Solitary Pulmonary Nodule: Medicare has approved the use of PET/CT in the assessment of SPN’s. Because of the low background uptake of FDG in the lung, the sensitivity of PET/CT for SPN’s is very high. In a meta analysis of over 1400 nodules, Gould et al (2001) found that PET had a sensitivity of 97% and an specificity of 78%.
1.Gould et al. Accuracy of PET for the diagnosis of pulmonary nodules and mass lesions: A Meta Analysis. JAMA 2001;2856:914-924.
Non-Small Cell Lung Cancer: Medicare has approved the use of PET/CT for staging, restaging and detecting recurrence in non-small cell lung cancer.
Lung Cancer & FDG PET Imaging Statistics**
Table 1: Utility of PET Imaging in Lung Cancer Diagnosis (N=1108)
Table 2: Utility of PET Imaging in Lung Cancer Staging (N=4005)
For this patient population there was a 37% change in the way the physician managed these patients based upon the PET scan.
Table 3: Utility of PET Imaging in Lung Cancer Recurrence (N=337)
Table 4: Utility ofPET Imaging in Monitoring Lung Cancer (N=270 )
** Reprinted by permission of the Society of Nuclear Medicine from: Gambhir, Sanjiv S., Czernin, Johannes, Schwimmer, Judy, Silverman, Daniel H.S., Coleman, R. Edward, Phelps, Michael E. “A Tabulated Summary of the FDG PET Literature” J Nucl Med 2001 42: 1-93.
Patient: 61yo male remote smoker. The patient presented with CP and abnormal CXR. He was treated for pneumonia without resolution. CT documented right lower lobe mass. He was scheduled for mediastinoscopy. Bone scan showed a cracked rib from a recent fall, but otherwise was called normal. PET/CT was ordered prior to surgery.
Results: Detected more disease than bone scan. Upstaged the patient to stage IV. Risk stratified the patient away from a futile invasive procedure.