Positron emission tomography in the diagnostic work-up of screening-detected lung nodules

Veronesi, Giulia; Travaini, Laura Lavinia; Maisonneuve, Patrick; Rampinelli, Cristiano; Bertolotti, Raffaella; Spaggiari, Lorenzo; Bellomi, Massimo; Paganelli, Giovanni

doi:10.1183/09031936.00066514

Cited by 45 publications

(30 citation statements)

References 30 publications

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“…Sensitivity was only 53% for adenocarcinomas, whereas it was 82-92% for the other cancer types [12]. Squamous cell carcinomas, nonsmall cell lung cancer and small cell lung cancer had the highest uptake values (maximum standardised uptake value), carcinoids had an intermediate uptake and adenocarcinomas had the lowest uptake, although the ranges overlapped, so it is not possible to use FDG uptake as a surrogate for histological typing.…”

Section: Is the Accuracy Of Pet The Same For All Tumour Types?mentioning

confidence: 95%

“…Most lung cancer types have an increased FDG uptake, but the degree varies from no uptake to a very high uptake [11,12]. Sensitivity was only 53% for adenocarcinomas, whereas it was 82-92% for the other cancer types [12].…”

Section: Is the Accuracy Of Pet The Same For All Tumour Types?mentioning

confidence: 99%

“…Since solid tumours generally have a higher cell density than both subsolid and nonsolid tumours, the FDG uptake and reliability of PET is higher in solid than in nonsolid tumours of the same size [11]. VERONESI et al [12] found that the accuracy (and sensitivity) for solid nodules was 76% (51%), 92% (86%) and 88% (98%) for nodules <10 mm, 10-15 mm and ≥15 mm, respectively. The figures were much lower for the partly or nonsolid nodules combined: 53% (17%), 47% (25%) and 70% (64%) for nodules <10 mm, 10-15 mm and ≥15 mm, respectively.…”

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confidence: 99%

“…The figures were much lower for the partly or nonsolid nodules combined: 53% (17%), 47% (25%) and 70% (64%) for nodules <10 mm, 10-15 mm and ≥15 mm, respectively. Hence, the performance of PET is better in solid nodules ≥10 mm and partly-solid nodules >15 mm, while PET cannot be relied upon in nonsolid nodules no matter the size [11,12].…”

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confidence: 99%

“…The article by VERONESI et al [12] is based upon 383 nodules that were examined by PET/CT over the first 6 years of the Italian nonrandomised single-centre Continuous Observation of Smoking Subjects (COSMOS) early detection trial for lung cancer. These nodules were read as indeterminate on low-dose CT. To qualify for PET/CT an indeterminate nodule should be noncalcified solid or partly solid >8 mm without appearing clearly benign, and a follow-up CT scan was performed 1 year later.…”

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confidence: 99%

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Assessing nodules detected in lung cancer screening: the value of positron emission tomography

Mortensen

2015

Eur Respir J

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@ERSpublicationsPET has the highest accuracy in differential diagnosis of upper lobe, solid >10 mm or partlysolid >15 mm nodules http://ow.ly/DKaur Lung cancer is the leading cause of death worldwide. Screening for lung cancer may improve the poor prognosis by detecting the cancer at an early stage where radical surgery still is possible. Several randomised clinical trials using low-dose computed tomography (CT) have been launched in high-risk smokers or former smokers in the USA and Europe [1][2][3]. The National Lung Screening Trial (NLST) randomised 53 454 subjects to undergo annual CT scans or chest radiographies for 3 years, and demonstrated that overall and lung cancer specific mortality was reduced in the CT arm [1]. For one case of death from lung cancer to be prevented, the number of patients that needed to be screened using CT compared with chest radiography was 320 [3]. The final mortality data testing of >32 000 individuals participating in the seven European randomised lung cancer CT screening trials (EUCT), where the control groups had no chest radiography, is expected in 2015 [2].The drawbacks of CT screening programmes also need to be taken into account. Most subjects eligible for screening will never develop lung cancer, but will be exposed to different potential harms such as distress while waiting for the test result, and the distress and complications related to the many false positive tests, which will require subsequent invasive diagnostic procedures in some individuals. In addition, the radiation exposure from low-dose CT in all participants and from additional imaging tests in many participants is a concern [4,5].In the baseline round ( prevalence), a positive nodule was detected in 8-30% of the participants in the CT groups of the randomised screening trials [3]. The false positive prevalence was 86-95% and lung cancer was detected in 0.8-2.2% of the participants. The variation in the results is partly due to differences in the screened populations, the criteria for defining a positive nodule and the follow-up procedures.Different management strategies are applied to discriminate between malignant and benign nodules, so the large number of false positives and number of subsequent workup procedures can be reduced. The second-line procedures most often comprise repeat CT scans after 3 months or at a later time-point to evaluate possible growth and/or change in morphology conspicuous of malignancy [4,6].Functional imaging by 18 F-fluorodeoxyglucose (FDG) positron emission tomography (PET) can also be used to evaluate if there is increased FDG uptake in a nodule indicating malignancy [6,7] as well for staging lung cancer [8]. PET is a quicker method to diagnose an indeterminate nodule as malignant or benign compared with waiting some months for a follow-up CT [7]. Recently, predictive tools based on patient and nodule characteristics have been introduced to estimate the cancer risk in screening studies [9].

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Section: Is the Accuracy Of Pet The Same For All Tumour Types?mentioning

confidence: 95%