The Role of 18F-FDG PET/CT Integrated Imaging in Distinguishing Malignant from Benign Pleural Effusion

Sun, Ying; Yu, Hongjuan; Ma, Jingquan; Lu, Peiou

doi:10.1371/journal.pone.0161764

Cited by 43 publications

(36 citation statements)

References 15 publications

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“…The avidity of the pleura for 18 FDG can be quantified using the maximum standardized uptake value (SUVmax) or assessed qualitatively by comparison with normal background activity ( Figure 2). The integration of 18 FDG-PET with chest CT (PET/CT) raised the sensitivity of CT findings alone from 70% to 93% in a study of 86 patients with metastatic pleural malignancy (15). In this study performed in an endemic area for tuberculosis (TB), the specificity of PET by itself for MPE was limited to 63% primarily by falsely positive TB pleuritis cases.…”

Section: Positron Emission Tomographymentioning

confidence: 90%

Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

et al. 2019

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Advanced malignancy is a prevalent cause of exudative pleural effusion. The management of malignant pleural effusion (MPE) has been the subject of several recent randomized controlled trials and excellent reviews. Less attention has been focused on another controversial and challenging aspect of MPE: establishing the diagnosis. Prior to selecting the optimal management strategy, the presence of an MPE must first be correctly identified with an emphasis on minimizing invasiveness and discomfort in a patient afflicted with late-stage cancer. The aim of the present review is to summarize the current knowledge about MPE diagnostics and to propose an algorithm for the diagnosis of MPE in established or suspected malignancy.

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Section: Positron Emission Tomographymentioning

confidence: 90%

Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

et al. 2019

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“…The 18 F‐fluorodeoxyglucose (FDG)‐positron emission tomography‐CT (PET/CT) is an integrated anatomical and metabolic imaging technique that is gaining prominence in the investigation of TB . The degree of FDG uptake by the pleura may assist in discriminating between benign effusions such as TB and malignant effusions . It has been used to differentiate inactive from active disease, to monitor treatment response, in assessing for cure and predicting the development of active TB in latent infection .…”

Section: Chest Imagingmentioning

confidence: 99%

“…47 The degree of FDG uptake by the pleura may assist in discriminating between benign effusions such as TB and malignant effusions. 48 It has been used to differentiate inactive from active disease, to monitor treatment response, in assessing for cure and predicting the development of active TB in latent infection. 48 However, it is a costly investigation and its role in the diagnostic and management pathways is still being refined.…”

Section: Computed Tomographymentioning

confidence: 99%

Tuberculous pleural effusion

2019

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Tuberculous effusion is a common disease entity with a spectrum of presentations from a largely benign effusion, which resolves completely, to a complicated effusion with loculations, pleural thickening and even frank empyema, all of which may have a lasting effect on lung function. The pathogenesis is a combination of true pleural infection and an effusive hypersensitivity reaction, compartmentalized within the pleural space. Diagnostic thoracentesis with thorough pleural fluid analysis including biomarkers such as adenosine deaminase and gamma interferon achieves high accuracy in the correct clinical context. Definitive diagnosis may require invasive procedures to demonstrate histological evidence of caseating granulomas or microbiological evidence of the organism on smear or culture. Drug resistance is an emerging problem that requires vigilance and extra effort to acquire a complete drug sensitivity profile for each tuberculous effusion treated. Nucleic acid amplification tests such as Xpert MTB/RIF can be invaluable in this instance; however, the yield is low in pleural fluid. Treatment consists of standard anti‐tuberculous therapy or a guideline‐based individualized regimen in the case of drug resistance. There is low‐quality evidence that suggests possible benefit from corticosteroids; however, they are not currently recommended due to concomitant increased risk of adverse effects. Small studies report some short‐ and long‐term benefit from interventions such as therapeutic thoracentesis, intrapleural fibrinolytics and surgery but many questions remain to be answered.

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“…Recent studies announced that PET/CT had demonstrated sensitivity ranging widely between 75% and 93%, also specificity between 88% and 96% in the identification of malignant pleural effusions. [20][21][22][25][26][27][28][29] This big difference may result from 60% mean sensitivity rate of pleural fluid cytology depending on the primary tumor, sample preparation and experience of the cytologist. 30 A review of 14 studies comprising 407 patients with malignant disease reported that PET/CT imaging had a sensitivity of 81% and specificity of 74% concluding that there was no basis for the inclusion of PET/CT in the diagnosis of malignant effusion.…”

Section: Discussionmentioning

confidence: 99%

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

Sarıçam¹

2020

Int Surg J

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Background: This study aimed to investigate the feasibility of F-18 fluorodeoxyglucose (FDG) positron emission computed tomography (PET/CT) in identifying the pleural invasion of metastatic breast cancers.Methods: A retrospective study was conducted to include 75 patients with untreated breast cancer who had undergone thoracoscopy to drain pleural effusions and to perform pleural biopsies. Whole group of patients were evaluated in terms of age, type of primary breast cancer, macroscopic appearance of pleura during thoracoscopy, maximum standardized FDG uptake value (SUV) reported by PET/CT scan in addition to presence of malignancy detected in pleura and/or pleural effusion.Results: All of 75 patients were female and mean age was 56.12±11.70. Metastatic disease was diagnosed in the pleura of 40 (53.3%) and in the pleural effusion of 43 (57.3%) patients. The sensitivity and specificity of PET/CT in detecting pleural metastases of breast carcinoma was calculated as 88.2% and 96.2% whereas PET/CT demonstrated sensitivity of 91.9% and specificity of 91.3% in identifying malignant pleural effusion. Cut-off values of FDG uptake were 4.25 for pleural metastases and 3.85 for malignant pleural effusions. PET/CT also indicated a false negative rate of 12.5%, a false positive rate of 16.28% and an overall accuracy rate of 85.33% in the diagnosis of pleural metastasis of breast carcinoma.Conclusions: PET/CT reporting an FDG uptake over 4 in the pleura or pleural effusion is beneficial in managing the patients with the suspicion of pleural metastases from breast cancer.

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The Role of 18F-FDG PET/CT Integrated Imaging in Distinguishing Malignant from Benign Pleural Effusion

Cited by 43 publications

References 15 publications

Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

Contemporary Approach to the Diagnosis of Malignant Pleural Effusion

Tuberculous pleural effusion

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

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