F-18-2-fluoro-2-deoxyglucose positron emission tomography compared to technetium-99m hexakis-2-methoxyisobutyl isonitrile single photon emission chest tomography in the diagnosis of indeterminate lung lesions.

BACKGROUND (18)FDG-PET plays a significant role in diagnosing malignancy of lung lesions but remains an expensive test available at a limited number of sites in Italy. OBJECTIVE We prospectively compare the diagnostic accuracy of (99m)Tc-MIBI- SPECT and (18)FDG-PET in patients with indeterminate lung lesions to demonstrate that (99m)Tc-MIBI-SPECT may be considered as a valid alternative when (18)FDG-PET is not available. METHODS 52 patients with indeterminate lung lesion were examined by (18)FDG-PET and (99m)Tc-MIBI-SPECT before surgery. The scintigraphic findings were analyzed visually and semiquantitatively and then correlated to the definitive diagnosis. RESULTS 38 were malignant lesions while 14 were benign. At visual analysis, the sensitivities of (18)FDG-PET and (99m)Tc-MIBI-SPECT were 92 and 84%, respectively (McNemar test p = 0.4), whereas the specificities were 78.6 and of 93% (p = 1.0), respectively. At semiquantitative analysis, (18)FDG-PET showed a sensitivity and specificity of 92 and 71.4%, respectively, while (99m)Tc-MIBI-SPECT produced a sensitivity and specificity of 86 and 100%, respectively (p = 0.194). For lymph node staging, (18)FDG-PET and (99m)Tc-MIBI-SPECT have a sensitivity and specificity of 88 and 92 of 77 and 100%, respectively. CONCLUSION (99m)Tc-MIBI-SPECT is similar to (18)FDG-PET in the detection of lung malignancies and represents an alternative when PET is not available. Yet, the combination of both techniques may improve patient selection for surgery.