Surgical Management and Pathological Outcomes of Pet-Avid Solitary Pulmonary Nodules: A Single-Center Retrospective Cohort

Research Article

Abstract

Introduction: Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is frequently used to estimate malignancy risk in solitary pulmonary nodules (SPNs), yet false-positive uptake is common in inflammatory and granulomatous disease.

Objective: To describe our surgical management of PET-avid SPNs and to evaluate the association between maximum standardized uptake value (SUVmax) and malignancy.

Method: We retrospectively reviewed 69 consecutive patients with SPNs (≤3 cm) showing increased FDG uptake (SUVmax ≥2.5) who underwent surgery between December 2008 and September 2011 at Akdeniz University. All patients lacked a definitive diagnosis after noninvasive or minimally invasive attempts. The initial procedure was diagnostic wedge resection with intraoperative frozen section; surgery was terminated for benign lesions, whereas primary lung cancer prompted anatomic resection with systematic mediastinal lymph node sampling. Categorical variables were compared with chi-square and continuous variables with Student’s t-test or Mann–Whitney U test as appropriate (p<0.05).

Results: The cohort included 46 men (66.7%) and 23 women (33.3%), with a mean age of 58.16±12.11 years. Final pathology showed benign disease in 46.4%, primary lung cancer in 42.0%, and metastasis in 11.6%. Wedge resection was performed in 55.1% and anatomic resection in 44.9%. Mean SUVmax was significantly higher in malignant than benign nodules (10.54±7.30 vs 4.61±2.27; p<0.001).

Conclusion: Nearly half of PET-avid SPNs were benign, underscoring the limited specificity of FDG-PET/CT in endemic inflammatory settings. Higher SUVmax was associated with malignancy, but surgical resection remains a valuable diagnostic and potentially curative strategy when tissue diagnosis cannot be obtained otherwise.