Alberto Bazzocchi MD, Abstract Co-Author: Nothing to Disclose

Stefano Brocchi MD, Presenter: Nothing to Disclose

Valentina Ambrosini, Abstract Co-Author: Nothing to Disclose

Giancarlo Facchini, Abstract Co-Author: Nothing to Disclose

Salvatore Ascanio, Abstract Co-Author: Nothing to Disclose

Giuseppe Battista, Abstract Co-Author: Nothing to Disclose

Stefano Fanti MD, Abstract Co-Author: Research Consultant, Siemens AG Advisory Board, Bayer AG

Criticisms and limitations of standard uptake value (SUV) in positron emission tomography (PET) imaging are well known. Our aim was to investigate the role of SUVmax in the detection of malignancy of solitary lung nodules and to study its potential prognostic value.

We retrospectively analyzed the clinical history of 1010 patients (657 males, 353 females, 72.6±11.8 year-old) who were submitted to PET/CT for solitary lung nodules, between January 2002 and May 2012 in a single centre. The analysis included the evaluation of images and physicians’ reports of PET/CT exams, anamnesis of patients and subsequent diagnostic examinations in their follow-up (imaging, biopsy specimen and/or pathological analysis after surgical resection). Follow-up of all patients ended with survival control at the time of the present study. Receiver operating characteristic (ROC) curves and Kaplan-Meier method were used for statistical analysis.

In 457/1010 (45.2%) subjects a non-small cell lung cancer (NSCLC) was diagnosed; in all other patients 553/1010 (54.8%) lesions were classified as non-oncologic diseases or benign. Area under the ROC curve was 0.956, with SUVmax cut-off value of 2.3, resulting in 93.6% and 90.4%, sensitivity and specificity respectively. The survival analysis was possible in 459 patients (217/459 NSCLC), with a mean follow-up of 70.2±30.34 months. Nodules with higher SUVmax value (>2.3) were associated with lower survival rate (p<0.0001): for SUVmax >2.3 and <2.3 the survival rates 1 year after PET imaging were respectively 75% and 94%, at 2 years after PET 59% and 90%, while survival expectancies at 3 years were 51% and 85%. The outcome was independent from the dimension of the lesion or from surgical/non-surgical treatment approach.

In conclusion, our single-centre experience showed that a cut-off value of 2.3 SUVmax is a very accurate marker for prognosis stratification in patients with solitary lung nodules.

The detection of a solitary lung nodule is common and its management critical. A PET/CT scan is often required to guide the clinicians in the management of such patients. The use of SUVmax from PET/CT imaging in a local large population showed to be very accurate in differentiating malignant from benign lesions and it deserves consideration in predicting patients prognosis.  

Bazzocchi, A, Brocchi, S, Ambrosini, V, Facchini, G, Ascanio, S, Battista, G, Fanti, S, Accuracy and Potential of Maximum Standard Uptake Value in the Diagnosis of Solitary Lung Nodules.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14014289.html