Standardized uptake value and radiological density attenuation as predictive and prognostic factors in patients with solitary pulmonary nodules: Our experience on 1,592 patients

D. Divisi, M. Barone, L. Bertolaccini, G. Rocco, P. Solli, R. Crisci, L. Ampollini, M. Alloisio, C. Andreetti, D. Amore, G. Baietto, A. Bandiera, C. Benato, D. Benetti, M. Benvenuti, A. Bertani, L. Bortolotti, E. Bottoni, P. Camplese, P. CarbognaniG. Cardillo, F. Carleo, C. Casadio, G. Cavallesco, C. Curcio, A. Denegri, G. Di Rienzo, G. Dolci, A. Droghetti, R. Gasparri, M. Ghisalberti, A. Gonfiotti, F. Guerrera, A. Imperatori, M. Infante, P. Lausi, F. Londero, C. Lopez, L. Luzzi, P. Maineri, P. Maniscalco, G. Marulli, M. Monteverde, A. Morelli, F. Mucilli, P. Natali, G. Negri, S. Nicotra, M. Nosotti, R. Perkmann, C. Poggi, F. Puma, M. Refai, A. Rinaldo, G. Rizzardi, L. Rosso, N. Rotolo, E. Russo, A. Sabatini, L. Spaggiari, A. Stefani, F. Stella, A. Terzi, M. Torre, D. Vinci, A. Viti, L. Voltolini, F. Zaraca

Research output: Contribution to journalArticlepeer-review


Background: Multislice computed tomography (MSCT) increased detection of solitary pulmonary nodules (SPNs), changing the management based on radiological and clinical factors. When 18-fluorine fluorodeoxyglucose positron emission tomography combined with computed tomography (18F-FDG-PET/CT) was considered for the evaluation of nodules, the maximum standardized uptake value (SUVmax) more than 2.5 is used frequently as a cut offfor malignancy. The purpose of this study is to evaluate SUVmax PET/CT and pulmonary attenuation patterns at MSCT in patients with SPN according to morphological and pathological characteristics of the lesion. Methods: A retrospective study on 1,592 SPN patients was carried out following approval by the Italian Registry of VATS Lobectomies. Results: All patients underwent VATS lobectomy. On histologic examination, 98.1% had primary or second metachronous primary lung cancers. In addition, 10.7% presented occult lymph node metastases (pN1 or pN2) on histological examination. Nodule attenuation on CT was associated with the histology of the lesion (p= 0.030); in particular, pure ground glass opacities (pGGOs) and partially solid nodules were related to adenocarcinomatous histotypes. Conversely, a significant relationship between SUVmax and age, nodule size, pathological node status (pN) was found (P=0.007, P=0.000 and P=0.002 respectively). Conclusions: Nodule attenuation can predict the histology of the lesion whereas SUVmax may relate to the propensity to lymph node metastases. © Journal of Thoracic Disease.
Original languageEnglish
Pages (from-to)2551-2559
Number of pages9
JournalJournal of Thoracic Disease
Issue number8
Publication statusPublished - 2017


  • fluorodeoxyglucose f 18, adult
  • aged
  • Article
  • cancer prognosis
  • female
  • ground glass opacity
  • histology
  • human
  • lobectomy
  • lung cancer
  • lung nodule
  • lymph node metastasis
  • major clinical study
  • male
  • maximum standardized uptake value
  • multidetector computed tomography
  • oncological parameters
  • positron emission tomography-computed tomography
  • predictive value
  • primary tumor
  • radiological parameters
  • retrospective study
  • tumor volume


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