Role of Positron Emission Tomography Scanning in the Management of Lung Nodules Detected at Baseline Computed Tomography Screening

Research output: Contribution to journalArticle

66 Citations (Scopus)

Abstract

Background: Indeterminate noncalcified lung nodules are a frequent finding when low-dose computed tomography (LD-CT) is used for lung cancer screening. The best clinical management for such nodules remains uncertain. We present results using positron tomography scanning (CT-PET) to evaluate LD-CT-detected lung nodules during the first year of the Continuing Observation of Smoking Subjects (COSMOS) early detection trial for lung cancer. Methods: A total of 5200 asymptomatic current or former smokers (≥20 pack-years) older than 50 years of age were enrolled in a single-institution screening trial using annual LD-CT. Growing nodules and those with a maximum diameter exceeding 8 mm were studied with CT-PET. Transthoracic needle biopsy was not a routine part of the protocol. Results: During the first year of study, 157 subjects underwent CT-PET, 66 of whom underwent surgical biopsy. Of the 58 lung cancers found on surgical biopsy, 51 were positive (standard uptake value >2.0) and seven were negative for malignancy by CT-PET. Sensitivity was 88% overall, but 100% in the subgroup with solid nodules of 10 mm or more. Among the 8 patients with benign disease at surgical biopsy, CT-PET was positive in 6 and negative in 2. Conclusions: CT-PET is a highly promising modality for identifying potentially malignant lesions in screening-detected lung nodules and appears particularly useful as an alternative, in the screening setting, to invasive procedures for the further investigation of uncertain nodules. Our findings also indicate that the standard uptake value threshold for positivity should be lowered for small nodules (

Original languageEnglish
Pages (from-to)959-966
Number of pages8
JournalAnnals of Thoracic Surgery
Volume84
Issue number3
DOIs
Publication statusPublished - Sep 2007

Fingerprint

Positron-Emission Tomography
Tomography
Lung
Lung Neoplasms
Biopsy
Needle Biopsy
Early Detection of Cancer
Positron Emission Tomography Computed Tomography
Smoking
Observation
Electrons
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

@article{be842c5c7cca411bb0381c56f6a1ec50,
title = "Role of Positron Emission Tomography Scanning in the Management of Lung Nodules Detected at Baseline Computed Tomography Screening",
abstract = "Background: Indeterminate noncalcified lung nodules are a frequent finding when low-dose computed tomography (LD-CT) is used for lung cancer screening. The best clinical management for such nodules remains uncertain. We present results using positron tomography scanning (CT-PET) to evaluate LD-CT-detected lung nodules during the first year of the Continuing Observation of Smoking Subjects (COSMOS) early detection trial for lung cancer. Methods: A total of 5200 asymptomatic current or former smokers (≥20 pack-years) older than 50 years of age were enrolled in a single-institution screening trial using annual LD-CT. Growing nodules and those with a maximum diameter exceeding 8 mm were studied with CT-PET. Transthoracic needle biopsy was not a routine part of the protocol. Results: During the first year of study, 157 subjects underwent CT-PET, 66 of whom underwent surgical biopsy. Of the 58 lung cancers found on surgical biopsy, 51 were positive (standard uptake value >2.0) and seven were negative for malignancy by CT-PET. Sensitivity was 88{\%} overall, but 100{\%} in the subgroup with solid nodules of 10 mm or more. Among the 8 patients with benign disease at surgical biopsy, CT-PET was positive in 6 and negative in 2. Conclusions: CT-PET is a highly promising modality for identifying potentially malignant lesions in screening-detected lung nodules and appears particularly useful as an alternative, in the screening setting, to invasive procedures for the further investigation of uncertain nodules. Our findings also indicate that the standard uptake value threshold for positivity should be lowered for small nodules (",
author = "Giulia Veronesi and Massimo Bellomi and Umberto Veronesi and Giovanni Paganelli and Patrick Maisonneuve and Paolo Scanagatta and Francesco Leo and Giuseppe Pelosi and Laura Travaini and Cristiano Rampinelli and Giuseppe Trifir{\`o} and Angelica Sonzogni and Lorenzo Spaggiari",
year = "2007",
month = "9",
doi = "10.1016/j.athoracsur.2007.04.058",
language = "English",
volume = "84",
pages = "959--966",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "The Society of Thoracic Surgeons. Published by Elsevier Inc",
number = "3",

