Chest
Volume 125, Issue 2, February 2004, Pages 489-493
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Clinical Investigations
NUCLEAR MEDICINE
Evaluation of Pleural Disease With 18-Fluorodeoxyglucose Positron Emission Tomography Imaging

https://doi.org/10.1378/chest.125.2.489Get rights and content

Study objectives

To study the ability of positron emission tomography (PET) using 18-fluorodeoxyglucose (FDG) to distinguish between benign and malignant disease in exudative pleural effusions and pleural thickening.

Design

Prospective study of 98 consecutive patients presenting with either pleural thickening or an exudative pleural effusion.

Setting

Department of pulmonary medicine of a university hospital.

Methods

FDG-PET was performed on each subject before invasive procedures were used to determine the etiologic diagnosis. FDG-PET data were analyzed by visual interpretation.

Results

Sixty-three of 98 patients were found to have malignant pleural disease after histologic analysis. Sixty-one of 63 patients with histologically confirmed malignant disease showed FDG uptake within the area of pleural thickening. Uptake was graded as intense in 51 cases and moderate in 10 cases. Only two patients with malignant pleural disease did not show increased FDG uptake. FDG-PET imaging showed an absence of FDG uptake, and correctly classified 31 of 35 benign lesions. For the remaining four lesions, intense FDG uptake was seen in one case of parapneumonic effusion, while moderate and localized uptake was observed in one parapneumonic, one tuberculous, and one uremic pleurisy. The sensitivity of the method to identify malignancy was 96.8% with a negative predictive value of 93.9%, while its specificity was 88.5% and its positive predictive value was 93.8%.

Conclusions

Our results suggest that FDG-PET is an effective tool for differentiating between benign and malignant pleural diseases.

Section snippets

Patient Selection

Ninety-eight consecutive patients presenting exudative pleural effusion and/or pleural thickening (mean age, 60.9 years; range, 36 to 83 years; 67 men and 31 women) were investigated. In all these patients, the combination of chest radiograph, thoracic CT scanning (PQ 2000 Fourth Generation; Picker; Cleveland, OH) and thoracocentesis failed to give an etiologic diagnosis. Sixty-seven patients had pleural effusion, 10 patients had diffuse pleural thickening, 2 patients had localized pleural

Results

The nature of pleural lesion was diagnosed from cytologic and histologic specimens obtained with blind-needle biopsy, thoracoscopy, and open surgical biopsy in 17, 62, and 5 subjects, respectively. In the remaining 14 patients, no specific histologic pattern other than pleural inflammation was observed. Because of the clinical context in these patients, no further invasive procedure was believed to be indicated, and the decision was made to classify the patient as having benign pleural disease.

Discussion

Little is known about application of FDG-PET imaging to the management of pleural disease. Our results indicate that FDG-PET is a useful tool to differentiate between benign and malignant pleural lesions. We confirm in a large series of patients our primary study1819 and the sparse data available20212223 involving small number of patients. Indeed, this technique has sensitivity and negative predictive value > 90% in diagnosing malignancy. With a sensitivity of 97%, PET-FDG is by far superior to

ACKNOWLEDGMENT

We thank Dr. Garry Harstein for reviewing the manuscript.

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  • Cited by (0)

    1

    Dr. Cataldo is a postdoctoral researcher from the Belgian National Fund for Scientific Research (FNRS), Belgium.

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