Thorac Cardiovasc Surg 2010; 58(7): 422-426
DOI: 10.1055/s-0030-1249945
Original Thoracic

© Georg Thieme Verlag KG Stuttgart · New York

18-Fluorine Fluorodeoxyglucose Positron Emission Tomography with Computerized Tomography Versus Computerized Tomography Alone for the Management of Solitary Lung Nodules with Diameters Inferior to 1.5 cm

D. Divisi1 , S. Di Tommaso1 , G. Di Leonardo1 , E. Brianzoni2 , A. De Vico1 , R. Crisci1
  • 1Department of Thoracic Surgery, University of L'Aquila, Teramo, Italy
  • 2Nuclear Medicine, Macerata Hospital, Macerata, Italy
Further Information

Publication History

received Dec. 13, 2009

Publication Date:
04 October 2010 (online)

Abstract

Objective: Aim of the study was to establish a noninvasive method for the preoperative characterisation of a pulmonary nodule when biopsy of the small mass is impossible. Methods: From 1 January 2006 to 31 December 2008, we observed 124 asymptomatic patients with a noncalcified single lung nodule highlighted by computerised tomography (CT) of the thorax. Patients were divided into 2 groups: Group A consisted of 57 patients with lesion diameters between 0.5 cm and 0.99 cm; Group B consisted of 67 patients with lesion diameters between 1.0 cm and 1.5 cm. Fibreoptic bronchoscopy was negative for endobronchial neoformation in all patients. The topographic distribution of the lesions advised against CT-guided transthoracic needle biopsy or video-assisted thoracoscopy. All patients had preoperative 18-fluorine fluorodeoxyglucose (18F‐FDG) positron emission tomography (PET) associated with CT of the thorax, which was compared with CT for evaluation of the mass. Results: Postoperative histological diagnosis revealed 54 primary lung cancers, 47 lung metastases and 23 benign lesions. In Group A the sensitivity of 18F‐FDG PET/CT and CT was 95 % and 73 % and the specificity was 72 % and 64 %, respectively (p = 0.000001 for 18F‐FDG PET/CT; p = 0.000177 for CT). In Group B the sensitivity of 18F‐FDG PET/CT and CT was 95 % and 97 %, and the specificity was 80 % and 87 %, respectively (p = 0.000001). Conclusions: Our study shows that 18F‐FDG PET/CT improves the identification and characterisation of potentially malignant pulmonary nodules with a diameter < 1 cm. This technique could be a valid alternative to a surgical approach, currently the main method to investigate indeterminate lung nodules.

