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Malignant Peritoneal Mesothelioma Features Shown by FDG-PET/CT
Kozo Kuribayashi1, Kazuhiro Kitajima2, Toshiyuki Minami1
1Department of Respiratory Medicine and Hematology, School of Medicine, Hyogo Medical University, Nishinomiya, Japan.
Background/Aim:
Malignant peritoneal meso-thelioma (MPeM) has no specific imaging findings that can distinguish it from other peritoneal tumors and the accuracy of peritoneal cytology is low, therefore definitive diagnosis is usually performed by histology. This study investigated whether F-fluorodeoxyglucose positron emission tomography/ computed tomography representing glucose metabolism is a useful modality for identifying biopsy sites using the tumor viability of MPeM.
Patients And Methods:
Sixty MPeM patients underwent pre-biopsy FDG-PET/CT examination. The findings were retrospectively evaluated, and histopathological subtype differences were investigated.
Results:
The diffuse MPeM type was found in 45 (75.0%) and the localized type in 15 (25.0%) cases. The most frequent site of occurrence was the peritoneum (91.7%), followed by the omentum (51.7%). FDG-avid results were noted in 55 patients (91.7%), while 5 (8.3%) showed no FDG uptake with a variety of maximum standardize uptake value (SUVmax) values (range=0-16.77, mean=7.32±4.05). In the 53 epithelial cases, mean SUVmax (7.09±4.07, range=0-16.77) was slightly lower compared to the 4 biphasic (8.30±4.70, range=2.35-13.36) and 3 sarcomatoid (10.08±2.64, range=8.21-13.10) cases, without any significant difference (p=0.12). Diffuse and focal disease patterns showed similar percentages in the three types. Six cases (10.0%) had nodal metastases and 6 (10.0%) extra-abdominal metastases. Compared to the biphasic and sarcomatoid groups, nodal metastases were more common in the epithelial group, while extra-abdominal metastases were more often seen in the biphasic and sarcomatoid groups. Ascites was seen in 53 (83.3%), pleural effusion in 43 (71.7%), and pleural plaque in 31 (51.7%) cases.
Conclusion:
Through reviewing and elucidation of the FDG-PET/CT features of MPeM, it was shown that FDG-PET/CT is an extremely useful modality for identifying biopsy sites of MPeM.
Insights
¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is highly effective for identifying biopsy sites in malignant peritoneal mesothelioma (MPeM). This imaging modality aids in diagnosis when other methods are insufficient, improving patient care.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiology
Background:
- Malignant peritoneal mesothelioma (MPeM) lacks specific imaging features for differentiation from other peritoneal tumors.
- Peritoneal cytology has low diagnostic accuracy, often necessitating histological confirmation.
- Histopathology remains the gold standard for definitive MPeM diagnosis.
Purpose of the Study:
- To evaluate the utility of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in identifying optimal biopsy sites for MPeM.
- To assess FDG-PET/CT's ability to reflect tumor viability in MPeM.
- To correlate FDG-PET/CT findings with histopathological subtypes of MPeM.
Main Methods:
- Retrospective analysis of pre-biopsy FDG-PET/CT scans from 60 MPeM patients.
- Evaluation of FDG uptake patterns and maximum standardized uptake values (SUVmax).
- Comparison of imaging findings across different histopathological subtypes (epithelial, biphasic, sarcomatoid).
Main Results:
- FDG-PET/CT identified MPeM in 91.7% of patients, demonstrating high sensitivity.
- The mean SUVmax was 7.32±4.05, with variations across histopathological subtypes but no statistically significant differences.
- Metastatic patterns (nodal and extra-abdominal) varied by subtype, and common findings included ascites (83.3%) and pleural effusion (71.7%).
Conclusions:
- FDG-PET/CT is a valuable tool for guiding biopsies in MPeM due to its ability to visualize metabolically active tumor sites.
- The imaging modality aids in characterizing disease extent and potential metastatic spread.
- FDG-PET/CT enhances diagnostic accuracy and treatment planning for MPeM.
