Use of PET/CT to aid clinical decision-making in cases of solitary pulmonary nodule: a probabilistic approach

Abstract

Objective: To determine the frequency with which 18F-FDG-PET/CT findings change the probability of malignancy classification of solitary pulmonary nodules. Materials and Methods: This was a retrospective analysis of all 18F-FDG-PET/CT examinations performed for the investigation of a solitary pulmonary nodule between May 2016 and May 2017. We reviewed medical records and PET/CT images to collect the data necessary to calculate the pre-test probability of malignancy using the Swensen model and the Herder model. The probability of malignancy was classified as low if < 5%, intermediate if 5-65%, and high if > 65%. Cases classified as intermediate in the Swensen model were reclassified by the Herder model. Results: We reviewed the records for 33 patients, of whom 17 (51.5%) were male. The mean age was 68.63 ± 12.20 years. According to the Swensen model, the probability of malignancy was intermediate in 23 cases (69.7%). Among those, the application of the Herder model resulted in the probability of malignancy being reclassified as low in 6 (26.1%) and as high in 8 (34.8%). Conclusion: 18F-FDG-PET/CT was able to modify the probability of malignancy classification of a solitary pulmonary nodule in more than 50% of the cases evaluated.

Clinical Analysis of Video-Assisted Thoracoscopic Surgery for Resection of Solitary Pulmonary Nodules and Influencing Factors in the Diagnosis of Benign and Malignant Nodules

“…The clinical symptoms and imaging features of benign and malignant SPN partially overlap, which brings great difficulties to clinicians in the diagnosis and treatment, and there is uncertainty. However, CT imaging features are still an important basis for diagnosis of benign and malignant nodules [ 18 ]. The results of this study show that benign and malignant nodules are significantly different in terms of patient age, nodule diameter, calcification, lobular sign, burr sign, vascular cluster sign, and pleural depression sign.…”

Whole-body magnetic resonance imaging for the diagnosis of metastasis in children and adolescents: a systematic review and meta-analysis

“…Although PET/CT is increasingly being used as the modality of choice for staging neoplasms (19)(20)(21)(22)(23)(24)(25) , exposure to even small doses of ionizing radiation may increase the risk of later radiation-induced malignancies, particularly in children (26,27) . Any PET/CT examination for staging or for the assessment of treatment response should be conducted after a clear evaluation of the risks of radiation exposure relative to the intended benefits.…”

“…All of the studies included children and adolescents with histopathological confirmation of the primary tumor. The mean sample size was 23 (range, [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Of the 118 patients, 45 (66%) were male.…”

PET/CT and the solitary pulmonary nodule

“…In the previous issue of Radiologia Brasileira, Mourato et al (1) reported the results of their research on the impact of 18 F-fluorodeoxyglucose positron emission tomography/computed tomography ( 18 FDG-PET/CT) on the characterization of pulmonary nodules as benign or malignant, comparing the Swensen model (2) with the Herder model (3) . They found that, in their small cohort (n = 33), the Herder model (which includes 18 FDG-PET/CT findings in the formula for predicting the probability of malignancy) changed the initial (Swensen model) classification of the probability of malignancy in over 50% of the cases.…”