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Original Articles: General Thoracic

Evaluation of Semiquantitative Assessments of Fluorodeoxyglucose Uptake on Positron Emission Tomography Scans for the Diagnosis of Pulmonary Malignancies 1 to 3 cm in Size

^a Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^b Department of Diagnostic Radiology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
^c Japanese Red Cross Kumamoto Health Care Center, Kumamoto, Japan
^d Division of General Thoracic Surgery, Department of Surgery, School of Medicine, Keio University, Tokyo, Japan

Accepted for publication September 30, 2008.

^_* Address correspondence to Dr Ohba, Department of Thoracic Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan (Email: oyasumi{at}kumamoto-u.ac.jp).

Background: To determine the optimal method of evaluating fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET) for the diagnosis of pulmonary malignancies, the sensitivity and specificity of visual assessment and the several semiquantitative analyses were compared.

Methods: Positron emission tomography data were analyzed for 130 pulmonary nodules from 1 to 3 cm in size (101 malignant and 29 benign nodules). The FDG uptake was measured by maximum standard uptake value (SUVmax), the contrast ratio (CR) of the SUV to the cerebellum (CR brain), and the CR of the SUV to the contralateral lung (CR lung). The CR lung was calculated from the SUV of the tumor (T) and that of the contralateral normal lung (N) and then was measured by two formulas, namely, T–N/T+N and T/N.

Results: The sensitivities of both CR lung T–N/T+N and CR lung T/N were significantly higher than those of visual assessment, SUVmax, and CR brain (p = 0.01 to p < 0.001). No significant difference in sensitivity was observed between the CR lung T–N/T+N and CR lung T/N. Both CR lung T–N/T+N and CR lung T+N successfully imaged well-differentiated lung adenocarcinoma more frequently than the visual assessment, SUVmax, and CR brain (p = 0.002 to p < 0.001), whereas there were no significant differences of sensitivity among those five methods for the diagnosis of other histologic types of pulmonary malignancies.

Conclusions: The FDG uptake evaluated by the CR lung is superior to that evaluated using the visual assessment, SUVmax, and CR brain for the diagnosis of pulmonary malignancies, especially for well-differentiated lung adenocarcinoma. The simplified formula of CR lung with T/N can be used in place of that with T–N/T+N.

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Invited Commentary

Kemp H. Kernstine and Gary L. Grunkemeier
Ann. Thorac. Surg. 2009 87: 891-892. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				K. H. Kernstine and G. L. Grunkemeier Invited commentary. Ann. Thorac. Surg., March 1, 2009; 87(3): 891 - 892. [Full Text] [PDF]