• Susan C van't Westeinde, Harry J de Koning, Frederik B Thunnissen, Matthijs Oudkerk, Harry J M Groen, Jan-Willem J Lammers, Carla Weenink, Rene Vernhout, Kristiaan Nackaerts, Willem Mali, and Rob J van Klaveren.
• Department of Pulmonary Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands. s.vantwesteinde@erasmusmc.nl
• J Thorac Oncol. 2011 Oct 1; 6 (10): 1704-12.

BackgroundIn computed tomography lung cancer screening programs, up to 30% of all resections are futile.ObjectiveTo investigate whether a preoperative positron emission tomography (PET) after a conclusive or inconclusive nonsurgical workup will reduce the resection rate for benign disease in test-positive participants of a lung cancer screening program.Methods¹⁸F-Fluorodeoxyglucose-PET scans were made in 220 test positives. Nodules were classified as positive, indeterminate, or negative based on visual comparison with background activity. Gold standard for a positive PET was the presence of cancer in the resection specimen or the detection of cancer during more than 2 years follow-up. Sensitivity, specificity, positive predictive value, and negative predictive value (NPV) were calculated at participant level and 95% confidence intervals (CIs) constructed.ResultsThe sensitivity of PET to detect cancer was 84.2% (95% CI: 77.6-90.7%), the specificity 75.2% (95% CI: 67.1-83.3), the positive predictive value 78.9% (95% CI: 71.8-86.0), and the NPV 81.2% (95% CI: 73.6-88.8). The resection rate for benign disease was 23%, but 26% of them had a diagnosis with clinical consequences. A preoperative PET after an inconclusive nonsurgical workup reduced the resection rate for benign lesions by 11 to 15%, at the expense of missing 12 to 18% lung cancer cases. A preoperative PET after a conclusive nonsurgical workup reduced the resection rate by 78% at the expense of missing 3% lung cancer cases.ConclusionA preoperative PET scan in participants with an inconclusive nonsurgical workup is not recommended because of the very low NPV, but after a conclusive nonsurgical workup, the resection rate for benign disease can be decreased by 72%.

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