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Lopci E, Castello A, Mansi L. FDG PET/CT for Staging and Restaging Malignant Mesothelioma. Semin Nucl Med 2022; 52:806-815. [PMID: 35965111 DOI: 10.1053/j.semnuclmed.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/11/2022]
Abstract
Malignant mesothelioma is an aggressive tumor originating from the mesothelial cells and presenting in general with a very poor prognosis. The pleural localization represents the prevailing disease site, while peritoneal involvement is commonly rare. The WHO classifies mesotheliomas into epithelioid, biphasic, and sarcomatoid histotypes, having diverse outcome with the sarcomatoid or biphasic forms showing the poorest prognosis. Given the peculiar rind-like pattern of growth, mesothelioma assessment is rather challenging for medical imagers. Conventional imaging is principally based on contrast-enhanced CT, while the role of functional and metabolic imaging is regarded as complementary. By focusing essentially on the staging and restaging role of [18F]FDG PET/CT in malignant mesotheliomas, the present review will summarize the available data present in literature and provide some hints on alternative imaging and future perspectives. Given the prevailing incidence of pleural disease, the majority of the information will be addressed on malignant pleural mesothelioma, although a summary of principal characteristics and imaging findings in patients with peritoneal mesothelioma will be also provided.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine Unit, IRCCS - Humanitas Research Hospital, Milan, Italy.
| | - Angelo Castello
- Nuclear Medicine Unit, Fondazione IRCCS Ca' Granda, Milan, Italy
| | - Luigi Mansi
- Interuniversity Research Center for the Sustainable Development (CIRPS), Rome, Italy
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Lopci E, Kobe C, Gnanasegaran G, Adam JA, de Geus-Oei LF. "PET/CT Variants and Pitfalls in Lung Cancer and Mesothelioma". Semin Nucl Med 2021; 51:458-473. [PMID: 33993985 DOI: 10.1053/j.semnuclmed.2021.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
2-deoxy-2-[18F]fluoro-D-glucose [18F]FDG-PET/CT represents the metabolic imaging of choice in various cancer types. Used either at diagnosis or during treatment response assessment, the modality allows for a more accurate definition of tumor extent compared to morphological imaging and is able to predict the therapeutic benefit earlier in time. Due to the aspecific uptake property of [18F]FDG there is an overlap of its distribution in normal and pathological conditions, which can make the interpretation of the imaging challenging. Lung and pleural neoplasia are no exception to this, thus acknowledging of possible pitfalls and artifacts are mandatory for image interpretation. While most pitfalls and artifacts are common for all indications with metabolic imaging with [18F]FDG-PET/CT, there are specific variants and pitfalls in lung cancer and malignant pleural mesothelioma. The aim of the present article is to shed light on the most frequent and relevant variants and pitfalls in [18F]FDG-PET/CT imaging in lung cancer and malignant pleural mesothelioma.
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Affiliation(s)
- Egesta Lopci
- Nuclear Medicine, IRCCS - Humanitas Research Hospital, Rozzano MI, Italy.
| | - Carsten Kobe
- Department of Nuclear Medicine, University Hospital and Medical Faculty, University of Cologne, Cologne, University of Cologne, Cologne, Germany
| | | | - Judit A Adam
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, University of Amsterdam, AMS, the Netherlands
| | - Lioe-Fee de Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, the Netherlands
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The prognostic value of 18F-fluorodeoxyglucose positron emission tomography/ computed tomography parameters in patients with malignant pleural mesothelioma. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2021; 29:92-100. [PMID: 33768986 PMCID: PMC7970077 DOI: 10.5606/tgkdc.dergisi.2021.20432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/23/2020] [Indexed: 12/29/2022]
Abstract
Background
In this study, we aimed to investigate the prognostic value of metabolic 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters in malignant pleural mesothelioma patients.
Methods
A total of 65 patients with malignant pleural mesothelioma (34 males, 31 females; median age: 60 years; range, 39 to 84 years) who underwent whole-body 18F-fluorodeoxyglucose positron emission tomography/computed tomography for staging before treatment between March 2008 and January 2018 were included. Relationships between clinicopathological factors and 18F-fluorodeoxyglucose positron emission tomography/computed tomography parameters and overall survival were evaluated using a log-rank test and Cox regression analysis.
Results
The median follow-up was 13 (range, 4 to 55) months. The Kaplan-Meier analysis revealed a mean survival time of 17±2.6 months. The cumulative two- and five-year survival rates were 34.8% and 7.8%, respectively. Univariate analysis showed that ≥60 age, left hemithorax involvement, a maximum standardized uptake value of ≥9.8, c-T4 status, c-M1 status, and non-surgery were negatively associated with overall survival (p<0.05). Multivariate analysis showed that ≥60 age, left hemithorax involvement, a maximum standardized uptake value of ≥9.8, c-M1 status, and a total lesion glycolysis of ≥180.2 g were negatively associated with overall survival (p<0.05).
