Development and validation of the PET-CT score for diagnosis of malignant pleural effusion

Abstract

Purpose Although some parameters of positron emission tomography with 18 F-fluorodeoxyglucose ( 18 F-FDG) and computed tomography (PET-CT) are somehow helpful in differentiating malignant pleural effusion (MPE) from benign effusions, no individual parameter offers sufficient evidence for its implementation in the clinical practice. The aim of this study was to establish the diagnostic accuracy of a scoring system based on PET-CT (the PET-CT score) in diagnosing MPE. Methods One prospective derivation cohort of patients with pleural effusions (84 malignant and 115 benign) was used to develop the PET-CT score for the differential diagnosis of malignant pleural effusion. The PET-CT score was then validated in another independent prospective cohort ( n = 74). Results The PET-CT parameters developed for discriminating MPE included unilateral lung nodules and/or masses with increased 18 F-FDG uptake (3 points); extrapulmonary malignancies (3 points); pleural thickening with increased 18 F-FDG uptake (2 points); multiple nodules or masses (uni- or bilateral lungs) with increased 18 F-FDG uptake (1 point); and increased pleural effusion 18 F-FDG uptake (1 point). With a cut-off value of 4 points in the derivation cohort, the area under the curve, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the PET-CT score to diagnose MPE were 0.949 (95% CI: 0.908–0.975), 83.3% (73.6%–90.6%), 92.2% (85.7%–96.4%), 10.7 (5.6–20.1), and 0.2 (0.1–0.3), respectively. Conclusions A simple-to-use PET-CT score that uses PET-CT parameters was developed and validated. The PET-CT score can help physicians to differentiate MPE from benign pleural effusions. Electronic supplementary material The online version of this article (10.1007/s00259-019-04287-7) contains supplementary material, which is available to authorized users.

Development and validation of a novel scoring system developed from a nomogram to identify malignant pleural effusion

“…Yang et al. [23] established a scoring system based on five PET-CT parameters for the differential diagnosis of MPE and BPE, and the sensitivity and specificity in the derivation cohort were 83.3% and 92.2%, respectively, with a cutoff value of 4. In addition, Porcel et al.…”

“…Unfortunately, no specific method for differentiating MPE from BPE is perfect in clinical settings. Yang et al [23] established a scoring system based on five PET-CT parameters for the differential diagnosis of MPE and BPE, and the sensitivity and specificity in the derivation cohort were 83.3% and 92.2%, respectively, with a cutoff value of 4. In addition, Porcel et al [24] constructed a CT scan-based scoring system, and this scoring model achieved a sensitivity of 88% and a specificity of 94% with a cutoff value of 7 points in the validation set.…”

Driverless artificial intelligence framework for the identification of malignant pleural effusion

“…Furthermore, a recent study [ 11 ] demonstrated that combination of four indexes (age, proteins, glucose, and lactic acid) selected by logistical regression to separate tuberculous pleurisy from BPE achieved 78% specificity and 93.5% sensitivity with an area under curve (AUC) of 0.915. Yang et al [ 12 ] exploited logistic model to develop a PET-CT scoring model for the differential diagnosis of MPE and BPE, and the scoring model yielded a sensitivity of 83.3% and a specificity of 92.2% with the cut-off value of 4 points in the training group. Hence, the predictive performances of diagnostic models created by logistical regression are somewhat limited.…”

Salivary microRNAs show potential as biomarkers for early diagnosis of malignant pleural effusion

“…Instead, medical thoracoscopy is considered as a highly sensitive (92.7%) method for diagnosing pleural effusions (3,14). This year, our group found that the PET-CT score can be an efficient method to diagnose MPE, with an area under the curve of 0.949 (15). However, both medical thoracoscopy and PET-CT require high technology support and have a high cost.…”