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Early Lung Cancer Detection Using Spiral Computed Tomography and Positron Emission Tomography

Departments of Radiology, Nuclear Medicine, Pathology, Pulmonary Medicine, and Thoracic Surgery, Clínica Universitaria; Department of Histology and Pathology, School of Medicine; and Division of Oncology, Center for Applied Medical Research (CIMA), Universidad de Navarra, Pamplona, Spain

Correspondence and requests for reprints should be addressed to Javier J. Zulueta, M.D., Pulmonary Medicine, Clínica Universitaria, Avda. Pio XII, 36, 31008 Pamplona, Spain. E-mail: jzulueta{at}unav.es

Rationale: Lung cancer screening using computed tomography (CT) is effective in detecting lung cancer in early stages. Concerns regarding false-positive rates and unnecessary invasive procedures have been raised. Objective: To study the efficiency of a lung cancer protocol using spiral CT and F-18-fluorodeoxyglucose positron emission tomography (FDG-PET). Methods: High-risk individuals underwent screening with annual spiral CTs. Follow-up CTs were done for noncalcified nodules of 5 mm or greater, and FDG-PET was done for nodules 10 mm or larger or smaller (> 7 mm), growing nodules. Results: A total of 911 individuals completed a baseline CT study and 424 had at least one annual follow-up study. Of the former, 14% had noncalcified nodules of 5 mm or larger, and 3.6% had nodules of 10 mm or larger. Eleven non–small cell lung cancers (NSCLC) and one small cell lung cancer (SCLC) were diagnosed in the baseline study (prevalence rate, 1.32%), and two NSCLCs in the annual study (incidence rate, 0.47%). All NSCLCs (92% of prevalence cancers) were diagnosed in stage I (12 stage IA, 1 stage IB). FDG-PET was helpful for the correct diagnosis in 19 of 25 indeterminate nodules. The sensitivity, specificity, positive predictive value, and negative predictive value of FDG-PET for the diagnosis of malignancy were 69, 91, 90, and 71%, respectively. However, the sensitivity and negative predictive value of the screening algorithm, which included a 3-month follow-up CT for nodules with a negative FDG-PET, was 100%. Conclusion: A protocol for early lung cancer detection using spiral CT and FDG-PET is useful and may minimize unnecessary invasive procedures for benign lesions.

Key Words: chronic obstructive pulmonary disease • lung neoplasm • pulmonary nodule • smoking

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