title: Performance of integrated FDG-PET/CT for differentiating benign and malignant lung lesions--results from a large prospective clinical trial.
abstract: OBJECTIVE
  The purpose of the study was to evaluate prospectively whether integrated 2-deoxy-2-[(18)F]fluoro-D-glucose positron emission tomography/computed tomography (FDG-PET/CT) is more accurate for determination of malignancy in newly diagnosed pulmonary lesions compared to separate interpretation of CT and FDG-PET.
  
  
  METHODS
  Two hundred and seventy-six patients with newly diagnosed lung lesions underwent FDG-PET/CT. Helical CT, FDG-PET, and FDG-PET/CT were interpreted separately to determine the performance of each imaging modality. Histopathology served as reference in all patients, and in further 60 patients, a benign lesion was verified at follow-up (mean follow-up of 1,040 days).
  
  
  RESULTS
  Histology revealed malignant lung tumors in 216 of 276 patients. With PET and PET/CT, a significantly lower number of lesions were classified as equivocal compared to CT alone (p < 0.001). Assuming that equivocal lesions are benign, performance of diagnostic tests was as follows: sensitivity, specificity, and accuracy for CT was 94, 75, and 90%, for PET 97, 83, and 94% (p = 0.021), and for PET/CT 96, 87, and 94% (p = 0.010). Assuming that equivocal lesions are malignant, sensitivity, specificity, and accuracy for CT was 99, 37, and 86%, for PET 99, 77, and 94% (p < 0.001), and for PET/CT 98, 68, and 92% (p = 0.002). PET and PET/CT showed the highest concordance (K = 0.912; confidence interval 0.866-0.958). In lesions less than or equal to 3 cm, there was a significant difference in the performance of PET alone and multidetector row CT as well as PET/CT and multidetector row CT (p = 0.007), irrespective if equivocal findings were judged as malignant or benign.
  
  
  CONCLUSIONS
  For differentiation of benign from malignant lung lesions, integrated FDG-PET/CT imaging was significantly more accurate than CT but not FDG-PET. The addition of metabolic imaging (FDG-PET) to morphological imaging (CT) leads to an increase in specificity and significantly reduced equivocal findings and is therefore recommended to further specify newly diagnosed lung lesions.
authors.affiliation: Department of Diagnostic and Interventional Radiology, University of Ulm, Robert-Koch-Str. 8, 89081, Ulm, Germany. sandra.pauls@uni-ulm.de
authors.forename: Sandra
authors.initials: S
authors.lastname: Pauls
authors.forename: Andreas K
authors.initials: AK
authors.lastname: Buck
authors.forename: Gisela
authors.initials: G
authors.lastname: Halter
authors.forename: Felix M
authors.initials: FM
authors.lastname: Mottaghy
authors.forename: Rainer
authors.initials: R
authors.lastname: Muche
authors.forename: Christina
authors.initials: C
authors.lastname: Bluemel
authors.forename: Susanne
authors.initials: S
authors.lastname: Gerstner
authors.forename: Stefan
authors.initials: S
authors.lastname: Krüger
authors.forename: Gerhard
authors.initials: G
authors.lastname: Glatting
authors.forename: Ludger
authors.initials: L
authors.lastname: Sunder-Plassmann
authors.forename: Peter
authors.initials: P
authors.lastname: Möller
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Brambs
authors.forename: Sven N
authors.initials: SN
authors.lastname: Reske
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000379:methods*; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019788:Fluorodeoxyglucose F18