Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT:
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ORIGINAL ARTICLE
Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT: the SPUTNIK trial J. R. Weir-McCall 1,2 & S. Harris 3 & K. A. Miles 4 & N. R. Qureshi 2 & R. C. Rintoul 5 & S. Dizdarevic 6 & L. Pike 7 & Heok K. Cheow 8 & Fiona J. Gilbert 1 & on behalf of the SPUtNIk investigators Received: 5 September 2020 / Accepted: 20 October 2020 # The Author(s) 2020
Abstract Purpose To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. Methods Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. Results Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. Conclusion In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. Trial registration ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063 Keywords Solitary pulmonary nodule (SPN) . DCE-CT . PET/CT . Diagnostic imaging . Lung cancer . Diagnostic accuracy trial . Cost-effectiveness
This article is part of the Topical Collection on Oncology - Chest. Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s00259-02005089-y. * Fiona J. Gilbert [email protected] 1
Department of Radiology, Biomedical Research Centre, University of Cambridge School of Clinical Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
2
Department of Radiology, Royal Papworth Hospital, Cambridge, UK
3
Public Health Sciences and Medical Statistics, University of Southampton, Southampton, UK
4
Institute of Nuclear Medicine, University College London, London, UK
5
Department of Thoracic Oncology, Royal Papworth Hospital / Department of Oncology, University of Cambridge
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