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. 2020 Jan-Feb;53(1):1-6.
doi: 10.1590/0100-3984.2019.0034.

Use of PET/CT to aid clinical decision-making in cases of solitary pulmonary nodule: a probabilistic approach

Felipe Alves Mourato  1 , Ana Emília Teixeira Brito  1 , Monique Sampaio Cruz Romão  1 , Renata Guerra Galvão Santos  1 , Cristiana Altino de Almeida  1 , Paulo José de Almeida Filho  1 , Aline Lopes Garcia Leal  1
Affiliations

Use of PET/CT to aid clinical decision-making in cases of solitary pulmonary nodule: a probabilistic approach

Felipe Alves Mourato et al. Radiol Bras. 2020 Jan-Feb.

Abstract

Objective: To determine the frequency with which 18F-FDG-PET/CT findings change the probability of malignancy classification of solitary pulmonary nodules.

Materials and methods: This was a retrospective analysis of all 18F-FDG-PET/CT examinations performed for the investigation of a solitary pulmonary nodule between May 2016 and May 2017. We reviewed medical records and PET/CT images to collect the data necessary to calculate the pre-test probability of malignancy using the Swensen model and the Herder model. The probability of malignancy was classified as low if < 5%, intermediate if 5-65%, and high if > 65%. Cases classified as intermediate in the Swensen model were reclassified by the Herder model.

Results: We reviewed the records for 33 patients, of whom 17 (51.5%) were male. The mean age was 68.63 ± 12.20 years. According to the Swensen model, the probability of malignancy was intermediate in 23 cases (69.7%). Among those, the application of the Herder model resulted in the probability of malignancy being reclassified as low in 6 (26.1%) and as high in 8 (34.8%).

Conclusion: 18F-FDG-PET/CT was able to modify the probability of malignancy classification of a solitary pulmonary nodule in more than 50% of the cases evaluated.

Keywords: Clinical decision-making; Decision support techniques; Medical oncology; Positron emission tomography; Pulmonary medicine; Solitary pulmonary nodule.

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Figures

Figure 1
Figure 1
Variation in the probability of malignancy classification per patient according to each model.
Figure 2
Figure 2
Examples of the use of 18F-FDG-PET/CT in SPNs. A: A nodule for which the probability of malignancy was 33.2% on the basis of clinical and CT findings, decreasing to 10% when the absence of 18F-FDG uptake was taken into account (a follow-up CT scan at two years out showed that the nodule had disappeared). B: A nodule for which the probability of malignancy was 6.2% on the basis of clinical and CT findings, increasing to 75.8% when the moderate 18F-FDG uptake was taken into account (a subsequent biopsy revealed an adenocarcinoma).
See this image and copyright information in PMC

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