MALIGN PLEVRAL MEZOTELYOMA AYIRICI TANISI VE PROGNOZUNDA 18F-FDG PET/ BT’NIN ROLÜ

Öz

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.

Anahtar Kelimeler

• Mezotelyoma,PET/BT,FDG

THE ROLE OF 18F-FDG PET-CT IN DIAGNOSIS AND PREDICTION OF PROGNOSIS IN MALIGNANT PLEURAL MESOTHELIOMA

Öz

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.

Anahtar Kelimeler

• Mesothelioma,PET/CT,FDG

Kaynakça

1. 1. Peto J, Decarli A, La Vecchia C, Levi F, Negri E. The European mesothelioma epidemic. Br J Cancer 1999;79(3):666.
2. 2. Linton A, Pavlakis N, O’connell R, Soeberg M, Kao S, Clarke S, et al. Factors associated with survival in a large series of patients with malignant pleural mesothelioma in New South Wales. Br J Cancer 2014;111(9):1860.
3. 3. Gorini G, De Gregorio G, Silvestri S, Chellini E, Cupelli V, Costantini AS. Survival of malignant pleural mesothelioma cases in the Tuscan Mesothelioma Register, 1988-2000: a population-based study. Eur J Cancer Prev 2005;14(3):1959.
4. 4. Hallifax R, Haris M, Corcoran J, Leyakathalikhan S, Brown E, Srikantharaja D, et al. Role of CT in assessing pleural malignancy prior to thoracoscopy. Thorax 2015;70(2):192-3.
5. 5. Yamamoto Y, Kameyama R, Togami T, Kimura N, Ishikawa S, Yamamoto Y, et al. Dual time point FDG PET for evaluation of malignant pleural mesothelioma. Nucl Med Commun 2009;30(1):25-9.
6. 6. Elboga U, Yılmaz M, Uyar M, Çelen YZ, Bakır K, Dikensoy Ö. The role of FDG PET-CT in differential diagnosis of pleural pathologies. Rev Esp Med Nucl Ima 2012;31(4):187-91.
7. 7. Yildirim H, Metintas M, Entok E, Ak G, Ak I, Dundar E, et al. Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study. J Thorac Oncol 2009;4(12):1480-4.
8. 8. Orki A, Akin O, Tasci A, Ciftci H, Urek S, Falay O, et al. The role of positron emission tomography/computed tomography in the diagnosis of pleural diseases. J Thorac Cardiovasc Surg 2009;57(04):217-21.

9. 9. Armato III SG, Coolen J, Nowak AK, Robinson C, Gill RR, Straus C, et al. Imaging in pleural mesothelioma: a review of the 12th International Conference of the International Mesothelioma Interest Group. Lung Cancer 2015;90(2):148-54.
10. 10. Kitajima K, Doi H, Kuribayashi K, Hashimoto M, Tsuchitani T, Tanooka M, et al. Prognostic value of pretreatment volume-based quantitative 18F-FDG PET/CT parameters in patients with malignant pleural mesothelioma. Eur J Radiol 2017;86:176-83.
11. 11. Incerti E, Broggi S, Fodor A, Cuzzocrea M, Gajate AS, Mapelli P, et al. FDG PET-derived parameters as prognostic tool in progressive malignant pleural mesothelioma treated patients. Eur J Nucl Med Mol I 2018;45(12):2071-8.
12. 12. Sharif S, Zahid I, Routledge T, Scarci M. Does positron emission tomography offer prognostic information in malignant pleural mesothelioma? Interact Cardiovasc Thorac Surg 2011;12(5):806-11.
13. 13. Abe Y, Tamura K, Sakata I, Ishida J, Ozeki Y, Tamura A, et al. Clinical implications of 18F-fluorodeoxyglucose positron emission tomography/computed tomography at delayed phase for diagnosis and prognosis of malignant pleural mesothelioma. Oncol Rep 2012;27(2):333-8.
14. 14. Lee S, Ghanem M, Herbertson R, Berlangieri SU, Byrne AJ, Tabone K, et al. Prognostic value of 18 F-FDG PET/ CT in patients with malignant pleural mesothelioma. Mol Imaging Biol 2009;11(6):473.
15. 15. Treglia G, Sadeghi R, Annunziata S, Lococo F, Cafarotti S, Bertagna F, et al. Diagnostic accuracy of 18F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and metaanalysis. Acad Radiol 2014;21(1):11-20.
16. 16. Kramer H, Pieterman RM, Slebos D-J, Timens W, Vaalburg W, Koëter GH, et al. PET for the evaluation of pleural thickening observed on CT. J Nucl Med 2004;45(6):995-8.
17. 17. Kadota K, Suzuki K, Sima CS, Rusch VW, Adusumilli PS, Travis WD. Pleomorphic epithelioid diffuse malignant pleural mesothelioma: a clinicopathological review and conceptual proposal to reclassify as biphasic or sarcomatoid mesothelioma. J Thorac Oncol 2011;6(5):896904.
18. 18. Wang ZJ, Reddy GP, Gotway MB, Higgins CB, Jablons DM, Ramaswamy M, et al. Malignant pleural mesothelioma: evaluation with CT, MR imaging, and PET. Radiographics 2004;24(1):105-19.
19. 19. Plathow C, Staab A, Schmaehl A, Aschoff P, Zuna I, Pfannenberg C, et al. Computed tomography, positron emission tomography, positron emission tomography/ computed tomography, and magnetic resonance imaging for staging of limited pleural mesothelioma: initial results. Invest Radiol 2008;43(10):737-44.