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

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.

摘要
研究目的：明确18F-脱氧葡萄糖正电子发射断层扫描/计算机断层扫描（18F-FDG-PET/CT）改变孤立性肺结节恶性概率分级的频率。
材料与方法：本研究为回顾性分析，纳入2016年5月至2017年5月期间所有因排查孤立性肺结节而行18F-FDG-PET/CT检查的病例。研究人员通过查阅病历资料及PET/CT影像，采用斯旺森模型（Swensen model）与赫德模型（Herder model）计算恶性肿瘤验前概率。恶性概率分级标准为：＜5%为低危，5%~65%为中危，＞65%为高危。对于经斯旺森模型分级为中危的病例，采用赫德模型进行重新分级。
结果：本研究共纳入33例患者，其中17例（51.5%）为男性，平均年龄为68.63±12.20岁。经斯旺森模型评估，23例（69.7%）患者的恶性概率为中危。其中，经赫德模型重新分级后，6例（26.1%）被调整为低危，8例（34.8%）被调整为高危。
结论：在本次评估的病例中，超过50%的孤立性肺结节患者的恶性概率分级可通过18F-FDG-PET/CT检查得到修正。