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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, Shrager JB. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma. J Thorac Cardiovasc Surg 2023; 165:371-381.e1. [PMID: 35568521 DOI: 10.1016/j.jtcvs.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. METHODS A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. RESULTS There was no association between tumor type and age group (P = .183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P < .001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P < .001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. CONCLUSIONS Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85.
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Affiliation(s)
- Catherine T Byrd
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Harrison B Konsker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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Reddy R. Comparative Role of MDCT and FDG-PET/CT in the Diagnostic Evaluation of Mediastinal Mass Lesions: An Institutional Experience. World J Nucl Med 2022; 21:200-209. [PMID: 36060087 PMCID: PMC9436519 DOI: 10.1055/s-0042-1751032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Abstract
Background Mediastinal mass lesions span a wide histopathological and radiological spectrum. Partition of the mediastinum into specific compartments aids in differential diagnosis of mass lesions, assistance in biopsies, and other surgical procedures. Multidetector row computed tomography (MDCT) is a promising three-dimensional imaging tool allowing substantial anatomical volumes to be routinely covered with isotropic submillimeter spatial resolution to precisely localize lesions and biopsy needles for both benign and malignant disease lesions of the mediastinum.
Objective The aim of this study was to categorize mass lesions according to the mediastinal compartments to study their MDCT characteristics and to provide a comparative role of fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in the diagnostic evaluation of mediastinal mass lesions.
Materials and Methods Patients with clinical or radiological suspicion of mediastinal lesions on the basis of an abnormal chest radiograph were referred to the department of radiodiagnosis at a tertiary care center between April 2015 and December 2019 for MDCT evaluation. A total of 80 cases were correlated with the histopathological diagnosis excluding aneurysms. Size, CT density (Hounsfield unit [HU] mean), and maximum standardized uptake value (SUVmax) of mediastinal and chest wall lesions were determined on FDG-PET/CT.
Results This study included a total of 102 cases, 72 males and 29 females. Mediastinal mass lesions were most common in the age group 46 to 60 years. Anterior mediastinum (n = 43, 42.2%) is the most commonly involved compartment followed by posterior mediastinum (n = 37, 35.9%) and middle mediastinum (n = 22, 21.8%). Transcompartmental involvement is more commonly seen involving the anterior and middle mediastinum. The SUVmax, HU mean, and size were higher in malignant cases (p = 0.001, p = 0.003, and p = 0.004, respectively). The current study found a cutoff value of 4.61 for SUVmax to discriminate benign lesions from malignant ones with a sensitivity and specificity of 73.7 and 75.9%, respectively (area under the curve: 0.841, 95% confidence interval: 0.793–0.965, p = 0.0001). The values of SUVmax and HU mean were higher in solid benign lesions than those of cystic benign lesions (p = 0.007 and p = 0.003, respectively).
Conclusion In the current study, MDCT has high diagnostic accuracy of ∼94% overall as compared with histopathology, and 97 and 92% for benign and malignant lesions, respectively, in the evaluation of mediastinal mass lesions. FDG-PET/CT may be complementary to conventional imaging methods for the evaluation of mediastinal and chest wall mass lesions. However, confirmatory tissue sampling is required to confirm PET positive findings for the definite diagnosis.
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Affiliation(s)
- Ravikanth Reddy
- Department of Radiology, St. John's Hospital, Bengaluru, Karnataka, India
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Zang S, Liu L, Bao J, Xiong M, Zhao Y, Lin S, Lin X. Thymic Extranodal Marginal-Zone Lymphoma of Mucosa-Associated Lymphoid Tissue: Pathological Features, 18F-FDG PET/CT Findings and Prognosis in 12 Cases. Front Med (Lausanne) 2022; 9:896647. [PMID: 35911381 PMCID: PMC9326041 DOI: 10.3389/fmed.2022.896647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Primary thymic extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is a rare type of MALT lymphoma. We aim to investigate the clinicopathologic features, 18F-FDG PET/CT findings and outcomes for patients with primary thymic MALT lymphoma; to explore the correlation between metabolic parameters and immunohistochemical phenotypes. Methods A retrospective single-center study enrolled 12 patients with primary thymic MALT lymphoma between 2010 and 2021. Nineteen 18F-FDG PET/CT scans were performed, and clinicopathologic and immunohistochemical characteristics, PET/CT imaging features, and outcomes were analyzed. Results The male-to-female ratio was 1. The median age at diagnosis was 40 (range 31–68). The long diameter of the lesions ranged from 3.5 to 15.7. Histopathological examinations revealed that the normal thymic lobular architecture was effaced by a diffuse lymphoid infiltrate, but residual Hassall corpuscles could still be identified, mostly with CD20+, PAX5+, CD3-, CD23-, CD10-, BCL-6-, cyclin D1-, EBER- and low Ki-67. The gene rearrangement indicated that the IGH gene but not TCR gene was found in 7 patients. Six initial PET/CT scans showed a mean SUVmax of 6.8 (range, 3.1–12.4), a mean MTV = 40.0 (range, 6.7–81.4), and a mean TLG = 144.3 (range, 19.7–286.4). During the follow-up period, there was no death except for the patient with DLBCL who died 59 months after diagnosis of primary thymic MALT. No significant correlation between SUVmax and Ki-67 index was observed (r = 0.355, P > 0.05). Conclusion Primary thymic MALT lymphoma should be considered in patients with multilocular cystic lesions with different degrees of 18F-FDG uptake in the anterior mediastinum. The results of this study showed no correlation between SUVmax and Ki-67 index.
