Deciphering the role of FDG-PET/CT in the management of sarcoidosis.

IF 9.5 1区医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-02-25 DOI:10.1016/j.chest.2025.02.017

Ryan Donnelly, Alessandro N Franciosi, Sarah H Forde, Michael McDermott, Michael P Keane, David J Murphy, Emmet E McGrath, Cormac McCarthy

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引用次数: 0

Abstract

Background: Fluoro-2-deoxyglucose-18 (FDG) positron emission tomography (PET/CT) has utility in identifying sites of active sarcoidosis. However, the role of FDG-PET/CT in predicting treatment response and guiding therapy outside of cardiac disease is yet to be completely understood.

Research question: Do physicians agree on the utility of FDG-PET/CT in sarcoid cases, and do they agree on the appropriate treatment response, based on the associated reports?

Study design and methods: Physicians respondents were presented with a series of anonymised sarcoidosis case vignettes. The perceived utility of FDG-PET/CT in each case, as well as the ultimate treatment decision following provision of FDG-PET/CT results was assessed. Inter-rater agreement was assessed overall and per case vignette specialty using Gwet's Agreeability Coefficient (AC1).

Results: Respondents (n=215) were predominantly respiratory physicians (86.78%) experienced in sarcoidosis management (94.39%), and a third of whom had >20 years' experience (32.66%). Pulmonary sarcoidosis case vignettes had the lowest rates of FDG-PET/CT endorsement among surveyed subspecialties (38 - 64%). Overall inter-rater agreement was assessed among physicians who positively endorsed an FDG-PET/CT. Treatment rationalisation based on FDG-PET/CT report was near-chance agreement for pulmonary AC1=0.178 (N=217, 95% CI 0.125- 0.234, p=0.07) and multisystem AC1=0.296 (N=168, 95% CI 0.066 - 0.477, p=0.41) cases, while agreement was highest for cases of cardiac sarcoidosis AC1=0.797 (N=374, 95% CI 0.759 - 0.838, p=<0.05).

Interpretation: Our results indicate a low agreement between physicians regarding their management of pulmonary sarcoidosis following FDG-PET/CT. This highlights a need for further research and clarity over the role of FDG-PET/CT in the therapeutic management of pulmonary sarcoidosis.

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来源期刊

Chest 医学-呼吸系统

CiteScore

13.70

自引率

3.10%

发文量

3369

审稿时长

15 days

期刊介绍： At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.