title: Impact of dual-time-point F-18 FDG PET/CT in the assessment of pleural effusion in patients with non-small-cell lung cancer.
abstract: OBJECTIVE
  The aim of this study was to assess the utility of dual-time-point F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) in differentiating benign from malignant pleural disease, in patients with non-small-cell lung cancer.
  
  
  METHODS
  A total of 61 patients with non-small-cell lung cancer and pleural effusion were included in this retrospective study. All patients had whole-body FDG PET/CT imaging at 60 ± 10 minutes post-FDG injection, whereas 31 patients had second-time delayed imaging repeated at 90 ± 10 minutes for the chest. Maximum standardized uptake values (SUV(max)) and the average percent change in SUV(max) (%SUV) between time point 1 and time point 2 were calculated. Malignancy was defined using the following criteria: (1) visual assessment using 3-points grading scale; (2) SUV(max) ≥2.4; (3) %SUV ≥ +9; and (4) SUV(max) ≥2.4 and/or %SUV ≥ +9. Analysis of variance test and receiver operating characteristic analysis were used in statistical analysis. P < 0.05 was considered significant.
  
  
  RESULTS
  Follow-up revealed 29 patient with malignant pleural disease and 31 patients with benign pleural effusion. The average SUV(max) in malignant effusions was 6.5 ± 4 versus 2.2 ± 0.9 in benign effusions (P < 0.0001). The average %SUV in malignant effusions was +13 ± 10 versus -8 ± 11 in benign effusions (P < 0.0004). Sensitivity, specificity, and accuracy for the 5 criteria were as follows: (1) 86%, 72%, and 79%; (2) 93%, 72%, and 82%; (3) 67%, 94%, and 81%; (4) 100%, 94%, and 97%.
  
  
  CONCLUSIONS
  Dual-time-point F-18 FDG PET can improve the diagnostic accuracy in differentiating benign from malignant pleural disease, with high sensitivity and good specificity.
authors.affiliation: Department of Nuclear Medicine, University Hospital Bonn, Bonn, Germany. Khaledk73@gmail.com
authors.forename: Khaled
authors.initials: K
authors.lastname: Alkhawaldeh
authors.forename: Hans-J
authors.initials: HJ
authors.lastname: Biersack
authors.forename: Anna
authors.initials: A
authors.lastname: Henke
authors.forename: Samer
authors.initials: S
authors.lastname: Ezziddin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000150:complications*; D003937:Diagnosis, Differential; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications*; D008297:Male; D008875:Middle Aged; D016066:Pleural Effusion, Malignant / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D049268:Positron-Emission Tomography; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed
chemical_list: D019788:Fluorodeoxyglucose F18