Chest
Clinical InvestigationsClinical Prediction Model To Characterize Pulmonary Nodules: Validation and Added Value of 18 F-Fluorodeoxyglucose Positron Emission Tomography
Section snippets
Materials and Methods
Between August 1997 and March 2001, all patients with an indeterminate SPN, which had been detected during normal clinical work in both university and community hospital settings, who had been referred for FDG-PET scanning were retrospectively identified from the database of the PET center at the VU University Medical Centre. In our database, the characteristics of all patients are registered using a modified version of the American College of Radiology Index for Radiologic Diagnoses.
An
Results
In total, 106 eligible patients were identified, of whom 61 (57.5%) proved to have malignant nodules. Referring physicians were pulmonologists from university hospitals (n = 25) and community hospitals (n = 81). Fifty-eight percent of the patients were men, and their mean age was 64 years (age range, 32 to 85 years) [Table 1]. The diagnosis of malignancy was based on histopathologic results in 55 patients and on radiologic growth of the lesion in 6 patients. The diagnosis of a benign lesion was
Discussion
In 2003, a comprehensive cost-effectiveness decision analysis was published,1 which included the full spectrum of diagnostic and therapeutic options for SPNs. The first stratification of this analysis was based on the result of a clinical risk assessment as provided by a previously developed multivariate logistic regression model.2 It was recognized that this model, which was developed in a North American population with pulmonary nodules discovered between 1984 and 1986 and a prevalence of
Conclusion
The clinical prediction model of Swensen et al2 has been proven to have external validity. However, especially in the lower range of its estimates, the model may underestimate the actual probability of malignancy. The visual analysis of FDG-PET scans is a robust and accurate method in radiologically indeterminate SPNs. The combination of visually read FDG-PET scans and pretest factors appears to yield the best accuracy. These results can help to adjust the diagnostic workup in individual
ACKNOWLEDGMENT
We thank V. Bongers, MD; R.A.M.J. Claessens, MD; M.A.L. Edelbroek, MD; D.A.K.C.J.M. Huysmans, MD; R.A. Valdés Olmos, MD; D.E.A. Zanin, MD; and A. Zwijnenburg, MD; who performed a visual analysis of FDG-PET scans using intensity scales to assess the interobserver correlation.
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