Conclusion
Metabolic parameters of 18F-fluorodeoxyglucose positron emission tomography/computed tomography have the potential to provide prognostic information for malignant pleural mesothelioma patients who are receiving surgery and/or chemotherapy.
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Naldi G, Bergomi S, Visca P, Cecere FL. Ovarian metastasis from malignant pleural mesothelioma. TUMORI JOURNAL 2020; 106:NP49-NP51. [PMID: 32684102 DOI: 10.1177/0300891620941610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Malignant pleural mesothelioma (MPM) is a rare and aggressive disease of the pleura with a dismal prognosis. Distant metastases most commonly occur in the liver, spleen, and thyroid gland. To our knowledge, ovarian metastases have never been described. CASE DESCRIPTION We describe a case of a woman with recurrent malignant pleural mesothelioma presenting a single ovarian metastasis, surgically resected. CONCLUSIONS This case report highlights the importance of using a complete staging protocol in patients with MPM to improve patient management. A whole-body computed tomography (CT) scan with contrast enhancement and possibly positron emission tomography-CT should be performed to identify any distant metastases before deciding on treatment strategy.
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Affiliation(s)
- Giuseppe Naldi
- Division of Thoracic Surgery, IRCCS-Regina Elena National Cancer Institute, La Sapienza University of Rome, Rome, Italy
| | - Serenella Bergomi
- Division of Nuclear Medicine, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Paolo Visca
- Division of Clinical Pathology, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
| | - Fabiana Letizia Cecere
- Division of Medical Oncology 1, IRCCS-Regina Elena National Cancer Institute, Rome, Italy
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AKDENİZ N, KÜÇÜKÖNER M, KAPLAN MA, URAKÇI Z, KARHAN O, YERLİKAYA H, LAÇİN Ş, KÖMEK H, IŞIKDOĞAN A. The Effect of Metabolic PET Parameters on Survival Outcome in Malignant Pleural Mesothelioma. DICLE MEDICAL JOURNAL 2020. [DOI: 10.5798/dicletip.705798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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6
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Kitajima K, Hashimoto M, Katsuura T, Kondo N, Minami T, Kuribayashi K, Hasegawa S, Kijima T, Yamakado K. Clinical utility of FDG-PET/CT for post-surgery surveillance of malignant pleural mesothelioma - Comparison with contrast-enhanced CT. Oncotarget 2019; 10:6816-6828. [PMID: 31827724 PMCID: PMC6887579 DOI: 10.18632/oncotarget.27324] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 10/19/2019] [Indexed: 02/06/2023] Open
Abstract
Objectives To assess the diagnostic accuracy of fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) findings for recurrent malignant pleural mesothelioma (MPM) after a radical surgery procedure and their impact on clinical management in comparison with contrast-enhanced CT. Results Treatment failure was confirmed in 40 patients. The patient-based area under the receiver-operating characteristic (ROC) curves (AUC)/sensitivity/specificity/accuracy were 0.915/90.0%/80.0%/88.0% for FDG-PET/CT, and 0.805/75.0%/90.0%/78.0% for contrast-enhanced CT, respectively. AUC and sensitivity values were significantly different between the modalities (both p=0.041). Patient-based AUC values for diagnosing locoregional recurrence (ipsilateral hemithoracic recurrence) and distant metastasis, including peritoneal dissemination and lung, bone, muscle, and liver metastasis, were also significantly different (p=0.023 and p=0.035, respectively). The findings of FDG-PET/CT resulted in a change of management for 14 of the 50 patients (28%) by initiating new treatment. Of six patients judged as not having recurrence by contrast-enhanced CT but truly having recurrence based on FDG-PET/CT findings, 4 patients received new treatment due toFDG-PET/CT. Methods Fifty patients who underwent radical surgery for MPM received FDG-PET/CT and contrast-enhanced neck/chest/abdomen/pelvis CT examinations for surveillance or suspected recurrence within a 2-week period. Diagnostic ability was determined on a patient and lesion-site basis by 2 experienced examiners, and the modalities were compared using ROC analysis and McNemar test results. Lesion status was determined on the basis of histopathology, radiological imaging and clinical follow-up for longer than 6 months. Conclusion FDG-PET/CT findings were shown to be more accurate for assessing MPM recurrence and more often led to therapy change than contrast-enhanced CT.
