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Editorials |

PET Scans for Lung Nodules: Costs and Cost-Effectiveness

Douglas Arenberg, MD; for the Veterans Affairs Positron Emission Tomography Imaging in the Management of Patients with Solitary Pulmonary Nodules (VA SNAP) Cooperative Study Group
Author and Funding Information

From the Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan.

Correspondence to: Douglas Arenberg, MD, Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, 1150 W. Medical Center Dr, SPC 5642, Ann Arbor, MI 48109; e-mail: darenber@umich.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;137(1):4-6. doi:10.1378/chest.09-1453
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Extract

Lung cancer’s staggering mortality, and our desire to reduce it, draws us repeatedly back to a sometimes heated debate about screening, its suspected benefits, and its known or suspected risks. From a societal perspective, one of the known risks of screening is the potentially immense financial cost. The approach currently under investigation centers on CT scans, which though very sensitive, are lacking in specificity. The result is that smokers (and nonsmokers) have a high rate of detection of lung nodules, but in a large international trial of lung cancer screening, fewer than 10% of prevalent nodules were lung cancer.1 Perhaps more remarkable, even among those with normal baseline CT scans who subsequently developed a lung nodule, fewer than 5% of these “incident” nodules proved to be cancer.1 As a result, health economists are rightfully anxious about the potential costs of screening for lung cancer, much of which may be spent on evaluating those nodules that are benign. One way to reduce the number of invasive procedures (and therefore costs) used to investigate solitary pulmonary nodules (SPNs) is to employ a strategy of watchful waiting on those perceived to be at a low risk. 18Flourodeoxy-glucose (FDG) PET scans have a high negative predictive value and can identify patients whose nodules could be safely managed by serial observation.

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