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Solitary Lung Nodule: Role of PET-CT in Management ... Solitary Pulmonary Nodule Clinical Prediction Model and PET Gould, MK et al. A clinical model to estimate the pretest probability

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  • Jeremy J. Erasmus, M. D.

    Solitary Lung Nodule: Role of PET-CT in Management

    I do not have any relevant financial relationships with any commercial interests

  • Growth Two Volume Doublings

    4-mm 5-mm 6.25-mm

    16-mm 20-mm 25-mm

  • Growth

    11/2002 11/2004 01/2007

  • FDG-PET-CT

  • FDG-PET False Positive

    • Meta-analysis of 40 studies, 1474 nodules

    • SUV > 2.5

    • Most nodules > 1-cm

    • Sensitivity 96.8%, specificity 78%

    • 22% false positive Gould MK, et al. Accuracy of PET for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285:914-24.

  • FDG-PET False Positive

  • FDG-PET False Negative

    • 136 pts with lung nodules

    • Nodules < 3-cm

    • Solid nodules sensitivity 90%, specificity 71%

    • < 1-cm 8/20 (40%) false negative

    • GG0 9/15 false negative Nomori H, et al. Lung Cancer 2004;45:19-27.

  • Adenocarcinoma

  • PET-CT/GGO

  • PET-CT/GGO

  • PET-CT/GGO

  • PET-CT/GGO

  • Respiration/SUV

    SUV = 10.8

  • Respiration/SUV

    SUV = 13.7 (27%)

  • • Patient age

    • Smoking history

    • Time since cessation of smoking

    • Nodule size mean 15-mm

    Solitary Pulmonary Nodule Clinical Prediction Model and PET

    Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388

  • • Pre-test probability low (20%)

    • PET negative

    • Post-test probability < 2%

    Follow-up

    Solitary Pulmonary Nodule Clinical Prediction Model and PET

    Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388

  • PET-CT Nodule

  • Hemorrhagic Cyst

  • • Pre-test probability high (65%)

    • PET negative

    • Post-test probability >10%

    Needle biopsy or VATS

    Solitary Pulmonary Nodule Clinical Prediction Model and PET

    Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388

  • Adenocarcinoma

    SUV 1.4

  • • 1520 patients

    • 22/62 NSCLC evaluated by PET

    • Nodules growing on CT

    • Average size 10-mm (range, 6.5-14-mm)

    • 7/22 false negative

    PET/Screen-Detected Nodules

    Lindell RM, et al. Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population. AJR 2005;185:126-31.

  • • Role of PET-CT limited by both false negative and positive FDG uptake

    • Appropriate use of PET-CT can improve patient management

    PET-CT Nodule Evaluation

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