News | September 25, 2014

Study Questions Accuracy of Lung Cancer Screens in Some Geographic Regions

September 25, 2014 — A new analysis of published studies found that FDG-PET technology is less accurate in diagnosing lung cancer versus benign disease in regions where infections like histoplasmosis or tuberculosis are common. Misdiagnosis of lung lesions suspicious for cancer could lead to unnecessary tests and surgeries for patients, with additional potential complications and mortality.

Histoplasmosis and other fungal diseases are linked to fungi that are often concentrated in bird droppings and are found in soils.

The study by investigators at Vanderbilt University and the Tennessee Valley Healthcare System-Veterans Affairs was led by Vanderbilt first author Stephen Deppen, Ph.D., and principal investigator Eric Grogan, M.D., MPH, and appeared in the Sept. 24 issue of JAMA.

Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. To estimate FDG-PET diagnostic accuracy, the authors reviewed lung cancer abstracts published in a 14-year period and included 70 studies in the meta-analysis. The studies included 8,511 nodules, 60 percent of which were malignant.

"The accuracy of FDG-PET for diagnosing lung nodules varied widely from study to study," said Deppen, assistant professor in thoracic durgery. "FDG-PET scans had more false positive results and, therefore were less specific in diagnosing lung cancer in regions of the world where infectious lung disease is common in the general population."

The most prevalent fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and through southern Ontario, Canada, and coccidioidomycosis is prevalent in the southwestern United States.

These infections can cause inflamed nodules in the lungs (granulomas), which can be mistaken for cancerous lesions by radiographic imaging.

In previous meta-analyses, FDG-PET was reported to be 90 to 94 percent accurate in the characterization of malignant or benign lung nodules. However, the current analysis found that FDG-PET was less reliable in regions where fungal lung disease is endemic.

"The frequency of benign lesions in these geographic regions could lead to unnecessary biopsies or lung surgeries in patients," said Grogan, staff surgeon at Veterans Hospital, assistant professor of surgery in the Department of Thoracic Surgery and assistant professor of medicine in the Institute for Medicine and Public Health at Vanderbilt. "However, some medical practices achieved greater test accuracy through robust reading methods, even in these regions."

The authors suggest that the use of FDG-PET to diagnose lung cancer be limited to non-endemic regions unless an institution has substantial and proven expertise in FDG-PET interpretation.

For more information: www.mc.vanderbilt.edu

Related Content

Transpara Deep Learning Software Matches Experienced Radiologists in Mammogram Reading
News | Computer-Aided Detection Software | January 12, 2018
Deep learning and artificial intelligence improves the efficiency and accuracy of reading mammograms, according to...
Fat Distribution in Women and Men Provides Clues to Heart Attack Risk
News | Women's Health | January 11, 2018
January 11, 2018 – It’s not the amount of fat in your body but where it is stored that may increase your risk for hea
Smartphone Addiction Creates Imbalance in Brain
News | Mobile Devices | January 11, 2018
Researchers have found an imbalance in the brain chemistry of young people addicted to smartphones and the internet,...
Emergency Radiologists See Inner Toll of Opioid Use Disorders

Rates of Imaging Positivity for IV-SUDs Complications. Image courtesy of Efren J. Flores, M.D.

News | Clinical Study | January 11, 2018
January 11, 2018 – Emergency radiologists are seeing a high prevalence of patients with complications related to opio
Minimally Invasive Treatment Provides Relief from Back Pain

Lumbar spine MRI showing disc herniation and nerve root at baseline and one month after treatment

News | Interventional Radiology | January 11, 2018
The majority of patients were pain free after receiving a new image-guided pulsed radiofrequency treatment for low back...
Study Finds No Evidence that Gadolinium Causes Neurologic Harm

MR images through, A, C, E, basal ganglia and, B, D, F, posterior fossa at level of dentate nucleus. Images are shown for, A, B, control group patient 4, and the, C, D, first and, E, F, last examinations performed in contrast group patient 13. Regions of interest used in quantification of signal intensity are shown as dashed lines for globus pallidus (green), thalamus (blue), dentate nucleus (yellow), and pons (red).

News | Contrast Media | January 11, 2018
January 11, 2018 — There is no evidence that accumulation in the brain of the element gadolinium speeds cognitive dec
CT Shows Enlarged Aortas in Former Pro Football Players

3-D rendering from a cardiac CT dataset demonstrating mild dilation of the ascending aorta.

News | Computed Tomography (CT) | January 11, 2018
Former National Football League (NFL) players are more likely to have enlarged aortas, a condition that may put them at...

Size comparison between 3-D printed prosthesis implant and a penny.

News | 3-D Printing | January 11, 2018
January 11, 2018 — Researchers using...
RSNA 2017 technical exhibits, expo floor, showing new radiology technology advances.
Feature | RSNA 2017 | January 11, 2018
January 11, 2018 — Here is a list of some of the key clinical study presentations, articles on trends and videos from
Hip Steroid Injections Associated with Bone Changes

58-year-old woman with left hip pain. X-ray from one month prior to the steroid/anesthetic injection demonstrates moderate joint space narrowing (arrows) and bony proliferation (arrowheads).

News | Orthopedic Imaging | January 11, 2018
January 11, 2018 – Osteoarthritis patients who received a steroid injection in the hip had a significantly greater in
Overlay Init