conclusions: The simultaneous diagnostic and therapeutic approach including CT-guided biopsy followed immediately by RFA of solitary malignant pulmonary lesions is a safe procedure. The potential of this combined approach is to avoid unnecessary therapies and to perform adequate therapies based on histology. Taking the local control rate into account, this approach should only be performed in those patients who are unable to undergo or who refuse surgery.

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Accuracy of FDG-PET to Diagnose Lung Cancer in a Region of Endemic Granulomatous Disease

Cited by 91 publications

References 26 publications

Accuracy of FDG PET/CT in the Evaluation of Solitary Pulmonary Lesions—Own Experience

Accuracy of FDG PET/CT in the Evaluation of Solitary Pulmonary Lesions—Own Experience

Image-guided drug delivery in lung cancer

Simultaneous Computed Tomography-Guided Biopsy and Radiofrequency Ablation of Solitary Pulmonary Malignancy in High-Risk Patients

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