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Detection and Staging of Preinvasive Lesions and Occult Lung Cancer in the Central Airways with ¹⁸F-Fluorodeoxyglucose Positron Emission Tomography: A Pilot Study

Authors' Affiliations: Departments of ¹ Pulmonology, ² Nuclear Medicine and PET Research, and ³ Pathology, Vrije Universiteit Medical Center, Amsterdam, The Netherlands

Requests for reprints: Tom G. Sutedja, Department of Pulmonology, Vrije Universiteit Medical Center, P.O. Box 7057, 1007 MB Amsterdam. Phone: 31-20-444-4782; Fax: 31-20-444-4328; E-mail: tg.sutedja{at}vumc.nl.

Purpose: To evaluate the role of ¹⁸F-fluorodeoxyglucose positron emission tomography (FDG-PET) in radiologically occult preinvasive lesions and lung cancer in the central airways.

Experimental Design: Twenty-two patients with 24 preinvasive lesions and early squamous cell cancer (SCC) being occult on high-resolution computed tomography were studied. All lesions were diagnosed based on histology sampled using autofluorescence bronchoscopy. FDG-PET findings were correlated with WHO histologic classification. FDG-PET was considered true-positive when the final diagnosis was SCC and true-negative when the lesions were classified as severe dysplasia or less.

Results: FDG-PET was true-positive in 8 of 11 and true-negative in 11 of 13 cases corresponding with a sensitivity of 73% [95% confidence interval (CI), 0.43-0.91] and specificity of 85% (95% CI, 0.57-0.97). Positive and negative predictive values were 80% (95% CI, 0.48-0.96) and 79% (95% CI, 0.52-0.93), respectively.

Conclusions: Our very preliminary data suggest that FDG-PET might be useful for the evaluation of early central airway lesions, being positive in most SCC and negative in cases of severe dysplasia. Validation in a larger multicenter study is needed.

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