solitary lung nodule: role of pet-ct in management...solitary pulmonary nodule clinical prediction...
TRANSCRIPT
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Jeremy J. Erasmus, M. D.
Solitary Lung Nodule: Role of PET-CT in Management
I do not have any relevant financial relationships with any commercial interests
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GrowthTwo Volume Doublings
4-mm 5-mm 6.25-mm
16-mm 20-mm 25-mm
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Growth
11/2002 11/2004 01/2007
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FDG-PET-CT
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FDG-PET False Positive
• Meta-analysis of 40 studies, 1474 nodules
• SUV > 2.5
• Most nodules > 1-cm
• Sensitivity 96.8%, specificity 78%
• 22% false positiveGould MK, et al. Accuracy of PET for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001;285:914-24.
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FDG-PET False Positive
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FDG-PET False Negative
• 136 pts with lung nodules
• Nodules < 3-cm
• Solid nodules sensitivity 90%, specificity 71%
• < 1-cm 8/20 (40%) false negative
• GG0 9/15 false negativeNomori H, et al. Lung Cancer 2004;45:19-27.
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Adenocarcinoma
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PET-CT/GGO
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PET-CT/GGO
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PET-CT/GGO
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PET-CT/GGO
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Respiration/SUV
SUV = 10.8
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Respiration/SUV
SUV = 13.7 (27%)
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• Patient age
• Smoking history
• Time since cessation of smoking
• Nodule size mean 15-mm
Solitary Pulmonary NoduleClinical Prediction Model and PET
Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388
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• Pre-test probability low (20%)
• PET negative
• Post-test probability < 2%
Follow-up
Solitary Pulmonary NoduleClinical Prediction Model and PET
Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388
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PET-CT Nodule
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Hemorrhagic Cyst
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• Pre-test probability high (65%)
• PET negative
• Post-test probability >10%
Needle biopsy or VATS
Solitary Pulmonary NoduleClinical Prediction Model and PET
Gould, MK et al. A clinical model to estimate the pretest probability of lung cancer in patients with solitary pulmonary nodules. Chest 2007;131:383-388
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Adenocarcinoma
SUV 1.4
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• 1520 patients
• 22/62 NSCLC evaluated by PET
• Nodules growing on CT
• Average size 10-mm (range, 6.5-14-mm)
• 7/22 false negative
PET/Screen-Detected Nodules
Lindell RM, et al. Lung cancer screening experience: a retrospective review of PET in 22 non-small cell lung carcinomas detected on screening chest CT in a high-risk population. AJR 2005;185:126-31.
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• Role of PET-CT limited by both false negative and positive FDG uptake
• Appropriate use of PET-CT can improve patient management
PET-CT Nodule Evaluation