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 journalArticle

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

Fingerprint

Solitary Pulmonary Nodule
Fluorodeoxyglucose F18
Multicenter Studies
Thorax
Lymph Nodes
Human Body
Neoplasms
Retrospective Studies
Public Health
Neoplasm Metastasis

Keywords

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

Cite this

Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule : the ITALIAN multicenter trial. / Spadafora, Marco; Pace, Leonardo; Evangelista, Laura; Mansi, Luigi; Del Prete, Francesco; Saladini, Giorgio; Miletto, Paolo; Fanti, Stefano; Del Vecchio, Silvana; Guerra, Luca; Pepe, Giovanna; Peluso, Giuseppina; Nicolai, Emanuele; Storto, Giovanni; Ferdeghini, Marco; Giordano, Alessandro; Farsad, Mohsen; Schillaci, Orazio; Gridelli, Cesare; Cuocolo, Alberto.

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 45, No. 11, 01.10.2018, p. 1908-1914.

Research output: Contribution to journalArticle

Spadafora, M, Pace, L, Evangelista, L, Mansi, L, Del Prete, F, Saladini, G, Miletto, P, Fanti, S, Del Vecchio, S, Guerra, L, Pepe, G, Peluso, G, Nicolai, E, Storto, G, Ferdeghini, M, Giordano, A, Farsad, M, Schillaci, O, Gridelli, C & Cuocolo, A 2018, 'Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial', European Journal of Nuclear Medicine and Molecular Imaging, vol. 45, no. 11, pp. 1908-1914. https://doi.org/10.1007/s00259-018-4043-y
Spadafora, Marco ; Pace, Leonardo ; Evangelista, Laura ; Mansi, Luigi ; Del Prete, Francesco ; Saladini, Giorgio ; Miletto, Paolo ; Fanti, Stefano ; Del Vecchio, Silvana ; Guerra, Luca ; Pepe, Giovanna ; Peluso, Giuseppina ; Nicolai, Emanuele ; Storto, Giovanni ; Ferdeghini, Marco ; Giordano, Alessandro ; Farsad, Mohsen ; Schillaci, Orazio ; Gridelli, Cesare ; Cuocolo, Alberto. / Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule : the ITALIAN multicenter trial. In: European Journal of Nuclear Medicine and Molecular Imaging. 2018 ; Vol. 45, No. 11. pp. 1908-1914.
@article{674e63d898e6426a9757611c93b954ae,
title = "Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial",
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.",
keywords = "F-fluorodeoxyglucose, Extra-thoracic lesions, Pulmonary nodule, Segmental-PET/CT",
author = "Marco Spadafora and Leonardo Pace and Laura Evangelista and Luigi Mansi and {Del Prete}, Francesco and Giorgio Saladini and Paolo Miletto and Stefano Fanti and {Del Vecchio}, Silvana and Luca Guerra and Giovanna Pepe and Giuseppina Peluso and Emanuele Nicolai and Giovanni Storto and Marco Ferdeghini and Alessandro Giordano and Mohsen Farsad and Orazio Schillaci and Cesare Gridelli and Alberto Cuocolo",
year = "2018",
month = "10",
day = "1",
doi = "10.1007/s00259-018-4043-y",
language = "English",
volume = "45",
pages = "1908--1914",
journal = "European Journal of Nuclear Medicine and Molecular Imaging",
issn = "1619-7070",
publisher = "Springer Verlag",
number = "11",

}

TY - JOUR

T1 - Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule

T2 - the ITALIAN multicenter trial

AU - Spadafora, Marco

AU - Pace, Leonardo

AU - Evangelista, Laura

AU - Mansi, Luigi

AU - Del Prete, Francesco

AU - Saladini, Giorgio

AU - Miletto, Paolo

AU - Fanti, Stefano

AU - Del Vecchio, Silvana

AU - Guerra, Luca

AU - Pepe, Giovanna

AU - Peluso, Giuseppina

AU - Nicolai, Emanuele

AU - Storto, Giovanni

AU - Ferdeghini, Marco

AU - Giordano, Alessandro

AU - Farsad, Mohsen

AU - Schillaci, Orazio

AU - Gridelli, Cesare

AU - Cuocolo, Alberto

PY - 2018/10/1

Y1 - 2018/10/1

N2 - 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.

AB - 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.

KW - F-fluorodeoxyglucose

KW - Extra-thoracic lesions

KW - Pulmonary nodule

KW - Segmental-PET/CT

U2 - 10.1007/s00259-018-4043-y

DO - 10.1007/s00259-018-4043-y

M3 - Article

VL - 45

SP - 1908

EP - 1914

JO - European Journal of Nuclear Medicine and Molecular Imaging

JF - European Journal of Nuclear Medicine and Molecular Imaging

SN - 1619-7070

IS - 11

ER -