Statistical analysis of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography ground-glass nodule findings

Abstract

F-fluorodeoxyglucose positron-emission tomography/computed tomography (F-FDG-PET/CT) is important in lung cancer diagnosis; false negatives are often caused by ground-glass nodules (GGNs). PET/CT utility in GGN diagnosis is unknown. The associations between GGN CT findings (size, properties), the pathological diagnosis and maximum standardized uptake value (SUV) were explored. Sixty-six patients with pathological stage IA1-IIA lung adenocarcinoma underwent surgical resection and PET/CT between January 2010 and December 2014. Clinical characteristics, CT findings, pathological diagnoses and PET/CT findings were retrospectively examined. The age range was 47-86 years (median, 69 years), the female/male ratio was 38:28 and the pathological stage was IA1, IA2, IA3, IB and IIA in 5, 30, 21, 9 and 1, respectively. Total and solid-part lesion diameters ranged from 7.00-41.13 mm (median, 19.43 mm) and 0.00-23.23 mm (median, 4.55 mm), respectively; the solid-part ratio (solid-part diameter/total diameter) was 0-77% (median, 20%). SUV ranged from a value too low for evaluation to 3.9 (median, 1.0). Pathological diagnoses were adenocarcinoma (AIS), minimally invasive adenocarcinoma (MIA), lepidic-predominant adenocarcinoma (LPA) and papillary predominant adenocarcinoma (PPA) in 17, 15, 32 and 2, respectively. Correlation coefficients for each factor and SUV for total and solid-part diameters were 0.513 (p<0.0001) and 0.461 (p<0.0001), respectively. All pure GGNs showed clinically unimportant SUV<2.5, even though some large GGNs were included (maximum, 40.0 mm). A total diameter ≥20 mm was significantly associated with FDG uptake (p<0.0001). SUV were <2.5 when the solid-part diameter was <4.55 mm. The AIS-MIA group showed significantly lower SUV than the LPA-PPA group (p=0.0008). There was no clinically important SUV with diagnostic value for pure or small part-solid GGNs. There were medium correlations for GGN total diameter, solid-part diameter, and SUV. We should note PET/CT's limitations in GGN diagnosis.

Relationship between 18F-FDG PET/CT Semi-Quantitative Parameters and International Association for the Study of Lung Cancer, American Thoracic Society/European Respiratory Society Classification in Lung Adenocarcinomas

“…In this study, we found that PET semi-quantitative parameters can be used as noninvasive imaging surrogates to distinguish between MIA and IA ( Fig. 2 ), which is consistent with several previous studies [ 24 25 26 ]. Notably, PET semi-quantitative parameters have the capability to differentiate AIS from MIA ( p < 0.05), especially for persistent pure GGN lesions.…”

Tumor Atelectasis Gives Rise to a Solid Appearance in Pulmonary Adenocarcinomas on High-Resolution Computed Tomography

“…Other PET-CT results confirm previous investigations. 38 This study reveals a significant association between both the visual analysis of FDG uptake (Table 3) and the visual FDG uptake and the selected pleural invasion on histologic section (p ¼ 0.001). The SUV max values found in the present study cannot be directly compared with those in the study of Tanaka et al, 37 as in our study, the acquisition of the images was started 60 minutes postinjection (in the study of Tanaka et al, 37 this was 90 min).…”

Tissue Fraction Correction and Visual Analysis Increase Diagnostic Sensitivity in Predicting Malignancy of Ground-Glass Nodules on [18F]-FDG PET/CT: A Bi-Centre Retrospective Study

“…In other studies, the false negativity rate of malignant pure GGN has been reported as high as 90-100% [13][14][15][16], which is thought to be because of the high proportion of <1-cm nodules [13,21] or the strict criterion of [ 18 F]-FDG uptake positivity (a SUV max ≥ 2.5 [14] or a higher [ 18 F]-FDG uptake than that of mediastinal blood pool activity [15]). To avoid high false negativity rates due to small size or a high standard of positive criteria, we evaluated only pure >1-cm GGNs and set the positivity criteria to be [ 18 F]-FDG uptake higher than background lung activity in visual analysis.…”

“…Several studies have shown that non-small cell lung cancer (NSCLC) expressed as subsolid nodules has lower [ 18 F]-FDG uptake than other types of NSCLC. In particular, the false-negative rate of a malignant pure GGN has been reported as high as 90-100% [13][14][15][16]. One of the reasons for the low [ 18 F]-FDG uptake of malignant subsolid nodules is that [ 18 F]-FDG is not distributed in the air portion within the nodule, which may underestimate the [ 18 F]-FDG uptake of the solid portion.…”