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PET Shown To Outperform CT in Characterization of Lung Nodules

By MedImaging staff writers
Posted on 25 Feb 2008

Researchers involved in a large, multi-institutional study comparing the accuracy of positron emission tomography (PET) and computed tomography (CT) imaging in the characterization of lung nodules discovered that PET was far more effective in detecting whether or not a nodule was malignant.

"CT and PET have been widely used to characterize solitary pulmonary nodules [SPNs] as benign or malignant,” said Dr. James W. Fletcher, professor of radiology at Indiana University School of Medicine (Indianapolis, IN, USA). "Almost all previous studies examining the accuracy of CT for characterizing lung nodules, however, were performed more than 15 years ago with outdated technology and methods, and previous PET studies were limited by small sample sizes. Detecting and characterizing SPNs is important because malignant nodules represent a potentially curable form of lung cancer. Identifying which SPNs are most likely to be malignant enables physicians to initiate the proper therapy before local or distant metastases develop,” said Dr. Fletcher.

In a head-to-head study addressing the limitations of previous studies, PET and CT images on 344 patients were independently interpreted by a panel of experts in each imaging modality, and their determination of benign and malignant nodules were compared to pathologic findings or changes in SPN size over the next two years.

The researchers found that when PET and CT results were interpreted as "probably” or "definitely” benign, the results were "strongly associated with a benign final diagnosis”--in other words, the modalities were equally effective at making this determination. PET's superior specificity (accuracy in characterizing a nodule as benign or malignant), however, resulted in correctly classifying 58% of the benign nodules that had been incorrectly classified as malignant on CT. Furthermore, when PET interpreted SPNs as definitely malignant, a malignant final diagnosis was 10 times more likely than a benign.

SPNs are typically encountered in both primary and specialty settings, frequently appearing on chest x-rays obtained for some other reason than cancer screening and are often the first sign of lung cancer. The question for these patients then becomes whether to undergo surgery, undergo a needle biopsy, or "watch and wait” to find out if the nodule is benign or malignant but treatable.

"In patients with an untreated and undiagnosed SPN between 7 and 30 mm, PET provides better identification of malignant nodules that require a more aggressive treatment approach,” said Dr. Fletcher. "PET in combination with CT can also provide good identification of those nodules that are most likely to be benign, suggesting that a ‘watch and wait' strategy can be adopted in lieu of unnecessary invasive--and expensive--procedures such as needle biopsy or surgery,” he added.

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68 (30.994415283203): SELECT fid FROM jos_deeppockets WHERE id=272500000 AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE id=272500000 AND published='1' LIMIT 1

69 (30.994415283203): SELECT id,name,sponsor_text FROM jos_deeppockets dp left outer join jos_channel_sponsor cs on dp.id=cs.fid WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id=213 ORDER BY `ordering`

70 (262.97569274902): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

71 (247.00164794922): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

72 (39.100646972656): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

73 (46.968460083008): SELECT show_live FROM jos_com_show_setting LIMIT 1

74 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

75 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

76 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

77 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

78 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

79 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

80 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

81 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

82 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

83 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

84 (28.848648071289): SELECT show_live FROM jos_com_show_setting LIMIT 1

85 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

86 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

87 (45.061111450195): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

88 (28.848648071289): SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

89 (33.140182495117): SELECT id,name,title FROM jos_deeppockets WHERE cat=10 AND TYPE='file_folder' AND published=1 AND id != 294743300 AND id != 294743301 AND id != 294743302 AND id != 294743303 AND id != 294743304 AND id != 294743305 AND id != 294743306 AND id != 294743307 AND id != 294743308 AND id != 294743309 AND id != 294743310 AND metakey != 'aacc' ORDER BY `ordering`

90 (60.081481933594): SELECT show_live FROM jos_com_show_setting LIMIT 1

91 (30.994415283203): SELECT show_live FROM jos_com_show_setting LIMIT 1

92 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

93 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

94 (72.002410888672): SELECT show_live FROM jos_com_show_setting LIMIT 1

95 (36.954879760742): SELECT show_live FROM jos_com_show_setting LIMIT 1

96 (34.093856811523): SELECT show_live FROM jos_com_show_setting LIMIT 1

97 (28.133392333984): SELECT show_live FROM jos_com_show_setting LIMIT 1

98 (26.941299438477): SELECT show_live FROM jos_com_show_setting LIMIT 1

99 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

100 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

101 (27.894973754883): SELECT show_live FROM jos_com_show_setting LIMIT 1

102 (27.179718017578): SELECT show_live FROM jos_com_show_setting LIMIT 1

103 (29.087066650391): SELECT show_live FROM jos_com_show_setting LIMIT 1

104 (66.041946411133): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

105 (43.869018554688): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

106 (50.067901611328): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

107 (46.968460083008): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

108 (71.048736572266): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

109 (45.061111450195): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

110 (54.121017456055): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

111 (498.05641174316): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

112 (547.88589477539): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

113 (309.94415283203): SELECT dp.name, dp.id, dp2.name as channel, ex.name as author_name, ex.specialization, ex.images FROM jos_deeppockets as dp LEFT JOIN jos_experts as ex ON ex.id = dp.author LEFT JOIN jos_deeppockets as dp2 ON dp2.id = dp.fid WHERE dp.author != 0 AND dp.cat = 10 AND dp.published = 1 AND ( (dp.fid = 294743300) OR (dp.fid = 294743301) OR (dp.fid = 294743302) OR (dp.fid = 294743303) OR (dp.fid = 294743304) OR (dp.fid = 294743305) OR (dp.fid = 294743306) OR (dp.fid = 294743307) OR (dp.fid = 294743308) OR (dp.fid = 294743309) OR (dp.fid = 294743310) ) ORDER BY RAND() LIMIT 1

