Öz
Abstract
Background: Malignant pleural effusion is defined as the presence of malignant cells in pleural effusion (PE) or biopsy specimens and occurs in 15% of all cancer patients. The most common cause is lung cancer in men and breast cancer in women. The reason for hospital admission is usually shortness of breath. The main goal of treatment is to relieve symptoms and prevent recurrence. PET/CT is an imaging system that combines the metabolic properties of PET with the morphologic properties of computed tomography. The patient can be managed more rapidly if malignant effusion can be detected on PET/CT. In this study, we aimed to predict the diagnostic impact of metabolic uptake of fluid in patients with malignant pleural effusion.
Methods: In our study, we aimed to find the contribution of PET/CT to the diagnosis of malignant pleural effusion by examining patients between 18 and 90 years of age who had malignancy as a result of pleural cytology and who underwent PET/CT with a primary diagnosis of malignancy. 26 patients were evaluated. The values analyzed were; the presence of PE FDG uptake, the presence of single or double uptake in PE, the presence of multiple pulmonary nodules, the presence of pleural thickness (PT) increase, PK diameter, the presence of FDG uptake in PK, primary pathology being lung or other organ, PE Standardized Uptake Value (SUV) max, PE SUVmax/ Med SUVmax, PE SUVmax/ Liver SUVmax, PE SUVmax/ primary tumor SUVmax, primary tumor SUV values.
Results: 6 of 26 patients had bilateral effusions and 12 patients had FDG uptake. 5 patients had pleural thickening and 4 of them had pleural uptake. In the ROC analysis, PE SUVmax, PE SUV / Med SUV, PE SUV / Liver SUV, and PE SUV / Primary tm SUV values were found to be significant in terms of predicting PE FDG uptake, while PT diameter was not significant.
Conclusions: Patients with malignant pleural effusion have a short life expectancy. Diagnosis and treatment management of patients should be performed effectively and rapidly. PET/CT can be used as a noninvasive diagnostic method for this purpose. Therefore, if further studies are performed, PET/CT in the diagnosis of MPE will contribute to patient management.
Anahtar Kelimeler
malignant pleural effusion PET/CT 18F-fluorodeoxyglucose cancer pleural metastasis
Destekleyen Kurum
none
Proje Numarası
-
Kaynakça
- 1. Poyraz N, Kalkan H, Ödev K, Ceran S. Imaging of pleural diseases: evaluation of imaging methods based on chest radiography. Tuberk Toraks. 2017;65(1):41-55.
- 2. Light RW. Pleural effusions. Med Clin North Am. 2011;95(6):1055-70.
- 3. Yazkan R. Malign plevral efüzyon. Turk J Clin Lab. 2016;7(1):19-22.
- 4. Yüksel M, Balcı AA. Göğüs Cerrahisi:" Kırmızı Kitap". İstanbul: Nobel Tıp Kitabevi; 2015.
- 5. Li Y, Mu W, Li Y, Song X, Huang Y, Jiang L. Predicting the nature of pleural effusion in patients with lung adenocarcinoma based on (18)F-FDG PET/CT. EJNMMI Res. 2021;11(1):108.
- 6. Nakajima R, Abe K, Sakai S. Diagnostic Ability of FDG-PET/CT in the Detection of Malignant Pleural Effusion. Medicine (Baltimore). 2015;94(29):e1010.
- 7. Erasmus JJ, McAdams HP, Rossi SE, Goodman PC, Coleman RE, Patz EF. FDG PET of pleural effusions in patients with non-small cell lung cancer. AJR Am J Roentgenol. 2000;175(1):245-9.
- 8. Toaff JS, Metser U, Gottfried M, Gur O, Deeb ME, Lievshitz G, et al. Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography. Invest Radiol. 2005;40(4):204-9.
- 9. Simsek FS, Yuksel D, Yaylali O, Aslan HS, Kılıçarslan E, Bir F, et al. Can PET/CT be used more effectively in pleural effusion evaluation? Jpn J Radiol. 2021;39(12):1186-94.
- 10. Hooper C, Lee YC, Maskell N, Group BTSPG. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2(Suppl 2):ii4-17.
- 11. Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol (English Edition). 2014;50(5):161-5.
