A Comparison of the Diagnostic Accuracy of18F-FDG PET and CT in the Characterization of Solitary Pulmonary Nodules

作者：James W. Fletcher, Steven M. Kymes, Michael K. Gould, Naomi P. Alazraki, R. Edward Coleman, Val J. Lowe, Charles S. Marn, George M. Segall, Lyn Aung Thet, Kelvin Lee, for the VA SNAP Cooperative Studies Group · 发表于：Journal of Nuclear Medicine · 年份：2008 · DOI：10.2967/jnumed.107.044990 · 被引用次数：153 · 研究领域：Lung Cancer Diagnosis and Treatment、Lung Cancer Treatments and Mutations、Medical Imaging and Pathology Studies

UNLABELLED: CT and PET are widely used to characterize solitary pulmonary nodules (SPNs). However, most CT accuracy studies have been performed with outdated technology and methods, and previous PET studies have been limited by small sample sizes and incomplete masking. Our objective was to compare CT and PET accuracy in veterans with SPN. METHODS: Between January 1999 and June 2001, we recruited 532 participants with SPNs newly diagnosed on radiography and untreated. The SPNs were 7-30 mm. All patients underwent (18)F-FDG PET and CT. A masked panel of 3 PET and 3 CT experts rated the studies on a 5-point scale. SPN tissue diagnosis or 2-y follow-up established the final diagnosis. RESULTS: A definitive diagnosis was established for 344 participants. The prevalence of malignancy was 53%. The average size was 16 mm. Likelihood ratios (LRs) for PET and CT results for combined ratings of either definitely benign (33% and 9% of patients, respectively) or probably benign (27% and 12%) were 0.10 and 0.11, respectively. LRs for PET and CT results for combined ratings of indeterminate (1% and 25%), probably malignant (21% and 39%), or definitely malignant (35% and 15%) were 5.18 and 1.61, respectively. Area under the receiver operating characteristic curve was 0.93 (95% confidence interval, 0.90-0.95) for PET and 0.82 (95% confidence interval, 0.77-0.86) for CT (P < 0.0001 for the difference). PET inter- and intraobserver reliability was superior to CT. CONCLUSION: Definitely and pro...