PET for staging mesothelioma – pro

Staging is the process of finding out how far the cancer has spread. Staging of mesothelioma is based on imaging studies such as x-rays, CT scans, and MRI scans.

Earlier studies indicate that PET holds great promise for Earlier studies indicate that PET holds great promise for diagnosing mesothelioma and determining mesothelioma staging, or the extent to which tumors have spread. At the University of Pennsylvania Medical Center, researchers evaluated 28 patients for mesothelioma using the sugar tracer fluoro–2–deoxy–D–glucose (FDG) and PET (Chest. 1998 Sep; 114(3): 713–22). In a comparison of PET imaging with thoracoscopy or surgical biopsies, PET successfully indicated the presence of disease in 24 patients, and of benign conditions in the other four. The uptake of FDG was significantly higher in diseased cells, and PET analysis also showed tumors in the lymph nodes of 9 patients. The lymph nodes appeared normal in CT scans. Another study at Brigham and Women’s Hospital and Harvard Medical School in Boston traced 15 patients, 11 of whom had mesothelioma and four who were disease–free. PET results were compared with laboratory analysis of biopsied fluids and tissues. PET detected all 11 primary tumors, and confirmed the absence of disease in the other four patients. Out of 28 disease–positive lesions, PET accurately detected. The exact role, however, is not etablished and I was not able to find any guidelines recommending PET over CT for staging. There are no guidelines that recommend routine PET surveillance of either mesothelioma or metastatic cancer to the pertineunum.

Aaseboe U, Billing B, Bjørck T, Brodin O, Brunsvig P, Forsløw U, Frank H, Hansen O, Harving H, Hillerdal G, Jakobsen KD, Johansson A, Ladegaard L, Lindh B, Melgaard P, Mygind N, Månsson T, Palshof T, Sundstrøm S, Sørensen P, Vigander T. Preoperative staging of mesothelioma by 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography fused imaging and mediastinoscopy compared to pathological findings after extrapleural pneumonectomy European Journal of Cardio-Thoracic Surgery. 2008 Nov;34(5):1090-6. Epub 2008 Sep 16.

Gerbaudo VH, Sugarbaker DJ, Britz-Cunningham S, Di Carli MF, Mauceri C, Treves ST. Assessment of malignant pleural mesothelioma with (18)F-FDG dual-head gamma-camera coincidence imaging: comparison with histopathology.Nucl Med. 2002 Sep;43(9):1144-9

Hinshaw JL, Pickhardt PJ. Imaging of primary malignant tumors of peritoneal and retroperitoneal origin Cancer Treatment and Research. 2008;143:281-97.

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