COMPARISON OF CT THORAX AND FDG PET-CT IN

DETECTING LUNG CANCER.

Name of the Student: Marylyn A/P Ganapragasam

Matric No.: GS59809
Name of Main Supervisor: Associate Professor Dr. Subapriya Suppiah

Programme : Masters in Radiology

Field of Study : Radiology a n d Imaging
Department : Faculty of Medicine a n d Health Sciences

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 Introduction
• Lung cancer is the leading cause of death in Malaysia. In the year 2007, overall, it is
the third commonest cancer after breast and colorectal cancer.
• In males, it is the first on the list and the fifth in females. In 2006, 2948 lung cancers
were reported (1445 in men and 603 in women).
• Even though the survival rate after a diagnosis of lung cancer is made is 49%, only
less than 2% of cancer patients are still alive in 5 years if the cancer has spread to
other parts of the body.
 This study aimed to

Evaluate the comparative effectiveness of

fluorine-18-fluorodeoxyglucose (F-FDG)-
PET/CT and chest CT in the detection of lung
cancer.

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R e s e a r c h Question
1. Is there a standard scoring system for assessing lung nodules?
Lung Nodule Risk Calculators:
• Brock University Calculator
• NPS-BIMC (Bayesian Inference Malignancy Calculator)
• Solitary Pulmonary Nodule Malignancy Risk (Mayo Clinic model)

2. Is there any biomedical image processing technique or machine learning algorithm for
detection of lung cancer?

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 Problem S t a t e m e n t
To outline structured way to determine which imaging modality is better.

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Objectives
General Objective
To evaluate retrospectively the comparative effectiveness of fluorine-18-fluorodeoxyglucose (F-FDG)-
PET/CT and chest CT in the detection of lung cancer.

Specific Objectives

i.To estimate the diagnostic accuracy of FDG-PET for pulmonary nodules suspicious for lung cancer in
Malaysian population.

ii.To estimate the diagnostic accuracy of CT Thorax for pulmonary nodules suspicious for lung cancer in
Malaysian population.

iii.To correlate and compare the diagnostic accuracy of both the modalities.

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Hypothesis
• H0: FDG PET-CT is not better than CT Thorax in
detection of lung cancer
• H1: FDG PET-CT better than CT Thorax in detection of
lung cancer

• H2: CT Thorax and FDG PET-CT are equally effective

in detection lung cancer.

• H4: Both CT Thorax and FDG PET-CT should be used

for better accuracy in detection of lung cancer
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Authors (Year of publication)
(Sheikhbahaei S et al., 2017)
(Deppen SA et al., 2014)
(B.M. Fischer et al., 2007)
(W. De Wever et al., 2007)
Type of study/No. of Findings/Conclusion
sample
Retrospective study Comparative effectiveness: 18F-FDG-PET/CT versus CT for
post-treatment follow-up of patients with lung cancer.
The sensitivity of F-FDG-PET/CT is superior to that of chest
CT in the detection of regional and distant metastasis, while
having comparable specificity.
Meta-Analysis Accuracy of FDG-PET to Diagnose Lung Cancer in Areas
With Infectious Lung Disease A Meta-analysis
The accuracy of FDG-PET for diagnosing lung nodules was
extremely heterogeneous. Use of FDG-PET combined with
computed tomography was less specific in diagnosing
malignancy in populations with endemic infectious lung
disease compared with nonendemic regions. 
Prospective study A prospective study of PET/CT in initial staging of small-
cell lung cancer: comparison with CT, bone scintigraphy
and bone marrow analysis
The results from this first study on PET/CT in SCLC indicates
that PET/CT can simplify and perhaps even improve the
accuracy of the current staging procedure in SCLC. 
Retrospective study Additional value of PET-CT in the staging of lung cancer:
comparison with CT alone, PET alone and visual
correlation of PET and CT
Integrated PET-CT improves the staging of lung cancer
through a better anatomic localization and characterization
of lesions and is superior to CT alone and PET alone.
Authors (Year of publication) Type of study/No. of Findings/Conclusion
sample

(Steven B.Markowitz MD et Prospective study Ability of Low-Dose Helical CT To Distinguish Between

al., 2007) Benign and Malignant Noncalcified Lung Nodules
Helical CT scanning detects many indeterminate nodules,
but few are malignant. CT scanning has high sensitivity and
specificity to detect early lung cancer. 

