TY - JOUR
T1 - Impact of solitary pulmonary nodule size on qualitative and quantitative assessment using 18F-fluorodeoxyglucose PET/CT
T2 - the SPUTNIK trial
AU - SPUtNIk investigators
AU - Weir-McCall, J. R.
AU - Harris, S.
AU - Miles, K. A.
AU - Qureshi, N. R.
AU - Rintoul, R. C.
AU - Dizdarevic, Sabina
AU - Pike, L.
AU - Cheow, Heok K.
AU - Gilbert, Fiona J.
AU - Banerjee, Anindo
AU - Brindle, Lucy
AU - Callister, Matthew
AU - Clegg, Andrew
AU - Cook, Andrew
AU - Cozens, Kelly
AU - Crosbie, Philip
AU - Dizdarevic, Sabina
AU - Eaton, Rosemary
AU - Eichhorst, Kathrin
AU - Frew, Anthony
AU - Gleeson, Fergus
AU - Groves, Ashley
AU - Han, Sai
AU - Jones, Jeremy
AU - Kankam, Osie
AU - Karunasaagarar, Kavitasagary
AU - Kurban, Lutfi
AU - Little, Louisa
AU - Madden, Jackie
AU - McClement, Clare
AU - Miles, Ken
AU - Moate, Patricia
AU - Peebles, Charles
AU - Pike, Lucy
AU - Poon, Fat Wui
AU - Sinclair, Donald
AU - Shah, Andrew
AU - Vale, Luke
AU - George, Steve
AU - Riley, Richard
AU - Lodge, Andrea
AU - Buscombe, John
AU - Green, Theresa
AU - Stone, Amanda
AU - Navani, Neal
AU - Shortman, Robert
AU - Azzopardi, Gabriella
AU - Doffman, Sarah
AU - Bush, Janice
AU - Smith, Elaine
N1 - Funding Information:
The SPUTNIK trial is funded by the NIHR HTA Programme (grant no: 09/22/117) and part funded by CRUK. RCR is part funded by the Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre and the Cancer Research Network: Eastern. NRQ is part funded by the Cambridge Biomedical Research Centre. FJG is an NIHR Senior Investigator. This work has in part been presented at the European Congress of Radiology, Vienna 2020.
Funding Information:
The SPUTNIK trial is funded by the NIHR HTA Programme (grant no: 09/22/117) and part funded by CRUK. RCR is part funded by the Cambridge Biomedical Research Centre, Cancer Research UK Cambridge Centre and the Cancer Research Network: Eastern. NRQ is part funded by the Cambridge Biomedical Research Centre. FJG is an NIHR Senior Investigator. This work has in part been presented at the European Congress of Radiology, Vienna 2020. SPUTNIK investigators Anindo Banerjee, Lucy Brindle, Matthew Callister, Andrew Clegg, Andrew Cook, Kelly Cozens, Philip Crosbie, Sabina Dizdarevic, Rosemary Eaton, Kathrin Eichhorst, Anthony Frew, Fergus Gleeson, Ashley Groves, Sai Han, Jeremy Jones, Osie Kankam, Kavitasagary Karunasaagarar, Lutfi Kurban, Louisa Little, Jackie Madden, Clare McClement, Ken Miles, Patricia Moate, Charles Peebles, Lucy Pike, Fat-Wui Poon, Donald Sinclair, Andrew Shah, Luke Vale, Steve George, Richard Riley, Andrea Lodge, John Buscombe, Theresa Green, Amanda Stone, Neal Navani, Robert Shortman, Gabriella Azzopardi, Sarah Doffman, Janice Bush, Jane Lyttle, Kenneth Jacob, Joris van der Horst, Joseph Sarvesvaran, Barbara McLaren, Lesley Gomersall, Ravi Sharma, Kathleen Collie, Steve O?Hickey, Jayne Tyler, Sue King, John O?Brien, Rajiv Srivastava, Hugh Lloyd-Jones, Sandra Beech, Andrew Scarsbrook, Victoria Ashford-Turner, Elaine Smith, Susan Mbale, Nick Adams, and Gail Pottinger.
Funding Information:
Open access funding provided by University of Cambridge. This project was funded by the NIHR Health Technology Assessment Programme (09 22 117). Acknowledgments
Publisher Copyright:
© 2020, The Author(s).
PY - 2021/5
Y1 - 2021/5
N2 - Purpose: To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. Methods: Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. Results: Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. Conclusion: In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. Trial registration: ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063
AB - Purpose: To compare qualitative and semi-quantitative PET/CT criteria, and the impact of nodule size on the diagnosis of solitary pulmonary nodules in a prospective multicentre trial. Methods: Patients with an SPN on CT ≥ 8 and ≤ 30 mm were recruited to the SPUTNIK trial at 16 sites accredited by the UK PET Core Lab. Qualitative assessment used a five-point ordinal PET-grade compared to the mediastinal blood pool, and a combined PET/CT grade using the CT features. Semi-quantitative measures included SUVmax of the nodule, and as an uptake ratio to the mediastinal blood pool (SURBLOOD) or liver (SURLIVER). The endpoints were diagnosis of lung cancer via biopsy/histology or completion of 2-year follow-up. Impact of nodule size was analysed by comparison between nodule size tertiles. Results: Three hundred fifty-five participants completed PET/CT and 2-year follow-up, with 59% (209/355) malignant nodules. The AUCs of the three techniques were SUVmax 0.87 (95% CI 0.83;0.91); SURBLOOD 0.87 (95% CI 0.83; 0.91, p = 0.30 versus SUVmax); and SURLIVER 0.87 (95% CI 0.83; 0.91, p = 0.09 vs. SUVmax). The AUCs for all techniques remained stable across size tertiles (p > 0.1 for difference), although the optimal diagnostic threshold varied by size. For nodules < 12 mm, an SUVmax of 1.75 or visual uptake equal to the mediastinum yielded the highest accuracy. For nodules > 16 mm, an SUVmax ≥ 3.6 or visual PET uptake greater than the mediastinum was the most accurate. Conclusion: In this multicentre trial, SUVmax was the most accurate technique for the diagnosis of solitary pulmonary nodules. Diagnostic thresholds should be altered according to nodule size. Trial registration: ISRCTN - ISRCTN30784948. ClinicalTrials.gov - NCT02013063
KW - Cost-effectiveness
KW - DCE-CT
KW - Diagnostic accuracy trial
KW - Diagnostic imaging
KW - Lung cancer
KW - PET/CT
KW - Solitary pulmonary nodule (SPN)
UR - http://www.scopus.com/inward/record.url?scp=85094822191&partnerID=8YFLogxK
U2 - 10.1007/s00259-020-05089-y
DO - 10.1007/s00259-020-05089-y
M3 - Article
C2 - 33130961
AN - SCOPUS:85094822191
SN - 1619-7070
VL - 48
SP - 1560
EP - 1569
JO - European Journal of Nuclear Medicine and Molecular Imaging
JF - European Journal of Nuclear Medicine and Molecular Imaging
IS - 5
ER -
