Positron emission tomography in the diagnosis of mesothelioma

Our plain-English summary of Positron emission tomography in the diagnosis of mesothelioma, by U. Haberkorn (Lung Cancer, 2004).

The study

• Author: U. Haberkorn
• Journal: Lung Cancer
• Published: 2004;45 Suppl 1:S73-6
• Type of article: Review
• Cited by: 19 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

The increasing incidence of malignant pleural mesothelioma has led to the development of new treatment strategies and a need for new diagnostic techniques to identify the extent of the disease at an early stage and to evaluate treatment. Computed tomography (CT) and magnetic resonance imaging (MRI) are helpful in identifying the location and extent of the involved areas but cannot always differentiate between benign and malignant processes. Fluorodeoxyglucose (FDG)-positron emission tomography (PET) imaging, which in oncology, is based on changes in metabolic pathways of glucose, has been shown in a number of studies to differentiate malign and benign lesions in patients with asbestos exposure. FDG-PET images were also found to provide excellent delineation of the active tumour sites. Further evaluations of this technique included a combined experimental/clinical study to investigate the difference in rates of FDG uptake between malignant and inflammatory cells and processes.

In plain English

This article was a short review, not an original study. The author described imaging methods for malignant pleural mesothelioma and summarized a small number of published studies of FDG-PET scanning, which measures how much of a sugar-based tracer tissue takes up. The author noted that diffuse pleural thickening can be benign or malignant, particularly in asbestos-exposed workers. Among the studies reviewed, one study of 14 patients found significant tracer uptake in 12 of 13 patients with malignant disease. Another, of 28 patients, reported a sensitivity of 91% and a specificity of 100% using a cut-off value of 2.0. A study of 18 patients had two false-positive results. A study of 17 patients found significantly shorter survival in the high-uptake group. The author cautioned that some epithelial mesotheliomas had uptake close to the threshold, that thin sheet-like tumours may be hard to measure, and that only a few small studies existed. The author concluded that definitive statements were not possible, but that PET may be helpful in difficult cases and in staging.

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 on FDG-PET imaging in mesothelioma (no new data collected by the author)
• Who was studied: Patients in the studies reviewed: 14 patients (Carretta et al.), 16 patients (Buchmann et al.), 28 patients (Benard et al.), 18 patients (Schneider et al.), 26 patients plus cell lines and rats (Zhuang et al.), and 17 patients in a prognosis study
• Exposure: Not an exposure study. Asbestos exposure is mentioned as background: pleural thickening in asbestos-exposed workers can be benign or malignant, and PET was discussed as a way to tell them apart.
• Main results:
  • In the study by Carretta et al., PET showed significant tracer uptake in 12 of 13 patients with malignant disease (overall accuracy 92%). There was one false negative, in a patient with epithelial mesothelioma.
  • In the study by Buchmann et al. of 16 patients, all 12 malignant tumours had high uptake, and the four benign lesions were correctly read as nonmalignant.
  • In the study by Benard et al. of 28 patients (24 with malignant disease), an uptake cut-off of 2.0 gave a sensitivity of 91% and a specificity of 100%.
  • In a study of 18 patients (Schneider et al.), there were two false-positive results.
  • In a dual-time study (Zhuang et al.) of 26 patients, uptake in known malignant lesions increased between earlier and delayed scans.
  • In a prognosis study of 17 patients, the high-uptake group had significantly shorter survival than the low-uptake group.
• The authors' conclusion: The author concluded that definitive statements about FDG-PET for diagnosing mesothelioma were not possible because few studies were available. The author added that PET may help in difficult cases where conventional imaging cannot establish whether a pleural lesion is malignant, and may be useful in staging.
• Limitations the authors state:
  • Only a few studies with limited numbers of patients were available.
  • Some epithelial mesotheliomas had uptake close to the threshold, suggesting possible overlap with severe pleural inflammation.
  • Thin, sheet-like tumours along the pleura may cause measurement problems (partial volume effects), especially for small lesions.
  • Very few mesothelioma patients had been studied for treatment response.

Topics

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

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

Related studies

• Good vibrations and the power of positron thinking: positron emission tomography and endoscopic ultrasound in staging of mesothelioma-two case reports — C.P. Carden, J.S. Myerson, et al. (2008)
• 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)
• 18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study — A. Carretta, C. Landoni, et al. (2000)
• Malignant pleural mesothelioma with heterologous osteoblastic elements: computed tomography, magnetic resonance, and positron emission tomography imaging characteristics of a rare tumor — R.A. Salgado, R. Corthouts, et al. (2005)
• 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)

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