References

  • 1 Stringfield J T, Markowitz D J, Bentz R R, Welch M H, Weq J G. The effect of tumor size and location on diagnosis by fiberoptic bronchoscopy.  Chest. 1977;  72 474-476
  • 2 Chouaid C, Atassi C, Housset B. Diagnostic des opacités rondes pulmonaires.  Encycl Méd Chir Pneumologie. 1997;  6 6-20
  • 3 Golfieri R, Sbrozzi F, De Santis F, Giampalma E, Cavina M, D'arienzo P, Gavelli G. Clinical role of CT-guided transthoracic needle biopsy in the diagnosis of solitary pulmonary nodules.  Radiol Med. 1998;  95 329-337
  • 4 Sortini D, Feo C V, Carcoforo P, Carrella G, Pozza E, Liboni A, Sortini A. Thoracoscopic localization techniques for patients with solitary pulmonary nodule and history of malignancy.  Ann Thorac Surg. 2005;  79 258-262
  • 5 Pittet O, Christodoulou M, Pezzetta E, Schimdt S, Schnyder P, Ris H B. Video-assisted thoracoscopic resection of a small pulmonary nodule after computed tomography-guided localization with a hook-wire system. Experience in 45 consecutive patients.  World J Surg. 2007;  31 575-578
  • 6 Smith M A, Battafarano R J, Meyers B F, Zoole J B, Cooper J D, Patterson G A. Prevalence of benign disease in patients undergoing resection for suspected lung cancer.  Ann Thorac Surg. 2006;  81 1824-1828
  • 7 Gould M K, Maclean C C, Kuschner W G, Rydzak C E, Owens D K. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis.  JAMA. 2001;  285 914-924
  • 8 Kim S K, Allen-Auerbach M, Goldin J, Fueger B J, Dahlbom M, Brown M, Czernin J, Schiepers C. Accuracy of PET/CT in characterization of solitary pulmonary lesions.  J Nucl Med. 2007;  48 214-220
  • 9 Lowe V J, Fletcher J W, Gobar L, Lawson M, Kirchner P, Valk P, Karis J, Hubner K, Delbeke D, Heiberg E V, Patz E F, Coleman R E. Prospective investigation of positron emission tomography in lung nodules.  J Clin Oncol. 1998;  16 1075-1084
  • 10 Fischer B M, Mortensen J, Langer S W, Loft A, Berthelsen A K, Daugaard G, Lassen U, Hansen H H. PET/CT imaging in response evaluation of patients with small cell lung cancer.  Lung Cancer. 2006;  54 41-49
  • 11 Mountain C F. Revisions in the international system for staging lung cancer.  Chest. 1997;  111 1710-1717
  • 12 Monnier-Cholley L, Arrivé L. Tomodensitométrie du thorax.  Encycl Méd Chir Pneumologie. 2004;  19 6-20
  • 13 Varoli F, Vergani C, Caminiti R, Francese M, Gerosa C, Bongini M, Roviaro G. Management of solitary pulmonary nodule.  Eur J Cardiothorac Surg. 2008;  33 461-465
  • 14 Yoshikawa K, Tsubota N, Kodama K, Ayabe H, Taki T, Mori T. Prospective study of extended segmentectomy for small lung tumors: the final report.  Ann Thorac Surg. 2002;  73 1055-1059
  • 15 Veronesi G, Bellomi M, Veronesi U, Paganelli G, Maisonneuve P, Scanagatta P, Leo F, Pelosi G, Travaini L, Rampinelli C, Trifirò G, Sonzogni A, Spaggiari L. Role of positron emission tomography scanning in the management of lung nodules detected at baseline computed tomography.  Ann Thorac Surg. 2007;  84 959-966
  • 16 Hickeson M, Yun M, Matthies A, Zhuang H, Adam L E, Lacorte L, Alavi A. Use of a corrected standardized uptake value based on the lesion size on CT permits accurate characterization of lung nodules on FDG-PET.  Eur J Nucl Med Mol Imaging. 2002;  29 1639-1647
  • 17 Jeong S Y, Lee K S, Shin K M, Bae Y A, Kim B T, Choe B K, Kim T S, Chung M J. Efficacy of PET/CT in the characterization of solid or partly solid solitary pulmonary nodules.  Lung Cancer. 2008;  61 186-194
  • 18 Herder G J, Golding R P, Hoekstra O S, Comans E F, Teule G J, Postmus P E, Smit E F. The performance of (18)F-fluorodeoxyglucose positron emission tomography in small solitary pulmonary nodules.  Eur J Nucl Med Mol Imaging. 2004;  31 1231-1236
  • 19 Kozower B D, Meyers B F, Reed C E, Jones D R, Decker P A, Putnam Jr J B. Does positron emission tomography prevent nontherapeutic pulmonary resections for clinical stage IA lung cancer?.  Ann Thorac Surg. 2008;  85 1166-1170
  • 20 Yi C A, Lee K S, Kim B T, Choi J Y, Kwon O J, Kim H, Shim Y M, Chung M J. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT.  J Nucl Med. 2006;  47 443-450

Dr. PhD. Duilio Divisi

Department of Thoracic Surgery
University of L'Aquila

Circonvallazione Ragusa 39

64100 Teramo

Italy

Phone: + 39 8 61 42 94 82

Fax: + 39 8 61 42 94 78

Email: duilio.divisi@aslteramo.it

    >