The impact of F-18 fluorodeoxyghicose positron emission tomography in the management of patients with lung nodule and associated risk of morbidity or indeterminate results at biopsy

The purpose of the study was to assess the clinical impact of positron emission tomography (PET) with fluorine-18 fluorodeoxyglucose (FDG) in the management of patients who were unsuitable candidates for transthoracic needle aspiration (TTNA) of solitary lung nodules. The PET study results of forty-six patients were retrospectively evaluated. The major indications for PET study were the inaccessibility of the lesion or the small size of the lung nodules for TTNA (n=16), a previous undiagnostic or a denied procedure (n=12), or massive chronic obstructive pulmonary disease (COPD) (n=13). A PET scan was also performed in 3 elderly patients and in 2 subjects treated with anticoagulant drugs. The patient's clinical history and the results of computed tomography (CT) were also evaluated to assess thepre-test likelihood of cancer (high, low or indeterminate probability) and their influence on the decision making process in comparison with PET results. No treatment was performed in 19/23 (83%) patients with negative PET studies and low or indeterminate pre-test likelihood for cancer, whereas a surgical assessment of lung nodules was obtained in the remaining 4 patients, all with high probability for tumour. All 19 patients with focal FDG lung nodule uptake had surgery or chemoradiotherapy irrespective of probability of cancer, whereas an antimicrobial therapy for infectious disease was performed in the 4 patients with equivocal PET studies and low or indeterminate likelihood. The results of FDG-PET study may influence the management of patients unsuitable for TTNA, whenever CT images do not strongly suggest cancer.