Assessment of Lung-RADS category 4 Pulmonary Nodules Detected with Thin-section Computed Tomography: Utility of ^sup 18^F-FDG PET/CT

Objectives: In the lung CT Screening Reporting and Data System (Lung-RADS), category 4 findings of solitary pulmonary nodules (SPNs) are suspicious and 18F-FDG PET/CT was recommended to use further evaluation. However, the performance of 18F-FDG PET/CT for differential diagnosis of SPNs with Lung-RA...

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Published inThe Journal of nuclear medicine (1978) Vol. 58; p. 82
Main Authors Liu, Haiping, Hou, Peng, Deng, Huaifu, Chen, Jingwu, Chen, Yeying, Chen, Ping, Pu, Yonglin
Format Journal Article
LanguageEnglish
Published New York Society of Nuclear Medicine 01.05.2017
Subjects
Benign
Computed tomography
Confidence intervals
Diagnosis
Diagnostic systems
Differential diagnosis
Fluorine isotopes
Lung cancer
Lung nodules
Medical diagnosis
Medical imaging
Nodules
Nuclear medicine
Patients
Positron emission
Positron emission tomography
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Summary:Objectives: In the lung CT Screening Reporting and Data System (Lung-RADS), category 4 findings of solitary pulmonary nodules (SPNs) are suspicious and 18F-FDG PET/CT was recommended to use further evaluation. However, the performance of 18F-FDG PET/CT for differential diagnosis of SPNs with Lung-RADS category 4 findings has not been studied. To investigate the utility of 18F-FDG PET/CT according to different types of Lung-RADS category 4 findings from thin-section CT. Methods: This study was approved by the institutional review board. 1406 patients with SPNs undergone 18F-FDG PET/CT scan from January 2006 to June 2015 were included. The Lung-RADS categories of the SPNs were assessed retrospectively and independently by two radiologists (H. L. and P. H.) from thin-section CT images (2.5mm). 1061 patients were rated Lung-RADS category 4. Maximal standardized uptake value (SUVmax) of SPNs was evaluated on the PET/CT. The reference standard was pathology and CT follow-up. To evaluate its differential diagnosis accuracy, receiver operating characteristic (ROC) curve analysis was performed. Results: There were 772 malignant and 289 benign nodules. The optimal cut-off value of the SUVmax for the differential diagnosis of malignant and benign nodules was 1.99 for SPNs. The area under the ROC curve (AUC) of SUVmax of the SPNs was 0.775 (95% confidence interval, 0.749-0.800, P<0.0001). When the cut-off value was set at 1.99, the sensitivity was 86.3%, specificity 53.6%, positive predictive value 83.3%, negative predictive value 59.4% and accuracy 77.4%, respectively. Conclusion: 18F-FDG PET/CT showed fair diagnostic performance for differentiating malignant from benign SPNs with Lung-RADS category 4 findings in our study.
ISSN:0161-5505
1535-5667