FDG-PET imaging and the diagnosis of non-small cell lung cancer in a region of high histoplasmosis prevalence

Study objective: Determine the sensitivity and specificity of [F-18]-fluorine-2-deoxy-D-glucose positron emission tomography (FDG-PET) in differentiating non-small cell lung cancer (NSCLC) from benign solitary pulmonary nodules (SPNs) in a region with a high endemic rate of histoplamosis. Design: Prospective, clinical study. Setting: University, tertiary referral hospital in the upper Mississippi River valley. Patients: Ninety patients with SPNs. Interventions: Independent interpretation of FDG-PET imaging, computed tomography and pathologic evaluation of the SPNs. Measurements and results: To detect malignant SPNs, FDG-PET imaging had a sensitivity of 93%, a specificity of 40%, a positive predictive value (PPV) of 88% and a negative predictive value (NPV) of 55%. Conclusions: In a region with a high prevalence of pulmonary fungal infection, FDG-PET is sensitive but has a low specificity and NPV for identifying NSCLC.In our study cohort, FDG-PET does not appear to reduce the need for SPN biopsies. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved.