Short report
Role of Tc-99m MIBI in the evaluation of single pulmonary
nodules: a preliminary report
Omar A Minaia, Shankar Rajab, Atul C Mehtaa, Eugene J Sullivana, Saeed U Khana, Asok Dasguptaa, Alejandro C Arroligaa
a Department
of Pulmonary and Critical Care Medicine, The Cleveland Clinic
Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA, b Department of
Nuclear Medicine
Correspondence to: Dr A C Arroliga
Received 26 October 1998; Returned to authors 15 January 1999; Revised version received 26 August 1999; Accepted for publication 4 October 1999
BACKGROUND
Survival in
bronchial carcinoma is closely related to the stage of the disease at
the time of diagnosis and a single pulmonary nodule represents a
potentially curable stage. This study was conducted to assess the
feasibility of using Tc-99m labelled 2-methoxy isobutyl isonitrile
(MIBI) to differentiate benign from malignant single pulmonary nodules.
METHODSA prospective
study was conducted in the outpatient pulmonary clinic at the Cleveland
Clinic Foundation. Twenty five patients with single pulmonary nodules
considered indeterminate by their physicians and undergoing a procedure
for tissue diagnosis were evaluated by Tc-99m MIBI SPECT scanning prior
to definitive testing. Assessment of MIBI uptake was done qualitatively
(subjectively) and quantitatively and correlated with the
histopathology and nodule size.
RESULTSOf the 21 patients with malignant lesions, 18 had increased uptake of MIBI
corresponding to the location of the nodule and were considered
positive. The predominant tumour types were large cell (n = 5) and
adenocarcinoma (n = 10). All four patients with benign lesions had
negative MIBI scans. For malignancy the overall specificity was 100%,
sensitivity was 85.7%, positive predictive value was 100%, and
negative predictive value was 57%. Quantitative uptake of MIBI
correlated with the diameter of the nodule with a correlation
coefficient of 0.61 by Spearman's rank sum test. This relationship was
statistically significant (p = 0.02).
CONCLUSIONThis
preliminary study suggests that Tc-99m MIBI has a very high specificity
and positive predictive value for malignant single pulmonary nodules
and might be a useful non-invasive diagnostic modality in their management.
Keywords: single pulmonary nodules; Tc-99m MIBI SPECT scanning; lung cancer
© 2000 by Thorax
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