}

TY - JOUR

T1 - Role of Positron Emission Tomography Scanning in the Management of Lung Nodules Detected at Baseline Computed Tomography Screening

AU - Veronesi, Giulia

AU - Bellomi, Massimo

AU - Veronesi, Umberto

AU - Paganelli, Giovanni

AU - Maisonneuve, Patrick

AU - Scanagatta, Paolo

AU - Leo, Francesco

AU - Pelosi, Giuseppe

AU - Travaini, Laura

AU - Rampinelli, Cristiano

AU - Trifirò, Giuseppe

AU - Sonzogni, Angelica

AU - Spaggiari, Lorenzo

PY - 2007/9

Y1 - 2007/9

N2 - Background: Indeterminate noncalcified lung nodules are a frequent finding when low-dose computed tomography (LD-CT) is used for lung cancer screening. The best clinical management for such nodules remains uncertain. We present results using positron tomography scanning (CT-PET) to evaluate LD-CT-detected lung nodules during the first year of the Continuing Observation of Smoking Subjects (COSMOS) early detection trial for lung cancer. Methods: A total of 5200 asymptomatic current or former smokers (≥20 pack-years) older than 50 years of age were enrolled in a single-institution screening trial using annual LD-CT. Growing nodules and those with a maximum diameter exceeding 8 mm were studied with CT-PET. Transthoracic needle biopsy was not a routine part of the protocol. Results: During the first year of study, 157 subjects underwent CT-PET, 66 of whom underwent surgical biopsy. Of the 58 lung cancers found on surgical biopsy, 51 were positive (standard uptake value >2.0) and seven were negative for malignancy by CT-PET. Sensitivity was 88% overall, but 100% in the subgroup with solid nodules of 10 mm or more. Among the 8 patients with benign disease at surgical biopsy, CT-PET was positive in 6 and negative in 2. Conclusions: CT-PET is a highly promising modality for identifying potentially malignant lesions in screening-detected lung nodules and appears particularly useful as an alternative, in the screening setting, to invasive procedures for the further investigation of uncertain nodules. Our findings also indicate that the standard uptake value threshold for positivity should be lowered for small nodules (

AB - Background: Indeterminate noncalcified lung nodules are a frequent finding when low-dose computed tomography (LD-CT) is used for lung cancer screening. The best clinical management for such nodules remains uncertain. We present results using positron tomography scanning (CT-PET) to evaluate LD-CT-detected lung nodules during the first year of the Continuing Observation of Smoking Subjects (COSMOS) early detection trial for lung cancer. Methods: A total of 5200 asymptomatic current or former smokers (≥20 pack-years) older than 50 years of age were enrolled in a single-institution screening trial using annual LD-CT. Growing nodules and those with a maximum diameter exceeding 8 mm were studied with CT-PET. Transthoracic needle biopsy was not a routine part of the protocol. Results: During the first year of study, 157 subjects underwent CT-PET, 66 of whom underwent surgical biopsy. Of the 58 lung cancers found on surgical biopsy, 51 were positive (standard uptake value >2.0) and seven were negative for malignancy by CT-PET. Sensitivity was 88% overall, but 100% in the subgroup with solid nodules of 10 mm or more. Among the 8 patients with benign disease at surgical biopsy, CT-PET was positive in 6 and negative in 2. Conclusions: CT-PET is a highly promising modality for identifying potentially malignant lesions in screening-detected lung nodules and appears particularly useful as an alternative, in the screening setting, to invasive procedures for the further investigation of uncertain nodules. Our findings also indicate that the standard uptake value threshold for positivity should be lowered for small nodules (

UR - http://www.scopus.com/inward/record.url?scp=34548008355&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=34548008355&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2007.04.058

DO - 10.1016/j.athoracsur.2007.04.058

M3 - Article

VL - 84

SP - 959

EP - 966

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 3

ER -