Since it was not possible to obtain biopsy confirmation in all abnormal PET sites on FDG-PET scans, the question may remain open as to the specificity of FDG-PET imaging in such circumstances. Because of the nature of malignant mesothelioma and the limited therapeutic options, our patient population did not undergo thoracotomy with systematic careful nodal staging. Because of the poor performance of CT or MRI in staging mediastinal involvement, these tests cannot be used as gold standards for this purpose. In staging non-small cell lung cancer, FDG-PET imaging consistently reaches sensitivity and specificity values that are significantly higher than those of MRIs or CT. Our results in a small subset of patient suggest that FDG-PET imaging can also be useful in identifying malignant nodal involvement from pleural mesothelioma. Buy claritin online Reading here The current exclusion criteria for extrapleural pneumonectomy at the University of Pennsylvania include transdiaphragmatic spread, contralateral or mediastinal involvement, and diffuse chest wall involvement. In all these situations, FDG-PET imaging can be helpful in predicting resectability.
FDG-PET imaging of malignant mesothelioma may be useful in many clinical or research situations. Because FDG-PET can pinpoint the areas of maximal disease activity, this modality can be used to select an optimal site for needle or thoracoscopic biopsies. Furthermore, this test might prove helpful in diagnosing recurrence after radical surgery in the face of equivocal CT scans. The assessment of disease response to treatment is very difficult in malignant mesothelioma with conventional imaging techniques. FDG-PET imaging can provide quantitative or semiquantitative indexes of disease activity that may be used to monitor the response of mesotheliomas to clinical or experimental therapeutic regimen.
PET with FDG is a sensitive imaging modality to detect and stage the extent of malignant mesotheliomas. FDG-PET imaging appears promising to differentiate malignant from benign involvement in patients with asbestos exposure who present with atypical diffuse pleural thickening or pleural effusion with a normal CT scan. This modality could also be used to select candidates who should undergo videoassisted thoracoscopy, when pleural fluid cytology results are negative in effusions of unknown etiology. Furthermore, FDG-PET scans can potentially be useful in the assessment of disease progression or in the evaluation of disease response to conventional or experimental treatments.