Letter to the Editor

Role of Positron Emission Tomography in the Diagnostic Workup of Solitary Pulmonary Nodule

Authors: M. Chadi Alraies, MD, FACP, Khaldoon Shaheen, MD, Abdul Hamid Alraiyes, MD, ABSM

Abstract

To the Editor


The pretest probability of solitary pulmonary nodule (SPN) malignancy is estimated either qualitatively by using clinical judgment through initial history, physical examination, assessment of risk factors, careful evaluation of the chest radiography, and computed tomography (CT) scan, or quantitatively by using the assistance of quantitative models.1 Lesions are further classified as benign, malignant, or indeterminate based upon the clinician’s overall impression. This assessment helps guide diagnostic testing, such as imaging studies or biopsy.1 CT has been shown to have poor specificity (58%) for characterization of the nodule.1 Approximately 70% to 75% of indeterminate nodules by CT scan prove to be malignant,2necessitating the use of positron emission tomography (PET), which is a more accurate test. PET can accurately characterize indeterminate SPN and should be included as part of an SPN workup. Further workup may be indicated based on PET imaging findings.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Fletcher JW, Kymes SM, Gould M, et al. A comparison of the diagnostic accuracy of 18F-FDG PET and CT in the characterization of solitary pulmonary nodules. J Nucl Med 2008; 49: 179–185.
 
2. Wahidi MM, Govert JA, Goudar RK, et al. Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest2007; 132 (3 suppl): 94S–107S.
 
3. Pauls S, Buck AK, Halter G, et al. Performance of integrated FDG-PET/CT for differentiating benign and malignant lung lesions—results from a large prospective clinical trial. Mol Imaging Biol 2008; 10: 121–128.
 
4. Alberts WM, American College of Chest Physicians. Diagnosis and management of lung cancer executive summary: ACCP evidence-based clinical practice guidelines (2nd edition). Chest 2007; 132 (3 suppl): 1S–19S.
 
5. Yang SN, Liang JA, Lin FJ, et al. Differentiating benign and malignant pulmonary lesions with FDG-PET. Anticancer Res 2001; 21: 4153–4157.