Present and future roles of FDG-PET/CT imaging in the management of malignant pleural mesothelioma

Our plain-English summary of Present and future roles of FDG-PET/CT imaging in the management of malignant pleural mesothelioma, by K. Kitajima, H. Doi, K. Kuribayashi (Japanese Journal of Radiology, 2016).

The study

• Authors: K. Kitajima, H. Doi, K. Kuribayashi
• Journal: Japanese Journal of Radiology
• Published: 2016;34(8):537-47
• Type of article: Review
• Cited by: 18 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

Positron emission tomography/computed tomography (PET/CT) integrated with 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluations in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool to manage patients with malignant pleural mesothelioma. We discuss different stages of patient management in malignant pleural mesothelioma, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.

In plain English

This article is a review, not a new study. The authors summarized published research on FDG-PET/CT, a scan that combines metabolic and anatomic imaging, in the care of patients with malignant pleural mesothelioma. It covered diagnosis, staging, treatment response, detecting recurrence and predicting survival. The article notes that this cancer is strongly associated with asbestos exposure, but it did not examine exposure. In the studies it cited, PET or PET/CT told mesothelioma apart from benign or inflammatory pleural disease with sensitivity of 60–100% and specificity of 78–100%. Cited studies found poor sensitivity for lymph node spread: 11% in one study, and 38% for N2 disease in another. In one study of 29 patients, PET/CT findings ruled out surgery in 41%. Some studies linked higher tracer uptake to shorter survival, and others found no link. The authors noted that the scan misses very small tumors, can show uptake in inflammation such as pleurodesis, and that ways of measuring response vary. The authors concluded that PET/CT is excellent for evaluating spread to lymph nodes and organs outside the chest, and that further research is needed.

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
• Who was studied: No patients of the authors' own were studied. The review covered published studies of FDG-PET and PET/CT in patients with malignant pleural mesothelioma, summarized in two tables. Example images from four patients are shown.
• Exposure: The subject is an imaging test (18F-FDG PET/CT), not an exposure. The introduction notes that malignant pleural mesothelioma is strongly associated with asbestos exposure. No fiber types, jobs or doses are studied.
• Main results:
  • Across cited studies, FDG-PET and PET/CT distinguished malignant pleural mesothelioma from inflammatory conditions and benign pleural tumors with sensitivity of 60–100%, specificity of 78–100% and accuracy of 91–98%.
  • In cited studies, FDG-PET had a sensitivity of 11% for detecting nodal metastases in mesothelioma patients.
  • In a cited study, FDG-PET/CT had a sensitivity of 38% for detecting N2 disease.
  • In a cited prospective study of 29 patients (Erasmus et al.), FDG-PET/CT precluded surgery in 41% of patients. It did so by identifying locally advanced tumors and metastases outside the chest that conventional imaging had not shown.
  • Cited studies of monitoring for recurrence after treatment reported sensitivity of 94–98% and specificity of 75–100% for whole-body FDG-PET/CT.
  • In a cited study of 20 patients given pemetrexed-based chemotherapy (Ceresoli et al.), median time to tumor progression was 14 months for early metabolic responders and 7 months for non-responders.
  • According to several cited authors, a high SUVmax (tracer uptake) was associated with shorter survival. Other cited reports found no correlation between SUVmax and survival.
• The authors' conclusion: The authors concluded that FDG-PET/CT is excellent for evaluating lymph node disease and metastases outside the chest at staging. They called for further analyses of chemotherapy response evaluation and prognosis, new PET cameras with higher spatial resolution, and new tracers.
• Limitations the authors state:
  • The authors state that FDG-PET has poor sensitivity for cancers smaller than one centimeter because of the limited spatial resolution of current cameras.
  • The authors state that FDG uptake also occurs in some benign tumors and in inflammatory conditions, including pleurodesis, which can produce false-positive results.
  • The authors state that FDG-PET/CT is inadequate for accurately defining the local extent of the tumor.
  • The authors state that methods, timing and thresholds for measuring treatment response vary across studies, so definite conclusions about response monitoring cannot yet be drawn.

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: Pleural Mesothelioma, Staging, Prognosis.

Related studies

• Whole-Body MRI: Comparison of Its Capability for TNM Staging of Malignant Pleural Mesothelioma With That of Coregistered PET/MRI, Integrated FDG PET/CT, and Conventional Imaging — Y. Ohno, M. Yui, et al. (2019)
• 18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma — D.O. Hall, C.E. Hooper, et al. (2018)
• 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)
• PET scan contribution in chest tumor management: a systematic review for thoracic surgeons — L. Duranti, F. Leo, et al. (2012)
• 18F-FDG-PET/CT of peritoneal tumors: a pictorial essay — J. Dubreuil, F. Giammarile, et al. (2017)
• 99mTc-HDP Bone Scintigraphy, SPECT/CT, and 18F-FDG PET/CT Diagnosis Imaging of Incidental Pleural Mesothelioma in a Patient With Biochemical Recurrences of Prostate Cancer: Is it Really a Coincidence? — P. Fernández-Rodríguez, J.J. Martín-Marcuartu, et al. (2020)

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