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Pleural Uptake Patterns in F18Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the
Samuel E Cohen1, Jaime Betancourt2,3, Guy W Soo Hoo2,3
1Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Background:
The confirmation of malignant pleural effusions (MPE) requires an invasive procedure. Diagnosis can be difficult and may require repeated thoracentesis or biopsies. F18Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) can characterize the extent of malignant involvement in areas of increased uptake. Patterns of uptake in the pleura may be sufficient to obviate the need for further invasive procedures.
Methods:
This is a retrospective review of patients with confirmed malignancy and suspected MPE. Patients who underwent diagnostic thoracentesis with cytology and contemporaneous FDG-PET were identified for analysis. Some underwent confirmatory pleural biopsy. The uptake pattern on FDG-PET underwent blinded review and was categorized based on the pattern of uptake.
Results:
One hundred consecutive patients with confirmed malignancy, suspected MPE and corresponding FDG-PET scans were reviewed. MPE was confirmed in 70 patients with positive pleural fluid cytology or tissue pathology. Of the remaining patients, 15 had negative cytopathology, 14 had atypical cells and 1 had reactive cells. Positive uptake on FDG-PET was noted in 76 patients. The concordance of malignant histology and positive FDG-PET occurred in 58 of 76 patients (76%). Combining histologically confirmed MPE with atypical cytology, positive pleural FDG-PET uptake had a positive predictive value of 91% for MPE. An encasement pattern had a 100% PPV for malignancy.
Conclusion:
Positive FDG-PET pleural uptake represents an excellent method to identify MPE, especially in patients with an encasement pattern. This may eliminate the need for additional invasive procedures in some patients, even when initial pleural cytology is negative.
Insights
Positron Emission Tomography (FDG-PET) scans can identify malignant pleural effusions (MPE) with high accuracy. This imaging technique may reduce the need for invasive diagnostic procedures in patients with suspected MPE.
Area of Science:
- Oncology
- Radiology
- Pulmonology
Background:
- Malignant pleural effusions (MPE) diagnosis typically requires invasive procedures like thoracentesis or biopsies.
- Diagnosing MPE can be challenging, often necessitating repeated invasive sampling.
- 18F-Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) can assess malignant involvement and may help avoid invasive procedures.
Purpose of the Study:
- To evaluate the utility of FDG-PET in diagnosing MPE.
- To determine the accuracy of FDG-PET patterns in identifying malignancy in the pleura.
- To assess if FDG-PET can obviate the need for further invasive diagnostic procedures.
Main Methods:
- Retrospective review of patients with confirmed malignancy and suspected MPE.
- Analysis of patients who underwent diagnostic thoracentesis with cytology and FDG-PET.
- Blinded review and categorization of FDG-PET uptake patterns.
Main Results:
- Of 100 patients, 70 had confirmed MPE. Positive FDG-PET uptake was observed in 76 patients.
- FDG-PET showed 76% concordance with malignant histology.
- Positive pleural FDG-PET had a 91% positive predictive value for MPE, with an encasement pattern showing 100% PPV.
Conclusions:
- Positive FDG-PET pleural uptake is a reliable method for identifying MPE.
- An encasement pattern on FDG-PET is highly predictive of malignancy.
- FDG-PET may reduce the need for additional invasive procedures, even with negative initial cytology.
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