title: The role of the ¹⁸f-fluorodeoxyglucose-positron emission tomography scan in the Nederlands Leuvens Longkanker screenings Onderzoek lung cancer screening trial.
abstract: BACKGROUND
  In computed tomography lung cancer screening programs, up to 30% of all resections are futile.
  
  
  OBJECTIVE
  To investigate whether a preoperative positron emission tomography (PET) after a conclusive or inconclusive nonsurgical workup will reduce the resection rate for benign disease in test-positive participants of a lung cancer screening program.
  
  
  METHODS
  ¹⁸F-Fluorodeoxyglucose-PET scans were made in 220 test positives. Nodules were classified as positive, indeterminate, or negative based on visual comparison with background activity. Gold standard for a positive PET was the presence of cancer in the resection specimen or the detection of cancer during more than 2 years follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated at participant level and 95% confidence intervals (CIs) constructed.
  
  
  RESULTS
  The sensitivity of PET to detect cancer was 84.2% (95% CI: 77.6-90.7%), the specificity 75.2% (95% CI: 67.1-83.3), the positive predictive value 78.9% (95% CI: 71.8-86.0), and the NPV 81.2% (95% CI: 73.6-88.8). The resection rate for benign disease was 23%, but 26% of them had a diagnosis with clinical consequences. A preoperative PET after an inconclusive nonsurgical workup reduced the resection rate for benign lesions by 11 to 15%, at the expense of missing 12 to 18% lung cancer cases. A preoperative PET after a conclusive nonsurgical workup reduced the resection rate by 78% at the expense of missing 3% lung cancer cases.
  
  
  CONCLUSIONS
  A preoperative PET scan in participants with an inconclusive nonsurgical workup is not recommended because of the very low NPV, but after a conclusive nonsurgical workup, the resection rate for benign disease can be decreased by 72%.
authors.affiliation: Department of Pulmonary Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands. s.vantwesteinde@erasmusmc.nl
authors.forename: Susan C
authors.initials: SC
authors.lastname: van't Westeinde
authors.forename: Harry J
authors.initials: HJ
authors.lastname: de Koning
authors.forename: Frederik B
authors.initials: FB
authors.lastname: Thunnissen
authors.forename: Matthijs
authors.initials: M
authors.lastname: Oudkerk
authors.forename: Harry J M
authors.initials: HJ
authors.lastname: Groen
authors.forename: Jan-Willem J
authors.initials: JW
authors.lastname: Lammers
authors.forename: Carla
authors.initials: C
authors.lastname: Weenink
authors.forename: Rene
authors.initials: R
authors.lastname: Vernhout
authors.forename: Kristiaan
authors.initials: K
authors.lastname: Nackaerts
authors.forename: Willem
authors.initials: W
authors.lastname: Mali
authors.forename: Rob J
authors.initials: RJ
authors.lastname: van Klaveren
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D000368:Aged; D018287:Carcinoma, Large Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002289:Carcinoma, Non-Small-Cell Lung / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D019788:Fluorodeoxyglucose F18; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D049268:Positron-Emission Tomography; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D055752:Small Cell Lung Carcinoma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015996:Survival Rate
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18