Evaluation of the diagnostic efficacy of 18 F-Fluorine-2-Deoxy-D-Glucose PET/CT for lung cancer and pulmonary tuberculosis in a Tuberculosis-endemic Country

Alexandre Niyonkuru; Xiaomin Chen; Khamis Hassan Bakari; Dilani Neranjana Wimalarathne; Altine Bouhari; Maher Mohamad Rajab Arnous; Xiaoli Lan

doi:10.1002/cam4.2770

Evaluation of the diagnostic efficacy of ¹⁸ F-Fluorine-2-Deoxy-D-Glucose PET/CT for lung cancer and pulmonary tuberculosis in a Tuberculosis-endemic Country

Cancer Med. 2020 Feb;9(3):931-942. doi: 10.1002/cam4.2770. Epub 2019 Dec 13.

Authors

Alexandre Niyonkuru^{1

2}, Xiaomin Chen^{1

2}, Khamis Hassan Bakari^{1

2}, Dilani Neranjana Wimalarathne^{1

2}, Altine Bouhari^{1

2}, Maher Mohamad Rajab Arnous^{1

2}, Xiaoli Lan^{1

2}

Affiliations

¹ Department of Nuclear Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Hubei Key Laboratory of Molecular Imaging, Wuhan, China.

Abstract

Objective: To determine the diagnostic efficacy of ¹⁸ F-FDG PET/CT in distinguishing between pulmonary tuberculosis (PTB) and lung cancer in solitary pulmonary nodule (SPN) in a country with a high prevalence of PTB.

Methods: Patients with SPN who underwent ¹⁸ F-FDG PET/CT imaging were retrospectively included in the study. The final diagnosis was established by histopathology. A linear regression equation was fitted to a scatter plot of size and SUVmax of lung cancer and PTB. ROC was used to determine the optimal cutoff values and diagnostic accuracy of ¹⁸ F-FDG PET/CT in PTB and lung cancer.

Results: About 514 patients were included with the mean age of 57.5 ± 10.6 years. Four hundred and seventy-five cases were diagnosed as lung cancer, and 39 cases were PTB by histopathology. ¹⁸ F-FDG PET/CT had sensitivity, specificity, and diagnostic accuracy of 96.0%, 48.7%, and 92.0%, respectively. Utilization of SUVmax ≥2.5 in SPN resulted in 2 and 11 false positives cases of lung cancer and PTB, respectively, whereas SUVmax <2.5 resulted in 18 and 10 false-positive cases of lung cancer and PTB, respectively. The SUVmax and the size of short-axis in the lung cancer group were statistically higher than those in the PTB group. The linear regression equation parameters indicated the slope of the regression line of lung cancer was greater than that of PTB. The ROC curve demonstrated the SUVmax cutoff values of 4.85 and 2.25 for lung cancer and PTB, respectively for predicting the diagnostic accuracy of ¹⁸ F-FDG PET/CT.

Conclusion: ¹⁸ F-FDG PET/CT has a higher sensitivity and diagnostic accuracy for malignant SPN. However, it has high false-positive rate and low specificity in tuberculosis endemic areas. Neither SUVmax nor the sizes of the nodules are valuable parameters for distinguishing between lung cancer and PTB. However, the SPN with larger short-axis and higher SUVmax would be inclined to malignant tumor.

Keywords: 18F-FDG PET/CT; diagnostic accuracy; lung cancer; pulmonary tuberculosis.

Publication types

Evaluation Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Biopsy / statistics & numerical data
China / epidemiology
Diagnosis, Differential
Endemic Diseases
Female
Fluorodeoxyglucose F18 / administration & dosage*
Humans
Incidence
Lung / diagnostic imaging*
Lung / pathology
Lung Neoplasms / diagnosis*
Lung Neoplasms / pathology
Male
Middle Aged
Positron Emission Tomography Computed Tomography / methods*
Positron Emission Tomography Computed Tomography / statistics & numerical data
Predictive Value of Tests
ROC Curve
Retrospective Studies
Tuberculosis, Pulmonary / diagnosis*
Tuberculosis, Pulmonary / epidemiology
Tuberculosis, Pulmonary / pathology

Substances

Fluorodeoxyglucose F18