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

M. Spadafora, L. Pace, L. Evangelista, L. Mansi, F. Del Prete, G. Saladini, P. Miletto, S. Fanti, S. Del Vecchio, L. Guerra, G. Pepe, G. Peluso, E. Nicolai, G. Storto, M. Ferdeghini, A. Giordano, M. Farsad, O. Schillaci, C. Gridelli, A. 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. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.
Original languageEnglish
Pages (from-to)1908-1914
Number of pages7
JournalEuropean Journal of Nuclear Medicine and Molecular Imaging
Volume45
Issue number11
DOIs
Publication statusPublished - 2018

Fingerprint

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

Keywords

  • 18F-fluorodeoxyglucose
  • Extra-thoracic lesions
  • Pulmonary nodule
  • Segmental-PET/CT
  • fluorodeoxyglucose f 18
  • aged
  • Article
  • cancer risk
  • cancer test
  • clinical assessment
  • clinical effectiveness
  • cohort analysis
  • comparative study
  • controlled study
  • diagnostic test
  • distant metastasis
  • female
  • follow up
  • histopathology
  • human
  • intermethod comparison
  • lung metastasis
  • lung nodule
  • lymph node metastasis
  • major clinical study
  • male
  • multicenter study
  • outcome assessment
  • population
  • positron emission tomography-computed tomography
  • predictive value
  • radiation exposure
  • risk assessment
  • risk factor
  • thorax injury
  • whole body imaging
  • clinical trial
  • diagnostic imaging
  • Italy
  • risk
  • Aged
  • Female
  • Fluorodeoxyglucose F18
  • Humans
  • Male
  • Positron Emission Tomography Computed Tomography
  • Risk
  • Solitary Pulmonary Nodule

