Utility of integrated computed tomography-positron emission tomography for selection of operable malignant pleural mesothelioma

Brad E. Wilcox, Rathan M. Subramaniam, Patrick J. Peller, Gregory L. Aughenbaugh, Francis C. Nichols, Marie Christine Aubry, James R. Jett

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Malignant pleural mesothelioma (MPM) is a primary malignancy characterized by local invasion of the pleura and metastasis. Despite advances in computed tomography (CT) and magnetic resonance imaging (MRI), accurately staging patients remains challenging. Recent studies have examined the use of integrated CT-positron emission tomography (PET) for staging patients. Materials and Methods: Mayo Clinic databases were queried to identify cases with a histologic diagnosis of MPM from 2000 to 2006. Inclusion criteria were a diagnosis of MPM, an available CT scan, and an initial staging integrated CT-PET scan. A total of 35 patients were identified who met the inclusion criteria. Computed tomography and integrated CT-PET scans were reviewed by experienced radiologists. Laboratory parameters were reviewed. The Mayo Clinic tumor registry and Social Security database were queried for survival data in patients in which no follow-up was available. Results: Findings on integrated CT-PET excluded 14 of 35 patients from surgical intervention. Extrapleural pneumonectomies (EPPs) were performed in 8 patients, and partial pleurectomies were performed in 2 patients. Upstaging from integrated CT-PET occurred in 70% of the patients when surgical pathology was available, 2 cases to an inoperable stage. Although not statistically significant, median survival was 20 months for patients undergoing an EPP and 12 months for patients excluded from surgical intervention by integrated CT-PET. Conclusion: Malignant pleural mesothelioma is a difficult disease to accurately stage. The most common reason for upstaging in our series was an increase in T (tumor; tumor-node-metastasis staging system) disease. Our data suggest that integrated CT-PET is excellent for detecting nodal and distant metastases. However, the ability of this imaging modality to correctly stage locoregional disease is not superior to the combination of CT and MRI as reported in the literature.

Original languageEnglish (US)
Pages (from-to)244-248
Number of pages5
JournalClinical Lung Cancer
Volume10
Issue number4
DOIs
StatePublished - Jan 1 2009

Fingerprint

Tomography
Pneumonectomy
Neoplasm Metastasis
Neoplasms
Magnetic Resonance Imaging
Malignant Mesothelioma
Positron Emission Tomography Computed Tomography
Databases
Surgical Pathology
Survival
Pleura
Social Security
Registries

Keywords

  • Extrapleural pneumonectomy
  • Locoregional disease
  • Parietal pleurectomy
  • Tumor-node-metastasis staging

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Utility of integrated computed tomography-positron emission tomography for selection of operable malignant pleural mesothelioma. / Wilcox, Brad E.; Subramaniam, Rathan M.; Peller, Patrick J.; Aughenbaugh, Gregory L.; Nichols, Francis C.; Aubry, Marie Christine; Jett, James R.

In: Clinical Lung Cancer, Vol. 10, No. 4, 01.01.2009, p. 244-248.

Research output: Contribution to journalArticle

Wilcox, Brad E. ; Subramaniam, Rathan M. ; Peller, Patrick J. ; Aughenbaugh, Gregory L. ; Nichols, Francis C. ; Aubry, Marie Christine ; Jett, James R. / Utility of integrated computed tomography-positron emission tomography for selection of operable malignant pleural mesothelioma. In: Clinical Lung Cancer. 2009 ; Vol. 10, No. 4. pp. 244-248.
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abstract = "Background: Malignant pleural mesothelioma (MPM) is a primary malignancy characterized by local invasion of the pleura and metastasis. Despite advances in computed tomography (CT) and magnetic resonance imaging (MRI), accurately staging patients remains challenging. Recent studies have examined the use of integrated CT-positron emission tomography (PET) for staging patients. Materials and Methods: Mayo Clinic databases were queried to identify cases with a histologic diagnosis of MPM from 2000 to 2006. Inclusion criteria were a diagnosis of MPM, an available CT scan, and an initial staging integrated CT-PET scan. A total of 35 patients were identified who met the inclusion criteria. Computed tomography and integrated CT-PET scans were reviewed by experienced radiologists. Laboratory parameters were reviewed. The Mayo Clinic tumor registry and Social Security database were queried for survival data in patients in which no follow-up was available. Results: Findings on integrated CT-PET excluded 14 of 35 patients from surgical intervention. Extrapleural pneumonectomies (EPPs) were performed in 8 patients, and partial pleurectomies were performed in 2 patients. Upstaging from integrated CT-PET occurred in 70{\%} of the patients when surgical pathology was available, 2 cases to an inoperable stage. Although not statistically significant, median survival was 20 months for patients undergoing an EPP and 12 months for patients excluded from surgical intervention by integrated CT-PET. Conclusion: Malignant pleural mesothelioma is a difficult disease to accurately stage. The most common reason for upstaging in our series was an increase in T (tumor; tumor-node-metastasis staging system) disease. Our data suggest that integrated CT-PET is excellent for detecting nodal and distant metastases. However, the ability of this imaging modality to correctly stage locoregional disease is not superior to the combination of CT and MRI as reported in the literature.",
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AU - Nichols, Francis C.

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