•Solitary pulmonary nodules (SPNs) are increasingly being detected with greater use of diagnostic and screening CT scans.

•2-deoxy-2-(¹⁸F)fluoro-D-glucose positron emission tomography – computed tomography (FDG PET-CT) is frequently used in the characterization of SPNs but there is a relative paucity of data to guide optimal management of patients with low or absent FDG uptake.

•Whilst there is strong evidence for the cost-effectiveness of PET-CT in NSCLC, there are no data in the above group of patients (Schreyogg 2010).

•In a landmark meta-analysis of more than 1400 patients, the sensitivity and specificity of FDG PET (cut-off SUVmax > 2.5) for SPNs more than 1 cm in diameter was 96.8% and 77.8% respectively (Gould 2001).

•Gould and co-workers (Gould 2001) also established that in a low-risk patient with a PET negative SPN (> 1cm), the post-test probability for confirmed malignancy was 1%. Conversely, for high-risk patients with a negative PET (nodule > 1cm), the post-test probability of malignancy was 14%.

•O and co-workers (O 2007) showed a 17-20% incidence of malignancy in a cohort of patients with a known extra-pulmonary malignancy and incidental pulmonary nodules with low or absent FDG uptake.

•Others have reported that up to one-third of SPNs can be malignant, and that it is particularly challenging to accurately determine an appropriate decision threshold in those with an intermediate pre-test clinical risk (Ost 2012).

•At our large, tertiary referral institution, 60-70 patients with solitary pulmonary nodules are referred to the Lung Multi-disciplinary Team Meeting every year, making up approximately 10% of our overall workload.

•The purpose of this study was to evaluate the longitudinal outcome of a cohort of patients with SPNs and low or absent FDG uptake.