Cite this

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

In: European Journal of Nuclear Medicine and Molecular Imaging, Vol. 45, No. 11, 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, 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. / 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.
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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. {\circledC} 2018, Springer-Verlag GmbH Germany, part of Springer Nature.",
keywords = "18F-fluorodeoxyglucose, Extra-thoracic lesions, Pulmonary nodule, Segmental-PET/CT, fluorodeoxyglucose f 18, aged, Article, cancer risk, cancer test, clinical assessment, clinical effectiveness, cohort analysis, comparative study, controlled study, diagnostic test, distant metastasis, female, follow up, histopathology, human, intermethod comparison, lung metastasis, lung nodule, lymph node metastasis, major clinical study, male, multicenter study, outcome assessment, population, positron emission tomography-computed tomography, predictive value, radiation exposure, risk assessment, risk factor, thorax injury, whole body imaging, clinical trial, diagnostic imaging, Italy, risk, Aged, Female, Fluorodeoxyglucose F18, Humans, Male, Positron Emission Tomography Computed Tomography, Risk, Solitary Pulmonary Nodule",
author = "M. Spadafora and L. Pace and L. Evangelista and L. Mansi and {Del Prete}, F. and G. Saladini and P. Miletto and S. Fanti and {Del Vecchio}, S. and L. Guerra and G. Pepe and G. Peluso and E. Nicolai and G. Storto and M. Ferdeghini and A. Giordano and M. Farsad and O. Schillaci and C. Gridelli and A. Cuocolo",
note = "Export Date: 1 February 2019 CODEN: EJNMA Correspondence Address: Spadafora, M.; Struttura Complessa di Medicina Nucleare, Ospedale del MareItaly; email: spamar@libero.it Chemicals/CAS: fluorodeoxyglucose f 18, 63503-12-8; Fluorodeoxyglucose F18 References: Callister, M.E., Baldwin, D.R., Akram, A.R., Barnard, S., Cane, P., Draffan, J., British Thoracic Society pulmonary nodule guideline development group; British Thoracic Society standards of care committee (2015) British Thoracic Society Guidelines for the Investigation and Management of Pulmonary Nodules, 70, pp. iiii1-ii54. , Thorax; Goldstraw, P., Crowley, J.J., The International Association for the Study of Lung Cancer international staging project on lung cancer (2006) J Thorac Oncol, 1, pp. 281-286; Sim, Y.T., Poon, F.W., Imaging of solitary pulmonary nodule-a clinical review (2013) Quant Imaging Med Surg, 3, pp. 316-326. , PID: 24404446; Huang, B., Law, M.W.M., Khong, P.L., Whole-body PET/CT scanning: estimation of radiation dose and cancer risk (2009) Radiology, 251, pp. 166-174. , PID: 19251940; Brix, G., Lechel, U., Glatting, G., Ziegler, S.I., M{\"u}nzing, W., M{\"u}ller, S.P., Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations (2005) J Nucl Med, 46, pp. 608-613; Yi, C.A., Lee, K.S., Kim, B.T., Choi, J.Y., Kwon, O.J., Kim, H., Tissue characterization of solitary pulmonary nodule: Comparative study between helical dynamic CT and integrated PET/CT (2006) J Nucl Med, 47, pp. 443-450; Al-Ameri, A., Malhotra, P., Thygesen, H., Plant, P.K., Vaidyanathan, S., Karthik, S., Risk of malignancy in pulmonary nodules: a validation study of four prediction models (2015) Lung Cancer, 89, pp. 27-30; Gould, M.K., Donington, J., Lynch, W.R., Mazzone, P.J., Midthun, D.E., Naidich, D.P., Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer (2013) American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 143, pp. ee93S-e120S. , 3rd ed, Chest; MacMahon, H., Austin, J.H., Gamsu, G., Herold, C.J., Jett, J.R., Naidich, D.P., Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner society (2005) Radiology, 237, pp. 395-400; Aberle, D.R., Adams, A.M., Berg, C.D., Black, W.C., Clapp, J.D., Reduced lung-cancer mortality with low-dose computed tomographic screening (2011) N Engl J Med, 365, pp. 395-409; Tasdemir, B., Urakci, Z., Dostbil, Z., Unal, K., Simsek, F.S., Teke, F., Effectiveness of the addition of the