title: Comparison of (11)C-choline PET/CT and enhanced CT in the evaluation of patients with pulmonary abnormalities and locoregional lymph node involvement in lung cancer.
abstract: Carbon-11 ((11)C)-choline positron emission tomography/computed tomography (PET/CT) is a new diagnostic method for detecting lung cancer. To prove whether it is superior to enhanced CT, we compared the diagnostic efficacy of these 2 approaches in 108 patients with pulmonary lesions and drew the conclusion that (11)C-choline PET/CT is not better at diagnosing primary lesions but is better at lymph node staging. This helps us to fully understand (11)C-choline PET/CT.
  
  
  BACKGROUND
  This study compares the diagnostic abilities of integrated (11)C-choline PET/CT imaging and contrast-enhanced helical CT imaging in pulmonary lesions and locoregional lymph node metastases in patients with lung cancer.
  
  
  METHODS
  One hundred eight patients with proven or suspected lung cancer underwent integrated (11)C-choline PET/CT and contrast-enhanced CT, followed by surgical resection and nodal staging.
  
  
  RESULTS
  The (11)C-choline PET/CT and CT diagnoses of pulmonary lesions and locoregional lymph node metastases were compared with pathologic findings, which revealed benign lesions in 26 patients (tuberculoma [8 patients], inflammatory pseudotumor [7 patients], hamartoma [6 patients], sclerosing hemangioma [4 patients], and pulmonary sequestration [1 patient]) and lung cancers in 82 patients (adenocarcinoma [39 patients], squamous cell carcinoma [23 patients], carcinoid [7 patients], small-cell lung cancer [5 patients], adenosquamous carcinoma [5 patients], and large-cell lung cancer [3 patients]). The accuracy, sensitivity, and specificity of (11)C-choline PET/CT for diagnosing lung cancer were 82.4%, 85.4%, and 73.1%, respectively, compared with 73.1%, 76.8%, and 61.5%, respectively, for CT. Differences between (11)C-choline PET/CT and CT in diagnosing lung cancer were not statistically significant (p = .503, .118, and .375, respectively). We used receiver operating characteristic (ROC) curve for analysis, finding the ROC of standard uptake value (SUV(max)) for diagnosing lung cancer. The cutoff value of SUV(max) was 3.54. Preoperative nodal staging was compared with postoperative histopathologic staging. (11)C-choline PET/CT correctly staged 80.5% of patients, 12.2% were overstaged, and 7.3% were understaged; for CT these values were 58.5%, 24.4%, and 17.1%, respectively. The accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of (11)C-choline PET/CT for lymph nodes were 83.8%, 82.4%, 84.1%, 50.3%, and 96.1%, respectively, compared with 69.3%, 63.7%, 71.2%, 30.2%, 91.0%, respectively, for CT.
  
  
  CONCLUSIONS
  Differences in the accuracy, sensitivity, specificity, PPV, and NPV between (11)C-choline PET/CT and CT are thus statistically significant for nodal staging (p = .003, .007, .000, .000, and .004, respectively). Although (11)C-choline PET/CT is not significantly better at diagnosing pulmonary lesions than is enhanced CT, (11)C-choline PET/CT has improved sensitivity, specificity, accuracy, PPV, and NPV relative to enhanced CT in the evaluation of locoregional lymph nodes.
authors.affiliation: Department of Thoracic Surgery, Provincial Hospital Affiliated to Shandong University, Shandong University, Jinan, Shandong Province, China.
authors.forename: Zhongmin
authors.initials: Z
authors.lastname: Peng
authors.forename: Qingwei
authors.initials: Q
authors.lastname: Liu
authors.forename: Meng
authors.initials: M
authors.lastname: Li
authors.forename: Mingyong
authors.initials: M
authors.lastname: Han
authors.forename: Shuzhan
authors.initials: S
authors.lastname: Yao
authors.forename: Qi
authors.initials: Q
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D002250:Carbon Radioisotopes; D002794:Choline; D003287:Contrast Media; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008198:Lymph Nodes / Q000000981:diagnostic imaging; D008207:Lymphatic Metastasis / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D002250:Carbon Radioisotopes; D003287:Contrast Media; D019275:Radiopharmaceuticals; D002794:Choline