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Zentralbl Chir 2014; 139(1): 108-113
DOI: 10.1055/s-0033-1360182
Übersicht – Thoraxchirurgie
Georg Thieme Verlag KG Stuttgart · New York

What Is the Clinical Value of PET/CT in the Diagnosis of Pulmonary Nodules?

Hat das PET-CT bei der Diagnostik des Lungenrundherds eine Bedeutung?
C. Lohrmann
Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
,
W. A. Weber
Molecular Imaging and Therapy Service, Memorial Sloan-Kettering Cancer Center, New York, New York, United States
› Author Affiliations
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Publication History

Publication Date:
28 February 2014 (online)

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Abstract

The noninvasive diagnostic workup of solitary pulmonary nodules (SPNs) continues to be a challenge for radiologists and nuclear medicine physicians. Morphological evaluation is useful to differentiate between benign and malignant SPNs, but there is a considerable overlap between the benign and the malignant features, resulting in a large fraction of morphologically indeterminate SPNs. Integrated PET/CT with the glucose analogue 18F-fluorodeoxyglucose (FDG PET/CT) can simultaneously evaluate morphological characteristics, anatomic location and metabolic status of SPNs. FDG PET/CT has been shown to result in an overall improved accuracy for the detection of malignant SPNs. In addition, it is the most accurate technique for the staging of malignant SPNs. On the other hand, there are many causes for false positive or false negative FDG PET/CTs. Therefore, FDG PET/CT cannot replace histological evaluation of SPNs, but can be clinically helpful in specific subgroups of patients with SPNs. The goal of this review is to provide an overview of the literature on PET/CT imaging in SPNs and to describe several clinical scenarios for the use of FDG PET/CT in SPNs.

Zusammenfassung

Die nicht invasive Diagnostik von solitären pulmonalen Rundherden ist noch immer eine Herausforderung für Radiologen und Nuklearmediziner. Anhand von morphologischen Kriterien können manche benigne von malignen Rundherden unterschieden werden. Es verbleibt aber eine große Gruppe von Rundherden, die weder sicher benigne noch sicher maligne Charakteristika aufweisen. Die PET/CT mit dem Glukoseanalogon Fluordeoxyglukose (FDG) ermöglicht es, in einer Untersuchung die Morphologie, anatomische Lokalisation und Stoffwechselaktivität von Rundherden zu beurteilen. Eine große Zahl von klinischen Studien hat gezeigt, dass die FDG-PET/CT die nicht invasive Diagnostik von Lungenrundherden verbessert. Die FDG-PET/CT ist auch das bildgebende Verfahren mit der höchsten diagnostischen Genauigkeit für das Staging von malignen Lungenrundherden. Es sind jedoch auch verschiedene Ursachen für falsch-positive und falsch-negative FDG-PET/CT Befund bekannt. Die FDG-PET/CT kann deshalb die histologische Sicherung von Lungenrundherden nicht ersetzen. In bestimmten Subgruppen von Patienten kann die FDG-PET/CT aber klinisch relevante Informationen liefern. Ziel dieser Arbeit ist es, einen Überblick über die aktuelle Literatur zur FDG-PET/CT beim solitären pulmonalen Rundherd zu geben und verschiedene klinische Szenarien zu beschreiben, in denen die FDG-PET/CT klinisch eingesetzt werden kann.

