Abstract
ObjectivesTo assess the diagnostic accuracy of fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) findings for recurrent malignant pleural mesothelioma (MPM) after a radical surgery procedure and their impact on clinical management in comparison with contrast-enhanced CT.ResultsTreatment failure was confirmed in 40 patients. The patient-based area under the receiver-operating characteristic (ROC) curves (AUC)/sensitivity/specificity/accuracy were 0.915/90.0%/80.0%/88.0% for FDG-PET/CT, and 0.805/75.0%/90.0%/78.0% for contrast-enhanced CT, respectively. AUC and sensitivity values were significantly different between the modalities (both p=0.041). Patient-based AUC values for diagnosing locoregional recurrence (ipsilateral hemithoracic recurrence) and distant metastasis, including peritoneal dissemination and lung, bone, muscle, and liver metastasis, were also significantly different (p=0.023 and p=0.035, respectively). The findings of FDG-PET/CT resulted in a change of management for 14 of the 50 patients (28%) by initiating new treatment. Of six patients judged as not having recurrence by contrast-enhanced CT but truly having recurrence based on FDG-PET/CT findings, 4 patients received new treatment due toFDG-PET/CT.MethodsFifty patients who underwent radical surgery for MPM received FDG-PET/CT and contrast-enhanced neck/chest/abdomen/pelvis CT examinations for surveillance or suspected recurrence within a 2-week period. Diagnostic ability was determined on a patient and lesion-site basis by 2 experienced examiners, and the modalities were compared using ROC analysis and McNemar test results. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months.ConclusionFDG-PET/CT findings were shown to be more accurate for assessing MPM recurrence and more often led to therapy change than contrast-enhanced CT.
Highlights
Diagnostic ability was determined on a patient and lesion-site basis by 2 experienced examiners, and the modalities were compared using receiver-operating characteristic (ROC) analysis and McNemar test results
FDG-positron emission tomography/computed tomography (PET/computed tomography (CT)) findings were shown to be more accurate for assessing malignant pleural mesothelioma (MPM) recurrence and more often led to therapy change than contrast-enhanced CT
Advances in both surgical and nonsurgical therapeutic strategies for cancer continue, cancer recurrence and distant metastasis following the initial treatment remain as major issues for patients with malignant pleural mesothelioma (MPM)
Summary
Advances in both surgical and nonsurgical therapeutic strategies for cancer continue, cancer recurrence and distant metastasis following the initial treatment remain as major issues for patients with malignant pleural mesothelioma (MPM). Contrast-enhanced computed tomography (CT) is a widely used modality for assessing treatment failure in MPM patients. Those results are not always specific enough to distinguish between a recurrent tumor and benign post-therapeutic changes. Recent studies have examined use of fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) for detecting recurrent [2,3,4]. This imaging modality detects increased utilization of glucose by malignant cells, revealing their high glucose uptake, making diagnosis of cancer recurrence and distant metastasis in the preclinical stage possible earlier than with more conventional techniques. We assessed FDG-PET/CT regarding its clinical usefulness for diagnosis of recurrent and metastatic MPM, and compared the findings with those obtained using contrast-enhanced CT
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