(Press-News.org) A new analysis of published studies found that FDG-PET technology is less accurate in diagnosing lung cancer versus benign disease in regions where infections like histoplasmosis or tuberculosis are common. Misdiagnosis of lung lesions suspicious for cancer could lead to unnecessary tests and surgeries for patients, with additional potential complications and mortality.
Histoplasmosis and other fungal diseases are linked to fungi that are often concentrated in bird droppings and are found in soils.
The study by investigators at Vanderbilt University and the Tennessee Valley Healthcare System-Veterans Affairs was led by Vanderbilt first author Stephen Deppen, Ph.D., and principal investigator Eric Grogan, M.D., MPH, and appeared in the Sept. 24 issue of JAMA.
Positron emission tomography (PET) combined with fludeoxyglucose F18 (FDG) is currently recommended for the noninvasive diagnosis of lung nodules suspicious for lung cancer. To estimate FDG-PET diagnostic accuracy, the authors reviewed lung cancer abstracts published in a 14 year period and included 70 studies in the meta-analysis. The studies included 8,511 nodules, 60 percent of which were malignant.
"The accuracy of FDG-PET for diagnosing lung nodules varied widely from study to study," said Deppen, assistant professor in Thoracic Surgery. "FDG-PET scans had more false positive results and, therefore were less specific in diagnosing lung cancer in regions of the world where infectious lung disease is common in the general population."
The most prevalent fungal lung diseases in the United States are histoplasmosis, coccidioidomycosis and blastomycosis. All three fungi reside in soils. Histoplasmosis and blastomycosis are common across much of the Mississippi, Ohio and Missouri river valleys and through southern Ontario, Canada, and coccidioidomycosis is prevalent in the southwestern U.S.
These infections can cause inflamed nodules in the lungs (granulomas) which can be mistaken for cancerous lesions by radiographic imaging.
In previous meta-analyses, FDG-PET was reported to be 90 to 94 percent accurate in the characterization of malignant or benign lung nodules. However, the current analysis found that FDG-PET was less reliable in regions where fungal lung disease is endemic.
"The frequency of benign lesions in these geographic regions could lead to unnecessary biopsies or lung surgeries in patients," said Grogan, staff surgeon at Veterans Hospital, assistant professor of Surgery in the Department of Thoracic Surgery and assistant professor of Medicine in the Institute for Medicine and Public Health at Vanderbilt. "However, some medical practices achieved greater test accuracy through robust reading methods, even in these regions."
The authors suggest that the use of FDG-PET to diagnose lung cancer be limited to non-endemic regions unless an institution has substantial and proven expertise in FDG-PET interpretation.
INFORMATION:
Other Vanderbilt and VA investigators include Jeffrey Blume, Ph.D., Clark Kensinger, M.D., Ashley Morgan, B.E., Melinda Aldrich, Ph.D., MPH, Pierre Massion, M.D., Ronald Walker, M.D., Melissa McPheeters, Ph.D., MPH, Joe (Bill) Putnam Jr., M.D.
Primary support for the study was from the Agency for Healthcare Research and Quality (R03H021554), and also included funding from the National Institutes of Health (KO7CA172294, UL1TR000011, CA90949, U01CA152662), the and the Department of Veterans Affairs (Grogan CDA 10-024).
Study questions accuracy of lung cancer screens in some geographic regions
2014-09-23
ELSE PRESS RELEASES FROM THIS DATE:
Asteroid named for University of Utah makes public debut
2014-09-23
SALT LAKE CITY, Sept. 23, 2014 – What's rocky, about a mile wide, orbits between Mars and Jupiter and poses no threat to Earth?
An asteroid named "Univofutah" after the University of Utah.
Discovered on Sept. 8, 2008, by longtime Utah astronomy educator Patrick Wiggins, the asteroid also known as 391795 (2008 RV77) this month was renamed Univofutah by the International Astronomical Union's Minor Planet Center in Cambridge, Massachusetts.
"It's neat," Wiggins says. "There aren't too many other universities on the whole planet with asteroids named after them. So that ...
Does size matter? MRI imaging sheds light on athletes most at risk for severe knee injury
2014-09-23
The successful rise and fall of an athlete's moving body relies on an orchestrated response of bones, joints, ligaments and tendons, putting the many angles and intersecting planes – literally the geometry – of a critical part like a knee joint to the test. But it's more than just a footfall error at the root of one of the most devastating of sports injuries: the ACL or anterior cruciate ligament tear. In fact, size – of the femoral notch that sits at the center of the knee joint – and volume of the ACL combine to influence the risk of suffering a noncontact ACL injury. ...
