18F-fluorodeoxyglucose PET/CT findings in pleural effusions of patients with known cancer

I. Letovanec; G. Allenbach; A. Mihaescu; M. Nicod Lalonde; S. Schmidt; R. Stupp; J.-W. Fitting; A. Boubaker; H.-B. Ris; J. O. Prior

doi:10.3413/Nukmed-0470-12-01

Nuklearmedizin - NuclearMedicine, Table of Contents

Nuklearmedizin 2012; 51(05): 186-193
DOI: 10.3413/Nukmed-0470-12-01

Original article

Schattauer GmbH

¹⁸F-fluorodeoxyglucose PET/CT findings in pleural effusions of patients with known cancer

A cytopathological correlationIdentifikation maligner Pleura-Ergüsse mittels ¹⁸F-Fluordeoxyglukose-PET/CTEine Korrelation mit zytopathologischen Befunden

I. Letovanec

¹University Institute of Pathology, Lausanne University Hospital, Switzerland

,

G. Allenbach

²Department of Nuclear Medicine, Lausanne University Hospital, Switzerland

,

A. Mihaescu

¹University Institute of Pathology, Lausanne University Hospital, Switzerland

,

M. Nicod Lalonde

²Department of Nuclear Medicine, Lausanne University Hospital, Switzerland

,

S. Schmidt

³Department of Radio logy, Lausanne University Hospital, Switzerland

,

R. Stupp

⁴Department of Oncology, Lausanne University Hospital, Switzerland

,

J.-W. Fitting

⁵Department of Pneumology, Lausanne University Hospital, Switzerland

,

A. Boubaker

²Department of Nuclear Medicine, Lausanne University Hospital, Switzerland

,

H.-B. Ris

⁶Department of Thoracic Surgery, Lausanne University Hospital, Switzerland

,

J. O. Prior

²Department of Nuclear Medicine, Lausanne University Hospital, Switzerland

› Author Affiliations

Abstract

Summary

Aim: Pleural effusion is common in cancer patients and to determine its malignant origin is of huge clinical significance. PET/CT with ¹⁸F-FDG is of diagnostic value in staging and follow-up, but its ability to differentiate between malignant and benign effusions is not precisely known. Patients, methods: We examined 50 PET/CT from 47 patients (29 men, 18 women, 60 ± 16 years) with pleural effusion and known cancer (24 NSCLC, 7 lymphomas, 5 breasts, 4 GIST, 3 mesotheliomas, 2 head and neck, 2 malignant teratoma, 1 colorectal, 1 oesophageal, 1 melanoma) for FDG uptake in the effusions using SUV_max. This was correlated to cytopathology performed after a median of 21 days (interquartile range –3 to 23), which included pH, relative distribution (macrophages, neutrophils, eosinophils, basophils, lymphocytes, plasmocytes), and absolute cell count. Results: Malignant cells were found in 17 effusions (34%) (6 NSCLC, 5 lymphomas, 2 breasts, 2 mesotheliomas, 2 malignant teratomas). SUV in malignant effusions were higher than in benign ones [3.7 (95%CI 1.8–5.6) vs. 1.7 g/ml (1.5–1.9), p = 0.001], with a correlation between malignant effuUntersion and SUV (Spearman coefficient ρ = 0.50, p = 0.001), but not with other cytopathological or radiological parameters (ROC area 0.83 ± 0.06). Using a 2.2-mg/l SUV threshold, 12 PET/CT studies were positive and 38 negative with sensitivity, specificity, positive and negative predictive values of 53%, 91%, 75% and 79%, respectively. For NSCLC only (n = 24), ROC area was 0.95 ± 0.04, 7 studies were positive and 17 negative with a sensitivity, specificity, positive and negative predictive values of 83%, 89%, 71 and 94%, respectively. Conclusion: PET/CT may help to differentiate the malignant or benign origin of a pleural effusion with a high specificity in patients with known cancer, in particular NSCLC.

Zusammenfassung

Ziel: Pleuraerguss ist ein häufiges Symptom, auch bei onkologischen Patienten, ohne dass es sich obligat um eine maligne Ätiologie handeln muss. Der Charakter des Ergusses und seine Pathogenese sind jedoch für weitere therapeutische Maßnahmen entscheidend. Die Wertigkeit der ¹⁸F-FDG-PET/CT für Staging und Nachsorge ist unbestritten, ob aber die PET zwischen malignem und benignem Erguss unterscheiden kann wurde noch wenig untersucht. Patienten und Methodik: Wir untersuchten 47 Tumor-Patienten (29 Männer, 18 Frauen, 60 ± 16 Jahre) mit Pleuraergüssen [24 nicht-kleinzellige Lungenkarzinome (NSCLC), 7 Lymphome, 5 Mammakarzinome, 4 GIST, 3 Mesotheliome, 2 HNO-Karzinome, 2 maligne Teratome, 1 Kolon/ Rektumkarzinom, 1 Ösophaguskarzinom, 1 Melanom] mit insgesamt 50 PET/CT. Die FDG-Konzentration in den Ergüssen wurde anhand Messungen des SUV_max, normalisiert auf das Körpergewicht geschätzt. Die Pleuraergüsse wurden alle punktiert, im Mittel 21 Tage (Interquartilbereich –6 bis +23 Tage) nach der PET-Untersuchung, und zytologisch untersucht, ebenso wurde die zelluläre Zusammensetzung (Makrophagen, Neutrophile, Eosinophile, Basophile, Lymphozyten, Plasmozyten) quantifiziert und der pH-Wert bestimmt. Ergebnis: Siebzehn Pleuraergüsse (34%) enthielten maligne Zellen (6 NSCLC, 5 Lymphome, 2 Mammakarzinome, 2 Mesotheliome, 2 maligne Teratome) und zeigten einen höheren SUV_max-Wert als Ergüsse ohne klare maligne Ursache [3,7 (95%CI 1,8–5,6) vs. 1,7 g/ml (1,5–1,9), p = 0,001]. Die malignen Pleuraergüsse korrelierten lediglich mit dem SUV (Spearman-Koeffizient ρ = 0,50, p = 0,001), jedoch nicht mit zytologischen oder radiologischen Parametern (ROC-Area 0,83 ± 0,06). Bei einer SUV_max-Schwelle von 2,2 mg/l, waren 12 PET/CT Untersuchungen positiv und 38 negativ, mit 53% Sensitivität, 91% Spezifizität, was sich in einen 75% positiven und 79% negativen prädiktiven Wert übersetzt. Analysieren wir lediglich NSCLC (n = 24) wird eine ROC von 0,95 ± 0,04 errechnet, 7 Unter suchungen waren positiv und 17 negativ, mit 83% Sensitivität, 89% Spezifizität, und somit 71% positivem und 94% negativem prädiktivem Wert. Schlussfolgerung: Die PET/CT erlaubt mit hoher Spezifizität zwischen malignen und benignen Pleuraergüssen zu unterscheiden, insbesondere bei NSCLC. Der negative prädiktive Wert von >90% ist klinisch von Bedeutung.

Keywords

Pleural effusion - tumour - PET/CT - FDG

Schlüsselwörter

Pleuraerguss - Tumor - EPT/CT - FDG

Full Text

References

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