Ali SARİKAYA, Gul Ege AKTAS, Selin SOYLUOGLU DEMİR

F-18 FDG PET/CT in primary and metastatic pleural involvement

Aim: The aim was to determine the contribution of FDG PET/CT to differential diagnosis of pleural involvements.Material and Methods: Images of the patients who were refereed for PET/CT evaluation with suspicion of mesothelioma were respectively analysed. They were classified according to final histopathologic diagnosis. Involvement patterns, SUVmax of the lesions, mediastinal and extrathoracic lymph node, peritoneum involvement, distant metastasis were evaluated.Results: Findings of 25 patients were analysed. According to final diagnosis; eight patients were mesothelioma, 9 patients were lung cancer, a patient was colon cancer, other 2 patients were diagnosed as renal cell cancer and metastasis of lymphoma. In 5patients; involvements were inflammatory. SUV max values of inflammatory cases (5.6±2.4) and cases with malign involvement (9.1±2.3) and pleural involvement patterns of benign and malignant cases were significantly different (p=0.001, p=0,01). SUV max of mesotheliomas, metastatic lesions were not statistically different (p=0.367). There were no significant differences between the pleural involvement patterns of pleural mesothelioma and metastatic pleural involvements (p=0,14). Mediastinal LAP’s were detected in 8 metastatic and in 6 mesothelioma cases. There was not any mediastinal LAP in benign cases. Peritoneal involvement was determined in 8 patients with pleural metastases, in 4 patients with mesothelioma. Bone marrow involvement, chest wall invasion was determined in one each mesothelioma cases. Contralateral lung lesion was determined in 1 metastatic patient. Invasion of chest wall was seen in 2, bone marrow involvement in 1, bone metastasis was detected in 4 patients. Two patients with metastatic involvement had hepatic metastasis, 4 had surrenal metastasis.Conclusion: SUV max values of benign lesions were significantly lower than malign involvements. Involvement patterns could be useful for differentiating benign from malign pleural involvements, when evaluated together with the SUVmax. There was not any difference between mesothelioma and metastatic involvements according to patterns, SUVmax values. PET/CT could determine the thoracic/extra-thoracic primary tumor. This would reduce the burden, cost of diagnostic process. Whole-body evaluation contributes a more accurate staging of malignant cases.

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Bakhshayesh Karam M, Karimi S, Mosadegh L, Chaibakhsh S. Malignant Mesothelioma Versus Metastatic Carcinoma of the Pleura: A CT Challenge. Iran J Radiol 2016;13(1)e10949.
Kim YK, Kim JS, Lee KW, Yi CA, Koo JM, Jung SH. Multidetector CT Findings and Differential Diagnoses of Malignant Pleural Mesothelioma and Metastatic Pleural Diseases in Korea. Korean J Radiol 2016;17(4):545-53.
Leung AN, Müller NL, Miller RR. CT in differential diagnosis of diffuse pleural disease. AJR Am J Roentgenol 1990;154(3)487-92.
Robinson BW, Lake RA. Advances in malignant mesothelioma. N Engl J Med 2005;353(15):1591-603.
Zahid I, Sharif S, Routledge T, Scarci M. What is the best way to diagnose and stage malignant pleural mesothelioma? Interact Cardiovasc Thorac Surg 2011;12(2):254-9.
Truong MT, Marom EM, Erasmus JJ. Preoperative evaluation of patients with malignant pleural mesothelioma: role of integrated CT-PET imaging. J Thorac Imaging 2006;21(2):146–53.
Pinelli V, Roca E, Lucchini S, Laroumagne S, Loundou A, Dutau H, et al. Positron Emission Tomography/ Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It? Respiration 2015;89(6):558-64.
Rusch VW. A proposed new international TNM staging system for malignant pleural mesothelioma. From the International Mesothelioma Interest Group. Chest 1995;108(4):1122-8.
Letovanec I, Allenbach G, Mihaescu A, Nicod Lalonde M, Schmidt S, Stupp R, et al. 18F-fluorodeoxyglucose PET/CT findings in pleural effusions of patients with known cancer: a cytopathological correlation. Nuklearmedizin 2012;51(5):186-93.
Alkhawaldeh K, Biersack HJ, Henke A, Ezziddin S. Impact of dual-time-point F-18 FDG PET/CT in the assessment of pleural effusion in patients with non- small-cell lung cancer. Clin Nucl Med 2011;36(6):423-8.
Kim BS, Kim IJ, Kim SJ, Pak K, Kim K. Predictive value of F-18 FDG PET/CT for malignant pleural effusion in non- small cell lung cancer patients. Onkologie 2011;34(6):298-303.
Toaff JS, Metser U, Gottfried M, Gur O, Deeb ME, Lievshitz G, et al. Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography. Invest Radiol 2005;40(4):204-9.
Duysinx B, Corhay JL, Larock MP, Withofs N, Bury T, hustinx R, et al. Contribution of positron emission tomography in pleural disease. Rev Mal Respir 2010;27(8):e47-53.
Murthy SC, Rice TW. Surgical management of malignant pleural effusions. Thorac Surg Clin 2013;23(1):43-9.
Doelken P. Management of pleural effusion in the cancer patient. Semin Respir Crit Care Med 2010;31(6):734-42.
Sahn S. Malignant pleural effusions. Eur Respir monograph 2002;22:177-88.
Hierholzer J, Luo L, Bittner RC, Stroszczynski C, Schröder RJ, Schoenfeld N, et al. MRI and CT in the differential diagnosis of pleural disease. Chest 2000;118(3):604-9.
Metintas M, Ucgun I, Elbek O, Erginel S, Metintas S, Kolsuz M, et al. Computed tomography features in malignant pleural mesothelioma and other commonly seen pleural diseases. Eur J Radiol 2002;41(1):1-9.
Flores RM, Akhurst T, Gonen M, Zakowski M, Dycoco J, Larson SM, et al. Positron emission tomography predicts survival in malignant pleural mesothelioma. J Thorac Cardiovasc Surg 2006;132(4):763-8.
Fuccio C, Spinapolice EG, Ferretti A, Castellucci P, Marzola MC, Trifirò G, et al. 18F-FDG-PET/CT in malignant mesothelioma. Biomed Pharmacother 2013;67(6):539-42.
Helm EJ, Matin TN, Gleeson FV. Imaging of the pleura. J Magn Reson Imaging 2010;32(6):1275-86.
Antunes G, Neville E, Duffy J, Ali N. BTS guidelines for the management of malignant pleural effusions. Thorax 2003;58(Suppl 2):ii29–ii38.