Infant cooing, babbling linked to hearing ability, MU researcher finds
2014-09-23
COLUMBIA, Mo. – Infants' vocalizations throughout the first year follow a set of predictable steps from crying and cooing to forming syllables and first words. However, previous research had not addressed how the amount of vocalizations may differ between hearing and deaf infants. Now, University of Missouri research shows that infant vocalizations are primarily motivated by infants' ability to hear their own babbling. Additionally, infants with profound hearing loss who received cochlear implants to help correct their hearing soon reached the vocalization levels of their ...
Solar energy-driven process could revolutionize oil sands tailings reclamation
2014-09-23
Edmonton—Cleaning up oil sands tailings has just gotten a lot greener thanks to a novel technique developed by University of Alberta civil engineering professors that uses solar energy to accelerate tailings pond reclamation efforts by industry.
Instead of using UV lamps as a light source to treat oil sands process affected water (OSPW) retained in tailings ponds, professors Mohamed Gamal El-Din and James Bolton have found that using the sunlight as a renewable energy source treats the wastewater just as efficiently but at a much lower cost.
"We know it works, so now ...
Antifreeze proteins in Antarctic fish prevent both freezing and melting
2014-09-23
Antarctic fish that manufacture their own "antifreeze" proteins to survive in the icy Southern Ocean also suffer an unfortunate side effect, researchers funded by the National Science Foundation (NSF) report: The protein-bound ice crystals that accumulate inside their bodies resist melting even when temperatures warm.
"We discovered what appears to be an undesirable consequence of the evolution of antifreeze proteins in Antarctic notothenioid fish," said University of Oregon doctoral student Paul Cziko, who led the research with University of Illinois animal biology ...
NYU-Mount Sinai Beth Israel study explores drug users' opinions on genetic testing
2014-09-23
Genomic medicine is rapidly developing, bringing with its advances promises of individualized genetic information to tailor and optimize prevention and treatment interventions. Genetic tests are already guiding treatments of the human immunodeficiency virus (HIV) and hepatitis c virus (HPC), and emerging research is showing genetic variants may be used to screen for an individual's susceptibility to addiction to a substance, and even inform treatments for addiction.
While there appear to be many benefits inherent in the development of this field and related research, ...
Slight alterations in microRNA sequences hold more information than previously thought
2014-09-23
(PHILADELPHIA) – Researchers have encountered variants or isoforms in microRNAs (miRNAs) before, but assumed that these variants were accidental byproducts. A recent study, published in the journal Oncotarget this month, shows that certain so called isomiRs have abundances that depend on geographic subpopulations and gender and that the most prevalent variant of a given miRNA may not be the one typically listed in the public databases.
"This study shows that microRNA isoforms are much more common than we had previously assumed. The fact that some isoforms are shared by ...
Mefloquine fails to replace SP for malaria prevention during pregnancy
2014-09-23
In this issue of PLOS Medicine, Clara Menendez from the Barcelona Institute for Global Health (ISGlobal), Spain, and colleagues report results from two large randomized controlled trials conducted in Africa to test an alternative drug for malaria prevention in HIV-negative and HIV-positive pregnant women.
Pregnant women and their unborn children are at a high risk for complications from malaria infection, and finding new treatment options is important because the malaria parasites are becoming increasingly resistant to the existing WHO-recommended drug sulphadoxine-pyrimethamine ...
Patients accept false-positives to achieve diagnostic sensitivity
2014-09-23
OAK BROOK, Ill. (September 23, 2014) – Both patients and healthcare professionals believe diagnosis of extracolonic malignancy with screening computed tomography (CT) colonography greatly outweighs the potential disadvantages of subsequent radiologic or invasive follow-up tests precipitated by false-positive diagnoses, according to a new study published in the October issue of the journal Radiology.
Diagnostic tests used for cancer screening programs usually target a specific organ. However, when screening for colorectal cancer with CT colonography, abdominal and pelvic ...
Medical students who attended community college likelier to serve poor communities
2014-09-23
IMPACT
The community college system represents a potential source of student diversity for medical schools and physicians who will serve poor communities; however, there are significant challenges to enhancing the pipeline from community colleges to four-year universities to medical schools. The authors recommend that medical school and four-year university recruitment, outreach and admissions practices be more inclusive of community college students.
FINDINGS
Researchers from UCLA, UC San Francisco and San Jose City College found that, among students who apply to and ...