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Affiliation(s)
- Kazuhiro Kitajima
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Masaki Hashimoto
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takayuki Katsuura
- Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Nobuyuki Kondo
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshiyuki Minami
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kozo Kuribayashi
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kijima
- Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Koichiro Yamakado
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Hino T, Kamitani T, Sagiyama K, Yamasaki Y, Okamoto I, Tagawa T, Ijichi K, Yamamoto H, Yabuuchi H, Honda H. Localized malignant pleural mesothelioma mimicking an anterior mediastinal tumor. Eur J Radiol Open 2019; 6:72-77. [PMID: 30740474 PMCID: PMC6357286 DOI: 10.1016/j.ejro.2019.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 01/22/2019] [Accepted: 01/24/2019] [Indexed: 12/30/2022] Open
Abstract
Localized malignant pleural mesothelioma (LMPM) is an extremely rare tumor. We report the case of a 40-year-old Japanese male with an LMPM mimicking an anterior mediastinal tumor due to invasion to the anterior mediastinum, and we discuss mainly the differentiation of LMPM from an anterior mediastinal tumor. The present tumor had a long shape along the pleura, and LMPM could be one of the differential diagnoses.
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Affiliation(s)
- Takuya Hino
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Takeshi Kamitani
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Koji Sagiyama
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Yuzo Yamasaki
- Department of Molecular Imaging & Diagnosis, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Isamu Okamoto
- Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tetsuzo Tagawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kayo Ijichi
- Pathophysiological and Experimental Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hidetaka Yamamoto
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hidetake Yabuuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Japan
| | - Hiroshi Honda
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Computed tomography features of local pleural recurrence in patients with malignant pleural mesothelioma treated with intensity-modulated pleural radiation therapy. Eur Radiol 2019; 29:3696-3704. [PMID: 30689034 DOI: 10.1007/s00330-018-5937-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/11/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study was conducted in order to describe the computed tomography (CT) features of local pleural recurrence in patients with malignant pleural mesothelioma undergoing intensity-modulated pleural radiation therapy (IMPRINT) as part of multimodality treatment. METHODS In this observational study, 58 patients treated with IMPRINT between September 21, 2004, and December 1, 2014 were included. Baseline and follow-up CT scans were qualitatively assessed. On follow-up scans, pleural thickening was categorized as unchanged, decreased, or new/increased. New/increased pleural abnormality was subcategorized as diffuse smooth pleural thickening, diffuse nodular pleural thickening, focal pleural nodule, or multiple pleural nodules. To identify features more frequently present at the time of local recurrence, follow-up scans with local recurrence were matched to four control scans; exact conditional logistic regression was performed. RESULTS Twenty-one (36%) patients had local pleural recurrence and 20 (34%) patients had nonpleural recurrence; 3 patients had both types of recurrence. The 1-year cumulative incidence rate of local recurrence was 27% (95% confidence interval 15, 39). On follow-up scans, three patterns of pleural abnormality were significantly associated with local recurrence: new/increased multiple pleural nodules (10 (48%) positive scans vs 0 control scans), new/increased diffuse nodular pleural thickening (7 (33%) positive scans vs 1 (1%) control scans), and new/increased focal pleural nodule (3 (14%) positive scans vs 1 (1%) control scan) (p < 0.001 for all). CONCLUSIONS Multiple new/increased pleural nodules are the feature most commonly present at local recurrence following IMPRINT; however, any pattern of increased nodular pleural thickening is suspicious. KEY POINTS • In patients with mesothelioma receiving intensity-modulated pleural radiation as part of multimodality therapy, increasing multiple pleural nodules is the computed tomography feature most commonly present at local recurrence. • In these patients, any CT pattern of increased nodular pleural thickening should be considered suspicious for local recurrence. • The most common sites of nonpleural recurrence were lung parenchyma, thoracic lymph nodes, and peritoneum.
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18F-Fluorodeoxyglucose PET/CT and dynamic contrast-enhanced MRI as imaging biomarkers in malignant pleural mesothelioma. Nucl Med Commun 2018; 39:161-170. [DOI: 10.1097/mnm.0000000000000789] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Zucali PA, Lopci E, Ceresoli GL, Giordano L, Perrino M, Ciocia G, Gianoncelli L, Lorenzi E, Simonelli M, De Vincenzo F, Setti LR, Bonifacio C, Bonomi M, Bombardieri E, Chiti A, Santoro A. Prognostic and predictive role of [ 18 F]fluorodeoxyglucose positron emission tomography (FDG-PET) in patients with unresectable malignant pleural mesothelioma (MPM) treated with up-front pemetrexed-based chemotherapy. Cancer Med 2017; 6:2287-2296. [PMID: 28941158 PMCID: PMC5633593 DOI: 10.1002/cam4.1182] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 08/07/2017] [Accepted: 08/12/2017] [Indexed: 12/11/2022] Open
Abstract
The aim of this study was to evaluate the role of metabolic parameters analyzed at baseline and at interim FDG‐PET in predicting disease outcome in unresectable MPM patients receiving pemetrexed‐based chemotherapy. A consecutive series of MPM patients treated between February 2004 and July 2013 with first‐line pemetrexed‐based chemotherapy, and evaluated by FDG‐PET and CT scan at baseline and after two cycles of chemotherapy, was reviewed. Best CT scan response was assessed according to modified RECIST criteria. Progression‐free survival (PFS) and overall survival (OS) were correlated with FDG‐PET parameters, such as maximum standardized uptake value (SUVmax), total lesion glycolysis (TLG), and percentage changes in SUVmax (∆SUV) and TLG (∆TLG). Overall, 142 patients were enrolled; 77 (54%) received talc pleurodesis before chemotherapy. Baseline SUVmax and TLG showed a statistically significant correlation with PFS and OS (P < 0.05) in both group of patients (treated and untreated with pleurodesis). In 65 patients not receiving pleurodesis, SUVmax reduction ≥25% (∆SUV ≥ 25%) and TLG reduction ≥30% (∆TLG ≥ 30%) were significantly associated with longer PFS (P < 0.05). Patients showing both ∆SUV ≥ 25% and ∆TLG ≥ 30% responses had a significant reduction in the risk of disease progression (HR:0.31, P < 0.001) and death (HR:0.52, P = 0.044). Neither ∆SUV nor ∆TLG showed similar association with survival outcomes in patients treated with pleurodesis. Our study confirmed the prognostic role of baseline FDG‐PET in a large series of MPM patients treated with first‐line pemetrexed‐based chemotherapy. Moreover, use of ∆SUV ≥ 25% and ∆TLG ≥ 30% as cut‐off values to define early metabolic response supported the role of FDG‐PET in predicting disease outcome and treatment response in patients not receiving pleurodesis.
