Pulmonary Nodules Clinical Trial
Official title:
A Pilot Study of PET-CT in the Assessment of Pulmonary Nodules in Children With Malignant Solid Tumors
Because the management of children with solid tumors hinges on the extent of disease, it is
crucial to identify metastatic sites. Helical chest computed tomography (CT) is the standard
method of excluding pulmonary metastases. However, CT lacks molecular information regarding
nodule histology and often biopsy is required to exclude malignancy. Biopsy procedures carry
known risks including those associated with anesthesia and sedation, infection,
pneumothorax, hemorrhage, pain and other post-procedure and post-operative complications and
may also add unnecessary cost to the management of the patient. We found that the ability of
three experienced pediatric radiologists to correctly predict nodule histology based on CT
imaging features was limited (57% to 67% rate of correct classification). Also, there was
only slight to moderate agreement in nodule classification between these reviewers.
Furthermore, of 50 children who have undergone pulmonary nodule biopsy at St. Jude in the
last five years, 44% (22/50) had only benign nodules.
Adult studies have shown that a nuclear medicine scan called fluoro-deoxyglucose (FDG)
positron emission tomography (PET) and the fusion modality PET-CT are superior to diagnostic
CT in distinguishing benign from malignant pulmonary nodules because FDG PET gives
information about the metabolic activity of the nodule. Nodules that are malignant have more
metabolic activity, hence more FDG uptake/intensity, than those that are benign. There has
been little work done in children to determine the value of PET or PET-CT in the evaluation
of pulmonary nodules.
In this study, we seek to assess the feasibility of performing PET-CT for the evaluation of pulmonary nodules in children to obtain preliminary data for sample size determination for a larger multi-institutional trial. The primary objective of the multi-institutional trial will be to compare the accuracy of diagnostic CT alone to PET-CT in distinguishing benign from malignant nodules in children with solid malignancies. We are hopeful that PET-CT will allow us to better direct the clinical management of these patients and to reduce the number of invasive procedures performed to confirm the presence of benign disease. ;
Observational Model: Cohort, Time Perspective: Cross-Sectional
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