RADIOLOGY / CLINICAL RESEARCH
How can we use positron emission tomography/
computed tomography more accurately for characterization of asbestos-related pleural thickening?
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1 |
Department of Nuclear Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey |
2 |
Department of Thoracic Surgery, Faculty of Medicine, Firat University, Elazig, Turkey |
3 |
Department of Nuclear Medicine, Antalya Education and Research Hospital, Antalya, Turkey |
4 |
Department of Pulmonology, Faculty of Medicine, Firat University, Elazig, Turkey |
5 |
Department of Pathology, Faculty of Medicine, Firat University, Elazig, Turkey |
6 |
Department of Nuclear Medicine, Elazig Medical Park Hospital, Elazig, Turkey |
CORRESPONDING AUTHOR
F. Selcuk Simsek
Firat University Faculty of Medicine, Nuclear Medicine Department
Submission date: 2019-02-12
Final revision date: 2019-08-02
Acceptance date: 2019-08-06
Online publication date: 2021-03-24
Publication date: 2023-03-01
Arch Med Sci 2023;19(2):385–391
KEYWORDS
TOPICS
ABSTRACT
Introduction:
There is no consensus about the standardized uptake value maximum (SUVmax) cut-off value to characterize pleural thickening worldwide. Sometimes, this causes unnecessary invasive diagnostic procedures. Our first aim is to determine a cut-off value for SUVmax. Secondly, we try to answer the following question: If we use this cut-off value together with morphological parameters, can we differentiate benign thickening from malignant pleural mesothelioma (MPM) more accurately?
Material and methods:
Thirty-seven patients who underwent 2-deoxy-2-fluoro-D-glucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) before pleural biopsy were included the study. All of patients had histopathologically proven primary pleural disease. Their [18F]FDG-PET/CT imaging reports were re-assessed. If a patient’s SUVmax or size of the thickening was not mentioned in the report, we calculated it with their [18F]FDG-PET/CT.
Results:
Age, pleural effusion, size, and SUVmax were found to have a relationship with MPM. We found the size > 14 mm, and SUVmax > 4.0 as cut-off values for MPM. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for size > 14 mm were found to be 86.4%, 85.2%, 82.6%, 88.5%, respectively. For SUVmax > 4.0, sensitivity, specificity, PPV, NPV were 90.9%, 87.0%, 85.1%, 92.2%, respectively.
Conclusions:
If a patient has SUVmax > 4.0 and/or size > 14 mm, the risk of MPM is high. These patients should undergo biopsy. If a patient’s SUVmax < 4.0, size < 14 mm and does not have pleural effusion, he/she has low risk for MPM. These patients can undergo the follow-up. If a patient’s SUVmax < 4, size < 14, and has pleural effusion the MPM risk is approximately 4%. These patients can undergo biopsy/cytology/follow-up. Novel studies are needed for these patients.