title: FDG PET/CT evaluation of pathologically proven pulmonary lesions in an area of high endemic granulomatous disease.
abstract: OBJECTIVE
  The goal of this study is to assess how reliable the threshold maximum standardized uptake value (maxSUV) of 2.5 on positron emission tomography-computed tomography (PET/CT) is for evaluation of solitary pulmonary lesions in an area of endemic granulomatous disease and to consider other imaging findings that may increase the accuracy of PET/CT.
  
  
  METHODS
  The staging PET/CT of 72 subjects with solitary pulmonary lesions (nodules (less than 3 cm) or masses (greater than 3 cm)) were retrospectively reviewed. Pathology proven diagnosis from tissue samples was used as the gold standard. Logistic regression was used to assess whether the subject's age, maxSUV, size of lesion, presence of emphysema, or evidence of granulomatous disease was predictive of malignancy.
  
  
  RESULTS
  Malignant lesions were identified in 84.7 % (61/72) of the 72 subjects. A threshold maxSUV of 2.5 had a sensitivity of 95.1 % (58/61), specificity of 45.5 % (5/11), positive predictive value of 90.6 % (58/64), negative predictive value of 62.5 % (5/8) and an accuracy of 87.5 % (63/72). The false negative rate was 4.9 %, and the false positive rate was 54.5 %. All 3 false negatives were less than or equal to 1.0 cm; however, false positives ranged from 1.1 to 5.6 cm. The false negatives had a mean (SD) maxSUV of 2.0 (0.4), whereas the false positives had a mean (SD) maxSUV of 5.6 (3.0). Emphysema was associated with 1.1 higher odds of malignancy, and evidence of granulomatous disease was associated with 0.34 lower odds of benign disease, however, neither was statistically significant (p = 0.92 and p = 0.31, respectively). Higher maxSUV was significantly associated with increased risk of malignancy (p = 8.3 × 10(-3)). Older age and larger size of lesion were borderline associated with increased risk of malignancy (p = 0.05 and p = 0.07, respectively).
  
  
  CONCLUSIONS
  In an area of high endemic granulomatous disease, the PET/CT threshold maxSUV of 2.5 retains a high sensitivity (95.1 %) and positive predictive value (90.6 %) for differentiating benign from malignant pulmonary lesions; however, the specificity (45.5) and negative predictive value (62.5) decrease due to increased false positives. The presence of emphysema and absence of evidence of granulomatous disease increases the probability that a pulmonary lesion is malignant; however, these were not statistically significant.
authors: Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA 94143, USA. ronnie.sebro@radiology.ucsf.edu
authors: Ronnie
authors: R
authors: Sebro
authors: Carina Mari
authors: CM
authors: Aparici
authors: Miguel
authors: M
authors: Hernandez-Pampaloni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002140:California / Q000453:epidemiology; D003047:Coccidioidomycosis / Q000453:epidemiology / Q000473:pathology*; D019353:Endemic Diseases / Q000706:statistics & numerical data*; D005260:Female; D019788:Fluorodeoxyglucose F18; D015769:Granuloma, Respiratory Tract / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008168:Lung / Q000473:pathology*; D008172:Lung Diseases, Fungal / Q000453:epidemiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000706:statistics & numerical data*; D009367:Neoplasm Staging / Q000706:statistics & numerical data; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
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