PET-FDG IMAGING AND TRANSTHORACIC NEEDLE LUNG ASPIRATION BIOPSY IN EVALUATION OF PULMONARY-LESIONS - A COMPARATIVE RISK-BENEFIT ANALYSIS

Background and objective: Positron emission tomography (PET) utilizing 2-[fluorine-18]-fluoro-2-deoxy-D-glucose (FDG) has been demonstrated to be highly accurate in differentiating benign from malignant pulmona ry nodules. Transthoracic fine-needle aspiration biopsy (TTNA) is gene rally the initial procedure of choice in the evaluation of peripheral lesions suspected to be malignant. Our objective was to determine whet her PET-FDG imaging, a noninvasive test, was equally efficacious as TT NA in the evaluation of lung lesions suspected to be malignant. Patien t selection: Thirty-three patients with 35 lung lesions who had underg one both PET-FDG imaging and TTNA were retrospectively selected from a n ongoing prospective study of PET-FDG imaging in the evaluation of so litary pulmonary nodules. Measurements: Diagnostic efficacy was determ ined by calculating sensitivity,specificity, positive and negative pre dictive value, and overall predictive accuracy for both PET-FDG imagin g and TTNA in differentiating benign from malignant lesions, Complicat ion rate also was documented for the two tests. Results: The PET imagi ng correctly identified all 26 malignant lesions, including 21 lesions diagnosed by TTNA and 7 of the 9 benign lung lesions, The TTNA was po sitive for malignancy in 21 lung lesions and missed the diagnosis of m alignancy in 5 lesions. Diagnostic sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy was 100 , 78, 93, 100, and 94% for PET imaging and 81, 100, 100, 64, and 86 fo r TTNA, respectively. Pneumothorax was documented in 16 patients (46%) , and 9 patients (26%) required a chest tube. There were no complicati ons with PET imaging. Conclusion: We conclude that PET imaging of the lung is as efficacious as TTNA, with less risk, and offers an alternat e noninvasive option in the evaluation and management of lung lesions suspected to be malignant.