Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions
Background: The confirmation of malignant pleural effusions (MPE) requires an invasive procedure. Diagnosis can be difficult and may require repeated thoracentesis or biopsies. <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) can characterize the extent of malignan...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-11-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/22/6977 |
| _version_ | 1797458866258051072 |
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| author | Samuel E. Cohen Jaime Betancourt Guy W. Soo Hoo |
| author_facet | Samuel E. Cohen Jaime Betancourt Guy W. Soo Hoo |
| author_sort | Samuel E. Cohen |
| collection | DOAJ |
| description | Background: The confirmation of malignant pleural effusions (MPE) requires an invasive procedure. Diagnosis can be difficult and may require repeated thoracentesis or biopsies. <sup>F18</sup>Fluorodeoxyglucose-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. |
| first_indexed | 2024-03-09T16:44:17Z |
| format | Article |
| id | doaj.art-b84385c50ef54493ae1a7ff80dad260c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T16:44:17Z |
| publishDate | 2023-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b84385c50ef54493ae1a7ff80dad260c2023-11-24T14:49:00ZengMDPI AGJournal of Clinical Medicine2077-03832023-11-011222697710.3390/jcm12226977Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural EffusionsSamuel E. Cohen0Jaime Betancourt1Guy W. Soo Hoo2Cedars-Sinai Medical Center, Los Angeles, CA 90048, USAWest Los Angeles Veterans Affairs Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USAWest Los Angeles Veterans Affairs Healthcare Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USABackground: The confirmation of malignant pleural effusions (MPE) requires an invasive procedure. Diagnosis can be difficult and may require repeated thoracentesis or biopsies. <sup>F18</sup>Fluorodeoxyglucose-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.https://www.mdpi.com/2077-0383/12/22/6977malignant pleural effusionpositron emission tomographymalignancyFDG-PETpleural disease |
| spellingShingle | Samuel E. Cohen Jaime Betancourt Guy W. Soo Hoo Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions Journal of Clinical Medicine malignant pleural effusion positron emission tomography malignancy FDG-PET pleural disease |
| title | Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions |
| title_full | Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions |
| title_fullStr | Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions |
| title_full_unstemmed | Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions |
| title_short | Pleural Uptake Patterns in <sup>F18</sup>Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) Scans Improve the Identification of Malignant Pleural Effusions |
| title_sort | pleural uptake patterns in sup f18 sup fluorodeoxyglucose positron emission tomography fdg pet scans improve the identification of malignant pleural effusions |
| topic | malignant pleural effusion positron emission tomography malignancy FDG-PET pleural disease |
| url | https://www.mdpi.com/2077-0383/12/22/6977 |
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