18F-FDG PET/CT in suspected recurrences of epithelial malignant pleural mesothelioma in asbestos-fibers-exposed patients (comparison to standard diagnostic follow-up)

Our plain-English summary of 18F-FDG PET/CT in suspected recurrences of epithelial malignant pleural mesothelioma in asbestos-fibers-exposed patients (comparison to standard diagnostic follow-up), by A. Niccoli-Asabella, A. Notaristefano, D. Rubini, et al (Clinical Imaging, 2013).

The study

• Authors: A. Niccoli-Asabella, A. Notaristefano, D. Rubini, C. Altini, C. Ferrari, N. Merenda, M. Fanelli, G. Rubini
• Journal: Clinical Imaging
• Published: 2013;37(6):1098-103
• Cited by: 20 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

This retrospective study evaluated the role of 18-fluorine-labeled 2-deoxy-2-fluoro-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with previous occupational or environmental exposure to asbestos, with histopathological diagnosis of epithelial malignant pleural mesothelioma and suspected recurrences, comparing the data from 18F-FDG PET/CT and computed tomography with contrast enhancement (CECT). 18F-FDG PET/CT has greater sensitivity than CECT in identifying local extent, lymph nodes, and metastasis. 18F-FDG PET/CT whole-body explorations are useful to monitor the follow-up and evaluate the metabolic response to chemo- and radiotherapy, modifying the scheduled treatment plan.

© 2013 Elsevier Inc. All rights reserved.

In plain English

This retrospective study from the University of Bari, Italy, looked at 57 previously treated patients (37 men, 20 women, aged 48 to 80) with epithelial malignant pleural mesothelioma and a suspected recurrence. All came from an "outbreak area" and had environmental and occupational asbestos exposure in the 1970s to 1980s. The article does not name fiber types. The authors compared FDG PET/CT scans with contrast-enhanced CT (CECT), using at least 12 months of clinical follow-up as the reference. Follow-up showed disease progression in 52 patients. PET/CT gave 51 true-positive, 5 true-negative, 1 false-negative and no false-positive results. CECT gave 50, 1, 2 and 4. Sensitivity was 98.1% for PET/CT and 96.2% for CECT. Specificity was 100% versus 20%, a difference that was not statistically significant. Overall agreement between the two scans was moderate, and agreement for lymph nodes was low. Recurrence showed no linear association with initial stage or with number of treatments. The authors concluded that PET/CT is a very promising, accurate, noninvasive follow-up tool. They noted that not all lesions could be biopsied, the design was retrospective, and treatment was not uniform.

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: retrospective study comparing the diagnostic performance of 18F-FDG PET/CT with contrast-enhanced CT (CECT), using clinical disease progression over at least 12 months as the gold standard
• Who was studied: 57 patients (20 women, 37 men), aged 48 to 80 years (average 66), with histologically proven epithelial malignant pleural mesothelioma, in restaging and follow-up after single or multimodal treatment, imaged at the Nuclear Medicine Unit, University of Bari, Italy; study dates not given
• Exposure: previous environmental and occupational asbestos exposure in the 1970s to 1980s in an outbreak area; no fiber type, product, job or dose is given
• Main results:
  • Clinical follow-up was positive (disease progression) in 52 of 57 patients and negative in 5
  • PET/CT: 51 true-positive, 5 true-negative, 1 false-negative, 0 false-positive; CECT: 50 true-positive, 1 true-negative, 2 false-negative, 4 false-positive
  • Sensitivity was 98.1% for PET/CT and 96.2% for CECT (P=1)
  • Specificity was 100% for PET/CT and 20% for CECT (P=.13), a difference that was not statistically significant
  • For all 57 patients, accuracy, PPV and NPV were 98.2%, 100% and 83.3% for PET/CT, and 89.4%, 92.5% and 33.3% for CECT
  • Overall agreement between PET/CT and CECT was moderate (K=0.403)
  • Agreement for lymph node involvement was low (K=0.176, P=.126); CECT showed enlarged lymph nodes in 21 patients, of whom only 10 had increased FDG uptake
  • Outcome (presence or absence of recurrence) showed no linear association with disease stage at first staging (P=.87); the same was found for number of treatments (P=.68)
  • SUVmax (the highest FDG uptake value) was not related to the number of lesions
• The authors' conclusion: The authors concluded that 18F-FDG PET/CT is a very promising, accurate, noninvasive tool for follow-up of patients with recurrent epithelial malignant pleural mesothelioma. They also concluded that recurrence was not related to the type of treatment or to disease stage at first staging.
• Limitations the authors state:
  • For ethical and clinical reasons, not all lesions could be biopsied during follow-up
  • Retrospective design
  • Patients were not treated under a uniform management protocol

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: Pleural Mesothelioma, Environmental Exposure, Metastasis.

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