RSS-Feed abonnieren
DOI: 10.1055/s-2008-1039314
© Georg Thieme Verlag KG Stuttgart · New York
The Role of Positron Emission Tomography/Computed Tomography in the Diagnosis of Pleural Diseases
Publikationsverlauf
received August 5, 2008
Publikationsdatum:
20. Mai 2009 (online)
![](https://www.thieme-connect.de/media/thoracic/200904/lookinside/thumbnails/10.1055-s-2008-1039314-1.jpg)
Abstract
Background: The aim of the study was to assess the role of F-18 fluoro-2-D-deoxyglucose positron emission tomography (18FDG‐PET)/computed tomography (CT) in patients with undiagnosed pleural diseases and to compare the findings with those of invasive diagnostic procedures. Methods: The study included 83 patients with pleural lesions (63 with pleural effusion; 20 with pleural thickening) on CT scan performed between November 2005 and December 2007. The study group consisted of 63 males and 20 females; their median age was 47 years. PET‐CT scan was performed for all patients before surgery. A maximum standard uptake value greater than 3.0 was accepted as positive for malignancy. For histopathological diagnosis, video-assisted thoracoscopic surgery was performed in 76 patients and a mini-thoracotomy was performed for the remaining 7 patients. Results: Postoperative histopathological examination revealed malignancy in 44 cases, 25 of which were malignant mesothelioma; the remaining 39 cases were benign. There were no false negative results, but two false positive results (tuberculosis). PET‐CT scanning had 100 % sensitivity, 94.8 % specificity and 97.5 % accuracy. Conclusion: Our study suggests that PET‐CT may be an effective tool for the differentiation of benign and malignant pleural diseases. We believe that PET/CT may prevent redundant surgical procedures in young patients who are SUVmax negative.
Key words
PET/CT - pleural diseases - VATS
References
- 1 Kramer H, Pieterman R M, Slebos D, Timens W, Vaalburg W, Koéter G H. et al . PET for the evaluation of pleural thickening observed on CT. J Nucl Med. 2004; 45 995-998
- 2 Bury T, Paulus P, Dowlati A, Corhay J L, Rigo P, Radermecker M F. Evaluation of pleural diseases with FDG‐PET imaging: preliminary report. Thorax. 1997; 52 187-189
- 3 Schaffler G J, Wolf G, Schoellnast H, Groell R, Maier A, Smolle-Jütner F M. et al . Non-small cell lung cancer: evaluation of pleural abnormalities on CT scans with 18F‐FDG‐PET. Radiology. 2004; 231 858-865
- 4 Flores R M, Akhurst T, Gonen M, Larson S M, Rush V W. Positron emission tomography defines metastatic disease but not locoregional disease in patient with malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2003; 126 11-15
