\[18F\]Fluorodeoxyglucose PET in Thoracic Malignancies

Our plain-English summary of [18F]Fluorodeoxyglucose PET in Thoracic Malignancies, by M.H. Vilstrup, D.A. Torigian (PET Clinics, 2014).

The study

• Authors: M.H. Vilstrup, D.A. Torigian
• Journal: PET Clinics
• Published: 2014;9(4):391-420, v
• Type of article: Review
• Cited by: 7 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

[(18)F]Fluorodeoxyglucose (FDG) PET is a robust quantitative molecular imaging technique that complements available structural imaging techniques for the detection and characterization of malignancy. This article provides an overview of the utility and applications of FDG-PET for the evaluation of patients with thoracic malignancy.

Copyright © 2014 Elsevier Inc. All rights reserved.

In plain English

This article was a review of published research on FDG-PET, a scan showing where tissues take up a radioactive sugar, usually combined with CT or MR imaging, in people with cancers of the chest. It focused mainly on non–small cell lung cancer and also covered small cell lung cancer, malignant pleural mesothelioma, esophageal cancer and thymic epithelial tumors. It did not report new patient data. In its mesothelioma section, the authors described other researchers' studies. A study of 83 patients with pleural lesions reported that FDG-PET/CT had 100% sensitivity, 95% specificity and 98% accuracy for telling malignant pleural mesothelioma from benign pleural disease. A study of 31 patients with asbestos exposure and pleural disease reported 94% sensitivity and 100% specificity when tumor uptake (SUVmax) above 2.2 was counted as malignant. In a study of 137 patients with mesothelioma, SUVmax greater than 10 before treatment was associated with a 1.9-fold greater risk of death. The authors noted that talc pleurodesis can raise FDG uptake through inflammation, and that other uses in mesothelioma require further investigation. They concluded that FDG-PET complements structural imaging in patients with chest cancers.

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: Narrative review of published studies (no new patient data)
• Who was studied: Published studies of patients with thoracic cancers: mainly non–small cell lung cancer, plus small cell lung cancer, malignant pleural mesothelioma, esophageal cancer and thymic epithelial tumors
• Exposure: The review studied an imaging technique (FDG-PET, mostly as PET/CT), not asbestos exposure. Asbestos is mentioned only in one cited study, of patients with asbestos exposure and pleural disease.
• Main results:
  • A cited retrospective study of 83 patients with pleural lesions reported FDG-PET/CT sensitivity, specificity and accuracy of 100%, 95% and 98% for differentiating malignant pleural mesothelioma from benign pleural disease
  • A cited prospective study of 31 patients with asbestos exposure and pleural disease reported that FDG-PET/CT identified malignant from benign pleural disease with sensitivity of 94% and specificity of 100%, using an SUVmax threshold of greater than 2.2
  • In a cited prospective study of 29 patients with malignant pleural mesothelioma, FDG-PET/CT precluded surgery in 38% of patients by finding locally advanced tumor and spread outside the chest not seen on conventional imaging
  • In a cited prospective study of 137 patients with malignant pleural mesothelioma, tumor SUVmax greater than 10 before treatment was associated with a 1.9-fold greater risk of death on multivariate analysis
  • In a cited prospective study of 23 patients with malignant pleural mesothelioma scanned before and after 1 cycle of chemotherapy, a decrease in tumor TLG (a measure of total tumor sugar uptake) correlated significantly with improved survival
  • The authors reported that current guidelines suggest FDG-PET/CT for staging patients with malignant pleural mesothelioma who are being considered for surgery, preferably before talc pleurodesis
• The authors' conclusion: The authors concluded that FDG-PET complements structural imaging techniques in evaluating patients with thoracic malignancy
• Limitations the authors state:
  • Talc pleurodesis can increase FDG uptake through inflammation, so staging is preferably done before it
  • Uses of FDG-PET in mesothelioma other than staging and radiation therapy planning require further investigation

Related studies

• PET scan contribution in chest tumor management: a systematic review for thoracic surgeons — L. Duranti, F. Leo, et al. (2012)
• ¹⁸F-FDG uptake on PET could be a predictive marker of excision repair cross-complementation group 1 (ERCC1) expression in patients with thoracic neoplasms? — K. Kaira, M. Endo, et al. (2012)
• 18-Fluorodeoxyglucose positron emission tomography as a tool for response prediction in solid tumours — D.J. De Maeseneer, B. Lambert, et al. (2010)
• ¹⁸F-FDG uptake on PET is a predictive marker of thymidylate synthase expression in patients with thoracic neoplasms — K. Kaira, N. Yamamoto, et al. (2014)
• 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)
• Integrated positron emission tomography-computed tomography does not accurately stage intrathoracic disease of patients undergoing trimodality therapy for malignant pleural mesothelioma — J. Pilling, J.A. Dartnell, et al. (2010)

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