Diagnostic Accuracy of Contrast-Enhanced Computed Tomography and Positron Emission Tomography With 18-FDG in Identifying Malignant Solitary Pulmonary Nodules

Abstract

Contrast-enhanced computed tomography (CECT) and positron emission tomography with 18-FDG (FDG-PET/CT) are used to identify malignant solitary pulmonary nodules. The aim of the study was to evaluate the accuracy of CECT and FDG-PET/CT in diagnosing the etiology of solitary pulmonary nodule (SPN).Eighty patients with newly diagnosed SPN >8 mm were enrolled. The patients were scheduled for either or both, CECT and FDG-PET/CT. The nature of SPN (malignant or benign) was determined either by its pathological examination or radiological criteria.In 71 patients, the etiology of SPN was established and these patients were included in the final analysis. The median SPN diameter in these patients was 13 mm (range 8–30 mm). Twenty-two nodules (31%) were malignant, whereas 49 nodules were benign.FDG-PET/CT was performed in 40 patients, and CECT in 39 subjects. Diagnostic accuracy of CECT was 0.58 (95% confidence interval [CI] 0.41–0.74). The optimal cutoff level discriminating between malignant and benign SPN was an enhancement value of 19 Hounsfield units, for which the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of CECT were 100%, 37%, 32%, and 100%, respectively. Diagnostic accuracy of FDG-PET/CT reached 0.9 (95% CI 0.76–0.9). The optimal cutoff level for FDG-PET/CT was maximal standardized uptake value (SUV max) 2.1. At this point, the sensitivity, specificity, PPV, and NPV were 77%, 92%, 83%, and 89%, respectively.The diagnostic accuracy of FDG-PET/CT is higher than that of CECT. The advantage of CECT is its high sensitivity and negative predictive value.

Evaluation of the Outcome of Lung Nodules Missed on 18F-FDG PET/MRI Compared with 18F-FDG PET/CT in Patients with Known Malignancies

“…Today, whole-body 18 F-FDG PET/CT is widely available and used not only to identify lung nodules but also to discriminate malignant from benign pulmonary masses, enabling a comprehensive tumor staging in a 1-stop shop examination (21)(22)(23). On the other hand, the latest transition from a mere research modality into clinical practice raised issues regarding the eligibility of 18 F-FDG PET/MRI to detect small pulmonary nodules compared with CT or PET/CT as the modality of choice for lung imaging.…”

A descriptive analysis of lung and pleural tumours in a premier referral centre in Sri Lanka

“…Characteristics of the lesion, involvement of fissures and lobes, ipsilateral and contralateral lung metastasis, involvement of pulmonary artery, vein and mediastinal lymph nodes are considered in radiological staging and assessing the resectability of malignant tumours (18) . A study conducted by Dabrowska et al concluded that CECT had high sensitivity and a negative predictive value in identifying malignant solitary pulmonary nodules (19). In our population, the sensitivity (94.6%) and specificity (90.9%) of CECT chest in diagnosing malignant lung and pleural tumours were high.…”

Risk stratification in the investigation of pulmonary nodules in a high‐risk cohort: positron emission tomography/computed tomography outperforms clinical risk prediction algorithms

“…Additionally, prevalence of malignancy in our patient group, again likely due to the complex nature of our referrals and pre‐selection, is higher than that described in most centres (67% compared to 20–57%) . By the time patients are referred to us, most lesions have strong radiological features of malignancy and/or have had observations showing lesion growth or other worrisome features.…”