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Affiliation(s)
| | - Egesta Lopci
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | | | - Laura Giordano
- Biostatistics, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Matteo Perrino
- Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | | | | | - Elena Lorenzi
- Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Matteo Simonelli
- Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | - Fabio De Vincenzo
- Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy
| | | | | | - Maria Bonomi
- Oncology, Humanitas Gavazzeni Clinic, Bergamo, Italy
| | | | - Arturo Chiti
- Nuclear Medicine, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy.,Humanitas University, Rozzano, Milan, Italy
| | - Armando Santoro
- Oncology, Humanitas Clinical and Research Hospital, Rozzano (Milan), Italy.,Humanitas University, Rozzano, Milan, Italy
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Bonomi M, De Filippis C, Lopci E, Gianoncelli L, Rizzardi G, Cerchiaro E, Bortolotti L, Zanello A, Ceresoli GL. Clinical staging of malignant pleural mesothelioma: current perspectives. LUNG CANCER-TARGETS AND THERAPY 2017; 8:127-139. [PMID: 28860886 PMCID: PMC5571821 DOI: 10.2147/lctt.s102113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.
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Affiliation(s)
- Maria Bonomi
- Department of Oncology, Thoracic and GU Oncology Unit
| | | | - Egesta Lopci
- Nuclear Medicine Unit, Humanitas Clinical and Research Hospital, Milan
| | | | - Giovanna Rizzardi
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - Luigi Bortolotti
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
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Richards WG. Malignant pleural mesothelioma: predictors and staging. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:243. [PMID: 28706911 DOI: 10.21037/atm.2017.06.26] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Malignant pleural mesothelioma remains a rapidly fatal cancer with few effective therapies. Unusual anatomic features complicate determination of stage and prognosis for individual patients. Validation of staging criteria has been difficult given the rarity of the disease and the fact that only a minority of patients undergo surgical resection with pathological examination of their tumors. Thus, additional heuristic factors and algorithms have been taken into account by clinicians to estimate prognosis and inform discussion of appropriate management strategies or clinical research protocols with patients.
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Affiliation(s)
- William G Richards
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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13
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Takuwa T, Hashimoto M, Matsumoto S, Kondo N, Kuribayash K, Nakano T, Hasegawa S. Post-recurrence chemotherapy for mesothelioma patients undergoing extrapleural pneumonectomy. Int J Clin Oncol 2017; 22:857-864. [DOI: 10.1007/s10147-017-1126-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/12/2017] [Indexed: 12/27/2022]
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Kanemura S, Kuribayashi K, Funaguchi N, Shibata E, Mikami K, Doi H, Kitajima K, Hasegawa S, Nakano T. Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma. Eur J Radiol 2016; 86:92-98. [PMID: 28027772 DOI: 10.1016/j.ejrad.2016.11.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 11/04/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Efficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT. METHODS Histologically confirmed MPM patients (N=82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders. RESULTS After three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0days (95% confidence interval [CI]: 545.9-910.1) and cumulative median TTP was 365.0days (95% CI: 296.9-433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p<0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p<0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p>0.05). CONCLUSION Several mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.
