Positron emission tomography in relation to Noguchi's classification for diagnosis of peripheral non-small-cell lung cancer 2 cm or less in size

World J Surg. 2007 Feb;31(2):314-7. doi: 10.1007/s00268-006-0475-9.

Abstract

Background: F-18 fluorodeoxyglucose positron emission tomography ((18)F-FDG-PET) scanning has become a critically important tool in diagnosis and management of non-small-cell lung cancer. However, the effectiveness of (18)F-FDG-PET as a diagnostic tool for small-sized lung cancer is controversial. The purpose of this study was to examine the accuracy of( 18)F-FDG-PET in relation to Noguchi's classification in the diagnosis of small peripheral non-small-cell lung cancer.

Methods: Between January 2003 and April 2006, 150 patients with peripheral lung lesions who were undergoing chest computed tomography (CT),( 18)F-FDG-PET, and operation were analyzed.

Results: Eighty-three patients had malignant lesions, and 67 patients had benign lesions. PET had a sensitivity, specificity, positive predictive value, and negative predictive value of 75.9%, 64.1%, 72.4%, and 68.3%, respectively. In 37 patients with peripheral lung cancer measuring 2.0 cm or less in the greatest diameter, the sensitivity was 51.4% and the specificity was 51.9%. Among them, all 4 cases of Noguchi type A adenocarcinoma [localized bronchioloalveolar carcinoma (LBAC)], 4 of 5 type B and 8 of 17 type C were false negative, while 9 of 11 (81.8%) types D, E, and F (invasive carcinomas without a BAC component) were true positive.

Conclusion: The accuracy of( 18)F-FDG-PET is generally low in distinguishing malignancy from benign lesions in small lesions (<2.0-cm diameter). The significance of PET as a diagnostic tool is small, especially when the tumor has a ground-glass component at a high rate. The sensitivity of PET is high in small invasive carcinomas without a BAC component, but it is difficult to distinguish carcinoma from benign tumor from its image.

MeSH terms

  • Adenocarcinoma, Bronchiolo-Alveolar / classification
  • Adenocarcinoma, Bronchiolo-Alveolar / diagnostic imaging*
  • Adenocarcinoma, Bronchiolo-Alveolar / pathology
  • Adult
  • Aged
  • Carcinoma, Non-Small-Cell Lung / classification
  • Carcinoma, Non-Small-Cell Lung / diagnostic imaging*
  • Carcinoma, Non-Small-Cell Lung / pathology
  • Female
  • Fluorodeoxyglucose F18*
  • Humans
  • Lung Neoplasms / classification
  • Lung Neoplasms / diagnostic imaging*
  • Lung Neoplasms / pathology
  • Male
  • Middle Aged
  • Mixed Tumor, Malignant / classification
  • Mixed Tumor, Malignant / diagnostic imaging*
  • Mixed Tumor, Malignant / pathology
  • Positron-Emission Tomography*
  • Predictive Value of Tests
  • Radiopharmaceuticals*
  • Reproducibility of Results

Substances

  • Radiopharmaceuticals
  • Fluorodeoxyglucose F18