Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial

Laura Evangelista, Alberto Cuocolo, Leonardo Pace, Luigi Mansi, Silvana Del Vecchio, Paolo Miletto, Silvia Sanfilippo, Sara Pellegrino, Luca Guerra, Giovanna Pepe, Giuseppina Peluso, Marco Salvatore, Rosj Galicchio, Michele Zuffante, Salvatore Annunziata, Mohsen Farsad, Agostino Chiaravalloti, Marco Spadafora

Research output: Contribution to journalArticlepeer-review


PURPOSE: The aim of this study was to determine the performance of 18F-FDG-PET/CT in patients with solitary pulmonary nodule (SPN), stratifying the risk according to the likelihood of pulmonary malignancy.

METHODS: FDG-PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. FDG uptake in SPN was assessed by a 4-point scoring system and semiquantitative analysis using the ratio between SUVmax in SPN and SUVmean in mediastinal blood pool (BP) and between SUVmax in SPN and SUVmean in liver (L). Histopathology and/or follow-up data were used as standard of reference.

RESULTS: SPN was malignant in 180 (36%) patients, benign in 175 (35%), and indeterminate in 147 (29%). The 355 patients with a definitive SPN nature (malignant or benign) were considered for the analysis. Considering FDG uptake ≥ 2, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, and accuracy were 85.6%, 85.7%, 86%, 85.2%, and 85.6% respectively. Sensitivity and PPV were higher (P < 0.05) in intermediate and high-risk patients, while specificity and NPV were higher (P < 0.05) in low-risk patients. On receiver operating characteristic curve analysis, the cut-offs for better discrimination between benign and malignant SPN were 1.56 (sensitivity 81% and specificity 87%) and 1.12 (sensitivity 81% and specificity 86%) for SUVmax/SUVmeanBP and SUVmax/SUVmeanL respectively. In intermediate and high-risk patients, including the SUVmax/SUVmeanBP, the specificity shifted from 85% and 50% to 100%.

CONCLUSION: Visual FDG-PET/CT has an acceptable performance in patients with SPN, but accuracy improves when SUVratios are considered, particularly in patients with intermediate and high risk of malignancy.

Original languageEnglish
Pages (from-to)1898-1907
Number of pages10
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Issue number11
Publication statusPublished - Oct 2018


  • Aged
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Italy
  • Male
  • Positron Emission Tomography Computed Tomography
  • Retrospective Studies
  • Solitary Pulmonary Nodule/diagnostic imaging


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