- 12. Yang MF, Tong ZH, Wang Z, Zhang YY, Xu LL, Wang XJ, et al. Development and validation of the PET-CT score for diagnosis of malignant pleural effusion. Eur J Nucl Med Mol Imaging. 2019;46(7):1457-67.
- 13. Arnold DT, De Fonseka D, Perry S, Morley A, Harvey JE, Medford A, et al. Investigating unilateral pleural effusions: the role of cytology. Eur Respir J. 2018;52(5).
- 14. Sun Y, Yu H, Ma J, Lu P. The Role of 18F-FDG PET/CT Integrated Imaging in Distinguishing Malignant from Benign Pleural Effusion. PLoS One. 2016;11(8):e0161764.
- 15. Zhang W, Liu Z, Duan X, Li Y, Shen C, Guo Y, Yang J. Differentiating malignant and benign pleural effusion in patients with lung cancer: an 18F-FDG PET/CT retrospectively study. Front Oncol. 2023;13:1192870.
- 16. Liao R, Yang X, Wang S, Zhou Q, Nie Q, Zhong W, et al. [Clinical role of F-18 FDG PET/CT in differentiating malignant and benign pleural effusion in patients with lung cancer]. Chin J Lung Cancer. 2012;15(11):652-5.
- 17. Porcel JM, Hernandez P, Martinez-Alonso M, Bielsa S, Salud A. Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest. 2015;147(2):502-12.
Öz
Abstract
Background: Malign plevral efüzyon , plevral efüzyon (PE) veya biyopsi örneklerinde malign hücrelerin varlığı olarak tanımlanır ve tüm kanser hastalarının %15’ inde görülür. Erkeklerde en sık sebep akciğer kanseri iken kadınlarda meme kanseridir . Hastaneye başvuru sebebi genelde nefes darlığıdır . Tedavide ana hedef semptomları ortadan kaldırmak ve tekrarlamasını önlemektir. PET/BT, PET’ in metabolik özellikleri bilgisayarlı tomografinin morfolojik özelliklerini birleştiren görüntüleme sistemidir. PET/BT’ de malign efüzyon tespit edilebilirse hastanın yönetimi daha hızlı yapılabilir. Biz bu çalışmada malign plevral efüzyon olan hastalarda sıvının metabolik tutulumunun tanıdaki etkisini öngörmeyi amaçladık.
Methods: Çalışmamızda plevral sitoloji sonucu malignitesi olup primer malignite tanısı olan PET/BT çekilmiş 18-90 yaş aralığında hastaları inceleyerek malign plevral efüzyon için PET/BT’nin tanıya katkısını bulmayı amaçladık. 26 tane hastayı değerlendirmeye aldık. Analize tabi tutulan değerler; PE FDG tutulumu varlığı, PE’de tek ya da çift tutulum olması, çoklu pulmoner nodül varlığı, plevral kalınlık (PK) artışı varlığı, PK çapı, PK’da FDG tutulumu varlığı, primer patolojinin akciğer veya diğer organ olması, PE Standardized Uptake Value (SUV) max, PE SUVmax/ Med SUVmax, PE SUVmax/ Karaciğer SUVmax, PE SUVmax/ primer tümör SUVmax, primer tümör SUV değerleridir.
Results: 26 hastanın 6’ sında efüzyon çift taraflıydı ve 12 hastanın efüzyonunda FDG tutulumu vardı. 5 hastada plevral kalınlaşma vardı bunların 4’ ünde plevra tutulumu mevcuttu. Yapılan ROC analizinde PE FDG tutulumunu tahmin bakımından; PE SUVmax, PE SUV / Med SUV, PE SUV / Liver SUV, PE SUV / Primer tm SUV değerlerinin anlamlı olduğu, PK çapının anlamlı olmadığı görülmüştür.
Conclusions: Malign plevral efüzyon hastalarında kısa bir yaşam süresi söz konusudur. Hastaların tanı ve tedavi yönetiminin etkin ve hızlı bir şekilde yapılması gerekmektedir. PET/BT bu amaçla noninvaziv bir tanı yöntemi olarak kullanılabilir. Bu nedenle ileri çalışmaların yapılması halinde MPE tanısında PET/BT’ nin hasta yönetimine katkısı olacaktır.
