Differentiation Between Malignant and Benign Pleural Effusion in Patients With Extra-Pleural Primary Malignancies

Toaff, Jacob S; Metser, Ur; Gottfried, Maya; Gur, Odelia; Deeb, Maher; Lievshitz, Gennady; Mercer, Diego; Even-Sapir, Einat

doi:10.1097/01.rli.0000154217.71461.b4

Cited by 65 publications

(40 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…With logistic analysis, pleural uptake on PETimageswasthemostimportantparameterforindentifyingmalignantpleuraleffusionofNSCLC.Itshowedthatthe respective sensitivity, specificity, PPV, NPV, and accuracy were87.5,88.8,95.5,72.7,and87.8%.Theseresultsweresimilar or mildly lower than previous reported measures [8][9][10][11]19].However,theaccuracyofourresultsonPETimageswas better than that of pleural fluid cytology and blind pleural biopsy [17].ThisrepresentsthatFDGPET/CTmaysubstitute otherinvasivetestsincaseswherethoracocentesisisconsideredimpossibleorofhighriskfortheelderly,orinsufficient quantity of pleural fluid is present. Unlike other studies [9,19],theaccuracyofourresultswaslowerthanthatofthoracoscopicbiopsy.Furthermore,consideringtheNPVofthecurrent study, it is doubtful that F-18 FDG PET/CT can completely replace thoracoscopic biopsy in pleural malignancy evaluation of lung cancer patients. As Schaffler et al [10] argue,F-18FDGPET/CTcanhelppinpointtheareasofmaximal activity of malignant pleural disease and navigate towardsthemostappropriateareaofbiopsy [10].…”

Section: Discussioncontrasting

confidence: 53%

“…They found that the most accurate parameter when identifying pleural effusion is the presence of increased uptake in the pleuraonPET/CTimages [19]. The quantitative parameter (L/Prim) and PET/CT parameters(pleuraluptakeonPETimagesandabnormalpleural lesionsonCTimages)showedsimilardiagnosticvalueswhen distinguishingbetweenmalignantandbenignpleuraleffusion by ROC analyses.…”

Section: Discussionmentioning

confidence: 91%

“…Thepresenceofcarcinomacellsinthepleuralfluidclassifies lungcancerasM1aintheTNMstagingsystem [12].Although malignant pleural effusion precludes curative resection, not [19] reviewed 31 patients with primary extrapleural malignancy with pleural effusion using CT and PET parameters. They found that the most accurate parameter when identifying pleural effusion is the presence of increased uptake in the pleuraonPET/CTimages [19].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Predictive Value of F-18 FDG PET/CT for Malignant Pleural Effusion in Non-Small Cell Lung Cancer Patients

Kim¹,

Kim

et al. 2011

Oncol Res Treat

View full text Add to dashboard Cite

Background: The purpose of this study was to evaluate the accuracy of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) imaging in the detection of malignant pleural effusion and pleural metastasis in patients with non-small cell lung cancer (NSCLC). Materials and Methods: We analyzed F-18 FDG PET/CT images of 33 lung cancer patients with pleural effusion. We used 2 categorical parameters to differentiate malignant from benign pleural effusion: i) quantitative parameters using maximum standardized uptake value (SUVmax of effusion and pleura, and the following ratios: lesion to aorta (L/Ao), to cerebellum (L/Cbl), to liver (L/Liv), to nonlesion (L/NL), and to primary lung cancer (L/Prim)) and ii) various parameters determined by PET and CT scans (uptake at the pleural region, Hounsfield unit, size, and morphology of any solid abnormality). Results: Malignant pleural effusions showed significantly higher L/Prim values than benign pleural effusions. The presence of pleural abnormality on CT and pleural region uptake on PET images were found to be significantly more frequent in cases of malignant pleural disease. These parameters could differentiate malignant and benign pleural effusion according to receiver operating characteristic (ROC) analyses. There were no statistical differences between L/Prim, pleural abnormality on CT, and pleural region uptake on PET images. Abnormal pleural region uptake on PET images was the most accurate parameter identifying malignant pleural effusion by logistic regression analysis. Conclusions: Our results suggest that F-18 FDG PET/CT can be used as a reliable and noninvasive method for the differentiation of malignant and benign pleural disease in patients with NSCLC.

