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DOI: 10.3413/Nukmed-0470-12-01
18F-fluorodeoxyglucose PET/CT findings in pleural effusions of patients with known cancer
A cytopathological correlationIdentifikation maligner Pleura-Ergüsse mittels 18F-Fluordeoxyglukose-PET/CTEine Korrelation mit zytopathologischen BefundenPublication History
received:
23 January 2012
accepted in revised form:
03 May 2012
Publication Date:
02 January 2018 (online)
Summary
Aim: Pleural effusion is common in cancer patients and to determine its malignant origin is of huge clinical significance. PET/CT with 18F-FDG is of diagnostic value in staging and follow-up, but its ability to differentiate between malignant and benign effusions is not precisely known. Patients, methods: We examined 50 PET/CT from 47 patients (29 men, 18 women, 60 ± 16 years) with pleural effusion and known cancer (24 NSCLC, 7 lymphomas, 5 breasts, 4 GIST, 3 mesotheliomas, 2 head and neck, 2 malignant teratoma, 1 colorectal, 1 oesophageal, 1 melanoma) for FDG uptake in the effusions using SUVmax. This was correlated to cytopathology performed after a median of 21 days (interquartile range –3 to 23), which included pH, relative distribution (macrophages, neutrophils, eosinophils, basophils, lymphocytes, plasmocytes), and absolute cell count. Results: Malignant cells were found in 17 effusions (34%) (6 NSCLC, 5 lymphomas, 2 breasts, 2 mesotheliomas, 2 malignant teratomas). SUV in malignant effusions were higher than in benign ones [3.7 (95%CI 1.8–5.6) vs. 1.7 g/ml (1.5–1.9), p = 0.001], with a correlation between malignant effuUntersion and SUV (Spearman coefficient ρ = 0.50, p = 0.001), but not with other cytopathological or radiological parameters (ROC area 0.83 ± 0.06). Using a 2.2-mg/l SUV threshold, 12 PET/CT studies were positive and 38 negative with sensitivity, specificity, positive and negative predictive values of 53%, 91%, 75% and 79%, respectively. For NSCLC only (n = 24), ROC area was 0.95 ± 0.04, 7 studies were positive and 17 negative with a sensitivity, specificity, positive and negative predictive values of 83%, 89%, 71 and 94%, respectively. Conclusion: PET/CT may help to differentiate the malignant or benign origin of a pleural effusion with a high specificity in patients with known cancer, in particular NSCLC.
Zusammenfassung
Ziel: Pleuraerguss ist ein häufiges Symptom, auch bei onkologischen Patienten, ohne dass es sich obligat um eine maligne Ätiologie handeln muss. Der Charakter des Ergusses und seine Pathogenese sind jedoch für weitere therapeutische Maßnahmen entscheidend. Die Wertigkeit der 18F-FDG-PET/CT für Staging und Nachsorge ist unbestritten, ob aber die PET zwischen malignem und benignem Erguss unterscheiden kann wurde noch wenig untersucht. Patienten und Methodik: Wir untersuchten 47 Tumor-Patienten (29 Männer, 18 Frauen, 60 ± 16 Jahre) mit Pleuraergüssen [24 nicht-kleinzellige Lungenkarzinome (NSCLC), 7 Lymphome, 5 Mammakarzinome, 4 GIST, 3 Mesotheliome, 2 HNO-Karzinome, 2 maligne Teratome, 1 Kolon/ Rektumkarzinom, 1 Ösophaguskarzinom, 1 Melanom] mit insgesamt 50 PET/CT. Die FDG-Konzentration in den Ergüssen wurde anhand Messungen des SUVmax, normalisiert auf das Körpergewicht geschätzt. Die Pleuraergüsse wurden alle punktiert, im Mittel 21 Tage (Interquartilbereich –6 bis +23 Tage) nach der PET-Untersuchung, und zytologisch untersucht, ebenso wurde die zelluläre Zusammensetzung (Makrophagen, Neutrophile, Eosinophile, Basophile, Lymphozyten, Plasmozyten) quantifiziert und der pH-Wert bestimmt. Ergebnis: Siebzehn Pleuraergüsse (34%) enthielten maligne Zellen (6 NSCLC, 5 Lymphome, 2 Mammakarzinome, 2 Mesotheliome, 2 maligne Teratome) und zeigten einen höheren SUVmax-Wert als Ergüsse ohne klare maligne Ursache [3,7 (95%CI 1,8–5,6) vs. 1,7 g/ml (1,5–1,9), p = 0,001]. Die malignen Pleuraergüsse korrelierten lediglich mit dem SUV (Spearman-Koeffizient ρ = 0,50, p = 0,001), jedoch nicht mit zytologischen oder radiologischen Parametern (ROC-Area 0,83 ± 0,06). Bei einer SUVmax-Schwelle von 2,2 mg/l, waren 12 PET/CT Untersuchungen positiv und 38 negativ, mit 53% Sensitivität, 91% Spezifizität, was sich in einen 75% positiven und 79% negativen prädiktiven Wert übersetzt. Analysieren wir lediglich NSCLC (n = 24) wird eine ROC von 0,95 ± 0,04 errechnet, 7 Unter suchungen waren positiv und 17 negativ, mit 83% Sensitivität, 89% Spezifizität, und somit 71% positivem und 94% negativem prädiktivem Wert. Schlussfolgerung: Die PET/CT erlaubt mit hoher Spezifizität zwischen malignen und benignen Pleuraergüssen zu unterscheiden, insbesondere bei NSCLC. Der negative prädiktive Wert von >90% ist klinisch von Bedeutung.
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