The Role of PET/CT in Assessing Pulmonary Nodules in Children With Solid Malignancies

OBJECTIVE. the purpose of this article is to assess the feasibility and utility of PET/CT in distinguishing benign from malignant pulmonary nodules in patients with solid childhood malignancies.SUBJECTS and METHODS. This prospective study was conducted between March 2008 and August 2010. We enrolled 25 subjects 21 years old or younger with solid childhood malignancies and at least one pulmonary nodule measuring 0.5-3.0 cm. PET/CT was performed within 3 weeks of diagnostic chest CT. Three panels of three reviewers each reviewed diagnostic CT only (panel 1), PET/CT only (panel 2), or diagnostic CT and PET/CT concurrently (panel 3) and predicted each nodule's histologic diagnosis as benign, malignant, or indeterminate. Interreviewer agreement was assessed with the kappa statistic. Using nodule biopsy or clinical follow-up as reference standards, the sensitivity, specificity, and accuracy for each panel was assessed. Logistic regression was used to assess the nodule's maximum standardized uptake value (SUVmax) association with its histologic diagnosis.RESULTS. There were 75 nodules with a median size of 0.74 cm (range, 0.18-2.38 cm); 48 nodules were malignant. Sensitivity was 85% (41/48) for panel 1, 60% (29/48) for panel 2, and 67% (32/48) for panel 3. All panels had poor specificities. Interreviewer agreement was moderate for panel 1 (0.43) and poor for panels 2 (0.22) and 3 (0.33). SUVmax was a significant predictor of histologic diagnosis (p = 0.004).CONCLUSION. PET/CT assessment of pulmonary nodules is feasible in children with solid malignancies but may not reliably improve our ability to predict a nodule's histologic diagnosis. the SUVmax may improve the performance of PET/CT in this setting.Society for Pediatric Radiology, Research and Education Foundation (Dorst-Fleischer Grant)St Jude Childrens Res Hosp, Div Diagnost Imaging, Memphis, TN 38105 USASt Jude Childrens Res Hosp, Dept Biostat, Memphis, TN 38105 USACincinnati Childrens Hosp Med Ctr, Dept Radiol, Cincinnati, OH 45229 USABritish Columbia Childrens Hosp, Dept Radiol, Vancouver, BC V6H 3V4, CanadaHosp Sick Children, Dept Radiol, Toronto, ON M5G 1X8, CanadaUniversidade Federal de São Paulo, Paulista Sch Med, GRAACC, Pediat Oncol Inst, São Paulo, BrazilSt Louis Childrens Hosp, Dept Radiol, St Louis, MO 63178 USASt Jude Childrens Res Hosp, Dept Surg, Memphis, TN 38105 USASt Jude Childrens Res Hosp, Dept Oncol, Memphis, TN 38105 USAUniversidade Federal de São Paulo, Paulista Sch Med, GRAACC, Pediat Oncol Inst, São Paulo, BrazilWeb of Scienc