(Gorka Bastarrika et al., Prospective study Early Lung Cancer Detection Using Spiral Computed
2005) Tomography and Positron Emission Tomography
A protocol for early lung cancer detection using spiral CT
and FDG-PET is useful and may minimize unnecessary
invasive procedures for benign lesions.
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American College of Radiology Committee on
Lung-RADS®. Lung-RADS Assessment
Categories version1.1.
 Images

First Reader Second Reader

Methodology
Flowchart
Visual Scoring
Malignant or Benign or
Indeterminate

Consensus

Sensitivity & Specificity

(Based on HP)
 R e s e a r c h Methodology

Study location
In this study, subject recruitment from Hospital Serdang and PPDN

Study Design
Retrospective study

Sample Population
Heterogeneous (Malay, Chinese, Indian)

Sampling method
Convenience Sampling
 R e s e a r c h Methodology

Sample Size Calculation

500 Patients past 10 years

Inclusion criteria
All patients with suspicious lung mass/ nodule referred for CT
Thorax and FDG PET-CT with HPE results.

Exclusion criteria
No HPE available
 R e s e a r c h Methodology

Study Instrument and Procedure

The purpose of the proforma paper is to gather patient
information from the Hospital Serdang and PPDN. The
subject number, age, gender, race, smoker or not, comorbids (COPD,
asthma, DM), CT Scan protocol (fixed mA, keV), visual scoring
(lesion size, location, lobe, margin, contrast enhancement, solitary
nodule).
R efer en ce
• Sheikhbahaei S, Ahn SJ, Young B, Taghipour M, Marcus C, Subramaniam RM. Comparative
effectiveness: 18F-FDG-PET/CT versus CT for post-treatment follow-up of patients with lung cancer.
Nucl Med Commun. 2017 Aug;38(8):720-725. doi: 10.1097/MNM.0000000000000707. PMID:
28678114.
• Deppen SA, Blume JD, Kensinger CD, et al. Accuracy of FDG-PET to Diagnose Lung Cancer in Areas
With Infectious Lung Disease: A Meta-analysis. JAMA. 2014;312(12):1227–1236.
doi:10.1001/jama.2014.11488
• B.M. Fischer, J. Mortensen, S.W. Langer, A. Loft, A.K. Berthelsen, B.L. Petersen, G. Daugaard, U.
Lassen, H.H. Hansen, A prospective study of PET/CT in initial staging of small-cell lung cancer:
comparison with CT, bone scintigraphy and bone marrow analysis, Annals of Oncology, Volume 18,
Issue 2, 2007, Pages 338-345, ISSN 0923-7534
• American College of Radiology Committee on Lung-RADS®. Lung-RADS Assessment Categories
version1.1.
• De Wever, W., Ceyssens, S., Mortelmans, L. et al. Additional value of PET-CT in the staging of lung
cancer: comparison with CT alone, PET alone and visual correlation of PET and CT. Eur Radiol 17, 23–
32 (2007). https://doi.org/10.1007/s00330-006-0284-4

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• Gorka Bastarrika , María José García-Velloso , Maria Dolores Lozano , Usua Montes ,
Wenceslao Torre , Natalia Spiteri , Arantza Campo , Luis Seijo , Ana Belén Alcaide , Jesús
Pueyo , David Cano , Isabel Vivas , Octavio Cosín , Pablo Domínguez , Patricia Serra , José
A. Richter , Luis Montuenga , and Javier J. Zulueta , 2005 Early Lung Cancer Detection
Using Spiral Computed Tomography and Positron Emission Tomography.
• Steven B. Markowitz, Albert Miller, Jeffrey Miller, Amy Manowitz, Sylvia Kieding, Lee
Sider, Alfredo Morabia, Ability of Low-Dose Helical CT To Distinguish Between Benign and
Malignant Noncalcified Lung Nodules, Chest, Volume 131, Issue 4, 2007, Pages 1028-1034,
ISSN 0012-3692.

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