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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

Purpose

Diagnosis of solitary pulmonary nodule (SPN) is an important public health issue and 18F-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

18F-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. 18F-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 18F-FDG uptake at level of SPN (negative predictive value 100%). Compared to wb-PET/CT, s-PET/CT could save about 2/3 of 18F-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 18FDG-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.

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Acknowledgements

We thank Christina A. Drace, Istituto Oncologico Veneto-IRCCS, Padova, Italia, for assistance in writing this manuscript.

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Authors and Affiliations

  1. Struttura Complessa di Medicina Nucleare, Ospedale del Mare, Napoli, Italy

    Marco Spadafora

  2. Struttura Complessa di Medicina Nucleare, Ospedale San Giuseppe Moscati, Avellino, Italy

    Marco Spadafora, Francesco Del Prete & Paolo Miletto

  3. Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”, Università degli Studi di Salerno, Salerno, Italy

    Leonardo Pace

  4. SSD Medicina Nucleare e Imaging Molecolare, Istituto Oncologico Veneto IOV – IRCCS, Padova, Italy

    Laura Evangelista & Giorgio Saladini

  5. Centro Interuniversitario di Ricerca per lo Sviluppo Sostenibile, Napoli-Roma, Italy

    Luigi Mansi

  6. Servizio di Medicina Nucleare, Policlinico S. Orsola Malpighi, Università degli Studi di Bologna, Bologna, Italy

    Stefano Fanti

  7. Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Napoli, Italy

    Silvana Del Vecchio & Alberto Cuocolo

  8. Unità di Medicina Nucleare, Ospedale San Gerardo, Università di Milano Bicocca, Monza, Italy

    Luca Guerra

  9. Unità di Medicina Nucleare, Cancer Center, Humanitas Research Hospital, Rozzano, Milano, Italy

    Giovanna Pepe

  10. Unità di Medicina Nucleare, Dipartimento delle Immagini, Medicina Futura IOS, Acerra, Napoli, Italy

    Giuseppina Peluso

  11. Unità di Medicina Nucleare, Dipartimento delle Immagini, SDN-IRCCS, Napoli, Italy

    Emanuele Nicolai

  12. Unità di Medicina Nucleare, Centro di Riferimento Oncologico della Basilicata-IRCCS, Rionero in Vulture, Potenza, Italy

    Giovanni Storto

  13. Unità di Medicina Nucleare, Dipartimento delle Immagini, Ospedale Universitario Integrato di Verona, Verona, Italy

    Marco Ferdeghini

  14. Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Roma, Italy

    Alessandro Giordano

  15. Dipartimento di Medicina Nucleare, Ospedale di Bolzano, Bolzano, Italy

    Mohsen Farsad

  16. Dipartimento di Biomedicina e Prevenzione, Università Tor Vergata, Roma, Italy

    Orazio Schillaci

  17. Servizio di Medicina Nucleare, IRCCS-Neuromed, Pozzilli, Isernia, Italy

    Orazio Schillaci

  18. Divisione di Oncologia Medica, Ospedale San Giuseppe Moscati, Avellino, Italy

    Cesare Gridelli

Authors
  1. Marco Spadafora
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  2. Leonardo Pace
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  3. Laura Evangelista
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  4. Luigi Mansi
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  5. Francesco Del Prete
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  6. Giorgio Saladini
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  7. Paolo Miletto
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  8. Stefano Fanti
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  9. Silvana Del Vecchio
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  10. Luca Guerra
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  11. Giovanna Pepe
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  12. Giuseppina Peluso
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  13. Emanuele Nicolai
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  14. Giovanni Storto
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  15. Marco Ferdeghini
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  16. Alessandro Giordano
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  17. Mohsen Farsad
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  18. Orazio Schillaci
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  19. Cesare Gridelli
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  20. Alberto Cuocolo
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Corresponding author

Correspondence to Marco Spadafora.

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Conflict of interest

None.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Italian Tailored Assessment of Lung Indeterminate Accidental Nodule

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Spadafora, M., Pace, L., Evangelista, L. et al. Risk-related 18F-FDG PET/CT and new diagnostic strategies in patients with solitary pulmonary nodule: the ITALIAN multicenter trial. Eur J Nucl Med Mol Imaging 45, 1908–1914 (2018). https://doi.org/10.1007/s00259-018-4043-y

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  • DOI: https://doi.org/10.1007/s00259-018-4043-y

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