Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial

Marco Spadafora, Leonardo Pace, Laura Evangelista, Luigi Mansi, Francesco Del Prete, Giorgio Saladini, Paolo Miletto, Stefano Fanti, Silvana Del Vecchio, Luca Guerra, Giovanna Pepe, Giuseppina Peluso, Emanuele Nicolai, Giovanni Storto, Marco Ferdeghini, Alessandro Giordano, Mohsen Farsad, Orazio Schillaci, Cesare Gridelli, Alberto Cuocolo

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-FDG PET/CT has proven to be more effective than CT alone. Pre-test risk stratification and clinical presentation of SPN could affect the diagnostic strategy. A relevant issue is whether thoracic segmental (s)-PET/CT could be implemented in patients with SPN. This retrospective multicenter study compared the results of FDG whole-body (wb)-PET/CT to those of s-PET/CT. Methods: 18F-FDG PET/CT of 502 patients, stratified for pre-test cancer risk, were retrospectively analyzed. The thoracic part of wb-PET/CT, considered s-PET/CT, was compared to wb-PET/CT. Clinical and PET/CT variables were investigated for SPN characterization as well as for identification of patients in whom s-PET/CT could be performed. Histopathology or follow-up data were used as a reference. Results: In the study population, 36% had malignant, 35% benign, and 29% indeterminate SPN. 18F-FDG uptake indicative of thoracic and extra-thoracic lesions was detectable in 13% and 3% of the patients. All patients with extra-thoracic metastases (n = 13) had thoracic lymph node involvement and highest 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-FDG dose, radiation exposure or scan-time, without affecting the clinical impact of PET/CT. Conclusion: Pre-test probability of malignancy can guide the diagnostic strategy of 18FDG-PET/CT in patients with SPN. In subjects with low-intermediate pretest probability s-PET/CT imaging might be planned in advance, while in those at high risk and with thoracic lymph node involvement a wb-PET/CT is necessary.
Original languageEnglish
Pages (from-to)1908-1914
Number of pages7
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume45
Issue number11
DOIs
Publication statusPublished - Oct 1 2018

Keywords

  • F-fluorodeoxyglucose
  • Extra-thoracic lesions
  • Pulmonary nodule
  • Segmental-PET/CT

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