Chest

Chest

Volume 108, Issue 2, August 1995, Pages 441-446
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Clinical Investigations; Articles; Selected Reports
PET-FDG Imaging and Transthoracic Needle Lung Aspiration Biopsy in Evaluation of Pulmonary Lesions: A Comparative Risk-Benefit Analysis

https://doi.org/10.1378/chest.108.2.441Get rights and content

Background and objective

Positron emission tomography (PET) utilizing 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) has been demonstrated to be highly accurate in differentiating benign from malignant pulmonary nodules. Transthoracic fine-needle aspiration biopsy (TTNA) is generally the initial procedure of choice in the evaluation of peripheral lesions suspected to be malignant. Our objective was to determine whether PET-FDG imaging, a noninvasive test, was equally efficacious as TTNA in the evaluation of lung lesions suspected to be malignant.

Patient selection

Thirty-three patients with 35 lung lesions who had undergone both PET-FDG imaging and TTNA were retrospectively selected from an ongoing prospective study of PET-FDG imaging in the evaluation of solitary pulmonary nodules.

Measurements

Diagnostic efficacy was determined by calculating sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy for both PET-FDG imaging and TTNA in differentiating benign from malignant lesions. Complication rate also was documented for the two tests.

Results

The PET imaging correctly identified all 26 malignant lesions, including 21 lesions diagnosed by TTNA and 7 of the 9 benign lung lesions. The TTNA was positive for malignancy in 21 lung lesions and missed the diagnosis of malignancy in 5 lesions. Diagnostic sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy was 100, 78, 93, 100, and 94% for PET imaging and 81, 100, 100, 64, and 86 for TTNA, respectively. Pneumothorax was documented in 16 patients (46%), and 9 patients (26%) required a chest tube. There were no complications with PET imaging.

Conclusion

We conclude that PET imaging of the lung is as efficacious as TTNA, with less risk, and offers an alternate noninvasive option in the evaluation and management of lung lesions suspected to be malignant.

(CHEST 1995; 108:441-46)

Section snippets

Patient Selection

Patients were selected from an ongoing prospective study of PET-FDG imaging in the evaluation of solitary pulmonary nodules. All 33 subjects who had both TTNA and PET-FDG imaging as part of their clinical evaluation were analyzed for this study. Subjects were evaluated at Creighton University Medical Center and the Veterans' Affairs Medical Center. All patients had plain chest x-ray films and CT scans of the chest and mediastinum. Lung lesions were classified as follows: (a) solitary pulmonary

Demographic and Clinical Data

Demographic and clinical data in 33 patients with 35 pulmonary lesions suspected to be malignant who underwent both PET imaging and TTNA is listed in Table 1.

There were 26 men and 7 women. The mean age was 65.15 years (range, 41 to 88 years). Of the 28 patients where spirometry was available, 20 (71%) had chronic airflow obstruction.

Lung lesions were as follows: solitary pulmonary nodules, 22; hilar lesions, 4; lung masses, 8; and multiple pulmonary nodules, 1. There were 26 malignant lesions

Discussion

The objective of the study was to determine whether a noninvasive test, such as PET-FDG imaging of the lung, was as efficacious as TTNA, an invasive procedure, in differentiating benign from malignant lung lesions. The results from our study demonstrate that PET-FDG imaging of the lung was as efficacious as TTNA and showed a trend toward higher sensitivity in identifying malignant lung lesions. Moreover, patients who underwent TTNA had a significant complication rate of pneumothorax, whereas

ACKNOWLEDGMENTS

The authors thank Kay Ryschon for statistical analysis and Dee Peters for secretarial assistance.

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Copyright © 1995 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.