brain region to the FDG-PET/CT imaging area in patients with suspected or diagnosed lung cancer (2016) Radiol Med, 121, pp. 218-224; Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N.J., Amir, E., Delivering affordable cancer care in high-income countries (2011) Lancet Oncol, 12, pp. 933-980; Einstein, A.J., Effects of radiation exposure from cardiac imaging. How good are the data? (2012) J Am Coll Cardiol, 59, pp. 553-565. , PID: 22300689; (2017) Strategic Plan for 2016–2020, , http://www.icrp.org/docs/ICRP{\%}20Strategic{\%}20Plan{\%}202016-2020.pdf, Accessed March 1; Boellaard, R., Delgado-Bolton, R., Oyen, W.J.G., Giammarile, F., Tatsch, K., Eschner, W., FDG PET/CT: EANM procedure guidelines for tumor imaging: version 2.0 (2015) Eur J Nucl Med Mol Imaging, 42, pp. 328-354; Delbeke, D., Coleman, R.E., Guiberteau, M.J., Brown, M.L., Royal, H.D., Siegel, B.A., Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0 (2006) J Nucl Med, 47, pp. 885-895; Spadafora, M., Pace, L., Mansi, L., Segmental 18F-FDG-PET/CT in a single pulmonary nodule: a better cost/effectiveness strategy (2017) Eur J Nucl Med Mol Imaging, 44, pp. 1-4. , PID: 27695909; Spadafora, M., Evangelista, L., Gridelli, C., Cuocolo, A., Alternative imaging strategy of solitary pulmonary nodule by FDG PET/CT: can be imagined a tailored PET? (2017) Eur J Radiol, 90, pp. 188-191. , PID: 28583632; Spadafora, M., Pace, L., Mansi, L., The delicate balance between present and future (2017) Eur J Nucl Med Mol Imaging, 44, pp. 346-347. , PID: 27909768; Hustinx, R., How to scan who: the delicate balance between selecting the patient and selecting the imaging protocol (2017) Eur J Nucl Med Mol Imaging, 44, pp. 5-7. , PID: 27624189; Evangelista, L., Spadafora, M., Pace, L., Mansi, L., Cuocolo, A., Italian tailored assessment of lung indeterminate accidental nodule by proposing a segmental PET/computed tomography (s-PET/CT): Rationale and study design of a retrospective, multicenter trial (2018) Curr Radiopharm, 11 (1), pp. 46-49; McWilliams, A., Tammemagi, M.C., Mayo, J.R., Roberts, H., Liu, G., Soghrati, K., Probability of cancer in pulmonary nodules detected on first screening CT (2013) N Engl J Med, 369, pp. 910-919; The 2007 Recommendations of the International Commission on Radiological Protection (2007) Ann ICRP, 37, pp. 1-332. , ICRP publication 103; Horeweg, N., van Rosmalen, J., Heuvelmans, M.A., van der Aalst, C.M., Vliegenthart, R., Scholten, E.T., Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening (2014) Lancet Oncol, 15, pp. 1332-1341; Kagna, O., Solomonov, A., Keidar, Z., Bar-Shalom, R., Fruchter, O., Yigla, M., The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer (2009) J Nucl Med Mol Imaging, 36, pp. 997-1004; Goldstraw, P., Crowley, J., Chansky, K., Giroux, D.J., Groome, P.A., Rami-Porta, R., International Association for the Study of Lung Cancer International Staging Committee. The IASLC Lung Cancer staging project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours (2007) J Thorac Oncol, 2, pp. 706-714; Iskandrian, A.E., Dilsizian, V., Garcia, E.V., Beanlands, R.S., Cerqueira, M., Soman, P., Myocardial perfusion imaging: lessons learned and work to be done-update (2018) J Nucl Cardiol, 25, pp. 39-52; Siegel, J.A., Pennington, C.W., Sacks, B., Subjecting radiologic imaging to the linear no-threshold hypothesis: a non sequitur of non-trivial proportion (2017) J Nucl Med, 58, pp. 1-6. , PID: 27493264; Iglehart, J.K., Health insurers and medical-imaging policy: a work in progress (2009) N Engl J Med, 360, pp. 1030-1037. , PID: 19264694; Patz, Pinsky, P., Jr., Gatsonis, C., Sicks, J.D., Kramer, B.S., Tammem{\"a}gi, M.C., Over-diagnosis manuscript writing team over-diagnosis in low-dose computed tomography screening for lung cancer (2014) JAMA Intern Med, 174, pp. 269-274",
year = "2018",
doi = "10.1007/s00259-018-4043-y",
language = "English",
volume = "45",
pages = "1908--1914",
journal = "European Journal of Pediatrics",
issn = "0340-6199",
publisher = "Springer Berlin Heidelberg",
number = "11",

