PET/CT UTILITY FOR IDENTIFYING PLEURAL AND/OR PERICARDIAL INVASION AND ITS IMPACT ON MORTALITY

Abstract

SESSION TITLE: Monday Fellow Case Report Posters SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: The presence of visceral pleural invasion (VPI) and pericardial invasion (PCI) are both separately poor markers of long-term survival in non-small cell lung cancer (NSCLC). PET-CT can help accurately stage, guide appropriate therapy as well as reduce the morbidity and costs of ineffective treatment. We present a case of a patient who had both pleural and pericardial invasion from adenocarcinoma of the lung. CASE PRESENTATION: We present a 61 year-old male veteran, with 100 pack-years and was stationed near the Chernobyl disaster who presented with hoarseness of voice, cough, dyspnea on exertion, unintentional weight loss and pleuritic chest discomfort. The patient underwent an ENT evaluation revealed paralysis of left vocal cord. Subsequently a CT of the chest revealed mediastinal/hilar lymphadenopathy, multiple pulmonary nodules, left adrenal mass, large left sided pleural effusion, and 2 pericardial masses. Echocardiogram (ECHO) confirmed 2 masses on the pericardium. PET-CT revealed intense signal in the mediastinum, peri-aortic lymph nodes, foci in the pancreas, involvement almost all of the left pleura, and the 2 pericardial masses. The SUV for the pleura and the 2 pericardial masses were 9.2 and 36. The patient underwent thoracentesis and pleural fluid analysis revealed metastatic adenocarcinoma. It was unclear what the primary source was but lung and pancreas were highly suspected. A subsequent mediastinal biopsy revealed well-moderately differentiated adenocarcinoma. Staining was positive for CK7, CDX2 and partially positive for Napsin A and CK20. It was negative for TTF-1 and CA19-9. Primary lung cancer was suspected but a pancreatic source could not be ruled out. The patient unfortunately succumbed to his severe metastatic disease shortly after his initial presentation. DISCUSSION: The presence of VPI and PCI invasion is an independent predictor of decreased long-term survival in NSCLC. Our case demonstrated a patient that has both VPI and PCI. PET/CT is useful for predicting VPI in patient that have a standardized uptake value(SUV) >4.3 and by contrast no involvement is associated with SUV less 4.3. It would be helpful if PET/CT could offer mortality prediction based on the surface area of involvement but this needs further study. Patients who did not develop PCI invasion showed encouraging long-term outcomes compared to those that do. Imaging modality, like ECHO and PET/CT are helpful in identifying PCI as seen in our patient. CONCLUSIONS: Multiple imaging techniques are essential in the diagnosis of VPI and PCI with NSCLC. The results of which are predictive of patient prognosis. This may allow a more timely work-up and identification of metastatic disease. Reference #1: Yousefi-Koma, A. et al. The Utility of Metabolic Imaging by 18F-FDG PET/CT in Lung Cancer: Impact on Diagnosis and Staging, Tanaffos 2013; 12(1): 16-25 Reference #2: Park, B. et al. Long-term survival in locally advanced non-small cell lung cancer invading the great vessels and heart, Thoracic Cancer 9 (2018) 598–605 Reference #3: Bai, J., et al. Prediction of pleural invasion using different imaging tools in non-small cell lung cancer, Ann Transl Med 2019;7(2):33 DISCLOSURES: No relevant relationships by Edward Conuel, source=Web Response No relevant relationships by Lezah McCarthy, source=Web Response No relevant relationships by Kristoffer Neu, source=Web Response No relevant relationships by Muhammad Salick, source=Web Response