Chest
Original Research: Disorders of the PleuraAccuracy of Fluorodeoxyglucose-PET Imaging for Differentiating Benign From Malignant Pleural Effusions: A Meta-analysis
Section snippets
Search Strategy and Study Selection
The systematic review was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.5 This study was registered with the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO) as CRD42011001392 (“Accuracy of FDG-PET for diagnosing malignant pleural effusions: a systematic review and meta-analysis”). We searched the Cochrane Library, PubMed/MEDLINE, and EMBASE from inception to June 2013 to identify
Characteristics of the Included Studies
A total of 619 studies were identified, of which 45 were retrieved for full-text review. Only 27 of those, published between 1997 and 2012, met the inclusion criteria.6, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33 Table 2 summarizes the design, participants, and findings of the initially selected studies. Subsequently, 12 studies with a high risk of bias based on the QUADAS-2 tool9, 12, 14, 17, 18, 19, 22, 23, 24, 26, 28, 31 and another,
Summary of Evidence
This meta-analysis summarizes 14 non-high risk of bias studies that assessed the diagnostic usefulness of FDG-PET imaging in patients with pleural effusions (or thickening). According to the data, in the best-case scenario, the yield of stand-alone PET imaging systems for labeling the malignant nature of pleural fluid accumulation, when qualitative criteria were applied, was sensitivity of 96%; specificity of 76%; LR positive, 4.09; LR negative, 0.06; and AUC, 0.95.
However, the stand-alone PET
Conclusions
The results of the present meta-analysis, based on 14 studies with > 600 patients spanning the last 16 years, suggest that, although of some value, FDG-PET imaging does not seem to change the probability of pleural malignancy sufficiently as to be recommended in the routine workup of effusions of undetermined cause. The FDG-PET imaging technique warrants broader prospective evaluations using: (1) gating acquisition techniques to reduce motion artifacts, (2) VOI analyses to enhance quantitative
Acknowledgments
Author contributions: J. M. P. had full access to all of the data in the study, takes responsibility for the integrity of the data and the accuracy of the data analysis, is guarantor for the entire manuscript, contributed to the study concept and design and to drafting the manuscript, and served as principal author. J. M. P. and P. H. contributed to the systematic review. M. M.-A. contributed to the statistical analysis. S. B. and A. S. contributed to revision of the manuscript. J. M. P., P.
References (36)
- et al.
Etiology of pleural effusions: analysis of more than 3, 000 consecutive thoracenteses
Arch Bronconeumol
(2014) - et al.
Pleural effusions
Dis Mon
(2013) - et al.
Contribution of positron emission tomography in pleural disease
Rev Mal Respir
(2010) - et al.
Metabolic imaging of malignant pleural mesothelioma with fluorodeoxyglucose positron emission tomography
Chest
(1998) - et al.
Clinical role of F-18 fluorodeoxyglucose positron emission tomography imaging in patients with lung cancer and suspected malignant pleural effusion
Chest
(2002) - et al.
Evaluation of pleural disease with 18-fluorodeoxyglucose positron emission tomography imaging
Chest
(2004) - et al.
Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study
J Thorac Oncol
(2009) - et al.
The role of FDG PET-CT in differential diagnosis of pleural pathologies
Rev Esp Med Nucl Imagen Mol
(2012) - et al.
Diagnostic accuracy of 18F-FDG-PET and PET/CT in the differential diagnosis between malignant and benign pleural lesions: a systematic review and meta-analysis
Acad Radiol
(2014) - et al.
Diagnostic performance of fluorine-18-fluorodeoxyglucose positron emission tomography in the assessment of pleural abnormalities in cancer patients: a systematic review and a meta-analysis
Lung Cancer
(2014)
Pearls and myths in pleural fluid analysis
Respirology
PRISMA Group Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement
Ann Intern Med
Clinical role of F-18 FDG PET/CT in differentiating malignant and benign pleural effusion in patients with lung cancer [in Chinese]
Zhongguo Fei Ai Za Zhi
QUADAS-2 Group. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies
Ann Intern Med
Evaluation of pleural diseases with FDG-PET imaging: preliminary report
Thorax
F-18-FDG PET for differential diagnosis of pleural processes [in German]
Nucl Med (Stuttg)
18-FDG positron emission tomography in the evaluation of malignant pleural diseases - a pilot study
Eur J Cardiothorac Surg
FDG PET of pleural effusions in patients with non-small cell lung cancer
AJR Am J Roentgenol
Cited by (88)
A PET-CT score for discriminating malignant from benign pleural effusions
2023, Medicina ClinicaDiagnosis and outcome of patients with idiopathic pleural effusions
2023, Revista Clinica EspanolaFDG PET/CT for Staging and Restaging Malignant Mesothelioma
2022, Seminars in Nuclear MedicineCitation Excerpt :Given the possibility to extract semi-quantitative parameters for [18F]FDG accumulation in target lesions, the use of optimal cut-offs for SUVmax (maximal standardized uptake value), varying from 2.0 to 3.5,30,36 has been applied to better differentiate underlying etiologies, including pleuritic, tuberculous pleurisy, etc.37 Indeed, benign pleural diseases tend to have a significantly lower [18F]FDG uptake compared to malignant lesions (Table 1). Therefore, by applying definite cut-offs, several authors have improved the performance of the modality in MPM diagnosis, with reported rates of sensitivity, specificity and accuracy ranging between 91% and 100%, 94.8% and 100%, and 97.5% and 98%, respectively.16,27-29,31,32,38,39,40 Yet, in case of very limited disease at early phases and for MPM localization in the costodiaphragmatic recesses, where movement artifacts and high physiologic activity in the liver and spleen are present, [18F]FDG PET/CT can show a reduced sensitivity.5,8,41
Malignant Pleural Effusion: Presentation, Diagnosis, and Management
2022, American Journal of MedicineUpdate on the diagnosis and management of malignant pleural effusions
2022, Respiratory MedicineStandardizing HIPEC and perioperative care for patients with ovarian cancer in the Netherlands using a Delphi-based consensus
2022, Gynecologic Oncology ReportsCitation Excerpt :PET/CT may be useful in the presence of lesions outside the abdomen and pelvis or indeterminate lymph node appearance, with a good specificity but a relatively poor sensitivity to detect metastases (Khiewvan et al., 2017). The diagnostic efficiency of PET/CT to detect malignant pleural effusion is moderate, precluding its use for discriminating malignant from benign pleural effusion (Porcel et al., 2015). The panel agreed that patients with parenchymal lesions in the liver or spleen, or metastases in paracardial, axillary, or inguinal lymph nodes do not qualify for HIPEC, even if complete resection of these lesions is accomplished.
FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.