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Title: The Role of PET/CT in Assessing Pulmonary Nodules in Children With Solid Malignancies
Authors: McCarville, M. Beth
Billups, Catherine
Wu, Jianrong
Kaufman, Robert
Kaste, Sue
Coleman, Jamie
Sharp, Susan
Nadel, Helen
Charron, Martin
Lederman, Henrique [UNIFESP]
Don, Steven
Shochat, Stephen
Daw, Najat C.
Shulkin, Barry
St Jude Childrens Res Hosp
Cincinnati Childrens Hosp Med Ctr
British Columbia Childrens Hosp
Hosp Sick Children
Universidade Federal de São Paulo (UNIFESP)
St Louis Childrens Hosp
Keywords: children
pulmonary nodules
solid malignancies
Issue Date: 1-Dec-2013
Publisher: Amer Roentgen Ray Soc
Citation: American Journal of Roentgenology. Reston: Amer Roentgen Ray Soc, v. 201, n. 6, p. W900-W905, 2013.
Abstract: OBJECTIVE. the purpose of this article is to assess the feasibility and utility of PET/CT in distinguishing benign from malignant pulmonary nodules in patients with solid childhood malignancies.SUBJECTS and METHODS. This prospective study was conducted between March 2008 and August 2010. We enrolled 25 subjects 21 years old or younger with solid childhood malignancies and at least one pulmonary nodule measuring 0.5-3.0 cm. PET/CT was performed within 3 weeks of diagnostic chest CT. Three panels of three reviewers each reviewed diagnostic CT only (panel 1), PET/CT only (panel 2), or diagnostic CT and PET/CT concurrently (panel 3) and predicted each nodule's histologic diagnosis as benign, malignant, or indeterminate. Interreviewer agreement was assessed with the kappa statistic. Using nodule biopsy or clinical follow-up as reference standards, the sensitivity, specificity, and accuracy for each panel was assessed. Logistic regression was used to assess the nodule's maximum standardized uptake value (SUVmax) association with its histologic diagnosis.RESULTS. There were 75 nodules with a median size of 0.74 cm (range, 0.18-2.38 cm); 48 nodules were malignant. Sensitivity was 85% (41/48) for panel 1, 60% (29/48) for panel 2, and 67% (32/48) for panel 3. All panels had poor specificities. Interreviewer agreement was moderate for panel 1 (0.43) and poor for panels 2 (0.22) and 3 (0.33). SUVmax was a significant predictor of histologic diagnosis (p = 0.004).CONCLUSION. PET/CT assessment of pulmonary nodules is feasible in children with solid malignancies but may not reliably improve our ability to predict a nodule's histologic diagnosis. the SUVmax may improve the performance of PET/CT in this setting.
ISSN: 0361-803X
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