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Affiliation(s)
- Shingo Kanemura
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kozo Kuribayashi
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
| | - Norihiko Funaguchi
- Department of Respiratory Medicine, Murakami Memorial Hospital, Asahi University, 3-23 Hashimoto-cho, Gifu 500-8523, Japan
| | - Eisuke Shibata
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Koji Mikami
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Hiroshi Doi
- Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Kazuhiro Kitajima
- Division of Nuclear Medicine and PET center, Department of Radiology, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Seiki Hasegawa
- Department of Thoracic Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
| | - Takashi Nakano
- Department of Respiratory Medicine, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan
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Present and future roles of FDG-PET/CT imaging in the management of malignant pleural mesothelioma. Jpn J Radiol 2016; 34:537-47. [PMID: 27222020 DOI: 10.1007/s11604-016-0555-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/12/2016] [Indexed: 12/11/2022]
Abstract
Positron emission tomography/computed tomography (PET/CT) integrated with 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) has emerged as a powerful tool for combined metabolic and anatomic evaluations in clinical oncologic imaging. This review discusses the utility of (18)F-FDG PET/CT as a tool to manage patients with malignant pleural mesothelioma. We discuss different stages of patient management in malignant pleural mesothelioma, including diagnosis, initial staging, therapy planning, early treatment response assessment, re-staging, and prognosis.
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Sharkey AJ, Bilancia R, Tenconi S, Nakas A, Waller DA. The management of the diaphragm during radical surgery for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2016; 50:311-6. [PMID: 27005974 DOI: 10.1093/ejcts/ezw045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/26/2016] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Macroscopic complete resection with lung preservation is the objective of radical management of pleural mesothelioma (MPM). Total removal of visceral and parietal pleura (pleurectomy/decortication) almost invariably proceeds to an extended pleurectomy/decortication (EPD) to ensure macroscopic complete resection. We suspected this may not always be necessary. METHODS We reviewed 314 patients, 86.0% male, median age 62 years (range 14-81 years) undergoing radical surgery for MPM from 1999 to 2014, by either EPD or extrapleural pneumonectomy. The extent of diaphragmatic muscle involvement was recorded from postoperative pathology. Patients were divided into three groups: no involvement, non-transmural, transmural diaphragmatic invasion. RESULTS A total of 213 (68%) patients underwent EPD, 237 (75.5%) had epithelioid disease and 57.6% were node positive. There was no difference between the three groups in terms of age, cell type, laterality, neoadjuvant chemotherapy and operation. There was a higher degree of diaphragm involvement in females (P = 0.01) and in patients with positive lymph nodes (P = 0.01). No evidence of diaphragmatic involvement was found following pathological assessment of the resection specimen in 119 patients (37.9%). The incidence of abdominal disease progression was 23.9%. There was no correlation with degree of diaphragmatic invasion (ρ = 0.01 P = 0.88). Overall survival of those with abdominal progression was similar to those with progression elsewhere: 14.5 vs 13.0 months (P = 0.79), and with those with no progression (16.7 months, P = 0.189). There was no difference in survival when stratified by diaphragmatic involvement (P = 0.44). CONCLUSIONS In our cohort, there was no evidence of diaphragmatic invasion in over 30% of patients, and we have also failed to find evidence that peritoneal disease progression affects overall survival following radical management. It may therefore theoretically be unnecessary to resect the diaphragm in all cases, and a pleurectomy-decortication could suffice. However, there is an unknown risk of R2 resection which would prejudice survival, and as such we would advocate resecting the diaphragm in all cases to avoid an R2 resection.
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Xie C, Gleeson F. The pleura. IMAGING 2016. [DOI: 10.1183/2312508x.10006715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cheng L, Tunariu N, Collins DJ, Blackledge MD, Riddell AM, Leach MO, Popat S, Koh DM. Response evaluation in mesothelioma: Beyond RECIST. Lung Cancer 2015; 90:433-41. [PMID: 26443279 DOI: 10.1016/j.lungcan.2015.08.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 07/05/2015] [Accepted: 08/17/2015] [Indexed: 12/12/2022]
Abstract
Malignant pleural mesothelioma (MPM) typically demonstrates a non-spherical growth pattern, so it is often difficult to accurately categorize change in tumour burden using size-based tumour response criteria (e.g., WHO (World Health Organisation), RECIST (Response Evaluation Criteria in Solid Tumours) and modified RECIST). Functional imaging techniques are applied to derive quantitative measurements of tumours, which reflect particular aspects of the tumour pathophysiology. By quantifying how these measurements change with treatment, it is possible to observe treatment effects. In this review, we survey the existing roles of CT and MRI for the management of MPM, including the currently applied size measurement criteria for the assessment of treatment response. New functional imaging techniques, such as positron emission tomography (PET), diffusion-weighted MRI (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) that may potentially improve the assessment of treatment response will be highlighted and discussed.
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Affiliation(s)
- Lin Cheng
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | - Nina Tunariu
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK; Department of Radiology, Royal Marsden Hospital, UK
| | - David J Collins
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | | | | | - Martin O Leach
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK
| | - Sanjay Popat
- Department of Medical Oncology, Royal Marsden Hospital, UK
| | - Dow-Mu Koh
- EPSRC-CR UK Cancer Imaging Centre, Institute of Cancer Research, UK; Department of Radiology, Royal Marsden Hospital, UK.