Key words

FDG - PET/CT - Imaging procedures - pulmonary nodules

Schlüsselwörter

FDG - PET/CT - Bildgebung - Lungenrundherd
 

  • References

  • 1 Ohno Y, Koyama H, Takenaka D et al. Dynamic MRI, dynamic multidetector-row computed tomography (MDCT), and coregistered 2-[fluorine-18]-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET)/CT: comparative study of capability for management of pulmonary nodules. J Magn Reson Imaging 2008; 27: 1284-1295
    CrossrefPubMedGoogle Scholar
  • 2 Hansell DM, Bankier AA, MacMahon H et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008; 246: 697-722
    CrossrefPubMedGoogle Scholar
  • 3 Tan BB, Flaherty KR, Kazerooni EA et al. The solitary pulmonary nodule. Chest 2003; 123 (Suppl. 01) S89-S96
    CrossrefPubMedGoogle Scholar
  • 4 Swensen SJ, Jett JR, Hartman TE et al. Lung cancer screening with CT: Mayo Clinic experience. Radiology 2003; 226: 756-761
    CrossrefPubMedGoogle Scholar
  • 5 Fischbach F, Knollmann F, Griesshaber V et al. Detection of pulmonary nodules by multislice computed tomography: improved detection rate with reduced slice thickness. Eur Radiol 2003; 13: 2378-2383
    CrossrefPubMedGoogle Scholar
  • 6 Lowe VJ, Fletcher JW, Gobar L et al. Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998; 16: 1075-1084
    CrossrefPubMedGoogle Scholar
  • 7 Jemal A, Siegel R, Ward E et al. Cancer statistics 2006. CA Cancer J Clin 2006; 56: 106-130
    Google Scholar
  • 8 American Cancer Society. Cancer Facts and Figures 2006. Atlanta (GA): American Cancer Society; 2006
    Google Scholar
  • 9 Viggiano RW, Swensen SJ, Rosenow 3rd EC. Evaluation and management of solitary and multiple pulmonary nodules. Clin Chest Med 1992; 13: 83-95
    PubMedGoogle Scholar
  • 10 Mountain CF. Revisions in the international system for staging lung cancer. Chest 1997; 111: 1710-1717
    CrossrefPubMedGoogle Scholar
  • 11 Erasmus JJ, Connolly JE, McAdams HP et al. Solitary pulmonary nodules: Part I. Morphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000; 20: 43-58
    CrossrefPubMedGoogle Scholar
  • 12 Swensen SJ, Viggiano RW, Midthun DE et al. Lung nodule enhancement at CT: multicenter study. Radiology 2000; 214: 73-80
    CrossrefPubMedGoogle Scholar
  • 13 Christensen JA, Nathan MA, Mullan BP et al. Characterization of the solitary pulmonary nodule: 18F-FDG PET versus nodule-enhancement CT. AJR Am J Roentgenol 2006; 187: 1361-1367
    CrossrefPubMedGoogle Scholar
  • 14 Schaefer JF, Vollmar J, Schick F et al. Solitary pulmonary nodules: dynamic contrast-enhanced MR imaging-perfusion differences in malignant and benign lesions. Radiology 2004; 232: 544-553
    CrossrefPubMedGoogle Scholar
  • 15 Gould MK, Maclean CC, Kuschner WG et al. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a metaanalysis. JAMA 2001; 285: 914-924
    CrossrefPubMedGoogle Scholar
  • 16 Vansteenkiste JF, Stroobants SS. PET scan in lung cancer: current recommendations and innovation. J Thorac Oncol 2006; 1: 71-73
    CrossrefPubMedGoogle Scholar
  • 17 Kagna O, Solomonov A, Keidar Z et al. The value of FDG-PET/CT in assessing single pulmonary nodules in patients at high risk of lung cancer. Eur J Nucl Med Mol Imaging 2009; 36: 997-1004
    CrossrefPubMedGoogle Scholar
  • 18 Kim SK, Allen-Auerbach M, Goldin J et al. Accuracy of PET/CT in characterization of solitary pulmonary lesions. J Nucl Med 2007; 48: 214-220
    PubMedGoogle Scholar