}

TY - JOUR

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

AU - Spadafora, M.

AU - Pace, L.

AU - Evangelista, L.

AU - Mansi, L.

AU - Del Prete, F.

AU - Saladini, G.

AU - Miletto, P.

AU - Fanti, S.

AU - Del Vecchio, S.

AU - Guerra, L.

AU - Pepe, G.

AU - Peluso, G.

AU - Nicolai, E.

AU - Storto, G.

AU - Ferdeghini, M.

AU - Giordano, A.

AU - Farsad, M.

AU - Schillaci, O.

AU - Gridelli, C.

AU - Cuocolo, A.

N1 - Export Date: 1 February 2019 CODEN: EJNMA Correspondence Address: Spadafora, M.; Struttura Complessa di Medicina Nucleare, Ospedale del MareItaly; email: spamar@libero.it Chemicals/CAS: fluorodeoxyglucose f 18, 63503-12-8; Fluorodeoxyglucose F18 References: Callister, M.E., Baldwin, D.R., Akram, A.R., Barnard, S., Cane, P., Draffan, J., British Thoracic Society pulmonary nodule guideline development group; British Thoracic Society standards of care committee (2015) British Thoracic Society Guidelines for the Investigation and Management of Pulmonary Nodules, 70, pp. iiii1-ii54. , Thorax; Goldstraw, P., Crowley, J.J., The International Association for the Study of Lung Cancer international staging project on lung cancer (2006) J Thorac Oncol, 1, pp. 281-286; Sim, Y.T., Poon, F.W., Imaging of solitary pulmonary nodule-a clinical review (2013) Quant Imaging Med Surg, 3, pp. 316-326. , PID: 24404446; Huang, B., Law, M.W.M., Khong, P.L., Whole-body PET/CT scanning: estimation of radiation dose and cancer risk (2009) Radiology, 251, pp. 166-174. , PID: 19251940; Brix, G., Lechel, U., Glatting, G., Ziegler, S.I., Münzing, W., Müller, S.P., Radiation exposure of patients undergoing whole-body dual-modality 18F-FDG PET/CT examinations (2005) J Nucl Med, 46, pp. 608-613; Yi, C.A., Lee, K.S., Kim, B.T., Choi, J.Y., Kwon, O.J., Kim, H., Tissue characterization of solitary pulmonary nodule: Comparative study between helical dynamic CT and integrated PET/CT (2006) J Nucl Med, 47, pp. 443-450; Al-Ameri, A., Malhotra, P., Thygesen, H., Plant, P.K., Vaidyanathan, S., Karthik, S., Risk of malignancy in pulmonary nodules: a validation study of four prediction models (2015) Lung Cancer, 89, pp. 27-30; Gould, M.K., Donington, J., Lynch, W.R., Mazzone, P.J., Midthun, D.E., Naidich, D.P., Evaluation of individuals with pulmonary nodules: When is it lung cancer? Diagnosis and management of lung cancer (2013) American College of Chest Physicians Evidence-Based Clinical Practice Guidelines, 143, pp. ee93S-e120S. , 3rd ed, Chest; MacMahon, H., Austin, J.H., Gamsu, G., Herold, C.J., Jett, J.R., Naidich, D.P., Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner society (2005) Radiology, 237, pp. 395-400; Aberle, D.R., Adams, A.M., Berg, C.D., Black, W.C., Clapp, J.D., Reduced lung-cancer mortality with low-dose computed tomographic screening (2011) N Engl J Med, 365, pp. 395-409; Tasdemir, B., Urakci, Z., Dostbil, Z., Unal, K., Simsek, F.S., Teke, F., Effectiveness of the addition of the brain region to the FDG-PET/CT imaging area in patients with suspected or diagnosed lung cancer (2016) Radiol Med, 121, pp. 218-224; Sullivan, R., Peppercorn, J., Sikora, K., Zalcberg, J., Meropol, N.J., Amir, E., Delivering affordable cancer care in high-income countries (2011) Lancet Oncol, 12, pp. 933-980; Einstein, A.J., Effects of radiation exposure from cardiac imaging. How good are the data? (2012) J Am Coll Cardiol, 59, pp. 553-565. , PID: 22300689; (2017) Strategic Plan for 2016–2020, , http://www.icrp.org/docs/ICRP%20Strategic%20Plan%202016-2020.pdf, Accessed March 1; Boellaard, R., Delgado-Bolton, R., Oyen, W.J.G., Giammarile, F., Tatsch, K., Eschner, W., FDG PET/CT: EANM procedure guidelines for tumor imaging: version 2.0 (2015) Eur J Nucl Med Mol Imaging, 42, pp. 328-354; Delbeke, D., Coleman, R.E., Guiberteau, M.J., Brown, M.L., Royal, H.D., Siegel, B.A., Procedure guideline for tumor imaging with 18F-FDG PET/CT 1.0 (2006) J Nucl Med, 47, pp. 885-895; Spadafora, M., Pace, L., Mansi, L., Segmental 18F-FDG-PET/CT in a single pulmonary nodule: a better cost/effectiveness strategy (2017) Eur J Nucl Med Mol Imaging, 44, pp. 1-4. , PID: 27695909; Spadafora, M., Evangelista, L., Gridelli, C., Cuocolo, A., Alternative imaging strategy of solitary pulmonary nodule by FDG PET/CT: can be imagined a tailored PET? (2017) Eur J Radiol, 90, pp. 188-191. , PID: 28583632; Spadafora, M., Pace, L., Mansi, L., The delicate balance between present and future (2017) Eur J Nucl Med Mol Imaging, 44, pp. 346-347. , PID: 27909768; Hustinx, R., How to scan who: the delicate balance between selecting the patient and selecting the imaging protocol (2017) Eur J Nucl Med Mol Imaging, 44, pp. 5-7. , PID: 27624189; Evangelista, L., Spadafora, M., Pace, L., Mansi, L., Cuocolo, A., Italian tailored assessment of lung indeterminate accidental nodule by proposing a segmental PET/computed tomography (s-PET/CT): Rationale and study design of a retrospective, multicenter trial (2018) Curr Radiopharm, 11 (1), pp. 46-49; McWilliams, A., Tammemagi, M.C., Mayo, J.R., Roberts, H., Liu, G., Soghrati, K., Probability of cancer in pulmonary nodules detected on first screening CT (2013) N Engl J Med, 369, pp. 910-919; The 2007 Recommendations of the International Commission on Radiological Protection (2007) Ann ICRP, 37, pp. 1-332. , ICRP publication 103; Horeweg, N., van Rosmalen, J., Heuvelmans, M.A., van der Aalst, C.M., Vliegenthart, R., Scholten, E.T., Lung cancer probability in patients with CT-detected pulmonary nodules: a prespecified analysis of data from the NELSON trial of low-dose CT screening (2014) Lancet Oncol, 15, pp. 1332-1341; Kagna, O., Solomonov, A., Keidar, Z., Bar-Shalom, R., Fruchter, O., Yigla, M., The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer (2009) J Nucl Med Mol Imaging, 36, pp. 997-1004; Goldstraw, P., Crowley, J., Chansky, K., Giroux, D.J., Groome, P.A., Rami-Porta, R., International Association for the Study of Lung Cancer International Staging Committee. The IASLC Lung Cancer staging project: Proposals for the revision of the TNM stage groupings in the forthcoming (seventh) edition of the TNM classification of malignant tumours (2007) J Thorac Oncol, 2, pp. 706-714; Iskandrian, A.E., Dilsizian, V., Garcia, E.V., Beanlands, R.S., Cerqueira, M., Soman, P., Myocardial perfusion imaging: lessons learned and work to be done-update (2018) J Nucl Cardiol, 25, pp. 39-52; Siegel, J.A., Pennington, C.W., Sacks, B., Subjecting radiologic imaging to the linear no-threshold hypothesis: a non sequitur of non-trivial proportion (2017) J Nucl Med, 58, pp. 1-6. , PID: 27493264; Iglehart, J.K., Health insurers and medical-imaging policy: a work in progress (2009) N Engl J Med, 360, pp. 1030-1037. , PID: 19264694; Patz, Pinsky, P., Jr., Gatsonis, C., Sicks, J.D., Kramer, B.S., Tammemägi, M.C., Over-diagnosis manuscript writing team over-diagnosis in low-dose computed tomography screening for lung cancer (2014) JAMA Intern Med, 174, pp. 269-274