-
5 Light R W.
Physiology of pleural fluid production and benign pleural effusion. Shields TW General thoracic surgery. Philadelphia, PA; Lippincott Williams & Wilkins 2000: 687-699 - 6 Carretta A, Landoni C, Melloni G, Ceresoli G L, Compierchio A, Fazio F. et al . 18-FDG positron emission tomography in the evaluation of malignant pleural diseases – a pilot study. Eur J Cardiothorac Surg. 2000; 17 377-383
- 7 Schneider D B, Clary-Macy C, Challa S, Sasse K C, Merrick S H, Hawkins R. et al . Positron emission tomography with F18-fluorodeoxyglucose in the staging and preoperative evaluation of malignant pleural mesothelioma. J Thorac Cardiovasc Surg. 2000; 120 128-133
- 8 Ruffini E, Rena O, Bongiovanni M, Cristofori R, Mancuso M, Filosso P L. et al . The significance of intraoperative pleural effusion during surgery for bronchogenic carcinoma. Eur J Cardiothorac Surg. 2002; 21 508-513
- 9 Gupta N C, Rogers J S, Graeber G M, Gregory J L, Waheed U, Mullet D. et al . Clinical role of F‐18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion. Chest. 2002; 122 1918-1924
- 10 Erasmus J J, McAdams P G, Rossi S E, Goodman P C, Coleman E C, Patz E F. FDG PET of pleural effusions in patients with non-small cell lung cancer. AJR. 2000; 175 245-249
- 11 Erasmus J J, Truong M T, Smythe W R, Munden R F, Morom E M, Rice D C. et al . Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: staging implications. J Thorac Cardiovasc Surg. 2005; 129 1364-1370
- 12 Brock M V, Hooker C M, Yung R, Guo M, Han Y, Ames S E. et al . Can we improve the cytologic examination of malignant pleural effusions using molecular analysis?. Ann Thorac Surg. 2005; 80 1241-1247
- 13 Roberts J R, Blum M G, Arildsen R, Drinkwater D C, Christiasn K R, Powers T A. et al . Prospective comparison of radiologic, thoracoscopic, and pathologic staging in patients with early non-small cell lung cancer. Ann Thorac Surg. 1999; 68 1154-1158
- 14 Tan C, Treasure T. Radical surgery for mesothelioma. IPN International Pleural Newsletter. 2006; 4 1-2
- 15 Bunyaviroch T, Coleman R E. PET evaluation of lung cancer. J Nucl Med. 2006; 47 451-468
- 16 Bryant A S, Cerfolio R J, Klemm K M, Ojha B. Maximum standart uptake value of mediastinal lymph nodes on integrated FDG‐PET‐CT predicts pathology in patients with non-small cell lung cancer. Ann Thorac Surg. 2006; 82 417-423
- 17 Cerfolio R J, Ojha B, Bryant A S, Bass C S, Bartalucci A A, Mountz M. The role of FDG‐PET scan in staging patients with non-small cell carcinoma. Ann Thorac Surg. 2003; 76 861-866
- 18 Cerfolio R J, Bryant A S, Ojha B, Eloubeidi M. Improving the inaccuracies of clinical staging of patients with NSCLC: a prospective trial. Ann Thorac Surg. 2005; 80 1207-1214
- 19 Bryant A S, Cerfolio R J. The maximum standardized uptake value on integrated FDG‐PET/CT is useful in differentiating benign from malignant pulmonary nodules. Ann Thorac Surg. 2006; 82 1016-1020
- 20 Schrevens L, Lorent N, Dooms C, Vansteenkiste J. The role of PET scan in diagnosis, staging, and management of non-small cell lung cancer. The Oncologist. 2004; 9 633-643
- 21 Birim O, Kappetein A P, Stijnen T, Bogers A JJC. Meta-analysis of positron emission tomographic and computed tomographic imaging in detecting mediastinal lymph node metastases in non-small cell lung cancer. Ann Thorac Surg. 2005; 79 375-382
- 22 Eloubeidi M A, Cerfolio R J, Chen V K, Demond R, Syed S, Ojha B. Endoscopic ultrasound-guided fine needle aspiration of mediastinal lymph node in patients with suspected lung cancer after positron emission tomography and computed tomography scans. Ann Thorac Surg. 2005; 79 263-268
- 23 Hillerdal G, Baris Y I. Radiological study of pleural changes in relation to mesothelioma in Turkey. Thorax. 1983; 38 443-448
- 24 Sahin A A, Coplu L, Selcuk Z T, Eryılmaz M, Emri S, Akhan O. et al . Malignant pleural mesothelioma caused by environmental exposure to asbestos or erionite in rural Turkey: CT findings in 84 patients. AJR Am J Roentgenol. 1993; 161 533-537
Dr. M. D. Alpay Orki
NATO Yolu, Bosna Bulvari, Izmir Sokak
Camlica Palmiye Sitesi 11-3
Yavuzturk-Uskudar
Istanbul
Turkey
Telefon: + 90 21 64 43 51 68
Fax: + 90 21 63 83 02 70
eMail: alpayorki@yahoo.com