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Kostron A, Friess M, Crameri O, Inci I, Schneiter D, Hillinger S, Stahel R, Weder W, Opitz I. Relapse pattern and second-line treatment following multimodality treatment for malignant pleural mesothelioma. Eur J Cardiothorac Surg 2015; 49:1516-23. [PMID: 26590183 DOI: 10.1093/ejcts/ezv398] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/01/2015] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES To analyse the relapse pattern and influence of second-line treatment after recurrence of malignant pleural mesothelioma (MPM) in patients who had previously undergone multimodality treatment. METHODS Between September 1999 and December 2013, 136 patients underwent macroscopic complete resection (MCR) by extrapleural pneumonectomy after induction chemotherapy for MPM. We analysed 106 patients who presented with recurrent disease until October 2014. Data were retrieved from our mesothelioma database, with additional information regarding precise localization gathered by reviewing the imaging and medical records. RESULTS The overall recurrence rate was 78% (106/136 patients). The median freedom from recurrence was 9 months after surgery [95% confidence interval (95% CI) 7-10]. Local recurrence only was observed in 33 patients (31%), distant metastases only in 27 patients (26%) and simultaneous distant and local recurrence in 46 patients (43%). Local recurrence was observed significantly less frequently in patients having received adjuvant radiotherapy (19 vs 47%, P = 0.003), but there was no significant impact on overall survival (OS) [radiation: 22 months (95% CI 19-24); no-radiation: 23 months (95% CI 18-27), P = 0.6]. The median OS was 22 months (95% CI 21-24), median post-recurrence survival (PRS) was 7 months (95% CI 5-9) and patients with local recurrence only survived significantly longer (12 months, 95% CI 8-16) compared with patients with distant recurrence only (5 months, 95% CI 2-8) or distant plus local relapse (6 months, 95% CI 3-9; P = 0.04). A total of 78 patients received a second-line therapy after tumour recurrence: chemotherapy (n = 48), local radiotherapy (n = 9), surgery (n = 10) or a combination thereof (n = 11). Patients undergoing second-line treatment survived significantly longer compared with patients not receiving therapy (P < 0.0005). The median PRS after surgery was significantly longer than that of patients receiving chemo-, radio- or chemo-radiotherapy (P = 0.04). CONCLUSIONS Local recurrence of MPM remains the most frequent type of relapse even after multimodality treatment including MCR. In the present cohort, active treatment seems beneficial to the patient since surgical excision of local tumour relapse has good long-term outcome in selected patients. Thus, second-line treatment may prolong PRS; however, these results need to be confirmed in a prospective manner.
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Affiliation(s)
- Arthur Kostron
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Martina Friess
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ornella Crameri
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Ilhan Inci
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Didier Schneiter
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Sven Hillinger
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Rolf Stahel
- Department of Oncology, University Hospital Zurich, Zurich, Switzerland
| | - Walter Weder
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Isabelle Opitz
- Division of Thoracic Surgery, University Hospital Zurich, Zurich, Switzerland
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Francis RJ, Segard T, Morandeau L, Lee YCG, Millward MJ, Segal A, Nowak AK. Characterization of hypoxia in malignant pleural mesothelioma with FMISO PET-CT. Lung Cancer 2015; 90:55-60. [PMID: 26259878 DOI: 10.1016/j.lungcan.2015.07.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 07/09/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Malignant pleural mesothelioma (MPM) is a chemotherapy resistant tumor with a poor prognosis. Hypoxia is increasingly recognized as an important factor in tumor aggressiveness and cellular resistance to chemotherapy and radiation treatment. This prospective pilot study was performed with [F-18] fluoromisonidazole (FMISO) PET-CT to characterize hypoxia in patients with MPM. MATERIALS AND METHODS Twenty prospectively recruited patients with histologically or cytologically confirmed MPM not currently receiving systemic or local treatment underwent both FMISO and fluorodeoxyglucose (FDG) PET-CT scans within 2 weeks. FMISO and FDG PET-CT scans were independently analyzed visually and semi-quantitatively using SUVmax and tumor to background ratio (TBR) in order to assess tumor hypoxia and metabolic activity. Lesion by lesion analysis was performed in sites of measurable pleural masses. RESULTS Visual analysis demonstrated tumor FMISO activity in 17 of 20 patients, and tumor FDG activity in 19 of 20 patients. Focal areas of bulky tumor were most likely to demonstrate hypoxia. In 19 patients suitable for semi-quantitative analysis the median FDG SUVmax was 6.4 (range 1.9-19.1), median FMISO SUVmax was 2.5 (range 1.4-3.7) and median FMISO TBR was 1.8 (1.1-2.5). There was a positive correlation between intensity of metabolic activity and hypoxia (r=0.72, p=0.001). Lesion by lesion analysis demonstrated a positive correlation between tumor thickness and FMISO activity (r=0.77, p<0.001). CONCLUSION This pilot study confirms that MPM is a tumor with significant areas of hypoxia, particularly in dominant tumor masses. The relationship of tumor hypoxia to effectiveness of chemotherapy and/or radiation therapy warrants prospective assessment.
