Plevral Lezyonların Ayırıcı Tanısında 18F-Florodeoksiglukoz Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografinin Rolünün Değerlendirilmesi

Öz

Amaç: Malignite tanısı bulunmayan, plevral kalınlaşması olan hastalarda Flor-18 florodeoksiglukoz pozitron emisyon tomografi/bilgisayarlı tomografi (18F-FDG PET/BT)’nin benign–malign plevral kalınlaşma/efüzyon ayrımındaki tanısal performansının retrospektif olarak değerlendirilmesi, maksimum standardize tutulum değeri (SUVmaks) için en uygun eşik değerini belirleyip klinik–radyolojik verilerle tanı doğruluğuna katkısının incelenmesi amaçlanmıştır. Yöntemler: Ocak 2018–Ekim 2023 arasında plevral kalınlaşma nedeniyle 18F-FDG PET/BT yapılan, malignite tanısı olmayan 78 hasta dâhil edildi. Plevral kalınlaşma ve efüzyon SUVmaks değerleri, kalınlaşma paterni, asbest maruziyeti ve sigara öyküsü retrospektif olarak analiz edildi. Bulgular: Plevral kalınlaşmaların SUVmaks değeri temelli benign–malign ayrımı açısından duyarlılığı %77,27, özgüllüğü %73,53 bulundu ve istatistiksel olarak anlamlıydı (p<0.05). Plevral efüzyonu olan 63 hastada SUVmaks temelli ayrımın duyarlılığı %68,8, özgüllüğü %55,3 idi ve istatistiksel olarak anlamlı değildi (p>0.05). Optimal SUVmaks eşik değeri plevral kalınlaşma için 3,58, efüzyon için 1,62 saptandı. FDG tutulumu diffüz kalınlaşmada fokale göre daha yüksekti (diffüz SUVmaks ortalama 6,38±4,85; fokal SUVmaks ortalama: 3,95±3,55). Asbest maruziyeti yalnızca malign mezotelyoma grubunda anlamlıydı. (p <0.05) Kalınlaşma paterni ve sigara ile malignite arasında anlamlı fark yoktu (p>0.05). Sonuç: 18F-FDG PET/BT, plevral kalınlaşmalı ve/veya efüzyonlu hastalarda malignite ayırıcı tanısında değerlidir. Plevral kalınlaşmada SUVmaks=3,58 eşiği tanısal katkı sağlar; efüzyonun değerlendirilmesinde sınırlılıklar mevcuttur. Eksternal validasyonun daha büyük kohortlarda yapılması gereklidir.

Anahtar Kelimeler

• Plevral neoplazmlar
• Plevral efüzyon
• FDG
• PET/BT
• Malign mezotelyoma.

Evaluation of the Role of Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Differential Diagnosis of Pleural Lesions

Öz

Objective: To retrospectively evaluate the diagnostic performance of fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in differentiating benign versus malignant pleural thickening/effusion in patients without a known malignancy, to determine the optimal cutoff for maximum standardized uptake value (SUVmax), and to assess the added value of clinical–radiologic variables for diagnostic accuracy. Methods: Seventy-eight patients who underwent 18F-FDG PET/CT for pleural thickening between January 2018 and October 2023 and had no diagnosis of malignancy were included. SUVmax values of pleural thickening and effusion, thickening pattern, asbestos exposure, and smoking history were analyzed retrospectively. Results: For distinguishing benign from malignant pleural thickening based on SUVmax, sensitivity was 77.27% and specificity was 73.53%, which was statistically significant (p < 0.05). Among 63 patients with pleural effusion, the sensitivity and specificity of an SUVmax-based distinction were 68.8% and 55.3%, respectively, and were not statistically significant (p > 0.05). The optimal SUVmax cutoff was 3.58 for pleural thickening and 1.62 for effusion. FDG uptake was higher in diffuse thickening than in focal thickening (diffuse mean SUVmax 6.38 ± 4.85; focal mean SUVmax 3.95 ± 3.55). Asbestos exposure was significant only in the malignant mesothelioma group (p < 0.05). There was no significant association between malignancy and thickening pattern or smoking history (p > 0.05). Conclusion: 18F-FDG PET/CT is valuable for the differential diagnosis of malignancy in patients with pleural thickening and/or effusion. An SUVmax cutoff of 3.58 provides diagnostic contribution for pleural thickening, whereas evaluation of effusion shows limitations. External validation in larger cohorts is required.

Anahtar Kelimeler

• Pleural Neoplasms
• Pleural Effusion
• Fluorodeoxyglucose F18
• Positron Emission Tomography Computed Tomography
• Mesothelioma
• Malignant

Kaynakça

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