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A Journal on Diseases of the Respiratory System
Official Journal of the Italian Society of Thoracic Endoscopy
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Minerva Pneumologica 2015 September;54(3):111-20
Value of fiberoptic bronchoscopy in addition to 18F-FDG-PET/CT in the differentiation of solitary pulmonary nodules: a prospective study
Conti V. 1, Marchi M. 1, Santi I. 2, Peterle C. 2, Cittanti C. 2, Panareo S. 2, Rinaldi R. 3, Contoli M. 1, Feggi L. 2, Papi A. 1, Ravenna F. 1
1 Pulmonology Unit, Department of Emergency, University Hospital Arcispedale S. Anna of Ferrara, Ferrara, Italy;
2 Nuclear Medicine Unit, Department of Diagnostic Imaging and Laboratory Medicine, University Hospital Arcispedale S. Anna of Ferrara, Ferrara, Italy;
3 Pathology Unit, Department of Diagnostic Imaging and Laboratory Medicine, University Hospital Arcispedale S. Anna of Ferrara, Ferrara, Italy
AIM: Evaluate the role of positron emission tomography (PET), fiberopticbronchoscopy (FOB) and PET+FOB in the diagnosis of solitary pulmonary nodules (SPN).
METHODS: A prospective study was performed in 58 patients (6 were excluded) with SPNwho underwent PET and FOB for lesion differentiation. FOB included transbronchial pulmonary biopsy (TBB), trans-bronchial pulmonary needle aspiration (TBNAp) and bronchial washing (BW). PET was positive when the standardized uptake value was ≥2.5, and FOB and the PET and FOB combination was positive when at least TBB, TBNA or BW was positive. The results were confirmed through histology after surgery or clinical follow-up. The sensitivity, specificity, accuracy, PPV and NPV of PET, FOB and PET+FOB were calculated.
RESULTS: Out of 52 patients, PET, FOB and PET+FOB resulted a true positive (TP) in 42, 20 and 42 cases, respectively, true negative (TN) in 6, 7 and 6 cases, false positive (FP) in 1, 0 and 1 cases, and false negative (FN) in 5, 25 and 3 cases. PET was FP in 1 TN FOB case and FN in 2 TP FOB cases. FOB was FN in 25 cases; 22 out of 25 were TP PET. The diagnostic performance of PET, FOB and PET+FOB were as follows: sensitivity 89%, 44% and 93%, respectively; specificity 86%, 100% and 86%; accuracy 89%, 52% and 92%; PPV (positive predictive value) 97%, 100% and 97%; NPV (negative predictive value) 54%, 21% and 66%.
CONCLUSION: PET+FOB showed a high sensitivity, accuracy and NPV compared to PET and FOB alone. PET has a high sensitivity but is not tumor-specific. FOB could be indicated for its high specificity and PPV.