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 pulmonary nodules. Transthoracic fine-needle aspiration biopsy (TTNA) is generally the initial procedure of choice in the evaluation of peripheral lesions suspected to be malignant. Our objective was to determine whether PET-FDG imaging, a noninvasive test, was equally efficacious as TTNA in the evaluation of lung lesions suspected to be malignant. PATIENT SELECTION Thirty-three patients with 35 lung lesions who had undergone both PET-FDG imaging and TTNA were retrospectively selected from an ongoing prospective study of PET-FDG imaging in the evaluation of solitary pulmonary nodules. MEASUREMENTS Diagnostic efficacy was determined by calculating sensitivity, specificity, positive and negative predictive value, and overall predictive accuracy for both PET-FDG imaging and TTNA in differentiating benign from malignant lesions. Complication rate also was documented for the two tests. RESULTS The PET imaging correctly identified all 26 malignant lesions, including 21 lesions diagnosed by TTNA and 7 of the 9 benign lung lesions. The TTNA was positive for malignancy in 21 lung lesions and missed the diagnosis of malignancy 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 for TTNA, respectively. Pneumothorax was documented in 16 patients (46%), and 9 patients (26%) required a chest tube. There were no complications with PET imaging. CONCLUSION We conclude that PET imaging of the lung is as efficacious as TTNA, with less risk, and offers an alternate noninvasive option in the evaluation and management of lung lesions suspected to be malignant.