Anahtar Kelimeler
malign plevral efüzyon PET/BT 18F-florodeoksiglukoz kanser plevral metastaz
Proje Numarası
-
Kaynakça
- 1. Poyraz N, Kalkan H, Ödev K, Ceran S. Imaging of pleural diseases: evaluation of imaging methods based on chest radiography. Tuberk Toraks. 2017;65(1):41-55.
- 2. Light RW. Pleural effusions. Med Clin North Am. 2011;95(6):1055-70.
- 3. Yazkan R. Malign plevral efüzyon. Turk J Clin Lab. 2016;7(1):19-22.
- 4. Yüksel M, Balcı AA. Göğüs Cerrahisi:" Kırmızı Kitap". İstanbul: Nobel Tıp Kitabevi; 2015.
- 5. Li Y, Mu W, Li Y, Song X, Huang Y, Jiang L. Predicting the nature of pleural effusion in patients with lung adenocarcinoma based on (18)F-FDG PET/CT. EJNMMI Res. 2021;11(1):108.
- 6. Nakajima R, Abe K, Sakai S. Diagnostic Ability of FDG-PET/CT in the Detection of Malignant Pleural Effusion. Medicine (Baltimore). 2015;94(29):e1010.
- 7. Erasmus JJ, McAdams HP, Rossi SE, Goodman PC, Coleman RE, Patz EF. FDG PET of pleural effusions in patients with non-small cell lung cancer. AJR Am J Roentgenol. 2000;175(1):245-9.
- 8. Toaff JS, Metser U, Gottfried M, Gur O, Deeb ME, Lievshitz G, et al. Differentiation between malignant and benign pleural effusion in patients with extra-pleural primary malignancies: assessment with positron emission tomography-computed tomography. Invest Radiol. 2005;40(4):204-9.
- 9. Simsek FS, Yuksel D, Yaylali O, Aslan HS, Kılıçarslan E, Bir F, et al. Can PET/CT be used more effectively in pleural effusion evaluation? Jpn J Radiol. 2021;39(12):1186-94.
- 10. Hooper C, Lee YC, Maskell N, Group BTSPG. Investigation of a unilateral pleural effusion in adults: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010;65 Suppl 2(Suppl 2):ii4-17.
- 11. Porcel JM, Esquerda A, Vives M, Bielsa S. Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol (English Edition). 2014;50(5):161-5.
- 12. Yang MF, Tong ZH, Wang Z, Zhang YY, Xu LL, Wang XJ, et al. Development and validation of the PET-CT score for diagnosis of malignant pleural effusion. Eur J Nucl Med Mol Imaging. 2019;46(7):1457-67.
- 13. Arnold DT, De Fonseka D, Perry S, Morley A, Harvey JE, Medford A, et al. Investigating unilateral pleural effusions: the role of cytology. Eur Respir J. 2018;52(5).
- 14. Sun Y, Yu H, Ma J, Lu P. The Role of 18F-FDG PET/CT Integrated Imaging in Distinguishing Malignant from Benign Pleural Effusion. PLoS One. 2016;11(8):e0161764.
- 15. Zhang W, Liu Z, Duan X, Li Y, Shen C, Guo Y, Yang J. Differentiating malignant and benign pleural effusion in patients with lung cancer: an 18F-FDG PET/CT retrospectively study. Front Oncol. 2023;13:1192870.
- 16. Liao R, Yang X, Wang S, Zhou Q, Nie Q, Zhong W, et al. [Clinical role of F-18 FDG PET/CT in differentiating malignant and benign pleural effusion in patients with lung cancer]. Chin J Lung Cancer. 2012;15(11):652-5.
- 17. Porcel JM, Hernandez P, Martinez-Alonso M, Bielsa S, Salud A. Accuracy of fluorodeoxyglucose-PET imaging for differentiating benign from malignant pleural effusions: a meta-analysis. Chest. 2015;147(2):502-12.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Nükleer Tıp, Klinik Tıp Bilimleri (Diğer) |
| Bölüm | Original Article |
| Yazarlar | |
| Proje Numarası | - |
| Yayımlanma Tarihi | 30 Nisan 2025 |
| Gönderilme Tarihi | 13 Şubat 2025 |
| Kabul Tarihi | 7 Nisan 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 35 Sayı: 2 |
Genel Tıp Dergisi Creative Commons Atıf-GayriTicari 4.0 Uluslararası Lisansı (CC BY NC) ile lisanslanmıştır.