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

Abstract

Malignant pleural mesothelioma (MPM) is an aggressive malignancy, frequently diagnosed at locally-advanced/metastatic stages. Due to a very poor prognosis and limited treatment options, the need to identify new prognostic markers represents a great clinical challenge. The prognostic role of metabolic information derived from Positron Emission Tomography (PET) with 18F-Fluoro-deoxy-glucose (18F-FDG) has been investigated in different MPM settings, however with no definitive consensus. In this comprehensive review, the prognostic value of FDG-PET imaging exclusively performed at staging in MPM patients was evaluated, conducting a literature search on PubMed/MEDLINE from 2010 to 2020. From the 19 selected studies, despite heterogeneity in several aspects, staging FDG-PET imaging emerges as a valuable prognostic biomarker, with higher tumor uptake predictive of worse prognosis, and with volumetric metabolic parameters like Metabolic Tumor Volume, (MTV) and Total Lesion Glycolisis (TLG) performing better than SUVmax. However, PET uptake parameters were not always confirmed as independent prognostic factors, especially in patients previously treated with pleurodesis and with a non-epithelioid histotype. Future prospective studies in larger and clinically homogeneous populations, and using more standardized methods of PET images analysis, are needed to further validate the value of staging FDG-PET in the prognostic MPM stratification, with a potential impact on better patient-tailored treatment planning, in the perspective of personalized medicine.

The Genes–Stemness–Secretome Interplay in Malignant Pleural Mesothelioma: Molecular Dynamics and Clinical Hints

“…This phenomenon has been demonstrated in MPM as well through PET/CT scan analysis with 2-[19 F]-fluoro-2-deoxy-D-glucose (F-FDG) tracers. In vivo, F-FDG uptake in pleural MPM shows high correlations with upregulation of GLUT1, HIF1, VEGF, CD34, Ki67, and MTOR upregulation, and poor patient prognoses; HIF-1 activation increases glucose transport (via GLUT-1) as well as glutamine and L-type amino acid transport (via LAT1) in pleural MPM [ 71 , 72 , 73 ]. Moreover, hypoxia is also known to promote the Invasive Growth program as a consequence of the activation of the MET-promoter gene by HIF-1alfa [ 74 ].…”

A Review of Posteromedial Lesions of the Chest Wall: What Should a Chest Radiologist Know?

“…Although CT is more precise in assessing bone lesions, MRI has a superior contrast resolution, revealing more details regarding tissue characterization and tumor extension [ 2 , 4 , 6 ]. 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is another complementary modality beneficial in initial staging, evaluation of response to treatment, and tumor recurrence [ 2 , 13 ].…”

18F-FDG PET/CT in Primary Mesothelioma of the Liver

“…5 In pleural and peritoneal mesothelioma, 18 F-FDG PET/CT is a metabolic imaging modality used for staging, restaging, and treatment response assessment. [6][7][8][9][10][11][12] This case presents the rarity of primary mesothelioma of the liver. Furthermore, we highlight the value of 18 F-FDG PET/CT in diagnosing and staging primary hepatic mesothelioma by ruling out a possible malignant primary tumor from elsewhere in the body and detecting lymph node metastases.…”

“…Because of the small number of documented cases, the literature does not offer a typical metastatic pattern; intrathoracic and intra-abdominal lymph node metastases are described 5. In pleural and peritoneal mesothelioma, 18 F-FDG PET/CT is a metabolic imaging modality used for staging, restaging, and treatment response assessment [6][7][8][9][10][11][12]. This case presents the rarity of primary mesothelioma of the liver.…”