TY - JOUR
T1 - Assessment of fluorodeoxyglucose F18–Labeled positron emission tomography for diagnosis of high-Risk lung nodules
AU - Maiga, Amelia W.
AU - Deppen, Stephen A.
AU - Mercaldo, Sarah Fletcher
AU - Blume, Jeffrey D.
AU - Montgomery, Chandler
AU - Vaszar, Laszlo T.
AU - Williamson, Christina
AU - Isbell, James M.
AU - Rickman, Otis B.
AU - Pinkerman, Rhonda
AU - Lambright, Eric S.
AU - Nesbitt, Jonathan C.
AU - Grogan, Eric L.
N1 - Funding Information:
Dr Maiga is supported by the Office of Academic Affiliations, Department of Veterans Affairs National Quality Scholars Program. Dr Grogan is a recipient of the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service career development award 10-024.
Publisher Copyright:
© 2017 American Medical Association. All rights reserved.
PY - 2018/4
Y1 - 2018/4
N2 - IMPORTANCE Clinicians rely heavily on fluorodeoxyglucose F18–labeled positron emission tomography (FDG-PET) imaging to evaluate lung nodules suspicious for cancer. We evaluated the performance of FDG-PET for the diagnosis of malignancy in differing populations with varying cancer prevalence. OBJECTIVE To determine the performance of FDG-PET/computed tomography (CT) in diagnosing lung malignancy across different populations with varying cancer prevalence. DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective cohort study at 6 academic medical centers and 1 Veterans Affairs facility that comprised a total of 1188 patients with known or suspected lung cancer from 7 different cohorts from 2005 to 2015. EXPOSURES 18F fluorodeoxyglucose PET/CT imaging. MAIN OUTCOME AND MEASURES Final diagnosis of cancer or benign disease was determined by pathological tissue diagnosis or at least 18 months of stable radiographic follow-up. RESULTS Most patients were male smokers older than 60 years. Overall cancer prevalence was 81% (range by cohort, 50%-95%). The median nodule size was 22 mm (interquartile range, 15-33 mm). Positron emission tomography/CT sensitivity and specificity were 90.1% (95% CI, 88.1%-91.9%) and 39.8% (95% CI, 33.4%-46.5%), respectively. False-positive PET scans occurred in 136 of 1188 patients. Positive predictive value and negative predictive value were 86.4% (95% CI, 84.2%-88.5%) and 48.7% (95% CI, 41.3%-56.1%), respectively. On logistic regression, larger nodule size and higher population cancer prevalence were both significantly associated with PET accuracy (odds ratio, 1.027; 95% CI, 1.015-1.040 and odds ratio, 1.030; 95% CI, 1.021-1.040, respectively). As the Mayo Clinic model–predicted probability of cancer increased, the sensitivity and positive predictive value of PET/CT imaging increased, whereas the specificity and negative predictive value dropped. CONCLUSIONS AND RELEVANCE High false-positive rates were observed across a range of cancer prevalence. Normal PET/CT scans were not found to be reliable indicators of the absence of disease in patients with a high probability of lung cancer. In this population, aggressive tissue acquisition should be prioritized using a comprehensive lung nodule program that emphasizes advanced tissue acquisition techniques such as CT-guided fine-needle aspiration, navigational bronchoscopy, and endobronchial ultrasonography.
AB - IMPORTANCE Clinicians rely heavily on fluorodeoxyglucose F18–labeled positron emission tomography (FDG-PET) imaging to evaluate lung nodules suspicious for cancer. We evaluated the performance of FDG-PET for the diagnosis of malignancy in differing populations with varying cancer prevalence. OBJECTIVE To determine the performance of FDG-PET/computed tomography (CT) in diagnosing lung malignancy across different populations with varying cancer prevalence. DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective cohort study at 6 academic medical centers and 1 Veterans Affairs facility that comprised a total of 1188 patients with known or suspected lung cancer from 7 different cohorts from 2005 to 2015. EXPOSURES 18F fluorodeoxyglucose PET/CT imaging. MAIN OUTCOME AND MEASURES Final diagnosis of cancer or benign disease was determined by pathological tissue diagnosis or at least 18 months of stable radiographic follow-up. RESULTS Most patients were male smokers older than 60 years. Overall cancer prevalence was 81% (range by cohort, 50%-95%). The median nodule size was 22 mm (interquartile range, 15-33 mm). Positron emission tomography/CT sensitivity and specificity were 90.1% (95% CI, 88.1%-91.9%) and 39.8% (95% CI, 33.4%-46.5%), respectively. False-positive PET scans occurred in 136 of 1188 patients. Positive predictive value and negative predictive value were 86.4% (95% CI, 84.2%-88.5%) and 48.7% (95% CI, 41.3%-56.1%), respectively. On logistic regression, larger nodule size and higher population cancer prevalence were both significantly associated with PET accuracy (odds ratio, 1.027; 95% CI, 1.015-1.040 and odds ratio, 1.030; 95% CI, 1.021-1.040, respectively). As the Mayo Clinic model–predicted probability of cancer increased, the sensitivity and positive predictive value of PET/CT imaging increased, whereas the specificity and negative predictive value dropped. CONCLUSIONS AND RELEVANCE High false-positive rates were observed across a range of cancer prevalence. Normal PET/CT scans were not found to be reliable indicators of the absence of disease in patients with a high probability of lung cancer. In this population, aggressive tissue acquisition should be prioritized using a comprehensive lung nodule program that emphasizes advanced tissue acquisition techniques such as CT-guided fine-needle aspiration, navigational bronchoscopy, and endobronchial ultrasonography.
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U2 - 10.1001/jamasurg.2017.4495
DO - 10.1001/jamasurg.2017.4495
M3 - Article
C2 - 29117314
AN - SCOPUS:85045639951
SN - 2168-6254
VL - 153
SP - 329
EP - 334
JO - JAMA Surgery
JF - JAMA Surgery
IS - 4
ER -