Contribution of positron emission tomography in pleural disease

Our plain-English summary of Contribution of positron emission tomography in pleural disease, by B. Duysinx, J.L. Corhay, M.P. Larock, et al (Revue des Maladies Respiratoires, 2010).

The study

• Authors: B. Duysinx, J.L. Corhay, M.P. Larock, N. Withofs, T. Bury, R. Hustinx, R. Louis
• Journal: Revue des Maladies Respiratoires
• Published: 2010;27(8):e47-53
• Type of article: Review
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Introduction: Positron emission tomography (PET) now plays a clear role in oncology, especially in chest tumours. We discuss the value of metabolic imaging in characterising pleural pathology in the light of our own experience and review the literature.

Background: PET is particularly useful in characterising malignant pleural pathologies and is a factor of prognosis in mesothelioma. Metabolic imaging also provides clinical information for staging lung cancer, in researching the primary tumour in metastatic pleurisy and in monitoring chronic or recurrent pleural pathologies.

Conclusions: PET should therefore be considered as a useful tool in the diagnosis of liquid or solid pleural pathologies.

Copyright © 2010 SPLF. Published by Elsevier Masson SAS. All rights reserved.

In plain English

This review by university hospital doctors in Liège, Belgium, covered how 18FDG PET scans help tell benign disease of the pleura (the lung lining) from cancer, using published studies and the authors' work. Across the studies reviewed, sensitivity (cancers detected) ranged from 89 to 100% and specificity (benign cases correctly called benign) from 67 to 100%. In the authors' 98-patient study, PET had 97% sensitivity and 88% specificity and correctly classified all six benign asbestos-related cases. Their second study involved 79 consecutive patients whose lymphocyte-rich exudative pleural effusions remained unexplained after CT and fluid sampling. In that group, an uptake value (SUVbw) of 2.2 separated malignant from benign pleurisy with 86% sensitivity and 75% specificity. A cited study of 30 asbestos-exposed patients with pleural and/or lung abnormalities found 89% sensitivity and 76% specificity for malignant pleural (7 cases) or lung (2 cases) disease. After talc pleurodesis, all 15 of the authors' patients showed increased uptake on PET. The authors concluded that PET is part of exploring pleural disease without replacing thoracoscopy. They also said that further studies must confirm its prognostic value in mesothelioma.

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 the literature combined with the authors' own experience, including their previously published studies
• Who was studied: Patients with pleural disease in published PET studies. These included the authors' own cohorts at Sart-Tilman University Hospital, Liège, Belgium: 98 patients with pleural disease of unknown cause, 79 consecutive patients with lymphocyte exudative pleural effusion unexplained after CT and thoracocentesis, and 15 patients after talc pleurodesis. Study dates were not given.
• Exposure: Not an exposure study. The subject was 18FDG PET imaging. Asbestos appears as one cause of benign pleural disease in the authors' cohorts and in a cited study of patients exposed to asbestos.
• Main results:
  • Across the published studies reviewed, PET sensitivity for malignant pleural disease ranged from 89 to 100% and specificity from 67 to 100%.
  • In the authors' 98-patient study, PET had a sensitivity of 97%, a specificity of 88%, and negative and positive predictive values of 94% each.
  • In the same 98-patient study, all six benign asbestos-related cases (among 35 benign disorders) were correctly classified by PET.
  • In the authors' study of 79 consecutive patients with lymphocyte exudative pleural effusion unexplained after CT and thoracocentesis, an SUVbw cut-off of 2.2 distinguished malignant from benign pleurisy with sensitivity 86%, specificity 75% and accuracy 82%.
  • In a cited study (Melloni et al.) of 30 patients exposed to asbestos with pleural and/or pulmonary anomalies, PET had a sensitivity of 89% and a specificity of 76% for the onset of malignant pleural (n = 7) or pulmonary (n = 2) disease.
  • In the authors' 15 patients after talc pleurodesis, PET showed increased uptake in all cases when performed between 7 days and 42 months after the procedure.
• The authors' conclusion: The authors concluded that PET can discriminate benign from malignant pleural disorders and is part of exploring pleural disease, without replacing thoracoscopy. In their view, its input in recurrent pleurisy has true clinical value, especially when the pleurisy is asbestos-related.
• Limitations the authors state:
  • The authors stated that further studies are needed to definitively confirm the prognostic value of PET in mesothelioma.
  • The authors described the evidence that PET helps find an unknown primary tumour as tenuous and based on few patients.
  • Talc pleurodesis can cause false-positive PET results, so the authors judged PET unsuitable for monitoring patients treated this way.

Topics

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

Medical terms in this study, explained in our Lexicon: Pathology, Prognosis, Mesothelioma, Staging, Lung Cancer, Pleurisy.

Related studies

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• 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)
• 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)
• Does positron emission tomography offer prognostic information in malignant pleural mesothelioma? — S. Sharif, I. Zahid, et al. (2011)
• High performance of F-fluorodeoxyglucose positron emission tomography and contrast-enhanced CT in a rapid outpatient diagnostic program for patients with suspected lung cancer — P. Brocken, H.F. van der Heijden, et al. (2014)

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