Can PET/CT be used more effectively in pleural effusion evaluation?

Fikri Selcuk Simsek; Dogangun Yuksel; Olga Yaylali; Halil Serdar Aslan; Emel Kılıçarslan; Ferda Bir; Muhammet Arslan; Fatma Ezgi Can; Erhan Ugurlu

doi:10.1007/s11604-021-01155-z

Can PET/CT be used more effectively in pleural effusion evaluation?

Jpn J Radiol. 2021 Dec;39(12):1186-1194. doi: 10.1007/s11604-021-01155-z. Epub 2021 Jun 24.

Authors

Fikri Selcuk Simsek¹, Dogangun Yuksel², Olga Yaylali², Halil Serdar Aslan³, Emel Kılıçarslan⁴, Ferda Bir⁴, Muhammet Arslan³, Fatma Ezgi Can⁵, Erhan Ugurlu⁶

Affiliations

¹ Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey. fselcuksimsek@gmail.com.
² Nuclear Medicine Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
³ Radiology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
⁴ Pathology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.
⁵ Biostatistics Department, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
⁶ Pulmonology Department, Faculty of Medicine, Pamukkale University, Denizli, Turkey.

PMID: 34165683
DOI: 10.1007/s11604-021-01155-z

Abstract

Purpose: Sometimes, characterization of pleural effusion (PE) can be challenging especially in patients whom invasive procedures/recurrent invasive procedures cannot be performed. The main purpose of the study is to answer this question, Can ¹⁸F-FDG-PET/CT contribute to reduction in the number of invasive procedures or patients undergoing to invasive procedures? Results may increase the effectiveness of patient management by facilitating clinical decision-making, especially in patients who cannot undergo invasive/recurrent invasive procedures.

Methods: Sixty-seven patients' ¹⁸F-FDG-PET/CT, pleural fluid cytologies (PFCs) and, if any, pleural biopsies were re-assessed. If patient's PFC/biopsy was malignant, effusion was considered as malignant. If two consecutive PFCs were negative in patients without biopsy, effusion was considered as benign. Characterization was based on consensus with baseline/follow-up ¹⁸F-FDG-PET/CT and clinical parameters in patients with one negative PFC (n = 6).

Results: None of the ¹⁸F-FDG-PET/CT parameters could characterize PE alone. However, if PE maximum standardized uptake value (SUV_max) > 1.3 or PE SUV_max/mean standardized uptake value of mediastinal blood pool (MBP SUV_mean) > 1.2 was combined with at least one of the following, specificity and positive predictive value (PPV) were 100%, accuracy was around 90%. Diffuse-nodular/nodular pleural thickness, post-obstructive atelectasis, nodule/mass with SUV_max > 2.5 in lung, multiple pulmonary nodules. All 29 patients who had SUV_max > 1.3 together with at least one of the mentioned four parameters diagnosed malignant pleural effusion (MPE). However, sensitivity and negative predictive value (NPV) were still insufficient.

Conclusion: Patients who have contraindications for invasive diagnostic methods, and meet the aforementioned criteria may be considered as MPE primarily. On the other hand, if PE SUV_max < 1.3 or PE SUV_max/MBP SUV_mean < 1.2 with the negativity of the all four parameters mentioned above, it is difficult to say that this can be considered as benign pleural effusion (BPE) according to our results.

Keywords: 18F-FDG-PET; CT; Combined approaches; Pleural effusion.

MeSH terms

Fluorodeoxyglucose F18
Humans
Multiple Pulmonary Nodules*
Neoplasm Recurrence, Local
Pleural Effusion* / diagnostic imaging
Positron Emission Tomography Computed Tomography
Radiopharmaceuticals

Substances

Radiopharmaceuticals
Fluorodeoxyglucose F18