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

  • Marco Spadafora
  • Leonardo Pace
  • Laura Evangelista
  • Luigi Mansi
  • Francesco Del Prete
  • Giorgio Saladini
  • Paolo Miletto
  • Stefano Fanti
  • Silvana Del Vecchio
  • Luca Guerra
  • Giovanna Pepe
  • Giuseppina Peluso
  • Emanuele Nicolai
  • Giovanni Storto
  • Marco Ferdeghini
  • Alessandro Giordano
  • Mohsen Farsad
  • Orazio Schillaci
  • Cesare Gridelli
  • Alberto Cuocolo
Original Article
  • 54 Downloads

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.

Keywords

Pulmonary nodule 18F-fluorodeoxyglucose Segmental-PET/CT Extra-thoracic lesions 

Notes

Acknowledgements

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

Compliance with ethical standards

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Marco Spadafora
    • 1
    • 2
  • Leonardo Pace
    • 3
  • Laura Evangelista
    • 4
  • Luigi Mansi
    • 5
  • Francesco Del Prete
    • 2
  • Giorgio Saladini
    • 4
  • Paolo Miletto
    • 2
  • Stefano Fanti
    • 6
  • Silvana Del Vecchio
    • 7
  • Luca Guerra
    • 8
  • Giovanna Pepe
    • 9
  • Giuseppina Peluso
    • 10
  • Emanuele Nicolai
    • 11
  • Giovanni Storto
    • 12
  • Marco Ferdeghini
    • 13
  • Alessandro Giordano
    • 14
  • Mohsen Farsad
    • 15
  • Orazio Schillaci
    • 16
    • 17
  • Cesare Gridelli
    • 18
  • Alberto Cuocolo
    • 7
  1. 1.Struttura Complessa di Medicina NucleareOspedale del MareNapoliItaly
  2. 2.Struttura Complessa di Medicina NucleareOspedale San Giuseppe MoscatiAvellinoItaly
  3. 3.Dipartimento di Medicina, Chirurgia e Odontoiatria “Scuola Medica Salernitana”Università degli Studi di SalernoSalernoItaly
  4. 4.SSD Medicina Nucleare e Imaging MolecolareIstituto Oncologico Veneto IOV – IRCCSPadovaItaly
  5. 5.Centro Interuniversitario di Ricerca per lo Sviluppo SostenibileNapoli-RomaItaly
  6. 6.Servizio di Medicina Nucleare, Policlinico S. Orsola MalpighiUniversità degli Studi di BolognaBolognaItaly
  7. 7.Dipartimento di Scienze Biomediche AvanzateUniversità degli Studi di Napoli Federico IINapoliItaly
  8. 8.Unità di Medicina Nucleare, Ospedale San GerardoUniversità di Milano BicoccaMonzaItaly
  9. 9.Unità di Medicina Nucleare, Cancer CenterHumanitas Research HospitalRozzanoItaly
  10. 10.Unità di Medicina Nucleare, Dipartimento delle ImmaginiMedicina Futura IOSAcerraItaly
  11. 11.Unità di Medicina Nucleare, Dipartimento delle ImmaginiSDN-IRCCSNapoliItaly
  12. 12.Unità di Medicina NucleareCentro di Riferimento Oncologico della Basilicata-IRCCSRionero in VultureItaly
  13. 13.Unità di Medicina Nucleare, Dipartimento delle ImmaginiOspedale Universitario Integrato di VeronaVeronaItaly
  14. 14.Istituto di Medicina NucleareUniversità Cattolica del Sacro CuoreRomaItaly
  15. 15.Dipartimento di Medicina NucleareOspedale di BolzanoBolzanoItaly
  16. 16.Dipartimento di Biomedicina e PrevenzioneUniversità Tor VergataRomaItaly
  17. 17.Servizio di Medicina NucleareIRCCS-NeuromedPozzilliItaly
  18. 18.Divisione di Oncologia MedicaOspedale San Giuseppe MoscatiAvellinoItaly

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