show abstract

Section: Discussioncontrasting

confidence: 53%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Predictive Value of F-18 FDG PET/CT for Malignant Pleural Effusion in Non-Small Cell Lung Cancer Patients

Kim¹,

Kim

et al. 2011

Oncol Res Treat

View full text Add to dashboard Cite

show abstract

“…Pleural effusion and metastases are also encountered when staging patients with lung cancer. It is broadly accepted that PET is inferior to CT in detecting pleural effusion; however, studies have shown that PET might be useful in discriminating between malignant and benign pleural effusion diagnosed by CT [70,71,72]. …”

Section: Stagingmentioning

confidence: 99%

The Future in Diagnosis and Staging of Lung Cancer: Positron Emission Tomography

Fischer

Mortensen²

2006

Respiration

View full text Add to dashboard Cite

Since its introduction in 1974, positron emission tomography (PET) has gained widespread use, especially in diagnosis and staging of lung cancer. In this respect, ¹⁸F-fluorodeoxyglucose (FDG) is by far the most used PET tracer exploiting the increased glucose uptake and metabolism in malignant cells. A large number of studies have suggested that addition of FDG-PET to conventional workup can improve diagnosis and staging in patients with non-small cell lung cancer (NSCLC). In meta-analysis, the sensitivity and specificity of PET in diagnosing single pulmonary nodules and masses is found to be 96 and 78%, respectively. In mediastinal staging, the sensitivity and specificity of PET is estimated to be 83 and 92%. In order to achieve high diagnostic values from PET, it is necessary to pay attention to a number of pitfalls, e.g., the uptake of FDG by inflammatory cells causing false-positive results, as well as size and histology of the tumour in order to avoid false-negative results. In 2001, the first integrated PET/computed tomography (CT) was installed, and since then, the use of this modality has expanded steadily, thereby decreasing examination time and overcoming the lack of anatomical details on PET. Recently, PET and PET/CT have become increasingly integrated in therapy planning and evaluation: response evaluation during and after chemotherapy, restaging after neoadjuvant therapy, planning of radiotherapy and detection of recurrent disease are all examples of emerging indications for PET and PET/CT in managing patients with lung cancer.

show abstract

“…A physical finding is characteristic of pleural effusion, and chest radiography and MSCT scan are considered "gold standards" in imaging diagnostics of pleural empyema. Positron emission tomography (18F-FDG-PET/CT) does not appear to be a diagnostic tool in evaluating patients with pleural effusion due to its low specificity and subsequent difficulty in differentiating between inflammatory and neoplastic disease (9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

Pleural Empyema Menagement: A Brief Review of Litterature

Arsenijević

Milisavljević

Mrvic

et al. 2018

Serbian Journal of Experimental and Clinical Research

View full text Add to dashboard Cite

show abstract

Differentiation Between Malignant and Benign Pleural Effusion in Patients With Extra-Pleural Primary Malignancies

Abstract: On PET-CT, the presence of concomitant pleural abnormalities is the most accurate criterion in determining the malignant nature of pleural effusion.

Cited by 65 publications

References 17 publications

Predictive Value of F-18 FDG PET/CT for Malignant Pleural Effusion in Non-Small Cell Lung Cancer Patients

Predictive Value of F-18 FDG PET/CT for Malignant Pleural Effusion in Non-Small Cell Lung Cancer Patients

The Future in Diagnosis and Staging of Lung Cancer: Positron Emission Tomography

Pleural Empyema Menagement: A Brief Review of Litterature

Contact Info

Product

Resources

About