title: Positron emission tomography in the diagnostic work-up of screening-detected lung nodules.
abstract: Low-dose computed tomography (CT) screening for lung cancer can reduce lung cancer mortality, but overdiagnosis, false positives and invasive procedures for benign nodules are worrying. We evaluated the utility of positron emission tomography (PET)-CT in characterising indeterminate screening-detected lung nodules. 383 nodules, examined by PET-CT over the first 6 years of the COSMOS (Continuous Observation of Smoking Subjects) study to diagnose primary lung cancer, were reviewed and compared with pathological findings (surgically-treated patients) or follow-up (negative CT for ⩾2 years, considered negative); 196 nodules were malignant. The sensitivity, specificity and accuracy of PET-CT for differentially diagnosing malignant nodules were, respectively, 64%, 89% and 76% overall, and 82%, 92% and 88% for baseline-detected nodules. Performance was lower for nodules found at repeat annual scans, with sensitivity ranging from 22% for nonsolid to 79% for solid nodules (p=0.0001). Sensitivity (87%) and specificity (73%) were high for nodules ⩾15 mm, better (sensitivity 98%) for solid nodules ⩾15 mm. PET-CT was highly sensitive for the differential diagnosis of indeterminate nodules detected at baseline, nodules ⩾15 mm and solid nodules. Sensitivity was low for sub-solid nodules and nodules discovered after baseline for which other methods, e.g. volume doubling time, should be used.
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy Both authors contributed equally giulia.veronesi@ieo.it.
authors.forename: Giulia
authors.initials: G
authors.lastname: Veronesi
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy Both authors contributed equally.
authors.forename: Laura L
authors.initials: LL
authors.lastname: Travaini
authors.affiliation: Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.
authors.forename: Patrick
authors.initials: P
authors.lastname: Maisonneuve
authors.affiliation: Dept of Radiological Science and Radiation Therapy, European Institute of Oncology, Milan, Italy.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Rampinelli
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Bertolotti
authors.affiliation: Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy Dept of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Spaggiari
authors.affiliation: Dept of Radiological Science and Radiation Therapy, European Institute of Oncology, Milan, Italy Dept of Health Sciences, University of Milan, Milan, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Bellomi
authors.affiliation: Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, Meldola, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Paganelli
mesh_terms: D000368:Aged; D019540:Area Under Curve; D055088:Early Detection of Cancer / Q000379:methods*; D005189:False Positive Reactions; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis*; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D012372:ROC Curve; D019275:Radiopharmaceuticals; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012907:Smoking; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18