Persistent Inflammation in Pulmonary Granuloma 48 Years after Talcage Pleurodesis, Detected by FDG-PET/CT

Abstract[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG–PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.

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“…3 ). Pleurodesis with inflammation-inducing agents, such as OK-432 or talc, results in high FDG uptake [ 8 , 9 ] (Fig. 4 ).…”

Section: Invasive or Surgical Proceduresmentioning

confidence: 99%

FDG–PET findings associated with various medical procedures and treatments

et al. 2022

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“…Markedly increased FDG uptake characterizes the process, which can persist for an unpredictable period ( Figure 7 ). 100 – 102 Several authors 103 – 106 have reported the presence of focal and/or diffused tracer accumulation visible on partially calcified pleural thickening years (up to decades) following pleurodesis. Since only 10% of pleural malignancies present with calcifications, major help in the identification of these cases is given by proper anamnesis and by the identification on CT images of concordance/overlap between FDG-avid lesions and highly CT-attenuated areas.…”

Section: Metabolic Imagingmentioning

confidence: 99%

“…Since only 10% of pleural malignancies present with calcifications, major help in the identification of these cases is given by proper anamnesis and by the identification on CT images of concordance/overlap between FDG-avid lesions and highly CT-attenuated areas. 99 , 104 – 106 The negative impact of FDG uptake induced by pleurodesis is seen at initial staging, as well as at response assessment, since the effective extent of MPM can be overestimated by the contemporary presence of pleural granulomatous reaction to talc.…”

Section: Metabolic Imagingmentioning

confidence: 99%

Clinical staging of malignant pleural mesothelioma: current perspectives

Bonomi¹,

Filippis²,

Lopci

et al. 2017

LCTT

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Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.

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“…1,4,5 It is well established, 6-20 that talc deposits in the pleura produce areas of increased 18 F-FDG uptake, for up to 48 years after the performance of TP. 18 Distinguishing pleural malignancy from talc-induced benign inflammatory changes is challenging by 18 F-FDG, especially in patients with history of both thoracic malignancy and TP. This diagnostic dilemma becomes even greater, when pulmonary parenchymal nodules develop because of talc-particle absorption through the pleura, with avid 18 F-FDG uptake.…”

Section: Figurementioning

confidence: 99%

Talc Pleurodesis With Intense 18F-FDG Activity But No 68Ga-DOTA-TATE Activity on PET/CT

Papadakis¹,

Millo²,

Bağcı³

et al. 2015

Clinical Nuclear Medicine

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Talc pleurodesis (TP) is a technique, widely employed in the management of patients with persistent pleural effusions or pneumothoraces not amenable to other treatment options. It is well documented, that talc deposits produce areas of highly increased 18F-FDG uptake, due to talc-induced inflammation. We present a case of a patient with history of TP who was evaluated with both 18F-FDG and 68Ga-DOTA-TATE. The hypermetabolic area seen on 18F-FDG-PET-CT in the region of talc placement, showed no uptake by 68Ga-DOTA-TATE, suggesting the potential role of 68Ga-DOTA-TATE-PET-CT in elucidating 18F-FDG-postitive lesions in patients with history of both neuroendocrine malignancy and TP.

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Persistent Inflammation in Pulmonary Granuloma 48 Years after Talcage Pleurodesis, Detected by FDG-PET/CT

Cited by 6 publications

References 13 publications

FDG–PET findings associated with various medical procedures and treatments

FDG–PET findings associated with various medical procedures and treatments

Clinical staging of malignant pleural mesothelioma: current perspectives

Talc Pleurodesis With Intense 18F-FDG Activity But No 68Ga-DOTA-TATE Activity on PET/CT

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