  • 19 Yi CA, Lee KS, Kim BT et al. Tissue characterization of solitary pulmonary nodule: comparative study between helical dynamic CT and integrated PET/CT. J Nucl Med 2006; 47: 443-450
    PubMedGoogle Scholar
  • 20 Weber G. Enzymology of cancer cells (second of two parts). N Engl J Med 1977; 296: 541-551
    CrossrefPubMedGoogle Scholar
  • 21 Lowe VJ, Fletcher JW, Gobar L et al. Prospective investigation of positron emission tomography in lung nodules. J Clin Oncol 1998; 16: 1075-1084
    CrossrefPubMedGoogle Scholar
  • 22 Wahidi MM, Govert JA, Goudar RK et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (Suppl. 03) S94-S107
    CrossrefPubMedGoogle Scholar
  • 23 Cronin P, Dwamena BA, Kelly AM et al. Solitary pulmonary nodules: meta-analytic comparison of cross-sectional imaging modalities for diagnosis of malignancy. Radiology 2008; 246: 772-782
    CrossrefPubMedGoogle Scholar
  • 24 Vansteenkiste JF, Stroobants SS. PET scan in lung cancer: current recommendations and innovation. J Thorac Oncol 2006; 1: 71-73
    CrossrefPubMedGoogle Scholar
  • 25 Fletcher JW, Kymes SM, Gould M et al. VA SNAP Cooperative Studies Group. A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. J Nucl Med 2008; 49: 179-185
    CrossrefPubMedGoogle Scholar
  • 26 Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol 2007; 188: 57-68
    CrossrefPubMedGoogle Scholar
  • 27 Jeong SY, Lee KS, Shin KM et al. Efficacy of PET/CT in the characterization of solid or partly solid solitary pulmonary nodules. Lung Cancer 2008; 61: 186-194
    CrossrefPubMedGoogle Scholar
  • 28 Chang CY, Tzao C, Lee SC et al. Incremental value of integrated FDG-PET/CT in evaluating indeterminate solitary pulmonary nodule for malignancy. Mol Imaging Biol 2010; 12: 204-209
    CrossrefPubMedGoogle Scholar
  • 29 Tsunezuka Y, Shimizu Y, Tanaka N et al. Positron emission tomography in relation to Noguchiʼs classification for diagnosis of peripheral non-small-cell lung cancer 2 cm or less in size. World J Surg 2007; 31: 314-317
    CrossrefPubMedGoogle Scholar
  • 30 Chun EJ, Lee HJ, Kang WJ et al. Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: The feasibility of integrated (18)F-FDG PET/CT. Lung Cancer 2009; 65: 180-186
    CrossrefPubMedGoogle Scholar
  • 31 Tsushima Y, Tateishi U, Uno H et al. Diagnostic performance of PET/CT in differentiation of malignant and benign nonsolid solitary pulmonary nodules. Ann Nucl Med 2008; 22: 571-577
    CrossrefPubMedGoogle Scholar
  • 32 Kim TJ, Park CM, Goo JM et al. Is there a role for FDG PET in the management of lung cancer manifesting predominantly as ground-glass opacity?. AJR Am J Roentgenol 2012; 198: 83-88
    CrossrefPubMedGoogle Scholar
  • 33 Hodnett PA, Ko JP. Evaluation and management of indeterminate pulmonary nodules. Radiol Clin North Am 2012; 50: 895-914
    CrossrefPubMedGoogle Scholar
  • 34 Aquino SL, Kuester LB, Muse VV et al. Accuracy of transmission CT and FDG-PET in the detection of small pulmonary nodules with integrated PET/CT. Eur J Nucl Med Mol Imaging 2006; 33: 692-696
    CrossrefPubMedGoogle Scholar
  • 35 Lowe VJ, Hoffman JM, DeLong DM et al. Semiquantitative and visual analysis of FDG-PET images in pulmonary abnormalities. J Nucl Med 1994; 35: 1771-1776
    PubMedGoogle Scholar
  • 36 Kim SK, Allen-Auerbach M, Goldin J et al. Accuracy of PET/CT in characterization of solitary pulmonary lesions. J Nucl Med 2007; 48: 214-220
    PubMedGoogle Scholar
  • 37 Bar-Shalom R, Kagna O, Israel O et al. Noninvasive diagnosis of solitary pulmonary lesions in cancer patients based on 2-fluoro-2-deoxy-D-glucose avidity on positron emission tomography/computed tomography. Cancer 2008; 113: 3213-3221