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Affiliation(s)
- Shengbing Zang
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lei Liu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Junjie Bao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Min Xiong
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yumo Zhao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Suxia Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Pathology, Sun Yat-sen University Cancer Center, Guangzhou, China
- Suxia Lin
| | - Xiaoping Lin
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Department of Nuclear Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- *Correspondence: Xiaoping Lin
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Ackman JB, Chung JH, Walker CM, Bang TJ, Carter BW, Hobbs SB, Kandathil A, Lanuti M, Madan R, Moore WH, Shah SD, Verde F, Kanne JP. ACR Appropriateness Criteria® Imaging of Mediastinal Masses. J Am Coll Radiol 2021; 18:S37-S51. [PMID: 33958117 DOI: 10.1016/j.jacr.2021.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 11/25/2022]
Abstract
Mediastinal masses can present with symptoms, signs, and syndromes or incidentally. Selecting the appropriate diagnostic imaging study for mediastinal mass evaluation requires awareness of the strengths and weaknesses of the various imaging modalities with regard to tissue characterization, soft tissue contrast, and surveillance. This publication expounds on the differences between chest radiography, CT, PET/CT, ultrasound, and MRI in terms of their ability to decipher and surveil mediastinal masses. Making the optimal imaging choice can yield diagnostic specificity, avert unnecessary biopsy and surgery, guide the interventionist when necessary, and serve as a means of surveillance for probably benign, but indeterminate mediastinal masses. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Jeanne B Ackman
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
| | | | | | - Tami J Bang
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Brett W Carter
- The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stephen B Hobbs
- University of Kentucky, Lexington, Kentucky, Councilor, ACR Kentucky Chapter, Vice Chair, Informatics and Integrated Clinical Operations, University of Kentucky
| | | | - Michael Lanuti
- Massachusetts General Hospital, Boston, Massachusetts, The Society of Thoracic Surgeons, Director, Thoracic Oncology, Division of Thoracic Surgery, Massachusetts General Hospital
| | - Rachna Madan
- Brigham & Women's Hospital, Boston, Massachusetts
| | - William H Moore
- New York University Langone Medical Center, New York, New York
| | - Sachin D Shah
- University of Chicago, Chicago, Illinois, Primary care physician. Associate Chief Medical Information Officer, University of Chicago Medicine
| | - Franco Verde
- Johns Hopkins University School of Medicine, Baltimore, Maryland, Director, Diagnostic Imaging, Johns Hopkins Bayview Medical Center
| | - Jeffrey P Kanne
- Specialty Chair, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Koç ZP, Özcan PP, Ayan E, Bozdoğan Arpacı R. Metabolic Characterization of Anterior Mediastinal Masses by 18F-FDG PET/CT. Mol Imaging Radionucl Ther 2020; 29:105-111. [PMID: 33094573 PMCID: PMC7583747 DOI: 10.4274/mirt.galenos.2020.05657] [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: 12/01/2022] Open
Abstract
Objectives To evaluate the role of 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) for the diagnosis of anterior mediastinal masses. Methods The oncological 18F-FDG PET/CT images of 41 patients (17 women, 24 men; age: 16-83 years, mean age: 50.5±19.5 years) who attended the nuclear medicine department between November 2016 and September 2017 were retrospectively evaluated for the metabolic characterization of their anterior mediastinal masses. Results Based on our results, the lesions of 4 patients were benign [maximum standard uptake value (SUVmax) <3] and that of 2 patients were non-tumoral (i.e., tuberculosis and sarcoidosis). The mean dimensions and the SUVmax levels of the malignant lesions were 6.4±3.7 cm and 11.9±9.6, respectively. The pathological results for the malign tumors were thymus tumors (n=8), lymphoma (n=8), lung cancer (n=11), carcinoid metastasis (n=2), thyroid carcinoma (n=2), germ cell carcinoma (n=1), schwannoma (n=1), and sarcoma (n=1). The degree of 18F-FDG accumulation could precisely identify the malign and benign tumors. Conclusion Thus, contrary to the known causes, it is possible that anterior mediastinal masses originate from structures other than the anterior mediastinal structures. In this study, the lymphoma and lung carcinoma pathology were more frequent than thymic lesions.
