Abstract Rationale The Miami VA Medical Center found a 83.5% concordance between the Positron emission tomography (PET) CT scan and the final lung cancer diagnosis and stage in their database. Regional variability in endemic fungi and other diseases causing lung nodules could confound a PET CT scan’s ability to accurately identify final lung cancer pathological stage. Methods A consortium of 13 regionally diverse VAMCs provided institutional data for the most recent lung cancer diagnoses. Using REDCap, data on stage suggested by PET CT, final pathological stage, biopsy strategies used, complications and timing of significant events during diagnostic evaluation and management were collected and analyzed. Results 121 cases of lung cancer were submitted including: 65.3% stage I, 12.9% stage II, 18.8% stage III and 3.0% stage IV. Mean risk scores for all nodules using the Brock and Mayo risk prediction algorithms were 29.9% and 60.3%, respectively. Transcutaneous (41%) and bronchoscopic (45%) techniques were primarily used for diagnosis. For cases diagnosed by bronchoscopy, 77.8% used curvilinear EBUS and 66.7% used navigational bronchoscopy. Twenty percent of cases were diagnosed by surgical biopsy and 2% by mediastinoscopy. Pneumothorax complications occurred in 18 patients (14.9%) with 2% requiring observation and 16.2% requiring a chest tube. Nineteen patients had bleeding complications with 16.2% described as minor and 3% described as major. For treatment, 65% received surgery, 31.6% received chemotherapy and 35.7% received radiation. PET CT accurately predicted the final pathological stage in 46.5% of the cases, erroneously upstaging and downstaging patients 20.8% and 32.7%, respectively. The percentage of patients out of the entire population where PET CT predicted final pathological stage accurately, downstaged or upstaged; stage I (31%, 10%, 13%), stage II (4%, 6%, 2%); stage III (6.9%, 1.0%, 7.9%) and stage IV (2%, 1%, 0%). In three patients (3.0%), PET CT erroneously suggested surgery was an option whereas in one patient (1%), PET CT suggested they were not a surgical candidate when they were. Median time from chest image to treatment was 105.5 days and PET CT to treatment was 74 days. Conclusions Marked differences in the accuracy of the PET CT to predict final pathological stage exist when evaluated across the nation, compared to solely in Miami. This variation may result from the effect lung cancer screening had on the two groups, as this current cohort had higher proportion (65.3%) stage I compared to theMiami data (40%). This abstract is funded by: VA LPOP (CU000172) CSP Project ID (L0019)
Holt et al. (2026) studied this question.