114 (72.002410888672): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

115 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

116 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

117 (38.14697265625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

118 (41.961669921875): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

119 (72.956085205078): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

120 (49.114227294922): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

121 (38.862228393555): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

122 (250.10108947754): SELECT * FROM trending_articles WHERE `journal_id` = 10 AND `timestamp` <= NOW() + INTERVAL 7 DAY ORDER BY `order`

123 (!!!!! 18923.997879028): SELECT * FROM jos_deeppockets WHERE jos_deeppockets.cat = 10 AND jos_deeppockets.type = 'deeppockets_item' AND jos_deeppockets.published = 1 AND jos_deeppockets.created + INTERVAL 14 DAY >= NOW() ORDER BY jos_deeppockets.hits DESC LIMIT 7

124 (487.08915710449): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=272500000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=272500000 AND type='deeppockets_item' AND published='1' LIMIT 1

125 (55.074691772461): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

126 (37.193298339844): ( SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.video != '' AND dp.video_source != '' AND dp.cat = 10 AND dp.published = 1 AND dp.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) UNION ( SELECT dpa.id, dpa.name, dpa.title, dpa.video, dpa.video_source, dpa.created FROM jos_deeppockets_archive AS dpa WHERE dpa.video != '' AND dpa.video_source != '' AND dpa.cat = 10 AND dpa.published = 1 AND dpa.type != 'deeppockets_item_link' ORDER BY created DESC LIMIT 3 ) ORDER BY created DESC LIMIT 3

127 (34.093856811523): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

128 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803337 LIMIT 1

129 (37.908554077148): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

130 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294803276 LIMIT 1

131 (28.848648071289): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

132 (29.087066650391): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets_archive AS dp WHERE dp.id = 294803276 LIMIT 1

133 (27.894973754883): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

134 (26.941299438477): SELECT dp.id, dp.name, dp.title, dp.video, dp.video_source, dp.created FROM jos_deeppockets AS dp WHERE dp.id = 294802958 LIMIT 1

135 (468.96934509277): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

136 (312.08992004395): SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

137 (36.954879760742): SELECT name FROM jos_deeppockets WHERE id=213

138 (31.948089599609): SELECT name FROM jos_deeppockets WHERE id=213

139 (513.79203796387): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

140 (501.15585327148): SELECT *, DATE_FORMAT(publish_up,'%d %b %Y') AS date_publish_up, DATE_FORMAT(publish_down,'%d %b %Y') AS date_publish_down FROM jos_events WHERE state=1 AND publish_up > NOW() and extra_info REGEXP '((;)|(^))213((;)|($))' AND catid IN (0,110) ORDER BY publish_up ASC LIMIT 3

141 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

142 (47.922134399414): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

143 (!!!!! 7640.8386230469): TRUNCATE TABLE jos_trademed_module

144 (101.80473327637): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

145 (56.028366088867): SELECT dp.*, ch.title as channel, exp.name as author_name, exp.specialization as author_specialization, exp.images as author_photo FROM jos_deeppockets_archive as dp LEFT JOIN jos_experts as exp ON exp.id = dp.author LEFT JOIN jos_deeppockets as ch ON dp.fid = ch.id WHERE 1=1 AND dp.cat=10 AND dp.id=272500000 AND (dp.type='deeppockets_item' OR dp.type='deeppockets_item_link') AND dp.published='1' LIMIT 1

146 (819.92149353027): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

147 (60.796737670898): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND (type='deeppockets_item' OR type='deeppockets_item_link') AND published='1' LIMIT 1

148 (64.849853515625): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

149 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

150 (!!!!! 1148.9391326904): SELECT jos_item.* FROM jos_item INNER JOIN jos_number ON jos_item.numberID=jos_number.id WHERE 1=1 AND (jos_item.imgMini<>'') AND jos_item.type='L' AND jos_item.numberID= ( SELECT jos_number.id FROM jos_number WHERE jos_number.journalID IN (10) and jos_number.id in (select distinct jos_number.id from jos_number join jos_item on jos_item.numberid=jos_number.id where jos_item.type='P') ORDER BY (CONVERT(SUBSTRING(issue,1,2),SIGNED) + (CONVERT(SUBSTRING(issue,3,2),SIGNED)*100)) DESC LIMIT 0,1 ) ORDER BY RAND() DESC LIMIT 6

151 (58.889389038086): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

152 (50.067901611328): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

153 (32.901763916016): SELECT fid FROM jos_deeppockets WHERE cat=10 AND id=272500000 AND type='deeppockets_item' AND published='1' union SELECT fid FROM jos_deeppockets_archive WHERE cat=10 AND id=272500000 AND type='deeppockets_item' AND published='1' LIMIT 1

154 (30.040740966797): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

155 (28.133392333984): select distinct links.* from jos_textlinks links join jos_textlinks_placement placement on links.id=placement.link_id where journal_id=(10) and (channel_id=213 or channel_id is null)

156 (34.093856811523): SELECT livesite FROM jos_dp_categories WHERE id=10 AND published='1' LIMIT 1

157 (61.988830566406): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

158 (46.014785766602): SELECT * FROM jos_deeppockets WHERE 1=1 AND id=272500000 AND published='1' union SELECT * FROM jos_deeppockets_archive WHERE 1=1 AND id=272500000 AND published='1' LIMIT 1

159 (37.908554077148): select jos_twitters.link from jos_twitters where cat=10

160 (33.140182495117): select jos_facebook.link from jos_facebook where cat=10

161 (31.948089599609): select jos_google_plus.link from jos_google_plus where cat=10

162 (31.948089599609): select jos_linkedin.link from jos_linkedin where cat=10

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