Chest

Chest

Volume 120, Issue 6, December 2001, Pages 1791-1797
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Clinical Investigations
CANCER
Accuracy of F-18 Fluorodeoxyglucose Positron Emission Tomography for the Evaluation of Malignancy in Patients Presenting With New Lung Abnormalities: A Retrospective Review

https://doi.org/10.1378/chest.120.6.1791Get rights and content

Study objective

To evaluate the accuracy of positron emission tomography (PET) in determining the presence of malignancy in patients presenting with new lung findings, either as an incidental finding or after treatment of a primary carcinoma.

Design

A retrospective review of the PET database of our hospital from April 29, 1997, to March 20, 1999, identified 196 patients referred for the evaluation of new lung findings, either as an incidental finding or following definitive treatment of a primary carcinoma. The diagnosis of either malignancy or a benign condition was established in 71 patients. This was determined by either histopathology from biopsy, or by subsequent imaging demonstrating disease progression, resolution, or stability of the initial lung findings.

Results

In patients presenting with new lung findings without a history of carcinoma (n = 37), the sensitivity and specificity of PET was 95% and 82%, respectively. In this population, the negative predictive value was 93% and the positive predictive value was 86%. PET was less sensitive and specific for evaluating metastatic or recurrent disease in patients previously treated for carcinoma. In patients presenting with a previously treated primary lung cancer (n = 13), the sensitivity of PET was 70%, with a specificity of 67%. The negative predictive value was only 40% and the positive predictive value was 88% in this subset of patients. In patients with an extrapulmonary primary carcinoma presenting with new lung nodules (n = 21), the sensitivity and specificity of PET was 92% and 63%, respectively. In this population, the negative predictive value was 83% while the positive predictive value was 80%. Of the 71 total cases for which follow-up data were available, there were 5 false-negative cases and 7 false-positive cases, for an overall sensitivity of 88%, specificity of 75%, negative predictive value of 81%, and positive predictive value of 84%.

Conclusions

The sensitivity of PET is highest for the evaluation of new malignancy in patients without a known primary carcinoma. PET is less sensitive for evaluating metastatic or recurrent disease.

Section snippets

Materials and Methods

We retrospectively reviewed the database of our hospital for all patients referred to our institution from the period of April 1997 through August 1999 for PET evaluation of any new lung abnormalities. Only patients presenting with new lung findings, either nodule or mass, or abnormal parenchymal opacities were evaluated. All patients included in our analysis had nodules ranging in size from 7 to 30 mm (measured on CT using lung algorithm windows). Patients with isolated pleural effusions or

Results

Malignancy or benignancy was established in 71 patients, of whom 46 had pathologic diagnosis of the lesion in question, and 24 had follow-up imaging demonstrating disease progression, regression or stability. One additional patient had histology obtained at autopsy. Overall, 60% of the patients (43 of 71 patients) presented with a single pulmonary lesion. The remaining 40% (28 of 71 patients) presented with multiple bilateral pulmonary nodules (range, 2 to≥ 20).

Overall, of the 71 patients with

Discussion

In our population, the overall sensitivity and specificity of PET scan for the evaluation of lung malignancy for all patient groups was 88% and 75%, respectively. In particular, PET was most accurate in patients without a history of carcinoma, in whom the sensitivity of PET was 95% and the specificity was 82%. This is similar to what is reported in the literature for PET evaluation of solitary pulmonary nodules (sensitivity, 82 to 100%; specificity, 75 to 100%).34567 In our study,

Conclusion

Our study confirms reports in the literature suggesting that PET has a high sensitivity of 95% and negative predictive value of 93% in evaluating new lung nodules in patients without a history of carcinoma.34567 In our study, however, PET is less reliable in assessing pulmonary metastasis (sensitivity, 70 to 92%; specificity, approximately 65%) in patients with a prior carcinoma. PET was least accurate in the evaluation of patients with a primary lung cancer and possible recurrent or metastatic

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Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.