Regional Variation of FDG-PET Scans to diagnose lung cancer

FDG-PET 扫描诊断肺癌的区域差异

• 批准号: 8505339
• 负责人: Eric L Grogan
• 金额: $ 5万
• 依托单位: VANDERBILT UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-07-10 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8505339
• 关键词: Regional; Variation; FDG; PET; Scans

DESCRIPTION (provided by applicant): Lung cancer kills over 160,000 people annually, more people than breast, prostate, kidney, colon, liver and skin cancer combined. More suspicious lung nodules are being found due to increased numbers of Computed Tomography (CT) scans being performed. F18-Fluorodeoxyglucose Positron Emission Tomography (FDG- PET) is approved by Centers for Medicare and Medicaid Services (CMS) for diagnosing suspicious lung nodules and is currently the most accurate non-invasive diagnostic tool available to clinicians. Lung cancer is typically metabolically active resulting in an FDG avid lesion seen on the PET scan. Active infections may also be metabolically active (FDG avid) resulting in false positive results. Retrospective single institution studies have demonstrated that infectious fungal lung diseases, such as histoplasmosis, reduce the specificity FDG- PET scans to diagnose lung cancer. Fungal lung disease is a soil based organism and common in the central Unites States. In regions of the country with high rates of fungal lung disease, false positive FDG-PET scans result in unnecessary lung operations being performed to diagnose lung cancer in 20 to 30 percent of cases. These operations have a 1-2% mortality rate. The ability to accurately and non-invasively diagnose lung cancer is limited by not knowing the circumstances and regions of the country that FDG-PET performs poorly. Understanding the regional variation of FDG-PET scan accuracy will aid cost-effectiveness studies, improve predictive models and help clinicians more accurately diagnose lung cancer. The American College of Surgeons Oncology Group (ACOSOG) Z4031 national cooperative study (5U10CA076001-11) was completed in 2006 and enrolled over 1000 patients with known or suspected lung cancer. The purpose of that study was to evaluate a serum blood test for lung cancer. Imaging reports and clinical data have been extracted into a database by trained reviewers for over 1000 patients and over 665 patients have FDG-PET scan results. The ACOSOG dataset provides an ideal source to examine the impact of FDG-PET. The purpose of our study is to test the hypothesis that regional accuracy of FDG-PET to diagnose lung cancer exists and determine if this test is useful in areas where there are high endemic rates of fungal lung disease. In aim 1 we will examine whether FDG-PET scan test characteristics in diagnosing lung cancer vary by institution and/or geographic region. This aim will determine the variation in specificity based on the enrolling institution and the relationship to the endemic histoplasmosis rate. In aim 2 we will use individual patient zip codes as a locator and examine whether false positive FDG-PET scans in the ACOSOG Z4031 study are increased in areas with endemic fungal disease compared to areas of with a low burden of fungal disease. The primary deliverable for aim 2 will use logistic regression to examine if an association exists between false positive FDG-PET scans to diagnose lung cancer and endemic histoplasmosis rates.

描述（由申请人提供）：肺癌每年杀死16万多人，比乳房，前列腺，肾脏，结肠，肝脏和皮肤癌的人多。由于进行了计算机断层扫描（CT）扫描数量增加，因此发现了更多可疑的肺结节。 F18-氟脱氧葡萄糖正电子发射断层扫描（FDG-PET）已获得Medicare和Medicaid服务中心（CMS）批准诊断可疑的肺结核，目前是临床医生可用的最准确的非侵入性诊断工具。肺癌通常具有代谢活性，导致在PET扫描中看到FDG狂热病变。活性感染也可能是代谢活性（FDG AVID），从而产生假阳性结果。回顾性的单一机构研究表明，感染性真菌肺部疾病（例如组织胞浆病）降低了特异性FDG-PET扫描以诊断肺癌。真菌肺疾病是一种基于土壤的生物，在中央统一状态中很常见。在真菌肺疾病率高的国家中，假阳性FDG-PET扫描导致在20％至30％的病例中进行不必要的肺作战以诊断肺癌。这些操作的死亡率为1-2％。准确和非侵入性诊断肺癌的能力受到不知道FDG-PET表现不佳的情况和地区的限制。了解FDG-PET扫描准确性的区域变化将有助于成本效益研究，改善预测模型并帮助临床医生更准确地诊断肺癌。美国外科医生肿瘤学院（ACOSOG）Z4031国家合作研究（5U10CA076001-11）于2006年完成，并招募了1000多名已知或疑似肺癌患者。该研究的目的是评估肺癌的血清血液检查。成像报告和临床数据已被训练有素的1000多名患者提取到数据库中，有665例患者的FDG-PET扫描结果。 ACOSOG数据集为检查FDG-PET的影响提供了理想的来源。我们研究的目的是检验以下假设：FDG-PET诊断肺癌的区域准确性存在，并确定该测试在真菌肺疾病率高的地区是否有用。在AIM 1中，我们将检查FDG-PET扫描测试特征在诊断肺癌中是否因机构和/或地理区域而异。该目标将根据注册机构和 与流行的组织胞浆病率的关系。在AIM 2中，我们将使用单独的患者邮政编码作为定位器，并检查AcoSOG Z4031研究中的假阳性FDG-PET扫描是否增加了特有真菌疾病的地区，与真菌疾病负担低的地区相比。 AIM 2的主要可交付能力将使用逻辑回归来检查假阳性FDG-PET扫描以诊断肺癌和流行性组织肿瘤率之间的关联。