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We read with interest the comment by Dr Carbone et al on our article1 and agree that nowadays CT-PET is the best imaging method for visualisation of suspected pulmonary nodules.
Transthoracic fine needle aspiration (TFNB) under CT-PET control could improve the accuracy of lung cancer diagnosis, especially in cases of solid lesions with a smaller standardised uptake value (SUV). Some data suggest that even 50% of pulmonary nodules with SUV <2.5 are benign.2
In the Continuing Observation of Smoking Subjects (COSMOS) study by Veronesi et al,3 CT-PET had a sensitivity of 100% in the diagnosis of solid pulmonary nodules of 10 mm and more. In our study the mean size of suspected lesions (described at the beginning of the Results section) was 2.4 cm (95% CI 2.2 to 2.5), which was comparable to data in the study by Veronesi et al (2.5 cm, range 0.6–6 cm), but the indication for TFNB was not only restricted to solid nodules. The sensitivity, specificity and accuracy of cytological and telomerase activity examinations in our study was adequate (89.3%, 96.9%, 90%, respectively) and was similar to the overall results achieved by Veronesi et al (88%, 93% and 91%, respectively). The diagnostic value of telomerase activity assessments in pulmonary tumours is only one of many benefits. Data show that telomerase activity in material derived from pulmonary nodules is also a prognostic factor for survival4 and could be a target for antitelomerase treatment.5
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