High SUVmax on FDG-PET Indicates Pleomorphic Subtype in Epithelioid Malignant Pleural Mesothelioma Supportive Evidence to Reclassify Pleomorphic as Nonepithelioid Histology
ABSTRACT We have recently proposed to reclassify the pleomorphic subtype of epithelioid malignant pleural mesothelioma (MPM) as nonepithelioid (biphasic/sarcomatoid) histology because of its similarly poor prognosis. We sought to investigate whether preoperative maximum standardized uptake value (SUVmax) on F-fluorodeoxyglucose (FDG) positron emission tomography (PET) correlates with histologic subtype in MPM.
Clinical data were collected for 78 patients with MPM who underwent preoperative FDG-PET. We retrospectively classified the epithelioid tumors into five subtypes: trabecular, tubulopapillary, micropapillary, solid, and pleomorphic. Tumors were categorized by SUVmax into two groups: low (<10.0) and high (≥10.0).
The median overall survival of epithelioid tumors with high SUVmax (n = 12) was significantly shorter (7.1 months) than that of epithelioid tumors with low SUVmax (n = 54, 18.9 months, p < 0.001) and comparable to nonepithelioid tumors (n = 12, 7.2 months). Epithelioid tumors with pleomorphic subtype (n = 9) had marginally higher SUVmax (mean ± SD: 10.6 ± 5.9) than epithelioid nonpleomorphic subtype (n = 57, 6.5 ± 3.2, p = 0.050), and were comparable to that of nonepithelioid tumors (n = 12, 9.1 ± 4.8). Among the epithelioid tumors with high SUVmax (n = 12), 50% (n = 6) showed pleomorphic subtype. In contrast, among epithelioid tumors with low SUVmax (n = 54), 6% (n = 3) showed epithelioid pleomorphic subtypes (p = 0.001). A positive correlation between mitotic count and SUVmax was observed (r = 0.30, p = 0.010).
Pleomorphic subtype of epithelioid MPM showed higher SUVmax than the epithelioid nonpleomorphic subtype and was similar to nonepithelioid histology. Preoperative SUVmax on FDG-PET in epithelioid MPM can indicate patients with pleomorphic subtype with poor prognosis, supporting their reclassification as nonepithelioid.
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ABSTRACT: Malignant mesothelioma (MM) is an uncommon neoplasm with a poor prognosis usually associated with asbestos exposure. 18F-fluoro-2-deoxy-d-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) has become an invaluable tool for the diagnosis, staging, and prognosis of this severe disease as it combines both anatomic and functional information in a single imaging procedure, allowing for improved management of this disease. For many authors, 18F-FDG-PET/CT is the cornerstone of the pre-therapeutic evaluation of mesothelioma patients, particularly when multimodal therapy (including extra-pleural pneumonectomy or omentectomy) is considered. However, while characteristic patterns have been reported as predictive of macroscopic pleural or peritoneal involvement, false negative findings are possible, both for pleural and peritoneal mesothelioma, during the initial diagnosis or during the patient's surveillance as illustrated by this report of three cases of suspected MM with negative PET/CT. This report highlights the limitations of PET/CT in the diagnostic evaluation of MM and the importance of histopathological confirmation by thoracoscopy and/or laparoscopy, which remain the most important diagnostic procedures in MM.Lung cancer (Amsterdam, Netherlands) 11/2012; 79(2). DOI:10.1016/j.lungcan.2012.10.017 · 3.74 Impact Factor
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ABSTRACT: Positron emission tomography is a powerful quantitative molecular imaging technique that is complementary to structural imaging techniques for purposes of disease detection and characterization. This review article will provide an overview of the applications of positron emission tomography for evaluation of patients with oncological diseases that may be encountered in the thorax.Journal of thoracic imaging 01/2013; 28(1):11-24. DOI:10.1097/RTI.0b013e318279449b · 1.49 Impact Factor
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ABSTRACT: A 50-year-old woman presented with upper abdominal pain for 2 months. Abdominal enhanced CT showed multiple hypodense cystic tumors in the liver with heterogeneous enhanced septations. FDG PET/CT showed hypermetabolic peripheral regions and internal septations of the tumors with SUVmax of 6.3. Multiple hepatic cystadenocarcinomas were suspected. The patient underwent resection of the tumors. Epithelial mesothelioma was confirmed by pathology. This case indicates primary hepatic mesothelioma should be added to the differential diagnosis of FDG-avid malignant hepatic tumors.Clinical nuclear medicine 03/2013; DOI:10.1097/RLU.0b013e31828da61d · 2.86 Impact Factor