PY - 2018

Y1 - 2018

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. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

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. © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

KW - 18F-fluorodeoxyglucose

KW - Extra-thoracic lesions

KW - Pulmonary nodule

KW - Segmental-PET/CT

KW - fluorodeoxyglucose f 18

KW - aged

KW - Article

KW - cancer risk

KW - cancer test

KW - clinical assessment

KW - clinical effectiveness

KW - cohort analysis

KW - comparative study

KW - controlled study

KW - diagnostic test

KW - distant metastasis

KW - female

KW - follow up

KW - histopathology

KW - human

KW - intermethod comparison

KW - lung metastasis

KW - lung nodule

KW - lymph node metastasis

KW - major clinical study

KW - male

KW - multicenter study

KW - outcome assessment

KW - population

KW - positron emission tomography-computed tomography

KW - predictive value

KW - radiation exposure

KW - risk assessment

KW - risk factor

KW - thorax injury

KW - whole body imaging

KW - clinical trial

KW - diagnostic imaging

KW - Italy

KW - risk

KW - Aged

KW - Female

KW - Fluorodeoxyglucose F18

KW - Humans

KW - Male

KW - Positron Emission Tomography Computed Tomography

KW - Risk

KW - Solitary Pulmonary Nodule

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 Pediatrics

JF - European Journal of Pediatrics

SN - 0340-6199

IS - 11

ER -