title: Overestimated value of (18)F-FDG PET/CT to diagnose pulmonary nodules: Analysis of 298 patients.
abstract: OBJECTIVE
  To investigate the accuracy and efficacy of combined 2-[(18)F]-fluoro-2-deoxy-d-glucose (FDG) positron-emission tomography (PET)/computed tomography (CT) in the diagnosis of pulmonary nodules.
  
  
  METHODS
  The present retrospective study included 298 patients with clinically suspected pulmonary malignancy who underwent preoperative PET/CT. The results of PET/CT were compared with the histopathological findings after thoracotomy or thoracoscopic surgery.
  
  
  RESULTS
  Of 298 patients, pulmonary malignancy was histopathologically diagnosed in 248 and benign lesions in 50 patients. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET/CT in detecting malignant lesions were 80.2%, 38%, 86.5%, 27.9%, and 73.1%, respectively. The specificity and NPV were very low, and the area under curve (AUC) in the receiver operating characteristic (ROC) curve analysis was 0.694. For 219 patients with non-small cell lung cancer (NSCLC), falsely negative results occurred in 43 patients. The multivariate risk-factor analysis identified high differentiation (p < 0.001), peripheral lung cancer (p = 0.016), non-pleural invasion (p = 0.001), tumour size ≤3 cm (p = 0.026), adenocarcinoma (p = 0.062) and non-smoker (p = 0.066) as risk factors for false negatives..
  
  
  CONCLUSIONS
  The study suggests that the role of PET/CT in the detection of pulmonary malignancy has been overestimated in the past. It warrants attention that high differentiation, peripheral lung cancer, non-pleural invasion, tumour size ≤3 cm, adenocarcinoma, and non-smoker were independent risk factors for negative PET/CT findings of NSCLC..
authors.affiliation: Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: S
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: B
authors.initials: B
authors.lastname: Zhao
authors.affiliation: Department of Nuclear Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: X
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Nuclear Medicine, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: J
authors.initials: J
authors.lastname: Yu
authors.affiliation: Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: S
authors.initials: S
authors.lastname: Yan
authors.affiliation: Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China.
authors.forename: C
authors.initials: C
authors.lastname: Lv
authors.affiliation: Department of Thoracic Surgery Ⅱ, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital and Institute, Beijing 100142, China. Electronic address: zlyangyue@bjmu.edu.cn.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000175:diagnosis*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods*; D049268:Positron-Emission Tomography / Q000379:methods*; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D003074:Solitary Pulmonary Nodule / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18