1 484

Cited 82 times in

Differentiation between malignancy and inflammation in pulmonary ground-glass nodules: The feasibility of integrated (18)F-FDG PET/CT.

Authors
 Eun Ju Chun  ;  Hyun Ju Lee  ;  Won Jun Kang  ;  Kwang Gi Kim  ;  Jin Mo Goo  ;  Chang Min Park  ;  Chang Hyun Lee 
Citation
 LUNG CANCER, Vol.65(2) : 180-186, 2009 
Journal Title
LUNG CANCER
ISSN
 0169-5002 
Issue Date
2009
MeSH
Female ; Fluorodeoxyglucose F18 ; Humans ; Inflammation/diagnostic imaging ; Inflammation/pathology ; Lung Neoplasms/diagnostic imaging* ; Lung Neoplasms/pathology ; Male ; Middle Aged ; Positron-Emission Tomography ; Radiopharmaceuticals ; Solitary Pulmonary Nodule/diagnostic imaging* ; Solitary Pulmonary Nodule/pathology ; Tomography, X-Ray Computed
Keywords
Ground-glass nodule ; Ground-glass opacity ; GGN ; GGO ; Solitary pulmonary nodules ; PET/CT ; F-FDG
Abstract
BACKGROUND: (18)F-FDG PET/CT has been used to differentiate malignant solid lung nodules from benign nodules. We assess the feasibility of integrated (18)F-FDG PET/CT for the differentiation of malignancy from inflammation manifested as ground-glass nodules (GGNs) on chest CT.

METHODS: A total of 68 GGNs in 45 patients (M:F=24:21; mean age, 61) fulfilled the following criteria: (a) nodules composed of >/=50% ground-glass opacity, (b) patients who underwent integrated PET/CT within 1 week following dedicated chest CT, (c) definitive diagnosis determined by pathological specimen or at least 9 months of follow-up, and (d) lesions >/=10mm in diameter. 36 malignant GGNs were pathologically proved as adenocarcinoma (n=20), bronchioloalveolar carcinoma (n=11), low-grade lymphoma (n=3), metastatic mucinous adenocarcinoma (n=1) and unknown low-grade malignancy (n=1). 32 inflammatory GGNs were confirmed as pneumonic infiltration as they had disappeared on follow-up CT and were associated with compatible clinical features (n=26) or as chronic inflammation with fibrosis by VATS biopsy (n=6). Using CT density histogram analysis, 14 were classified as pure GGNs and 54 as part-solid nodules. Integrated PET/CT was evaluated by measuring the maximum standardized uptake value (SUV) at the region of interest located at each lesion. The Mann-Whitney U test was performed to compare the SUV of malignancy and inflammation. The optimal cut-off value of SUV to differentiate malignancy from inflammation was determined using a receiver operating characteristic-based positive test. Sensitivity, specificity, accuracy, and positive predictive values (PPV) and negative predictive values (NPV) were calculated at the level of the optimal cut-off value. SUV showing 100% PPV for inflammatory GGNs was evaluated.

RESULTS: In part-solid nodules, the maximum SUV was significantly higher in inflammation (2.00+/-1.18; range, 0.48-5.60) than in malignancy (1.26+/-0.71; range, 0.32-2.6) (P=0.018). On the other hand, in pure GGNs, the maximum SUV of malignancy (0.64+/-0.19; range, 0.43-0.96) and inflammation (0.74+/-0.28; range, 0.32-1.00) showed no difference (P=0.37). Using the optimal cut-off value of SUV as 1.2 (P=0.01) sensitivity, specificity, accuracy, PPV and NPV in part-solid nodules were 62.1%, 80.0%, 70.4%, 78.3% and 64.5%, respectively. Six part-solid nodules, which showed a maximum SUV of higher than 2.6, were all inflammations.

CONCLUSION: The part-solid nodules with positive FDG-PET could be inflammatory nodules rather than malignant nodules. This is a quite paradoxical result when considering the basic knowledge that malignant pulmonary nodules have higher glucose metabolism.
Full Text
http://www.sciencedirect.com/science/article/pii/S0169500208006120
DOI
10.1016/j.lungcan.2008.11.015
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Nuclear Medicine (핵의학교실) > 1. Journal Papers
Yonsei Authors
Kang, Won Jun(강원준) ORCID logo https://orcid.org/0000-0002-2107-8160
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/104248
사서에게 알리기
  feedback

qrcode

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

Browse

Links