title: Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study.
abstract: BACKGROUND
  Several studies have already addressed the potential role of an increased fluorine 18 fluorodeoxyglucose (18F FDG) uptake in identification of pleural malignancy. In this pilot study, we investigate the role of 18F-FDG positron emission tomography/computed tomography (PET/CT) for differentiating asbestos-related benign pleural disease from malignant mesothelioma.
  
  
  METHODS
  The study population comprised 31 consecutive patients (17 malignant mesotheliomas, nine benign asbestos pleurisies, and five diffuse pleural fibrosis) with a mean age of 61 years between January 2006 and December 2008. Thoracoscopy or image-guided pleural needle biopsy were systematically performed to reveal pathologic diagnosis and/or clinical follow-up for at least 3 years for presence or absence of malignant pleural effusion. ROCs analyses for standardized uptake value (SUV) adjusted to body weight were calculated between benign and malignant pleural diseases.
  
  
  RESULTS
  18F-FDG PET/CT imaging correctly detected the presence of malignancies in 15 of 17 patients with malignant mesothelioma for sensitivity, specificity, and overall accuracy of 88.2%, 92.9%, and 90.3%, respectively. 18F-FDG PET/CT imaging correctly identified 13 of 14 cases of benign pleural disease. The mean SUV values were 6.5 +/- 3.4 for malignant mesothelioma cases and 0.8 +/- 0.6 for benign pleural diseases (p < 0.001). When we compared the two groups of pleural disease, a cut-off value of 2.2 for SUV gave the best accuracy with 94.1%, 100%, 100%, and 93.3% for sensitivity, specificity, positive predictive value, and negative predictive value, respectively.
  
  
  CONCLUSIONS
  Preliminary results of this trial provide evidence that 18F-FDG PET/CT imaging is a highly accurate and reliable noninvasive test to decide for further investigation of differentiating malignant mesothelioma from benign pleural disease.
authors.affiliation: Department of Chest Diseases, Medical Faculty, Osmangazi University, Eskisehir, Turkey. heylul2002@yahoo.com
authors.forename: Huseyin
authors.initials: H
authors.lastname: Yildirim
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Metintas
authors.forename: Emre
authors.initials: E
authors.lastname: Entok
authors.forename: Guntulu
authors.initials: G
authors.lastname: Ak
authors.forename: Ilknur
authors.initials: I
authors.lastname: Ak
authors.forename: Emine
authors.initials: E
authors.lastname: Dundar
authors.forename: Sinan
authors.initials: S
authors.lastname: Erginel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001194:Asbestos / Q000009:adverse effects*; D002273:Carcinogens / Q000494:pharmacology; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008654:Mesothelioma / Q000000981:diagnostic imaging*; D008875:Middle Aged; D010865:Pilot Projects; D010995:Pleural Diseases / Q000000981:diagnostic imaging* / Q000209:etiology; D010997:Pleural Neoplasms / Q000000981:diagnostic imaging*; D049268:Positron-Emission Tomography / Q000379:methods*; D011379:Prognosis; D019275:Radiopharmaceuticals; D014057:Tomography, X-Ray Computed
chemical_list: D002273:Carcinogens; D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18; D001194:Asbestos