Malign Plevral Mezotelyoma Tanısında 18F-FDG PET/BT Görüntülemenin Rolü

Amaç: Malign plevral mezotelyoma (MPM) ön tanısı ile 18F-FDG PET/BT görüntülemesi yapılan hastalarda, plevral kalınlık ve mediastinal lenf nodlarının, boyut ile SUVmax değerlerinin tanısal etkinliğini araştırmayı amaçladık. Yöntemler: Mayıs 2018 ile Şubat 2020 tarihleri arasında kliniğimize, MPM ön tanısıyla başvuran ve 18F-FDG PET/BT görüntülemesi yapılan 54 hasta retrospektif olarak incelendi. Hastaların 28’i kadın (%51,8) ve 26’sı erkek (%48,2) olup ortalama yaşları 58,8 idi. Tüm hastaların plevral kalınlık değerleri, mediastinal lenf nodlarının boyutları ve tüm lezyonların SUVmax değerleri ölçüldü. PET/BT görüntüleme sonrası yapılan histopatolojik inceleme sonucu hastaların 23’ünde MPM, 20’sinde benign plevral hastalık (BPH) ve 11’inde metastatik plevral hastalık (MPH) saptandı. Bulgular: Tüm gruplar arasında plevral kalınlığın median SUVmax değeri açısından yapılan karşılaştırmada; istatistiki anlamlılık bulundu (p=0.003). Plevral kalınlığın median SUVmax parametresi ikili grup karşılaştırılmalarında; BPH grubun median SUVmax değeri MPM ve MPH’ya göre istatistiki anlamlı olacak şekilde düşük bulundu (p değerleri sırasıyla p:0.034 ve p:0.023). Diğer parametrelerde ise MPM ile diğer gruplar karşılaştırıldığında istatistiki anlamlı fark bulunmadı. MPM grubunu tespit etmedeki SUVmax cut-off değeri 6,75 alındığında %69,6 sensitivite ve %67,6 spesifiteye sahip olup istatistiki anlamlı fark bulundu. Sonuç: Malign plevral mezotelyomayı diğer plevral patolojilerden ayırt etmede plevral kalınlığın median SUVmax değerinin kullanılabileceği sonucuna varıldı.

The Role of 18F-FDG PET/CT in the Diagnosis of Malignant Pleural Mesothelioma

Objective: We aimed to investigate the diagnostic efficiency of pleural thickness and mediastinal lymph nodes, size and SUVmax values in patients with a pre-diagnosis of malignant pleural mesothelioma (MPM) who underwent 18F-FDG PET/CT imaging. Methods: Fifty-four patients who were admitted to our clinic with a diagnosis of MPM and had 18F-FDG PET/CT imaging between May 2018 and February 2020 were retrospectively analyzed. 28 of the patients were female (%51,8) and 26 were male (%48,2) and their average age was 58,8. Pleural thickness values of all patients, sizes of mediastinal lymph nodes and SUVmax values of all lesions were measured. Histopathological examination after PET/CT imaging revealed MPM in 23 patients, benign pleural disease (BPH) in 20, and metastatic pleural disease (MPH) in 11 patients. Results: In the comparison between all groups in terms of median SUVmax value of pleural thickness; statistical significance was found (p=0.003). Median SUVmax parameter of pleural thickness in paired group comparisons; The median SUVmax value of the BPH group was found to be statistically significantly lower than MPM and MPH (p values p:0.034 and p:0.023 respectively). In other parameters, when MPM and other groups were compared, no statistically significant difference was found. When the cut-off value of SUVmax for detecting MPM group was taken as 6,75, it had %69,6 sensitivity and %67,6 specificity, and a statistically significant difference was found. Conclusion: It was concluded that the median SUVmax value of pleural thickness can be used to distinguish malignant pleural mesothelioma from other pleural pathologies.

