Quality statement 3
Rationale |
PET-CT examinations undertaken for assessment of solid pulmonary nodules are reported using qualitative assessment with an ordinal scale to define FDG uptake as absent, faint, moderate or intense, in relation to background lung tissue and mediastinal blood pool, to facilitate use of the Herder risk prediction model.
The Herder risk prediction model is the most accurate at predicting malignancy in solid pulmonary nodules and has been validated in a UK population. It uses clinical and radiological factors in conjunction with FDG uptake within the pulmonary nodule to determine the risk of malignancy. The incorporation of FDG uptake has a synergistic effect on the predictive accuracy of clinicoradiological prediction models but is dependent on the accurate classification of FDG uptake within solid pulmonary nodules using qualitative assessment with an ordinal scale. The standardisation of reporting of FDG uptake within solid pulmonary nodules on PET-CT facilitates reliable reproducibility of the Herder risk prediction model in clinical practice. |
Quality measure |
Structure:
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Description of what the quality statement means for each audience |
Service providers:
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Relevant existing indicators | Local MDT minutes/database/audit |
National data sources | National Lung Cancer Audit, Society for Cardiothoracic Surgery Thoracic Registry |
Source references | BTS Guidelines for the Investigation and Management of Pulmonary Nodules, 20153; NICE Lung Cancer: Diagnosis and Management Guideline, 20114; RCP/RCR Evidence-based indications for the use of PET-CT in the United Kingdom, 20165 |
Other information |
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Definitions |
BTS qualitative ordinal scale for classification of solid pulmonary nodules with FDG PET-CT
Absent: uptake indiscernible from background lung tissue. Faint: uptake less than or equal to mediastinal blood pool. Moderate: uptake greater than mediastinal blood pool. Intense: uptake markedly greater than mediastinal blood pool. |