Clinical utility of 18-fluorodeoxyglucose positron emission tomography/computed tomography in malignant pleural mesothelioma

Our plain-English summary of Clinical utility of 18-fluorodeoxyglucose positron emission tomography/computed tomography in malignant pleural mesothelioma, by T. Terada, C. Tabata, R. Tabata, et al (Experimental and Therapeutic Medicine, 2012).

The study

• Authors: T. Terada, C. Tabata, R. Tabata, H. Okuwa, S. Kanemura, E. Shibata, T. Nakano
• Journal: Experimental and Therapeutic Medicine
• Published: 2012;4(2):197-200
• Cited by: 24 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor of mesothelial origin associated with asbestos exposure. MPM has a limited response to conventional chemotherapy and radiotherapy, thus early diagnosis of MPM is extremely critical. CT scans have limited accuracy in the differentiation between benign and malignant pleural disease. Several studies have reported that 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the assessment of thoracic malignancy such as lung cancer. Here, we investigated the clinical utility of PET in patients with MPM. The maximum SUV (SUVmax) of 18F-FDG was measured in 47 MPM patients and 29 non-MPM patients including those with pleural thickening. We demonstrated that patients with MPM had significantly higher SUVmax levels than a population with non-malignant pleural disease. The Kaplan-Meier method revealed significant differences in overall survival between groups with SUVmax levels lower and higher than the assumed cut-off. Our data suggest that SUVmax levels are useful as an aid for diagnosis and prognosis of MPM.

In plain English

This study, from Hyogo College of Medicine Hospital in Japan, examined whether PET/CT scans using a radioactive sugar tracer (18F-FDG) could help diagnose malignant pleural mesothelioma (MPM) and predict survival. The authors measured the highest tracer uptake (SUVmax) in 47 patients with MPM and 29 patients with non-malignant pleural disease, some of whom had benign asbestos pleurisy. They saw these patients between September 2009 and April 2011. Patients with MPM had a significantly higher average SUVmax (5.3) than the non-malignant group (1.2). At a cut-off of 3.5, the scan identified 59.6% of MPM patients, and 93.1% of non-malignant patients fell below the cut-off. The authors noted that the sensitivity was not high. SUVmax was higher in sarcomatoid tumors than in other types, and it rose with stage. Overall survival differed significantly between the 19 patients below the cut-off and the 28 at or above it (p=0.02). In a multivariate survival analysis, the article reported age as an independent prognostic factor. The authors suggested that SUVmax is a useful diagnostic and prognostic imaging tool for MPM.

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: Single-hospital clinical study comparing 18F-FDG PET/CT measurements (SUVmax) between patients with and without malignant pleural mesothelioma, with survival analysis in the mesothelioma patients
• Who was studied: 76 patients seen at the Department of Respiratory Medicine of Hyogo College of Medicine Hospital, Japan, from September 2009 to April 2011: 47 with malignant pleural mesothelioma and 29 with non-malignant pleural disease (including benign asbestos pleurisy, plaque, pleural thickening and other pleurisy)
• Exposure: The measured exposure was 18F-FDG PET/CT uptake (SUVmax), not asbestos dose. Asbestos exposure history was recorded: 32 of the 47 MPM patients had a documented history of asbestos exposure. No fiber types were reported.
• Main results:
  • Distinguishing MPM from non-MPM patients by SUVmax gave an area under the ROC curve of 0.803 (95% CI, 0.722-0.885)
  • At a cut-off SUVmax of 3.5, sensitivity was 59.6% and specificity was 93.1%
  • At that cut-off, the positive predictive value was 93.3% and the negative predictive value was 58.7%
  • Mean SUVmax was 5.3 (plus or minus 4.4) in MPM patients versus 1.2 (plus or minus 1.8) in non-MPM patients, including those with benign asbestos pleurisy (p less than 0.01)
  • Among MPM patients, mean SUVmax was 4.6 (plus or minus 3.9) in non-sarcomatoid and 10.2 (plus or minus 5.4) in sarcomatoid tumors (p=0.01)
  • Among MPM patients, mean SUVmax tended to increase with stage: stage I 1.5, stage II 3.5, stage III 6.3, stage IV 7.6 (p less than 0.01)
  • There was no significant difference in SUVmax between patients with benign asbestos pleurisy (1.8 plus or minus 1.5) and the other non-MPM patients (1.1 plus or minus 1.8)
  • MPM patients were split at the 3.5 cut-off: 19 patients below it (mean SUVmax 1.4) and the remaining 28 at or above it
  • Overall survival differed significantly between MPM patients with SUVmax below 3.5 and those at or above 3.5 (p=0.02). The text does not state the direction.
  • In Cox multivariate analysis of MPM patients (age, gender, histology, performance status, SUVmax), the article reported an independent prognostic effect on survival for age (65 or under versus over 65; HR 2.4; 95% CI 1.07-5.23; p=0.03). No independent result for SUVmax is reported.
• The authors' conclusion: The authors suggested that SUVmax levels are a novel, useful diagnostic and prognostic imaging tool for MPM
• Limitations the authors state:
  • The authors noted that the diagnostic sensitivity (59.6%) and negative predictive value (58.7%) of SUVmax were not high

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure, Chemotherapy, CT Scan, Lung Cancer, Pleural Thickening, Overall Survival, Prognosis.

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)
• 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)
• 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)
• Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography-computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/decortication — A. Bille, S. Chicklore, et al. (2013)
• 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)
• 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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