PDF

___

1.Bridda A, Padoan I, Mencarelli R, Frego M. Peritonealmesothelioma: a review. Med Gen Med. 2007; 9: 32.
2.Robinson BW, Lake RA. Advances in malignantmesothelioma. N Engl J Med. 2005; 353: 1591-603.
3.Travis WD, Brambilla E, Müller-Hermelink HK,Harris CC. Pathology and Genetics: Tumors of the Lung,Pleura, Thymus, and Heart, IARC. 2004; 125-44.
4.Beckett P, Edwards J, Fennell D, et al. Demographics,management and survival of patients with malignantpleural mesothelioma in the National Lung CancerAudit in England and Wales. Lung Cancer. 2015; 88:344-8.
5.Sarısoy HT, İnan N, Demirci A. Plevra PatolojilerindeRadyolojik Görüntüleme, Plevra Hastalıkları veTedavisi. Journal of Clinical and Analytical Medicine.2011; 10-5.
6.Bandi V, Lunn W, Ernst A, et al. Ultrasound vs. CT indetecting chest wall invasion by tumor: a prospectivestudy. Chest 2008; 133: 881-6.
7.Nickell LT, Lichtenberger JP, Khorashadi L, et al.Multimodality imaging for characterization,classification, and staging of malignant pleuralmesothelioma. Radiographics 2014; 34: 1692-706.
8.Gill RR, Patz S, Muradyan I, Seethamraju RT. NovelMR Imaging Applications for Pleural evaluation. MagnReson Imaging Clin N Am. 2015; 179–95.
9.Elliott HS, Metser U, de Perrot M, et al. 18F-FDGPET/CT in the management of patients with malignantpleural mesothelioma being considered formultimodality therapy: experience of a tertiaryreferral center. Br J Radiol. 2018; 91.
10.Metintas S, Ak G, Metintas M. Trends in malignantpleural mesothelioma in Eskisehir province of Turkeyfrom January 1990 to December 2016. EuropeanRespiratory Journal. 2017; 50: PA1591.
11.Ocak B, Şahin AB, Dakiki B, et al. The benefit ofsurgery on survival for patients with stage 1 and 2malignant pleural mesothelioma. Dicle TıpDergisi/Dicle Med J. 2020; 47: 770-8.
12.Yildirim H, Metintas M, Entok E, et al. Clinical valueof fluorodeoxyglucose positron emissiontomography/computed tomography in differentiationof malignant mesothelioma from asbestos- relatedbenign pleural disease: an observational pilot study. JThorac Oncol. 2009; 4: 1480-4.
13.Elboğa U, Yılmaz M, Uyar M, et al. Plevralpatolojilerin ayırıcı tanısında 18F-FDG PET-BT'ninrolü: Rev Esp Med Nucl Imagen Mol. 2012; 187-91.
14.Akdeniz N, Küçüköner M, Kaplan MA, et al. TheEffect of Metabolic PET Parameters on SurvivalOutcome in Malignant Pleural Mesothelioma. Dicle TıpDergisi/Dicle Med J. 2020; 47: 16-23.
15.Yu C, Xia X, Qin C, et al. Is SUVmax Helpful in theDifferential Diagnosis of Enlarged Mediastinal LymphNodes?; Contrast Media & Molecular Imaging. 2018; 9.
16.Kumar A, Dutta R, Kannan U, et al. Evaluation ofmediastinal lymph nodes using 18F-18F-FDG PET-CTscan and its histopathologic correlation: Annals ofThoracic Medicine. 2011; 6: 11–6.
17.Lawek Berzenji, Paul E. Van Schil, Laurens Carp.The eighth TNM classification for malignant pleuralmesothelioma. Transl Lung Cancer Res. 2018; 7: 543-9.
18.Metintas M, Ucgun I, Elbek O, et al. Computedtomography features in malignant pleuralmesothelioma and other commonly seen pleuraldiseases. Eur J Radiol. 2002; 41: 1-9.