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Affiliation(s)
- Roslyn J Francis
- School of Medicine and Pharmacology, University of Western Australia, Crawley 6009 & Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia.
| | - Tatiana Segard
- Department of Nuclear Medicine/WA PET Service, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Laurence Morandeau
- RAPID labs, Medical Technology and Physics, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Y C Gary Lee
- School of Medicine and Pharmacology, University of Western Australia, Crawley 6009 & Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Michael J Millward
- School of Medicine and Pharmacology, University of Western Australia, Crawley 6009 & Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Amanda Segal
- PathWest, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, Crawley 6009 & Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
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22
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Multiple Primary Hepatic Malignant Mesotheliomas Mimicking Cystadenocarcinomas on Enhanced CT and FDG PET/CT. Clin Nucl Med 2014; 39:619-22. [DOI: 10.1097/rlu.0b013e31828da61d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tertemiz KC, Ozgen Alpaydin A, Gurel D, Savas R, Gulcu A, Akkoclu A. Multiple distant metastases in a case of malignant pleural mesothelioma. Respir Med Case Rep 2014; 13:16-8. [PMID: 26029551 PMCID: PMC4246255 DOI: 10.1016/j.rmcr.2014.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction Malignant pleural mesothelioma (MPM) is a malignant of mesodermal neoplasm and arises from multipotential mesothelial or subserosal cells of the pleura, pericardium and peritoneum. Case A seventy five year-old male patient was admitted with chest and lower limb pain. He was a heavy smoker and exposed to environmental asbestos in his childhood. PET-CT scans showed multiple pathological FDG uptakes in lungs and other organs. Biopsies performed from lung and anterior thigh muscles were reported as epitheloid type malignant pleural mesothelioma. Discussion We emphasize that unexpected distant metastases can be observed in MPM and occasionally primary diagnosis can be determined by the biopsy of the metastatic regions. This case also points out the role of PET-CT in the staging of malign mesothelioma by determining different metastatic sites.
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Affiliation(s)
- Kemal Can Tertemiz
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | | | - Duygu Gurel
- Pathology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Recep Savas
- Nuclear Medicine, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Aytac Gulcu
- Radiology, Dokuz Eylul University Medical Faculty, Izmir, Turkey
| | - Atila Akkoclu
- Pulmonary Diseases, Dokuz Eylul University Medical Faculty, Izmir, Turkey
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van Zandwijk N, Clarke C, Henderson D, Musk AW, Fong K, Nowak A, Loneragan R, McCaughan B, Boyer M, Feigen M, Currow D, Schofield P, Nick Pavlakis BI, McLean J, Marshall H, Leong S, Keena V, Penman A. Guidelines for the diagnosis and treatment of malignant pleural mesothelioma. J Thorac Dis 2013; 5:E254-307. [PMID: 24416529 PMCID: PMC3886874 DOI: 10.3978/j.issn.2072-1439.2013.11.28] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 11/25/2013] [Indexed: 12/24/2022]
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Patterns of disease progression on 18F-fluorodeoxyglucose positron emission tomography–computed tomography in patients with malignant pleural mesothelioma undergoing multimodality therapy with pleurectomy/decortication. Nucl Med Commun 2013; 34:1075-83. [DOI: 10.1097/mnm.0b013e3283653862] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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FDG PET/CT in the Management of Primary Pleural Tumors and Pleural Metastases. AJR Am J Roentgenol 2013; 201:W215-26. [DOI: 10.2214/ajr.13.10572] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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28
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Fuccio C, Spinapolice EG, Ferretti A, Castellucci P, Marzola MC, Trifirò G, Rubello D. ¹⁸F-FDG-PET/CT in malignant mesothelioma. Biomed Pharmacother 2013; 67:539-42. [PMID: 23583476 DOI: 10.1016/j.biopha.2013.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 01/24/2013] [Indexed: 11/30/2022] Open
Abstract
It is well known the useful role of ¹⁸F-FDG-PET/CT for differential diagnosis between benign and malignant disease, for staging, for monitoring response and for prognosis regarding mesothelioma. Recently, literature was enriched with new interesting studies regarding the potential applications of ¹⁸F-FDG-PET/CT in this field. The purpose of this review is to evaluate articles published on line (PubMed) from January 2011 until October 2012 in order to obtain an overview of recent progress of molecular imaging in malignant mesothelioma. The main topics concern the use of ¹⁸F-FDG-PET/CT in radiation therapy planning, monitoring of treatment (surgery/chemotherapy) response and prognosis assessment.
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Affiliation(s)
- Chiara Fuccio
- Nuclear Medicine Unit, Fondazione Salvatore Maugeri, Pavia, Italy.
