Source: Annual Congress 2010 - State of the art imaging
Disease area: Respiratory infections, Thoracic oncology

Abstract

Background: Although integrated PET/CT forms an integral part of the evaluation process of patients with a solitary pulmonary nodule (SPN) it was only introduced to South Africa in 2008. The incidence of pulmonary tuberculosis (TB) in the Western Cape Province is 940 cases per 100,000, which is the highest recorded incidence. The diagnostic efficiency of PET/CT for SPN in such a setting is unknown.
Methods: We enrolled 20 consecutive patients (59.3 +/- 8.4 years, 10 males) with SPNs based on chest radiographs. SPNs were defined as intrapulmonary lesions ≤4cm in largest diameter. Integrated PET/CT was performed on all patients, followed by tissue acquisition by endoscopy, transthoracic FNA or surgery.
Results: Benign diagnoses were made in 11 patients (55%), malignant diagnoses in 9 patients. Benign diagnoses were TB granulomata (n=4), pulmonary harmatoma (n=1), rheumatoid nodule (n=1), solitary fibrous tumour (n=1), active MDR-TB (n=1), pneumonia (n=1), and abscess (n=1). One lesion was classified as benign based on radiographic follow up. Malignant diagnoses were squamous cell carcinoma (n=6), adenocarcinoma (n=2), and large cell carcinoma (n=1). No malignancy had an SUVmax below 2.5. All TB granulomata were true negative findings on PET/CT, whereas active MDR-TB was a false positive finding. An SUVmax cut-off of 2.5 had a sensitivity and NPV of 100% in detecting malignancy (specificity of 64%, PPV 69%).
Conclusion: In this pilot sample an SPN with an SUVmax ≤ 2.5 can be considered benign. Specificity and PPV are low in a population where benign SPNs are common.

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F. von Groote-Bidlingmaier, J. Warwick, M. Bernasconi, C. F. N. Koegelenberg, A. Mowlana, E. M. Irusen, P. Schubert, A. Ellman, C. T. Bolliger (Cape Town, South Africa). The diagnostic value of integrated PET/CT in solitary pulmonary nodules in an area with the world‘s highest recorded incidence of tuberculosis (a pilot study). Eur Respir J 2010; 36: Suppl. 54, 5280

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