Abstract
PurposeAlthough some parameters of positron emission tomography with 18F-fluorodeoxyglucose (18F-FDG) and computed tomography (PET-CT) are somehow helpful in differentiating malignant pleural effusion (MPE) from benign effusions, no individual parameter offers sufficient evidence for its implementation in the clinical practice. The aim of this study was to establish the diagnostic accuracy of a scoring system based on PET-CT (the PET-CT score) in diagnosing MPE.MethodsOne prospective derivation cohort of patients with pleural effusions (84 malignant and 115 benign) was used to develop the PET-CT score for the differential diagnosis of malignant pleural effusion. The PET-CT score was then validated in another independent prospective cohort (n = 74).ResultsThe PET-CT parameters developed for discriminating MPE included unilateral lung nodules and/or masses with increased 18F-FDG uptake (3 points); extrapulmonary malignancies (3 points); pleural thickening with increased 18F-FDG uptake (2 points); multiple nodules or masses (uni- or bilateral lungs) with increased 18F-FDG uptake (1 point); and increased pleural effusion 18F-FDG uptake (1 point). With a cut-off value of 4 points in the derivation cohort, the area under the curve, sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio of the PET-CT score to diagnose MPE were 0.949 (95% CI: 0.908–0.975), 83.3% (73.6%–90.6%), 92.2% (85.7%–96.4%), 10.7 (5.6–20.1), and 0.2 (0.1–0.3), respectively.ConclusionsA simple-to-use PET-CT score that uses PET-CT parameters was developed and validated. The PET-CT score can help physicians to differentiate MPE from benign pleural effusions.
Highlights
Electronic supplementary material The online version of this article contains supplementary material, which is available to authorized users.Malignant pleural effusion (MPE) is frequently observed in multiple malignancies, with lung cancer being the most frequent underlying malignancy [1, 2]
At the best cut-off of 4 points, the Positron emission tomography (PET)-computed tomography (CT) score yielded 83.3% sensitivity, 92.2% specificity (85.7–96.4%), 10.7 positive likelihood ratio (5.6–20.1), 0.2 negative likelihood ratio (0.1–0.3), and AUC 0.949 (0.908–0.975) (Table 5 and Fig. 2a and b), indicating that the PET-CT score provides acceptable differential diagnostic accuracy for patients with MPE and performs significantly better than any single PET-CT parameter
confidence intervals (CIs) confidence interval, 18 F-FDG 18 F-fluorodeoxyglucose, OR odds ratio, SUV standardized uptake value, tobackground ratio (TBR) target-to-background ratio acceptable discrimination between MPE and benign effusion was confirmed in the validation cohort: sensitivity 89.7%, specificity 88.6% (73.3–96.8%), positive likelihood ratio 7.9 (3.1–19.9), negative likelihood ratio 0.1 (0.1–0.3), and AUC 0.942 (0.863–0.983), respectively. This is the largest prospective study that has investigated the diagnostic accuracy of PET-CT for patients with MPE
Summary
As the prognosis for patients with MPE is poor [3, 4], an efficacious procedure that can establish a definite diagnosis as early as possible with a minimum risk and discomfort is highly desirable. Series examining the diagnostic rate for malignancy of pleural cytology has reported a mean sensitivity of about 60% (range 40–87%), which has highlighted the challenge of MPE diagnosis [5, 6]. It is important to avoid subjecting frail patients to unnecessarily invasive procedures and to select just those who may benefit the most from such interventions. Positron emission tomography (PET) with 18Ffluorodeoxyglucose (18F-FDG) was reported for the first time to be an effective tool in the evaluation of pleural diseases in 1997 by Bury et al [7].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: European Journal of Nuclear Medicine and Molecular Imaging
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
