Positron Emission Tomography/Computed Tomography for the Pleural Staging of Malignant Pleural Mesothelioma: How Accurate Is It?

Abstract

Background: Careful clinical staging in patients with malignant pleural mesothelioma (MPM) is fundamental in management planning. Positron emission tomography/computed tomography (PET/CT) is increasingly recognized as an important staging modality. Objectives: The purpose of this study was to assess whether the metabolic activity of the pleural tumor detected with PET/CT correlates with specific endoscopic features and pleural distribution of the lesions as assessed by medical thoracoscopy. Methods: Consecutive patients with MPM and available PET/CT performed before thoracoscopy were separated into 2 groups, according to their standardized uptake value (SUV). Kaplan-Meier-analysis for survival was performed on groups with low and high SUV. Agreement between PET/CT and thoracoscopy evaluation was analyzed using Cohen's kappa coefficient. The Wilcoxon test was used to compare the median SUV, and the χ² test was used to evaluate differences in endoscopic findings. Results: A total of 32 patients were included. The median maximum SUV (SUV max) was 6.1 and patients were separated into 2 groups based on this cutoff. Patients with SUV max <6.1 had a better survival than those with SUV max ≥6.1 (p = 0.005). The comparison between PET/CT and thoracoscopy showed a fair agreement for visceral and diaphragmatic pleural involvement and moderate agreement for the presence of nodular lesions. There was a statistically significant association between median SUV max and visceral pleural involvement; nodular lesions and visceral pleural involvement were more common in the high-SUV group than in the low-SUV group (p = 0.0012 and p = 0.03, respectively). Conclusions: PET/CT data may be predictive of thoracoscopic features of MPM associated with prognosis and staging, but the correlation is moderate at best. A degree of disagreement exists between these two modalities, which supports thoracoscopy as the gold standard for assessment of local invasion in MPM.

The Prognostic Value of 18F-FDG PET Imaging at Staging in Patients with Malignant Pleural Mesothelioma: A Literature Review

“…Analyzing the full-text version of the remaining 31 studies, there were 12 excluded (4 articles including patients with MPM recurrence); 3 articles from the same referring center; 3 articles including MPM patients with both baseline (pre-treatment) and post-treatment PET, but not reporting prognostic analysis of baseline PET data; 1study with a prognostic analysis performed only in a subgroup population; and 1 article including patients with both peritoneal and pleural mesothelioma, with no separate information on MPM subgroup). Finally, 19 studies were included and analyzed in this review [ 29 , 32 , 33 , 34 , 35 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ].…”

Endoscopic diagnosis and management of pleural effusion in malignant pleural mesothelioma

“…Positron emission tomography (PET)/CT scanning may be helpful in determining the local extent of MPM, but without sufficient accuracy compared to the endoscopic evaluation (8,9).…”

Clinical guidelines on diagnosis and management of patients with malignant pleural mesothelioma (part 1)

“…Роль различных методов при определении стадии ЗМП оценивалась в 17 исследованиях [25,[34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49]. Кроме этого, найдены 1 систематический обзор [50] и 1 метаанализ [51].…”