Clinical utility of FDG-PET/CT for post-surgery surveillance of malignant pleural mesothelioma – Comparison with contrast-enhanced CT
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Kazuhiro Kitajima1, Masaki Hashimoto2, Takayuki Katsuura1, Nobuyuki Kondo2, Toshiyuki Minami3, Kozo Kuribayashi3, Seiki Hasegawa2, Takashi Kijima3 and Koichiro Yamakado4
1 Division of Nuclear Medicine and PET Center, Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
2 Department of Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
3 Division of Respiratory Medicine, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
4 Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
Keywords: mesothelioma; positron emission tomography; computed tomography; recurrence
Received: September 18, 2019 Accepted: October 19, 2019 Published: November 26, 2019
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.
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.
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.
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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