FDG PET/CT in the management of primary pleural tumors and pleural metastases

Our plain-English summary of FDG PET/CT in the management of primary pleural tumors and pleural metastases, by M. Kruse, S.J. Sherry, V. Paidpally, et al (AJR. American Journal of Roentgenology, 2013).

The study

• Authors: M. Kruse, S.J. Sherry, V. Paidpally, G. Mercier, R.M. Subramaniam
• Journal: AJR. American Journal of Roentgenology
• Published: 2013;201(2):W215-26
• Type of article: Review
• Cited by: 39 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

OBJECTIVE. FDG PET/CT is emerging as an important modality in the evaluation of pleural tumors. PET/CT has an established role in the diagnosis and staging and shows promise in therapy planning, therapy response assessment, and providing prognostic information in patients with malignant pleural mesothelioma. This modality has distinct advantages in characterizing other primary pleural tumors and pleural metastases. CONCLUSION. FDG PET/CT is a useful imaging modality in the management of patients with primary pleural tumors and pleural metastases.

In plain English

This article was a review, not a new study. The authors summarized published research on FDG PET/CT, a scan that pairs a radioactive sugar tracer with CT, in pleural tumors and pleural metastases. It included no patient group of its own; its figures showed individual example cases. In the studies it reviewed, FDG PET identified malignancy with sensitivity of 95–97% and specificity of 78–92%. One cited study of patients with asbestos exposure reported that PET/CT told malignant from benign pleural disease apart with sensitivity of 94% and specificity of 100%, using an SUV cutoff of 2.2. In another cited study of 29 patients, PET/CT precluded surgery in 41%. Findings on prognosis were mixed. A cited study of 137 patients linked SUVmax greater than 10 with 1.9 times greater risk of death, while other reports found no correlation with survival. The authors noted that inflammation can cause false-positive results and that many studies of solitary fibrous tumor were small. They concluded that PET/CT had proven utility in distinguishing benign from malignant pleural thickening.

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 literature on FDG PET/CT imaging of pleural tumors, illustrated with individual patient images
• Who was studied: No original study population. The article reviewed published studies on malignant pleural mesothelioma, solitary fibrous tumor of the pleura, pleural lipoma and liposarcoma, and pleural metastases. The figures showed individual example patients.
• Exposure: Not an exposure study; the subject was the imaging technique FDG PET/CT. Asbestos appears only as background: the authors described malignant pleural mesothelioma's association with asbestos and cited one study of patients with asbestos exposure. No fiber types were named.
• Main results:
  • In the studies the authors reviewed (refs 21–26), qualitative FDG PET assessment correctly identified malignancy with sensitivity of 95–97% and specificity of 78–92%.
  • A cited study (ref 27) of patients with asbestos exposure reported that FDG PET/CT distinguished malignant from benign pleural disease with sensitivity of 94% and specificity of 100%, using an SUV cutoff of 2.2.
  • In a cited prospective study of 29 patients (Erasmus et al., ref 44), FDG PET/CT precluded surgery in 41% of patients. The review also noted that several other studies found PET/CT was not superior to CT or MRI for locoregional staging.
  • On prognosis in malignant pleural mesothelioma, a cited study of 137 patients (Flores et al., ref 55) found that SUVmax greater than 10 was associated with 1.9 times greater risk of death in multivariate analysis. Other cited reports found no correlation between SUVmax and survival.
  • The authors described FDG uptake in inflammatory processes, including after talc pleurodesis, as a source of false-positive findings.
• The authors' conclusion: The authors concluded that FDG PET/CT had proven utility in differentiating benign from malignant pleural thickening and an increasing role in staging, treatment monitoring and prognosis of malignant pleural mesothelioma. They also concluded that volume-based PET measures, such as metabolic tumor volume or total lesion glycolysis, are prognostic factors in mesothelioma, while reports on SUVmax are mixed.
• Limitations the authors state:
  • The authors stated that many studies of solitary fibrous tumor of the pleura were limited by small numbers of patients, and that large multicenter studies are needed.
  • The authors stated that PET/CT may have difficulty with tumors that take up little tracer, such as epithelial mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Staging, Pleural Mesothelioma.

Related studies

• Prognostic value of 18F-FDG standard uptake value by integrated PET/CT in the staging of malignant pleural mesothelioma — G. Genestreti, A. Moretti, et al. (2012)
• Current evidence base of FDG-PET/CT imaging in the clinical management of malignant pleural mesothelioma: emerging significance of image segmentation and global disease assessment — S. Basu, B. Saboury, et al. (2011)
• The association of 18F-FDG PET/CT parameters with survival in malignant pleural mesothelioma — A. Klabatsa, S. Chicklore, et al. (2014)
• A case of primary pericardial mesothelioma detected by 18F-FDG PET/CT — F. Aga, Y. Yamamoto, et al. (2012)
• 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)
• 18F-FDG PET/CT in the management of patients with malignant pleural mesothelioma being considered for multimodality therapy: experience of a tertiary referral center — H.S. Elliott, U. Metser, et al. (2018)

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