[18-Fluoro-deoxy-glucose (15FDG) positon emission tomography (PET) for the evaluation of malignant pleural disease]

Malignant Pleural Effusion: A Multidisciplinary Approach

Malignant pleural effusion (MPE) has become an increasingly prevalent complication in oncological patients, negatively impacting their quality of life and casting a shadow over their prognosis. Owing to the pathophysiological mechanisms involved and the heterogeneous nature of the underlying disease, this entity is both a diagnostic and therapeutic challenge. Advances in the understanding of MPE have led to a shift in the treatment paradigm towards a more personalized approach. This article provides a comprehensive review and update on the pathophysiology of MPE and describes the diagnostic tools and the latest advances in the treatment of this complex clinical entity.

Clinical and biologic prognostic factors in malignant pleural mesothelioma

Malignant pleural mesothelioma is an extremely aggressive neoplasm of the pleura mainly attributable to asbestos exposure. Conventional medical, physical, and surgical treatments and their combinations are basically ineffective and just a few subjects experience some benefit. No definite guidelines can be provided in patient selection and therapeutic strategies. Currently, malignant pleural mesothelioma therapy is guided by clinical stage and patient characteristics, which are quite unreliable, rather than by the histological or molecular features of the tumor. In the present review the impact on prognosis of classic (i.e. etiology, age, gender, histology, staging), as well as relatively new clinical factors such as quality of life, positron emission tomography assessment, and occult residual disease, are firstly evaluated. In the second section of the review several biological variables and genetic markers, which have been recently recognized as the bases of the disease onset and development, are listed and discussed. There are serum and tissue markers. The latter are mainly related to cell cycle regulation, apoptosis, and growth factor pathways. These novel factors may play an important role in defining the prognosis of the disease and, subsequently, may have a place in addressing therapy.

Imaging of non-cardiac, non-traumatic causes of acute chest pain

Non-traumatic chest pain is a common symptom in patients who present in the emergency department. From a clinical point of view, it is important to differentiate cardiac chest pain from non-cardiac chest pain (NCCP). Among the plethora of potential causes of NCCP, life-threatening diseases, such as aortic dissection, pulmonary embolism, tension pneumothorax, and esophageal rupture, must be differentiated from non-life threatening causes. The majority of NCCP, however, is reported to be benign in nature. The presentation of pain plays an important role in narrowing the differential diagnosis and initiating further diagnostic management and treatment. As the benign causes tend to recur, and may lead to patient anxiety and great costs, a meticulous evaluation of the patient is necessary to diagnose the underlying disorder or disease.

Contribution of positron emission tomography in pleural disease

INTRODUCTION

Positron emission tomography (PET) now plays a clear role in oncology, especially in chest tumours. We discuss the value of metabolic imaging in characterising pleural pathology in the light of our own experience and review the literature.

BACKGROUND

PET is particularly useful in characterising malignant pleural pathologies and is a factor of prognosis in mesothelioma. Metabolic imaging also provides clinical information for staging lung cancer, in researching the primary tumour in metastatic pleurisy and in monitoring chronic or recurrent pleural pathologies.

CONCLUSIONS

PET should therefore be considered as a useful tool in the diagnosis of liquid or solid pleural pathologies.

[Usefulness of positron emission tomography-computed tomography in respiratory medicine]

The introduction of positron emission tomography (PET) into the management of neoplastic disease in respiratory patients signified an important change from classic algorithms based exclusively on anatomic information obtained through computed tomography (CT). Non-small cell lung cancer and solitary pulmonary nodule were the 2 diseases in which metabolic PET imaging offered the highest diagnostic yield, as has been evident since the inclusion of this technology among the services available within the Spanish national health service. However, a number of limitations were encountered in relation to the lack of anatomic definition in PET imaging, as had been described in the literature. The appearance in 2001 of hybrid PET-CT devices has not only helped remedy those defects, but has also made it possible to combine anatomic and metabolic information in a single image, making this hybrid technology the most valuable tool in the current diagnostic arsenal.