Soliter Pulmoner Nodüllerin Değerlendirilmesi: Malign Lezyonların Ayırıcı Tanısında F-18 FDG PET/BT’ Nin Tanısal Değeri

Amaç: Soliter pulmoner nodüllerde tedavi yaklaşımının doğru şekilde belirlenmesi açısından malign - benign lezyon ayırıcı tanısının yapılması oldukça önemlidir. Flor-18 florodeoksiglukoz (F-18 FDG) PET/BT, morfolojik ve metabolik bilgiyi bir arada sunarak lezyon karakterizasyonuna önemli katkı sağlayan bir görüntüleme yöntemidir. Çalışmamızda, soliter pulmoner nodüllerde F-18 FDG PET/BT yönteminin malign lezyon ayırıcı tanısına katkısının araştırılması amaçlanmıştır. Yöntemler: Bilgisayarlı tomografide maksimum aksiyel çapı 1-3 cm arasında soliter pulmoner nodül saptanan, nodül karakterizasyonu amacı ile F-18 FDG PET/BT tetkiki uygulanan 54 hastaya ait bulgular retrospektif olarak değerlendirildi. Tüm hastaların histopatolojik tanıları mevcuttu. Nodüllerin maksimum aksiyel çapları ve maksimum standardize tutulum değerleri (maksSTD) belirlenerek histopatolojik son tanılar ile karşılaştırıldı. MaksSTD için 2,5 eşik değer olarak kabul edildiğinde (benign

Evaluation Of Solitary Pulmonary Nodules: Diagnostic Value Of F-18 FDG PET/CT In The Differential Diagnosis Of Malignant Lesions

Objective: The differential diagnosis of malign and benign lesions is very important for the accurate determination of the treatment approach in solitary pulmonary nodules. Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT is an imaging method that provides significant contribution to lesion characterization by providing morphological and metabolic information together. In our study, we aimed to research the contribution of F-18 FDG PET/CT to the differential diagnosis of malignant lesions in solitary pulmonary nodules. Methods: Fifty-four patients who had solitary pulmonary nodule with maximal axial diameter of 1-3 cm on computed tomography and underwent F-18 FDG PET/CT for nodule characterization were retrospectively evaluated. All patients had histopathological diagnosis. Maximum axial diameters and maximum standardized uptake values (maxSUV) of nodules were determined and compared with histopathological diagnoses. Assuming a threshold of 2.5 for maxSUV (benign

PDF

___

1. Czernin J, Allen-Auerbach M, Nathanson D, Herrmann K. PET/CT in Oncology: Current Status and Perspectives. Curr Radiol Rep 2013; 1: 177-90.
2. Yankelevitz DF, Henscke CI.Does 2 years stability imply that pulmonary nodüle are benign?Am J Roentgenol 1997; 168:325-8.
3. Hou S, Lin X, Wang S, et al. Combination of positron emission tomography/computed tomography and chest thin-layer highresolution computed tomography for evaluation of pulmonary nodules: Correlation with imaging features, maximum standardized uptake value, and pathology. Medicine (Baltimore) 2018;97(31):e11640. doi: 10.1097/MD.0000000000011640.
4. Gould MK, Maclean CC, Kuschner WG, Rydzak CE, Owens DK. Accuracy of positron emission tomography for diagnosis of pulmonary nodules and mass lesions: a meta-analysis. JAMA 2001; 285: 914–24.
5. Li Y, Su M, Li F, Kuang A, Tian R. The value of ¹⁸F-FDG-PET/CT in the differential diagnosis of solitary pulmonary nodules in areas with a high incidence of tuberculosis. Ann Nucl Med 2011; 25: 804-11.
6. Jeong SY, Lee KS, Shin KM, et al. Efficacy of PET/CT in the characterization of solid or partly solid solitary pulmonary nodules. Lung Cancer 2008; 61: 186–94.
7. Jeong YJ, Yi CA, Lee KS. Solitary pulmonary nodules: detection, characterization, and guidance for further diagnostic workup and treatment. AJR Am J Roentgenol 2007; 188: 57– 68.
8. Kim BT, Kim Y, Lee KS, et al. Localized form of bronchioloalveolar carcinoma: FDG PET findings. AJR Am J Roentgenol 1998; 170: 935 – 9.
9. Cheran SK, Nielsen ND, Patz EF. FalseNegative Findings for Primary Lung Tumors on FDG Positron Emission Tomography: Staging and Prognostic Implications. AJR Am J Roentgenol 2004; 182: 1129-32.
10. Fletcher JW, Kymes SM, Gould M, et al. A comparison of the diagnostic accuracy of 18FFDG PET and CT in the characterization of solitary pulmonary nodules. J Nucl Med 2008; 49: 179–85.
11. Matthies A, Hickeson M, Cuchiara A, Alavi A. Dual time point 18F‑FDG PET for the evaluation of pulmonary nodules. J Nucl Med 2002; 43: 871‑5.
12. Barger RL Jr., Nandalur KR. Diagnostic performance of dual‑time 18F‑FDG PET in the diagnosis of pulmonary nodules: A metaanalysis. Acad Radiol 2012; 19: 153‑8.
13. Zhang L, Wang Y, Lei J, Tian J, Zhai Y. Dual time point 18FDG‑PET/CT versus single time point 18FDG‑PET/CT for the differential diagnosis of pulmonary nodules: A metaanalysis. Acta Radiol 2013; 54: 770‑7.
14. Sathekge MM, Maes A, Pottel H, Stoltz A, van de Wiele C. Dual time‑point FDG PET‑CT for differentiating benign from malignant solitary pulmonary nodules in a TB endemic area. S Afr Med J 2010;100:598‑601.
15. Chang CY, Tzao C, Lee SC, et al. Incremental value of integrated FDG-PET/CT in evaluating indeterminate solitary pulmonary nodule for malignancy. Mol Imaging Biol 2010; 12: 204-9.
16. Ooi GC, Khong PL, Yau YY. Advances in imaging of the solitary pulmonary nodule. Hong Kong Med J 2004; 10: 107–16.
17. Erasmus JJ, Connolly JE, McAdams HP, Roggli VL. Solitary pulmonary nodules: Part I. orphologic evaluation for differentiation of benign and malignant lesions. Radiographics 2000; 20: 43-58.
18. Yang D, Li Y, Liu J, et al. Study on solitary pulmonary nodules: correlation between diameter and clinical manifestation and pathological features. Zhongguo Fei Ai Za Zhi 2010; 13: 607-11.
19. Nguyen NC, Kaushik A, Wolverson MK, Osman MM. Is there a common SUV threshold in oncological FDG PET/CT, at least for some common indications? A retrospective study. Acta Oncologica 2011; 50: 670-77.
20. Orlacchio A, Schillaci O, Antonelli L, et al. Solitary pulmonary nodules: morphological and metabolic characterisation by FDG-PET-MDCT. Radiol med 2007; 112: 157–73.
21. Davies B, Ghosh S, Hopkinson D, Vaughan R, Rocco G. Solitary pulmonary nodules: pathological outcome of 150 consecutively resected lesions. Interact Cardiovasc Thorac Surg 2005; 4: 18–20.