title: Accuracy of FDG-PET to diagnose lung cancer in a region of endemic granulomatous disease.
abstract: BACKGROUND
  The 18 F-fluorodeoxyglucose-positron emission tomography (FDG-PET) is used to evaluate suspicious pulmonary lesions due to its diagnostic accuracy. The southeastern United States has a high prevalence of infectious granulomatous lung disease, and the accuracy of FDG-PET may be reduced in this population. We examined the diagnostic accuracy of FDG-PET in patients with known or suspected non-small cell lung cancer treated at our institution.
  
  
  METHODS
  A total of 279 patients, identified through our prospective database, underwent an operation for known or suspected lung cancer. Preoperative FDG-PET in 211 eligible patients was defined by standardized uptake value greater than 2.5 or by description ("moderate" or "intense") as avid. Sensitivity, specificity, positive and negative predictive values, likelihood ratios, and decision diagrams were calculated for FDG-PET in all patients and in patients with indeterminate nodules.
  
  
  RESULTS
  In all eligible patients (n=211), sensitivity and specificity of FDG-PET were 92% and 40%, respectively. Positive and negative predictive values were 86% and 55%. Overall FDG-PET accuracy to diagnose lung cancer was 81%. Preoperative positive likelihood ratio for FDG-PET diagnosis of lung cancer in this population was 1.5 compared with previously published values of 7.1. In 113 indeterminate lesions, 65% had lung cancer and the sensitivity and specificity were 89% and 40%, respectively. Twenty-four benign nodules (60%) had false positive FDG-PET scans. Twenty-two of 43 benign nodules (51%) were granulomas.
  
  
  CONCLUSIONS
  In a region with endemic granulomatous diseases, the specificity of FDG-PET for diagnosis of lung cancer was 40%. Clinical decisions and future clinical predictive models for lung cancer must accommodate regional variation of FDG-PET scan results.
authors: Department of Thoracic Surgery, Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, Tennessee 37232, USA.
authors: Stephen
authors: S
authors: Deppen
authors: Joe B
authors: JB
authors: Putnam
authors: Gabriela
authors: G
authors: Andrade
authors: Theodore
authors: T
authors: Speroff
authors: Jonathan C
authors: JC
authors: Nesbitt
authors: Eric S
authors: ES
authors: Lambright
authors: Pierre P
authors: PP
authors: Massion
authors: Ron
authors: R
authors: Walker
authors: Eric L
authors: EL
authors: Grogan
references: Ann Intern Med. 2003 May 6;138(9):724-35
references: 12729427
references: Radiology. 1996 May;199(2):297-306
references: 8668768
references: JAMA. 2001 Feb 21;285(7):914-24
references: 11180735
references: Chest. 2007 Sep;132(3 Suppl):178S-201S
references: 17873168
references: Chest. 2007 Sep;132(3 Suppl):108S-130S
references: 17873164
references: Chest. 2003 Jan;123(1 Suppl):89S-96S
references: 12527568
references: Chest. 2005 Oct;128(4):2289-97
references: 16236886
references: Ann Thorac Surg. 2004 Sep;78(3):1017-23; discussion 1017-23
references: 15337041
references: N Engl J Med. 2000 Jul 27;343(4):254-61
references: 10911007
references: Radiology. 1993 Feb;186(2):415-22
references: 8421744
references: Ann Thorac Surg. 2006 Sep;82(3):1016-20
references: 16928527
references: Chest. 2003 Jan;123(1 Suppl):129S-136S
references: 12527572
references: Eur J Health Econ. 2005 Sep;6(3):203-14
references: 15834623
references: Chest. 1997 Aug;112(2):416-22
references: 9266877
references: J Nucl Med. 1996 Sep;37(9):1428-36
references: 8790186
references: Medicine (Baltimore). 1981 Jul;60(4):231-66
references: 7017339
references: Chest. 2010 Jan;137(1):53-9
references: 19525359
references: Ann Intern Med. 2003 Dec 2;139(11):879-92
references: 14644890
references: Lung Cancer. 2004 May;44(2):175-81
references: 15084382
references: Chest. 2007 Sep;132(3 Suppl):94S-107S
references: 17873163
references: Oncologist. 2001;6(2):147-52
references: 11306726
references: J Nucl Med. 2009 May;50 Suppl 1:122S-50S
references: 19403881
references: J Thorac Cardiovasc Surg. 2003 Dec;126(6):1943-51
references: 14688710
references: Thorax. 2002 Jan;57(1):11-4
references: 11809983
references: Lung Cancer. 2002 Jun;36(3):297-301
references: 12009241
references: J Nucl Med. 2006 May;47(5):885-95
references: 16644760
references: South Med J. 1991 Nov;84(11):1360-1
references: 1948222
references: Chest. 2007 Sep;132(3 Suppl):131S-148S
references: 17873165
references: J Nucl Med. 1995 Oct;36(10):1836-9
references: 7562051