Clinical utility of 18-fluorodeoxyglucose positron emission tomography/computed tomography in malignant pleural mesothelioma

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignant tumor of mesothelial origin associated with asbestos exposure. MPM has a limited response to conventional chemotherapy and radiotherapy, thus early diagnosis of MPM is extremely critical. CT scans have limited accuracy in the differentiation between benign and malignant pleural disease. Several studies have reported that 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) plays an important role in the assessment of thoracic malignancy such as lung cancer. Here, we investigated the clinical utility of PET in patients with MPM. The maximum SUV (SUVmax) of 18F-FDG was measured in 47 MPM patients and 29 non-MPM patients including those with pleural thickening. We demonstrated that patients with MPM had significantly higher SUVmax levels than a population with non-malignant pleural disease. The Kaplan-Meier method revealed significant differences in overall survival between groups with SUVmax levels lower and higher than the assumed cut-off. Our data suggest that SUVmax levels are useful as an aid for diagnosis and prognosis of MPM.

The F-18 FDG PET/CT and CT evaluation of pleural plaques

“…Previous reports have shown a diagnostic sensitivity of 60-100%, specificity of 78-100% and accuracy of 91-98% (10,11). In a previous study in case of SUV max level of 2.0 accepted as a cut-off level the sensitivity of FDG PET was 91% and specificity was 100% (12).…”

18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma

“…A number of previous studies [9,[13][14][15][16][17][18][19][20], mostly retrospective and observational, have considered the relationship between survival and PET measurements at baseline. Of these, 8 studies [13][14][15][16][17][18][19][20] with a total of 594 patients found that high SUVmax or TLG at baseline indicated worse survival, and one with 41 patients [9] found no relationship. Three studies have considered percentage change in SUVmax, TLG and MTV after chemotherapy; two [9,12] with a total of 64 patients found that a percentage reduction in TLG was indicative of better OS, while one [20] with 131 patients found a percentage reduction in SUVmax was related to longer OS.…”

Clinical staging of malignant pleural mesothelioma: current perspectives

“… 72 , 74 , 76 Optimal cutoff values for FDG uptake have been defined, ranging from 2 69 to 3.5. 77 In an early study, Benard et al 69 examined 28 consecutive patients with suspected malignant mesothelioma. Of these, 24 were confirmed as malignant, showing a highly significant increase in FDG uptake compared to benign lesions.…”

“…92 – 98 Flores et al incorporated SUV max into a prognostic model with stage and histology, observing that SUV >10 MPM were associated with poor prognosis. 94 According to Terada et al, 77 SUV max >3.5 might identify patients with poor prognosis. Similarly, SUV max was an independent predictor of survival in two other patient series, with cutoff values of 10.7 and 5, respectively.…”