Assessment of 18F-fluorodeoxyglucose dual-head gamma camera in asbestos lung diseases

Our plain-English summary of Assessment of 18F-fluorodeoxyglucose dual-head gamma camera in asbestos lung diseases, by B. Melloni, J. Monteil, F. Vincent, et al (The European Respiratory Journal, 2004).

The study

• Authors: B. Melloni, J. Monteil, F. Vincent, F. Bertin, S. Gaillard, T. Ducloux, S. Verbeke, A. Maubon, J.C. Vandroux, F. Bonnaud
• Journal: The European Respiratory Journal
• Published: 2004;24(5):814-21
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The purpose of this study was to evaluate the performance of 18F-fluorodeoxyglucose (18FDG) imaging via coincidence detection emission tomography (CDET) in identifying malignant lesions in subjects exposed to asbestos. A total of 30 patients exposed to asbestos underwent 18FDG-CDET between January 2000 and June 2003. A CDET scan of the thorax and abdomen was performed 60 min after injection of 18FDG in fasting patients, and results were obtained in slices in three axes. The CDET results were compared to those from computed tomography (CT), and pleural or surgical biopsy in patients with positive 18FDG-CDET results. All primary malignant mesotheliomas accumulated 18FDG (n=6), and, in two patients, CDET findings were superior to those of CT, allowing early detection. In two cases, lung carcinomas with malignant pleural effusion were also detected. There were five false positive CDET results: three unilateral pleural thickening, one rounded atelectasis, and one benign lung nodule. All patients with pleural plaques showed no significant 18FDG uptake. Malignant diseases were detected by 18FDG-CDET imaging with a sensitivity of 89% and specificity of 71%. Coincidence detection emission tomography can identify malignant mesothelioma in selected subjects exposed to asbestos. Coincidence detection emission tomography appears to be a useful noninvasive method for the follow-up of subjects with exposure risk of asbestosis.

In plain English

This retrospective study from the university hospital in Limoges, France, tested whether a lower-cost scanning method could identify cancers in people exposed to asbestos. The method was 18F-fluorodeoxyglucose imaging with a dual-head gamma camera, called coincidence detection emission tomography (CDET). Thirty consecutive patients (29 men, one woman) were scanned between January 2000 and June 2003. All had occupational asbestos exposure, mainly in construction, maintenance, demolition and refractory materials. Nine had cancer: six malignant mesothelioma, two lung cancer and one pleural sclerosing epithelioid sarcoma. The scan detected eight of the nine and missed the sarcoma. All six mesotheliomas showed up, including two in patients without symptoms whose tumours CT had not identified. The scan was wrongly positive in five people without cancer: three with pleural thickening, one with rounded atelectasis and one with a benign lung nodule. The pleural plaques themselves showed no uptake in the 16 people who had them. Sensitivity was 89%. Specificity was 76% in the results section but 71% in the abstract. The authors concluded the method could be useful in selected asbestos-exposed patients and said larger series are needed to confirm this.

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 diagnostic accuracy study of consecutive patients at one hospital, comparing CDET scan results with CT, biopsy or surgery, and follow-up
• Who was studied: 30 consecutive patients (29 males, one female; mean age 61 years, range 43 to 77) referred for imaging abnormalities such as pleural plaques, diffuse pleural fibrosis and/or asbestosis, Centre Hospitalier et Universitaire de Limoges, France, January 2000 to June 2003. 23 were current or former smokers.
• Exposure: Self-reported occupational asbestos exposure, mainly in construction, maintenance, demolition and refractory materials. Fiber types and doses were not reported.
• Main results:
  • Of 9 cancers (6 malignant mesothelioma, 2 lung cancer, 1 pleural sclerosing epithelioid sarcoma), 8 were detected by CDET. The sarcoma was a false negative.
  • CDET was positive in all 6 patients with malignant mesothelioma. In 2 patients without symptoms who had pleural plaques, the scan showed localised high uptake, and surgery (VATS) revealed an extensive mesothelioma not identified by CT.
  • In 2 patients with unilateral pleural effusion, CDET showed uptake. Investigation found lung adenocarcinoma with malignant pleural effusion.
  • CDET was falsely positive in 5 patients without cancer: 3 with unilateral parietal pleural thickening, 1 with rounded atelectasis, and 1 with a solitary lung nodule found to be benign granulomatosis.
  • The pleural plaques themselves showed no 18FDG uptake in the 16 subjects who had them. This refers to the plaques, not to every patient with plaques: two patients with plaques had uptake that led to the detection of mesothelioma.
  • Benign disease was correctly assessed in 16 of 21 patients. Sensitivity for malignant disease was 89% and specificity 76% (the abstract gives specificity as 71%).
• The authors' conclusion: The authors concluded that 18FDG-CDET could be a useful imaging method for detecting chest cancers in selected patients exposed to asbestos.
• Limitations the authors state:
  • CDET is less sensitive than full-ring PET scanners and does not allow quantitative measurements.
  • The results need confirmation in larger series.

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: Thorax, Biopsy, Malignant Mesothelioma, Carcinoma, Pleural Effusion, Pleural Thickening, Rounded Atelectasis, Pleural Plaques.

Related studies

• 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)
• Positron emission tomography with f18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma — D.B. Schneider, C. Clary-Macy, et al. (2000)
• The role of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiating between benign and malignant adrenal lesions — P. Ozcan Kara, T. Kara, et al. (2011)
• Role of integrated 18-fluorodeoxyglucose position emission tomography-computed tomography in patients surveillance after multimodality therapy of malignant pleural mesothelioma — C. Tan, S. Barrington, et al. (2010)
• Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma — Y. Abe, K. Tamura, et al. (2012)
• Prognostic and predictive role of [18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with unresectable malignant pleural mesothelioma (MPM) treated with up-front pemetrexed-based chemotherapy — P.A. Zucali, E. Lopci, et al. (2017)

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