\[(18)F\]-FDG PET and localized fibrous mesothelioma

Our plain-English summary of [(18)F]-FDG PET and localized fibrous mesothelioma, by J. Cortes, J. Rodriguez, M.J. Garcia-Velloso, et al (Lung, 2003).

The study

• Authors: J. Cortes, J. Rodriguez, M.J. Garcia-Velloso, N. Rodriguez-Espiteri, J.F. Boan, J.M. Castellano, W. Torre
• Journal: Lung
• Published: 2003;181(1):49-54
• Type of article: Case report, Review
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The aim of this article is to present our experience with positron emission tomography (PET) and localized fibrous mesothelioma and to review the literature on this issue. During the past five years we found three patients with a complete clinical history who underwent a CT scan of the thorax and (18)F-fluorodeoxyglucose positron emission tomography ([(18)F]-FDG-PET) and were diagnosed with localized fibrous mesothelioma. Two of the patients were asymptomatic men and the third was a woman with chest pain. The standardized uptake value was 2.1 in one case, and in the other two an absence of FDG uptake was seen. All three had complete resection of the tumor, and in one case the presurgery diagnosis was adenocarcinoma. In one patient the tumor relapsed twice, and the other two patients are alive without any evidence of disease. The value of FDG-PET in the differential diagnosis of pulmonary and pleural abnormalities has gained ground during the last few years. As in most benign tumors, the FDG uptake is usually low (< 2.5) in the localized fibrous mesothelioma. However, more studies are necessary to define the role of FDG-PET in assessing this tumor.

In plain English

This article described three patients at a hospital in Pamplona, Spain, who over five years had a PET scan with a glucose-based tracer (FDG) before surgery and were found to have localized fibrous mesothelioma. It also reviewed earlier reports on PET in this tumor. The article does not mention asbestos. A scan reading (SUV) above 2.5 was treated as suggesting cancer. A 64-year-old man with a 2 by 2 cm nodule showed no tracer uptake. After surgery in January 1999 he had no remaining evidence of disease. A 62-year-old man, whose needle biopsy had shown localized fibrous mesothelioma, also showed no uptake. His 25-cm tumor, removed in May 1997, came back in November 1999 and again in July 2002, when it was judged unresectable and chemotherapy was planned. A 50-year-old woman with chest pain, whose needle biopsy had suggested lung adenocarcinoma, had a reading of 2.1. Surgery in February 2000 showed localized fibrous mesothelioma. The authors concluded that uptake is usually low (below 2.5) in this tumor, as in most benign tumors, but that the role of PET in assessing it remains to be determined.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case series of three patients with a review of the literature
• Who was studied: Three patients (a 64-year-old man, a 62-year-old man and a 50-year-old woman) at the Clínica Universitaria de Navarra, Pamplona, Spain, over five years. All had a chest CT scan and an FDG-PET scan before surgery and were found to have localized fibrous mesothelioma. One of them (Patient 2) had already had this tumor shown by needle biopsy before his PET scan.
• Exposure: No asbestos or other exposure is described. The study examined tracer (FDG) uptake on PET imaging, with an SUV above 2.5 counted as positive.
• Main results:
  • Patient 1 (64-year-old man, 2 by 2 cm solitary pulmonary nodule): PET showed no FDG uptake. The tumor was removed in January 1999 and he had no remaining evidence of disease.
  • Patient 2 (62-year-old man, lesion of 15 by 10 cm on CT): a needle biopsy showed localized fibrous mesothelioma with areas of necrosis.
  • In Patient 2, PET showed an area with no metabolic activity and the tumor was considered benign. A 25-cm mass was removed in May 1997.
  • In Patient 2 the tumor recurred in November 1999 (operated on in January 2000) and relapsed again in July 2002. It was then considered unresectable because of several intrapulmonary nodules, and chemotherapy was decided on.
  • Patient 3 (50-year-old woman with chest pain, 10-cm mass, needle biopsy reported as lung adenocarcinoma): PET showed low FDG uptake (SUVmax = 2.1). Surgery in February 2000 showed localized fibrous mesothelioma, and she had no evidence of disease at the time of writing.
  • Two of the three tumors had no FDG uptake and one had an SUV of 2.1. By common criteria all three were considered benign, although the tumor in Patient 2 recurred twice despite showing no uptake.
• The authors' conclusion: The authors concluded that the role of FDG-PET in assessing localized fibrous mesothelioma remains to be determined. FDG uptake is usually low (below 2.5) in this tumor, as with benign tumors, and more studies are needed.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Mesothelioma, CT Scan, Thorax, Adenocarcinoma, Differential Diagnosis.

Related studies

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• The role of FDG PET-CT in differential diagnosis of pleural pathologies — U. Elboga, M. Yılmaz, et al. (2012)
• Do high glucose levels have differential effect on FDG uptake in inflammatory and malignant disorders? — H.M. Zhuang, A. Cortés-Blanco, et al. (2001)
• Positron emission tomography in the diagnosis of mesothelioma — U. Haberkorn (2004)
• Volume-based parameter of 18)F-FDG PET/CT in malignant pleural mesothelioma: prediction of therapeutic response and prognostic implications — H.Y. Lee, S.H. Hyun, et al. (2010)
• Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study — H. Yildirim, M. Metintas, et al. (2009)

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