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Oncology-Clinical Diagnosis: Solid TumorsLung Cancer II |
1 Diagnostic Imaging - Nuclear Medicine, AORN Monaldi, Naples, Italy
226
Objectives: At state, the role of 18F-FDG PET in the staging and in the follow-up (FU) of malignant pleural mesothelioma (MPM) has not been established. Our aim was to evaluate the role of serial 18F-FDG PET/CT in the clinical management of patients (pts) affected by malignant pleural mesothelioma (MPM).
Methods: 70 pts (57male, 13 female) affected by or suspected of MPM underwent 18F-FDG (0.45MBq FDG/kg) PET/CT Total-Body (Siemens Biograph 16sl, 3D) as follows: -45/70pts (GrA) for diagnosis and staging; -20/70pts (GrB) in chemotherapy (ChT)FU; -5/70pts (GrC) in post-surgery plus the 3rd cycle of ChT FU. PET/CT evaluation included visual and semi-quantitative measures of tumour uptake (SUV max value >3.5 was considered abnormal). All tumors were confirmed by histopathology.
Results: GrA(45pts): When compared to histopathological findings, 31 pts with MPM showed abnormal pleural uptake (100% of true positive pts), MPM was excluded in 13/14 true negative pts (92%). When compared to CT alone, FDG-PET/CT better defined contralateral nodal involvement (N3) in 7pts and distant metastasis which were missed on CT in 4 pts, which excluded surgery in a total of 11 pts (35.4%). However, FDG-PET underestimated homolateral nodal involvement in 12 pts vs CT alone. GrB(20pts): Metabolic response assessment defined: -14 early responder pts to first line ChT (at the end of the 3rd cycle); -6 non-responder pts, inducing choice of second line ChT. In responder pts, no significant differences in homolateral nodal involvement evaluation at PET/CT and CT alone comparison. GrC(5pts): FDG-PET/CT predicted response to therapy in all pts.
Conclusions: FDG-PET-CT appears useful in the clinical management of MPM pts. It can better detect distant metastasis and contralateral nodal involvement vs CT alone and can predict metabolic response to ChT.
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