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dc.contributor.authorGibson, Glenna
dc.contributor.authorKumar, Aravind Ravi
dc.contributor.authorSteinke, Karin
dc.contributor.authorBashirzadeh, Farzad
dc.contributor.authorRoach, Rebecca
dc.contributor.authorWindsor, Morgan
dc.contributor.authorWare, Robert
dc.contributor.authorFielding, David
dc.description.abstractBackground: Clinical prediction models and 18-fluorine-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) are used for the assessment of solitary pulmonary nodules (SPN); however, a biopsy is still required before treatment, which carries risk. Aim: To determine the combined predictive benefit of one such model combined with modern PET/CT data to improve decision-making about biopsy prior to treatment and possibly reduce costs. Methods: Patients with a SPN undergoing 18F-FDG-PET/CT from January 2011 to December 2012 were retrospectively identified; 143 patients met inclusion criteria. PET/CT studies were rated (5-point visual scale), and CT characteristics were determined. Tissue was obtained by endobronchial ultrasonography with guide sheath (EBUS-GS), CT-guided biopsy and/or surgery. EBUS-transbronchial needle aspiration (TBNA) was used instead of nodule biopsy if there were PET-positive sub-centimetre lymph nodes. Results: The prediction model yielded an area under the receiver operating characteristic curve (AUC-ROC) of 64% (95% confidence interval (CI) 0.55–0.75). PET/CT increased this to 75% (95% CI 0.65–0.84). The 11% improvement is statistically significant. PET/CT score was the best single predictor for malignancy. A PET score of 1–2 had a specificity of 100% (CI 0.73–1.0), whereas a score of 4–5 had a sensitivity of only 76% (CI 0.68–0.84). No significant difference in clinical prediction scores between groups was noted. PET/CT showed the greatest benefit in true negatives and in detecting small mediastinal lymph nodes to allow EBUS-TBNA with a higher diagnostic rate. Cost analysis did not support a policy of resection-without-tissue diagnosis. Conclusion: PET/CT improves the clinical prediction of SPN, but its greatest use is in proving benignity. High PET scores had high false positive rates and did not add to clinical prediction. PET should be incorporated early in decision-making to allow for more effective biopsy strategies.
dc.publisherJohn Wiley and Sons
dc.relation.ispartofjournalInternal Medicine Journal
dc.subject.fieldofresearchCardiovascular medicine and haematology
dc.subject.fieldofresearchClinical sciences
dc.subject.fieldofresearchHealth services and systems
dc.subject.fieldofresearchPublic health
dc.subject.keywordsScience & Technology
dc.subject.keywordsLife Sciences & Biomedicine
dc.subject.keywordsGeneral & Internal Medicine
dc.subject.keywordsSolitary pulmonary nodule
dc.titleRisk stratification in the investigation of pulmonary nodules in a high-risk cohort: Positron emission tomography/computed tomography outperforms clinical risk prediction algorithms
dc.typeJournal article
dc.type.descriptionC1 - Articles
dcterms.bibliographicCitationGibson, G; Kumar, AR; Steinke, K; Bashirzadeh, F; Roach, R; Windsor, M; Ware, R; Fielding, D, Risk stratification in the investigation of pulmonary nodules in a high-risk cohort: Positron emission tomography/computed tomography outperforms clinical risk prediction algorithms, Internal Medicine Journal, 2017, 47 (12), pp. 1385-1392
gro.hasfulltextNo Full Text
gro.griffith.authorWare, Robert

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