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 journalArticle

Abstract

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
Volume45
Issue number11
DOIs
Publication statusPublished - Oct 1 2018

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Solitary Pulmonary Nodule
Multicenter Studies
Neoplasms
Sensitivity and Specificity
Fluorodeoxyglucose F18
ROC Curve

Keywords

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

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Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial. / Evangelista, Laura; Cuocolo, Alberto; Pace, Leonardo; Mansi, Luigi; Del Vecchio, Silvana; Miletto, Paolo; Sanfilippo, Silvia; Pellegrino, Sara; Guerra, Luca; Pepe, Giovanna; Peluso, Giuseppina; Salvatore, Marco; Galicchio, Rosj; Zuffante, Michele; Annunziata, Salvatore; Farsad, Mohsen; Chiaravalloti, Agostino; Spadafora, Marco.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 45, No. 11, 01.10.2018, p. 1898-1907.

Research output: Contribution to journalArticle

Evangelista, L, Cuocolo, A, Pace, L, Mansi, L, Del Vecchio, S, Miletto, P, Sanfilippo, S, Pellegrino, S, Guerra, L, Pepe, G, Peluso, G, Salvatore, M, Galicchio, R, Zuffante, M, Annunziata, S, Farsad, M, Chiaravalloti, A & Spadafora, M 2018, 'Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 45, no. 11, pp. 1898-1907. https://doi.org/10.1007/s00259-018-4016-1
Evangelista, Laura ; Cuocolo, Alberto ; Pace, Leonardo ; Mansi, Luigi ; Del Vecchio, Silvana ; Miletto, Paolo ; Sanfilippo, Silvia ; Pellegrino, Sara ; Guerra, Luca ; Pepe, Giovanna ; Peluso, Giuseppina ; Salvatore, Marco ; Galicchio, Rosj ; Zuffante, Michele ; Annunziata, Salvatore ; Farsad, Mohsen ; Chiaravalloti, Agostino ; Spadafora, Marco. / Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial. In: European Journal of Nuclear Medicine and Molecular Imaging. 2018 ; Vol. 45, No. 11. pp. 1898-1907.
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abstract = "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.",
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TY - JOUR

T1 - Performance of FDG-PET/CT in solitary pulmonary nodule based on pre-test likelihood of malignancy: results from the ITALIAN retrospective multicenter trial

AU - Evangelista, Laura

AU - Cuocolo, Alberto

AU - Pace, Leonardo

AU - Mansi, Luigi

AU - Del Vecchio, Silvana

AU - Miletto, Paolo

AU - Sanfilippo, Silvia

AU - Pellegrino, Sara

AU - Guerra, Luca

AU - Pepe, Giovanna

AU - Peluso, Giuseppina

AU - Salvatore, Marco

AU - Galicchio, Rosj

AU - Zuffante, Michele

AU - Annunziata, Salvatore

AU - Farsad, Mohsen

AU - Chiaravalloti, Agostino

AU - Spadafora, Marco

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

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

U2 - 10.1007/s00259-018-4016-1

DO - 10.1007/s00259-018-4016-1

M3 - Article

VL - 45

SP - 1898

EP - 1907

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

IS - 11

ER -