title: The role of PET/CT in assessing pulmonary nodules in children with solid malignancies.
abstract: OBJECTIVE. The purpose of this article is to assess the feasibility and utility of PET/CT in distinguishing benign from malignant pulmonary nodules in patients with solid childhood malignancies. SUBJECTS AND METHODS. This prospective study was conducted between March 2008 and August 2010. We enrolled 25 subjects 21 years old or younger with solid childhood malignancies and at least one pulmonary nodule measuring 0.5-3.0 cm. PET/CT was performed within 3 weeks of diagnostic chest CT. Three panels of three reviewers each reviewed diagnostic CT only (panel 1), PET/CT only (panel 2), or diagnostic CT and PET/CT concurrently (panel 3) and predicted each nodule's histologic diagnosis as benign, malignant, or indeterminate. Interreviewer agreement was assessed with the kappa statistic. Using nodule biopsy or clinical follow-up as reference standards, the sensitivity, specificity, and accuracy for each panel was assessed. Logistic regression was used to assess the nodule's maximum standardized uptake value (SUVmax) association with its histologic diagnosis. RESULTS. There were 75 nodules with a median size of 0.74 cm (range, 0.18-2.38 cm); 48 nodules were malignant. Sensitivity was 85% (41/48) for panel 1, 60% (29/48) for panel 2, and 67% (32/48) for panel 3. All panels had poor specificities. Interreviewer agreement was moderate for panel 1 (0.43) and poor for panels 2 (0.22) and 3 (0.33). SUVmax was a significant predictor of histologic diagnosis (p = 0.004). CONCLUSION. PET/CT assessment of pulmonary nodules is feasible in children with solid malignancies but may not reliably improve our ability to predict a nodule's histologic diagnosis. The SUVmax may improve the performance of PET/CT in this setting.
authors.affiliation: 1 Division of Diagnostic Imaging, Radiological Sciences (MS 220), St. Jude Children's Research Hospital, 262 Danny Thomas Pl, Memphis, TN 38105.
authors.forename: M Beth
authors.initials: MB
authors.lastname: McCarville
authors.forename: Catherine
authors.initials: C
authors.lastname: Billups
authors.forename: Jianrong
authors.initials: J
authors.lastname: Wu
authors.forename: Robert
authors.initials: R
authors.lastname: Kaufman
authors.forename: Sue
authors.initials: S
authors.lastname: Kaste
authors.forename: Jamie
authors.initials: J
authors.lastname: Coleman
authors.forename: Susan
authors.initials: S
authors.lastname: Sharp
authors.forename: Helen
authors.initials: H
authors.lastname: Nadel
authors.forename: Martin
authors.initials: M
authors.lastname: Charron
authors.forename: Henrique
authors.initials: H
authors.lastname: Lederman
authors.forename: Steven
authors.initials: S
authors.lastname: Don
authors.forename: Stephen
authors.initials: S
authors.lastname: Shochat
authors.forename: Najat C
authors.initials: NC
authors.lastname: Daw
authors.forename: Barry
authors.initials: B
authors.lastname: Shulkin
mesh_terms: D000293:Adolescent; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media; D003937:Diagnosis, Differential; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011446:Prospective Studies; D019275:Radiopharmaceuticals; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media; D019275:Radiopharmaceuticals