    CrossrefPubMedGoogle Scholar
  • 38 Huang B, Law MW, Khong PL. Whole-body PET/CT scanning: estimation of radiation dose and cancer risk. Radiology 2009; 251: 166-174
    CrossrefPubMedGoogle Scholar
  • 39 Leide-Svegborn S. Radiation exposure of patients and personnel from a PET/CT procedure with 18F-FDG. Radiat Prot Dosimetry 2010; 139: 208-213
    CrossrefPubMedGoogle Scholar
  • 40 Griffey RT, Sodickson A. Cumulative radiation exposure and cancer risk estimates in emergency department patients undergoing repeat or multiple CT. AJR Am J Roentgenol 2009; 192: 887-892
    CrossrefPubMedGoogle Scholar
  • 41 Gould MK, Donington J, Lynch WR et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2013; 143 (Suppl. 05) Se93-Se120
    CrossrefPubMedGoogle Scholar
  • 42 Patel VK, Naik SK, Naidich DP et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 1: radiologic characteristics and imaging modalities. Chest 2013; 143: 825-839
    CrossrefPubMedGoogle Scholar
  • 43 Patel VK, Naik SK, Naidich DP et al. A practical algorithmic approach to the diagnosis and management of solitary pulmonary nodules: part 2: pretest probability and algorithm. Chest 2013; 143: 840-846
    CrossrefPubMedGoogle Scholar
  • 44 Gould MK, Ananth L, Barnett PG. Veterans Affairs SNAP Cooperative Study Group. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007; 131: 383-388
    CrossrefPubMedGoogle Scholar
  • 45 Yonemori K, Tateishi U, Uno H et al. Development and validation of diagnostic prediction model for solitary pulmonary nodules. Respirology 2007; 12: 856-862
    CrossrefPubMedGoogle Scholar
  • 46 May BJ, Levsky JM, Godelman A et al. Should CT play a greater role in preventing the resection of granulomas in the era of PET?. AJR Am J Roentgenol 2011; 196: 795-800
    CrossrefPubMedGoogle Scholar
  • 47 Copp DH, Godwin JD, Kirby KA et al. Clinical and radiologic factors associated with pulmonary nodule etiology in organ transplant recipients. Am J Transplant 2006; 6: 2759-2764
    CrossrefPubMedGoogle Scholar
  • 48 Swensen SJ, Silverstein MD, Ilstrup DM et al. The probability of malignancy in solitary pulmonary nodules. Application to small radiologically indeterminate nodules. Arch Intern Med 1997; 157: 849-855
    CrossrefPubMedGoogle Scholar
  • 49 Soret M, Bacharach SL, Buvat I. Partial-volume effect in PET tumor imaging. J Nucl Med 2007; 48: 932-945
    CrossrefPubMedGoogle Scholar
  • 50 Berghmans T, Dusart M, Paesmans M et al. European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. Primary tumor standardized uptake value (SUVmax) measured on fluorodeoxyglucose positron emission tomography (FDG-PET) is of prognostic value for survival in non-small cell lung cancer (NSCLC): a systematic review and meta-analysis (MA) by the European Lung Cancer Working Party for the IASLC Lung Cancer Staging Project. J Thorac Oncol 2008; 3: 6-12
    CrossrefPubMedGoogle Scholar
  • 51 Nair VS, Barnett PG, Ananth L et al. Veterans Affairs Solitary Nodule Accuracy Project Cooperative Studies Group. PET scan 18F-fluorodeoxyglucose uptake and prognosis in patients with resected clinical stage IA non-small cell lung cancer. Chest 2010; 137: 1150-1156
    CrossrefPubMedGoogle Scholar
  • 52 Hain SF, Curran KM, Beggs AD et al. FDG-PET as a “metabolic biopsy” tool in thoracic lesions with indeterminate biopsy. Eur J Nucl Med 2001; 28: 1336-1340
    CrossrefPubMedGoogle Scholar