A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules

James Fletcher, Steven M. Kymes, Michael Gould, Naomi Alazraki, R. Edward Coleman, Val J. Lowe, Charles Marn, George Segall, Lyn A. Thet, Kelvin Lee

Research output: Contribution to journalArticle

102 Citations (Scopus)

Abstract

CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. Methods: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent 18F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. Results: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P < 0.0001 for the difference). PET inter- and intraobserver reliability was superior to CT. Conclusion: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.

Original languageEnglish
Pages (from-to)179-185
Number of pages7
JournalJournal of Nuclear Medicine
Volume49
Issue number2
DOIs
StatePublished - Feb 1 2008

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Solitary Pulmonary Nodule
Fluorodeoxyglucose F18
Confidence Intervals
Veterans
Radiography
ROC Curve
Sample Size
Neoplasms
Technology

Keywords

  • CT
  • Diagnosis
  • Oncology
  • PET
  • Respiratory
  • SPN

ASJC Scopus subject areas

  • Radiological and Ultrasound Technology

Cite this

A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. / Fletcher, James; Kymes, Steven M.; Gould, Michael; Alazraki, Naomi; Coleman, R. Edward; Lowe, Val J.; Marn, Charles; Segall, George; Thet, Lyn A.; Lee, Kelvin.

In: Journal of Nuclear Medicine, Vol. 49, No. 2, 01.02.2008, p. 179-185.

Research output: Contribution to journalArticle

Fletcher, J, Kymes, SM, Gould, M, Alazraki, N, Coleman, RE, Lowe, VJ, Marn, C, Segall, G, Thet, LA & Lee, K 2008, 'A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules', Journal of Nuclear Medicine, vol. 49, no. 2, pp. 179-185. https://doi.org/10.2967/jnumed.107.044990
Fletcher, James ; Kymes, Steven M. ; Gould, Michael ; Alazraki, Naomi ; Coleman, R. Edward ; Lowe, Val J. ; Marn, Charles ; Segall, George ; Thet, Lyn A. ; Lee, Kelvin. / A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. In: Journal of Nuclear Medicine. 2008 ; Vol. 49, No. 2. pp. 179-185.
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abstract = "CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. Methods: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent 18F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. Results: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53{\%}. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33{\%} and 9{\%} of patients, respectively) or probably benign (27{\%} and 12{\%}) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1{\%} and 25{\%}), probably malignant (21{\%} and 39{\%}), or definitely malignant (35{\%} and 15{\%}) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95{\%} confidence interval, 0.90-0.95) for PET and 0.82 (95{\%} confidence interval, 0.77-0.86) for CT (P < 0.0001 for the difference). PET inter- and intraobserver reliability was superior to CT. Conclusion: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.",
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AU - Gould, Michael

AU - Alazraki, Naomi

AU - Coleman, R. Edward

AU - Lowe, Val J.

AU - Marn, Charles

AU - Segall, George

AU - Thet, Lyn A.

AU - Lee, Kelvin

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N2 - CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. Methods: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent 18F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. Results: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P < 0.0001 for the difference). PET inter- and intraobserver reliability was superior to CT. Conclusion: Definitely and probably benign results on PET and CT strongly predict benign SPN. However, such results were 3 times more common with PET. Definitely malignant results on PET were much more predictive of malignancy than were these results on CT. A malignant final diagnosis was approximately 10 times more likely than a benign final diagnosis in participants with PET results rated definitely malignant.

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