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

GrowthTwo 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 positiveGould 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 negativeNomori 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 NoduleClinical 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 NoduleClinical 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 NoduleClinical 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