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Affiliation(s)
- Zehra Pınar Koç
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Pınar Pelin Özcan
- Mersin University Faculty of Medicine, Department of Nuclear Medicine, Mersin, Turkey
| | - Erhan Ayan
- Mersin University Faculty of Medicine, Department of Thoracic Surgery, Mersin, Turkey
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18F-FDG-PET/CT predicts grade of malignancy and invasive potential of thymic epithelial tumors. Gen Thorac Cardiovasc Surg 2020; 69:274-281. [PMID: 32734427 DOI: 10.1007/s11748-020-01439-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/07/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to evaluate the ability of fluorine-18-fluorodeoxyglucose positron emission tomography coupled with computed tomography (18F-FDG-PET/CT) to predict the WHO malignancy grade, initial staging, and invasive potential of thymic epithelial tumors. METHODS We retrospectively reviewed the medical records of 56 patients with thymic epithelial tumors who were evaluated by PET/CT before surgery and underwent surgical resection. We analyzed the relationship of the maximum standardized uptake value (SUVmax) with the WHO histological classification, tumor invasion, TNM classification, and the Masaoka-Koga classification. RESULTS There were differences of SUVmax of the FDG-PET between thymic carcinoma (9.09 ± 3.34) and thymoma (4.86 ± 2.45; p < 0.01), thymic carcinoma (9.09 ± 3.34) and high-grade thymoma (6.01 ± 2.78; p < 0.01), and high-grade thymoma (6.01 ± 2.78) and low-grade thymoma (4.06 ± 1.86; p < 0.01). The cut-off value for the SUVmax was 7.40 and 5.40, and the sensitivity/specificity for predicting the histologic subtype of each group was 0.72/0.79 and 0.61/0.85, respectively. According to T classification, SUVmax was significantly higher in T3 (8.31 ± 2.57) than in T1a (4.45 ± 2.06; p < 0.01). Regarding Masaoka-Koga classification and WHO histological classification, a significantly higher SUVmax was detected in patients with stage III and IV disease than in those with stage I and II diseases (p < 0.01). The cut-off value for SUVmax was 5.40 in Masaoka-Koga stage and 5.60 in the WHO classification; the sensitivity/specificity for predicting the histologic subtype was 0.85/0.80 and 0.89/0.78, respectively. CONCLUSIONS FDG-PET is a useful tool to predict aggressiveness of thymic epithelial tumors.
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Gentili F, Pelini V, Lucii G, Luzzi L, Mazzei FG, Fausto A, Volterrani L, Mazzei MA. Update in diagnostic imaging of the thymus and anterior mediastinal masses. Gland Surg 2019; 8:S188-S207. [PMID: 31559186 DOI: 10.21037/gs.2019.05.06] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Anterior mediastinal masses include a wide spectrum of malignant and benign pathologies with a large percentage represented by thymic lesions. Distinguishing these masses on diagnostic imaging is fundamental to guide the proper management for each patient. This review illustrates possibilities and limits of different imaging modalities to diagnose a lesion of the anterior mediastinum with particular attention to thymic disease.
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Affiliation(s)
- Francesco Gentili
- Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Veronica Pelini
- Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Gabriele Lucii
- Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Luzzi
- Thoracic Surgery Unit, Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Alfonso Fausto
- Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Luca Volterrani
- Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Maria Antonietta Mazzei
- Department of Medicine, Surgery and Neuro Sciences, Diagnostic Imaging, University of Siena, Azienda Ospedaliera Universitaria Senese, Siena, Italy
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