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

• Published in: European journal of nuclear medicine and molecular imaging Vol. 45; no. 11; pp. 1908 - 1914
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.10.2018; Springer Nature B.V
• Subjects: Cancer; Cardiology; Computed tomography; Diagnostic systems; Fluorine isotopes; Imaging; Lesions; Lymph nodes; Lymphatic system; Malignancy; Medical diagnosis; Medicine; Medicine & Public Health; Metastases; Nuclear Medicine; Oncology; Original Article; Orthopedics; Patients; Population studies; Positron emission; Positron emission tomography; Public health; Radiation dosage; Radiation effects; Radiology; Risk analysis; Thorax; Tomography; Segmental-PET/CT; Extra-thoracic lesions; Pulmonary nodule; F-fluorodeoxyglucose
• ISSN: 1619-7070; 1619-7089; 1619-7089
• DOI: 10.1007/s00259-018-4043-y

Purpose Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18 F-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 18 F-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. 18 F-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 18 F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18 F-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 18 FDG-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.