title: Diagnostic Performance of (18)F-Fluorodeoxyglucose in 162 Small Pulmonary Nodules Incidentally Detected in Subjects Without a History of Malignancy.
abstract: BACKGROUND
  Solitary pulmonary nodule (SPN) still represents a diagnostic challenge. The aim of our study was to evaluate the diagnostic performance of (18)F-fluorodeoxyglucose positron emission tomography-computed tomography in one of the largest samples of small SPNs, incidentally detected in subjects without a history of malignancy (nonscreening population) and undetermined at computed tomography.
  
  
  METHODS
  One-hundred and sixty-two small (>0.8 to 1.5 cm) and, for comparison, 206 large nodules (>1.5 to 3 cm) were retrospectively evaluated. Diagnostic performance of (18)F-fluorodeoxyglucose visual analysis, receiver-operating characteristic (ROC) analysis for maximum standardized uptake value (SUVmax), and Bayesian analysis were assessed using histology or radiological follow-up as a golden standard.
  
  
  RESULTS
  In 162 small nodules, (18)F-fluorodeoxyglucose visual and ROC analyses (SUVmax = 1.3) provided 72.6% and 77.4% sensitivity and 88.0% and 82.0% specificity, respectively. The prevalence of malignancy was 38%; Bayesian analysis provided 78.8% positive and 16.0% negative posttest probabilities of malignancy. In 206 large nodules (18)F-fluorodeoxyglucose visual and ROC analyses (SUVmax = 1.9) provided 89.5% and 85.1% sensitivity and 70.8% and 79.2% specificity, respectively. The prevalence of malignancy was 65%; Bayesian analysis provided 85.0% positive and 21.6% negative posttest probabilities of malignancy. In both groups, malignant nodules had a significant higher SUVmax (p < 0.0001) than benign nodules. Only in the small group, malignant nodules were significantly larger (p = 0.0054) than benign ones.
  
  
  CONCLUSIONS
  (18)F-fluorodeoxyglucose can be clinically relevant to rule in and rule out malignancy in undetermined small SPNs, incidentally detected in nonscreening population with intermediate pretest probability of malignancy, as well as in larger ones. Visual analysis can be considered an optimal diagnostic criterion, adequately detecting a wide range of malignant nodules with different metabolic activity.
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy. Electronic address: ml.calcagni@rm.unicatt.it.
authors.forename: Maria Lucia
authors.initials: ML
authors.lastname: Calcagni
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Taralli
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Cardillo
authors.affiliation: Unit of Pathology, Scientific Institute for Research and Health Care "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Graziano
authors.affiliation: Unit of Radiology, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Ialongo
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Mattoli
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Di Franco
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Caldarella
authors.affiliation: Unit of Thoracic Surgery, Carlo Forlanini Hospital, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Carleo
authors.affiliation: Institute of Physics, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Indovina
authors.affiliation: Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giordano
mesh_terms: D000368:Aged; D001499:Bayes Theorem; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D033162:Incidental Findings; D008175:Lung Neoplasms / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D049268:Positron-Emission Tomography; D011237:Predictive Value of Tests; D012372:ROC Curve; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D003074:Solitary Pulmonary Nodule / Q000000981:diagnostic imaging*; D014057:Tomography, X-Ray Computed
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18