Background:To evaluate the role of computed tomography (CT) -guided needle biopsy and sodium iodide fluorine-18 fluorodeoxyglucose positron emission tomography (FDG-PET) in the investigation of solitary pulmonary nodules (SPN), which are discovered on screening chest radiographs, and to determine the cost-effectiveness of these modalities.Material/Methods: We have used decision-tree analysis models to assess the accuracy and cost-effectiveness of four strategies for the diagnosis and management of SPNs: CT alone strategy (baseline), CT plus FDG-PET strategy, CT plus FDG-PET plus CT-guided needle biopsy strategy, and CT plus CT-guided needle biopsy strategy. Reported values of prevalence of cancer, and sensitivity and specificity of each diagnostic modality were applied to the decision-tree models using Japanese health care costs.Results: The prevalence of lung cancer among SPNs discovered on the lung cancer screening was less than 10%. In this prevalence, the strategies using CT-guided needle biopsy were the cost-effective alternatives to the CT alone strategy (cost saving was i436,470 – i456,478 per patient), and had higher accuracies (95–96% vs. 67%). Both effects were mainly the result of reducing the number of the candidates who undergo unnecessary thoracotomy for a benign SPN, and these results were true over a wide range of prevalence of cancer (0–55%). The cost saving and accuracy of the CT plus FDG-PET strategy (359,206 and 92%) were approaching to those of the strategies using CT-guided needle biopsy.Conclusions: The introduction of CT-guided needle biopsy and FDG-PET for the evaluation of SPNs, which are discovered on screening chest radiograph, is potentially cost-effective in Japan with high accuracy.

Keywords: Coin Lesion, Pulmonary - radiography, Cost-Benefit Analysis, Decision Trees, Fluorodeoxyglucose F18 - pharmacology, Lung Neoplasms - diagnosis, Mass Screening, Prevalence, Radiopharmaceuticals, Sensitivity and Specificity, Tomography, Emission-Computed, Tomography, X-Ray Computed - economics, Cost-Benefit Analysis, Decision Trees, Fluorodeoxyglucose F18 - pharmacology, Lung Neoplasms - diagnosis, Mass Screening, Prevalence, Radiopharmaceuticals, Sensitivity and Specificity, Solitary Pulmonary Nodule - radiography, Tomography, Emission-Computed, Tomography, X-Ray Computed - economics