Early lung cancer detection using spiral computed tomography and positron emission tomography.
BACKGROUND
Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised.


OBJECTIVE
To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET).


METHODS
High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules.


RESULTS
A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non-small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%.


CONCLUSIONS
A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.
Bastarrika
Gorka
G
Department of Radiology, Clínica Universitaria, Avda. Pio XII, 36, 31008 Pamplona, Spain.
García-Velloso
María José
MJ
Lozano
Maria Dolores
MD
Montes
Usua
U
Torre
Wenceslao
W
Spiteri
Natalia
N
Campo
Arantza
A
Seijo
Luis
L
Alcaide
Ana Belén
AB
Pueyo
Jesús
J
Cano
David
D
Vivas
Isabel
I
Cosín
Octavio
O
Domínguez
Pablo
P
Serra
Patricia
P
Richter
José A
JA
Montuenga
Luis
L
Zulueta
Javier J
JJ
D000328:Adult; D017677:Age Distribution; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging* / Q000453:epidemiology; D008297:Male; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D015995:Prevalence; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects*; D013030:Spain / Q000453:epidemiology; D013147:Spirometry; D036542:Tomography, Spiral Computed / Q000379:methods*
D019788:Fluorodeoxyglucose F18