i̇st tıp fak derg Journal of Istanbul Faculty of Medicine 1305-6441 Istanbul University Health Care Administration Sağlık Kurumları Yönetimi MALIGN PLEVRAL MEZOTELYOMA AYIRICI TANISI VE PROGNOZUNDA 18F-FDG PET/ BT’NIN ROLÜ THE ROLE OF 18F-FDG PET-CT IN DIAGNOSIS AND PREDICTION OF PROGNOSIS IN MALIGNANT PLEURAL MESOTHELIOMA https://orcid.org/0000-0001-6945-2003 Has Sımsek Duygu İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0002-1158-5361 Kuyumcu Serkan İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0002-1267-2379 Sanlı Yasemin İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0003-0360-358X Okan Zeynep Gozde İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0003-2157-4778 Ozkan Berker İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0003-0912-8214 Turkmen Cuneyt İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0002-4836-567X Yılmazbayhan Emine Dilek İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ https://orcid.org/0000-0002-5533-0969 Mudun Ayse İSTANBUL ÜNİVERSİTESİ, İSTANBUL TIP FAKÜLTESİ 10 21 2019 82 4 168 173 03 01 2019 07 12 2019 Copyright © 1916, Journal of Istanbul Faculty of Medicine 1916 Journal of Istanbul Faculty of Medicine

Amaç: Bu çalışmanın amacı, malign ve benign plevral hastalığın ayırıcı tanısında 18F-FDG PET/BT’nin performansı ve malign plevral mezotelyomadaki (MPM) prognostik değerini incelemektir. Yöntem: Konvansiyonel BT’de saptanan diffüz ya da nodüler plevral kalınlaşma nedeniyle 18F-FDG PET/BT çekilen 58 hasta retrospektif olarak incelendi. 18F-FDG PET/BT taramaları, maksimum standartlaştırılmış uptake değeri (SUVmax) kullanılarak görsel ve yarı kantitatif olarak değerlendirildi. Pozitif/negatif tutulum ayrımında eşik değeri olarak mediastinal kan havuzu SUVmax değerleri kullanıldı. 18F-FDG PET/BT bulguları, histopatolojik bulgular ve sağkalım verileri ile karşılaştırıldı. Hastalar klinik ve radyolojik olarak takip edildi. Bulgular: 58 hastanın 38’inde (%65,5) plevral lezyonlar FDG pozitifti; 28/38 hastada (%73,6) MPM ve 10/38 hastada (%26,4) benign plevral hastalık tanısı histopatolojik olarak saptandı. Negatif 20/58 taramanın (%34,5) 18’i iki yıllık takip ile benign hastalık kabul edilirken radyolojik progresyon saptanan 2 hastaya MPM tanısı kondu. Duyarlılık, özgüllük, doğruluk, pozitif prediktif ve negatif prediktif değerler sırasıyla %93, %64, %79, %73 ve %90 idi. Ortanca genel sağkalım süresi 14,5 ay olarak bulundu. Daha yüksek SUVmax düzeyi (SUVmax> 7,4), daha kısa sağkalım ile ilişkili bulundu (13 ay; 24 ay) (p=0,032). Sonuç: 18F-FDG PET/BT, malign/benign plevral lezyonların ayırıcı tanısı için duyarlı bir görüntüleme yöntemi olup biyopsi hedefinin belirlenmesi ve hastaların yönetiminde etkilidir. MPM SUVmax değeri prognozu öngörme potansiyeline sahiptir.

Objective: The purpose of this study is to evaluate the performance of 18F-FDG PET/CT in the differential diagnosis of malignant and benign pleural disease as well as its prognostic value in the malignant pleural mesothelioma (MPM). Methods: Fifty-eight patients who underwent 18F-FDG PET/ CT due to diffuse or nodular pleural thickening determined on conventional CT were retrospectively analyzed.18F-FDG PET/ CT scans were evaluated visually and semiquantitatively using maximum standardized uptake value (SUVmax). Mediastinal blood pool SUVmax was used as a threshold value for defining positive/negative accumulation of tracer. 18F-FDG PET/CT findings were compared with histopathological and survival data. Patients were followed up clinically/radiologically. Results: Thirty-eight of fifty-eight patients (65.5%) had FDG (+) pleural lesions; 28/38 patients (73.6%) were diagnosed MPM and 10/38 patients (26.4%) were determined benign pleural disesase histopathologically. 20/58 scans (34.5%) were negative, and 18 of them were assumed benign based on two years follow-up, whereas 2 patients were diagnosed MPM by biopsy due to radiologic progression. Sensitivity, specificity, accuracy, positive predictive, and negative predictive values were 93%, 64%, 79%, 73%, and 90% respectively. Median overall survival was found to be 14.5 months. Higher SUVmax level (SUVmax>7.4) was associated with shorter survival (13 vs. 24 months)(p=0.032). Conclusion: 18F-FDG-PET/CT is a sensitive imaging method for differential diagnosis of malignant/benign pleural lesions, indicates the target of biopsy, and effects the management of patients. SUVmax of MPM has a potential role for predicting the prognosis.

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