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High SUVmax on FDG-PET indicates pleomorphic subtype in epithelioid malignant pleural mesothelioma: supportive evidence to reclassify pleomorphic as nonepithelioid histology. J Thorac Oncol 2012; 7:1192-7. [PMID: 22617244 DOI: 10.1097/jto.0b013e3182519d96] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND 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. METHODS 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). RESULTS 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). CONCLUSIONS 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
PET/CT provides a comprehensive staging, post-therapeutic surveillance, and outcome prognosis of malignant pleural mesothelioma based on its hypermetabolic behavior. This ability of PET may allow the monitoring, prediction, and detection of uncommon distant gastrointestinal clinical manifestations of this disease. The authors present a case of PET/CT imaging of pleural mesothelioma disseminating to the abdomen and pelvis, inducing an incarcerated inguinal hernia.
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Southekal S, McQuaid SJ, Kijewski MF, Moore SC. Evaluation of a method for projection-based tissue-activity estimation within small volumes of interest. Phys Med Biol 2012; 57:685-701. [PMID: 22241591 PMCID: PMC3741654 DOI: 10.1088/0031-9155/57/3/685] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A new method of compensating for tissue-fraction and count-spillover effects, which require tissue segmentation only within a small volume surrounding the primary lesion of interest, was evaluated for SPECT imaging. Tissue-activity concentration estimates are obtained by fitting the measured projection data to a statistical model of the segmented tissue projections. Multiple realizations of two simulated human-torso phantoms, each containing 20 spherical 'tumours', 1.6 cm in diameter, with tumour-to-background ratios of 8:1 and 4:1, were simulated. Estimates of tumour- and background-activity concentration values for homogeneous as well as inhomogeneous tissue activities were compared to the standard uptake value (SUV) metrics on the basis of accuracy and precision. For perfectly registered, high-contrast, superficial lesions in a homogeneous background without scatter, the method yielded accurate (<0.4% bias) and precise (<6.1%) recovery of the simulated activity values, significantly outperforming the SUV metrics. Tissue inhomogeneities, greater tumour depth and lower contrast ratios degraded precision (up to 11.7%), but the estimates remained almost unbiased. The method was comparable in accuracy but more precise than a well-established matrix inversion approach, even when errors in tumour size and position were introduced to simulate moderate inaccuracies in segmentation and image registration. Photon scatter in the object did not significantly affect the accuracy or precision of the estimates.
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Affiliation(s)
- Sudeepti Southekal
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
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Dimarakis I, Rehman S, Machaal A, Shah R. PET-CT in the diagnosis of localized malignant pleural mesothelioma. Clin Imaging 2011; 35:476-7. [PMID: 22040794 DOI: 10.1016/j.clinimag.2011.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2011] [Accepted: 03/06/2011] [Indexed: 11/18/2022]
Abstract
A 67-year-old man presented with right-sided chest and shoulder pain. Chest roentgenogram demonstrated a right upper zone shadow. Computed tomography (CT) revealed a pleural mass and adjacent chest wall disease. Image-guided percutaneous biopsy suggested malignant mesothelioma. We describe the use of 18-fluorodeoxyglucose-positron emission tomography (PET-CT) in the diagnosis and management of localized malignant mesothelioma.
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Affiliation(s)
- Ioannis Dimarakis
- Department of Cardiothoracic Surgery, University Hospital South Manchester, Manchester, UK.
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FRANCIS ROSLYN, SEGARD TATIANA, MORANDEAU LAURENCE. Novel molecular imaging in lung and pleural diseases. Respirology 2011; 16:1173-88. [DOI: 10.1111/j.1440-1843.2011.02059.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Gerbaudo VH, Katz SI, Nowak AK, Francis RJ. Multimodality Imaging Review of Malignant Pleural Mesothelioma Diagnosis and Staging. PET Clin 2011; 6:275-97. [PMID: 27156724 DOI: 10.1016/j.cpet.2011.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Early diagnosis and accurate disease staging in patients with malignant pleural mesothelioma (MPM) are essential in classifying such patients into prognostic subgroups to allow delivery of stage-specific therapies. This review addresses the current status of multimodality imaging in the diagnosis and staging of MPM. Clinical, research, and future directions in computed tomography (CT), magnetic resonance imaging, and PET/CT diagnosis and staging of MPM are discussed, including the use of novel PET probes. The article concludes with important take-home messages summarized as the pearls and pitfalls of each diagnostic modality in the diagnosis and staging of patients with MPM.
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Affiliation(s)
- Victor H Gerbaudo
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Harvard Medical School, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Sharyn I Katz
- Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania School of Medicine, 1 Silverstein Building, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Anna K Nowak
- Department of Medical Oncology, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia
| | - Roslyn J Francis
- Department of Medical Oncology, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia; Department of Molecular Imaging, School of Medicine and Pharmacology, University of Western Australia, Sir Charles Gairdner Hospital, Hospital Avenue, Nedlands 6009, Western Australia, Australia
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