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Occurrence of neoplasia in single pulmonary nodules (SPN) with no visual FDG uptake or FDG uptake SUVs less than 2.5 established by long term clinical follow-up

¹ Nuclear Medicine, University at Buffalo, Buffalo, New York

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Objectives: FDG PET is a highly sensitive method in characterizing single pulmonary nodules (SPN) with SUV > 2.5. However, the predictive value of negative FDG PET scans (visual or quantitative) is not well established. The purpose of this study was to compare the occurrence of neoplasia in SPNs with no visual FDG uptake versus FDG uptake and SUV less than 2.5.

Methods: A total of 128 pts presented with single pulmonary nodule (SPN) and negative PET scans were referred from a single outpatient pulmonary practice. Patients were scanned on a Posicam camera 45 minutes following injection of 10-15 mCi of FDG. There were 60 males and 68 females, 56% between the ages of 51-70 years, mean nodule size ranged between 1.73 to 2.02 cm. 56% were current or former smokers. Follow-up ranged from 22 to 40 months (mean 31.5 months).

Results: Of the 128 pts with SPN, 76 had no visual FDG uptake; 6 were malignant by biopsy and 70 were negative for malignancy on clinical follow-up. In contrast, only 29 of the 52 pts (56%) with FDG uptake < 2.5 were negative for malignancy. Thirty-four of these pts had biopsy. The difference in proportion of malignancy between the no FDG uptake (7.9%) and FDG uptake groups (44%) is statistically significant (Likelihood Ratio Chi-Square = 23.5, P < >0001). In 50 of 76 pts with no FDG uptake, the lesions remained stable in size in 50 pts, resolved in 5, whereas lesions in only 10 pts with FDG uptake remained unchanged.

Conclusions: SPN with no visual FDG uptake have a relatively low likelihood of malignancy (7.9%) compared to lesions with FDG SUV less than 2.5 (44%). This study confirms our previous work (JNM 2006, 47:173) that there is no predetermined fixed value of SUV cutoff that is accurately able to diagnose malignancy in small pulmonary nodules.

Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Abdel-Nabi, H. Articles by Baker, J. PubMed Articles by Abdel-Nabi, H. Articles by Baker, J.