False-Negative 18F-Fluorodeoxyglucose PET/CT in Malignant Pleural Mesothelioma

Our plain-English summary of False-Negative 18F-Fluorodeoxyglucose PET/CT in Malignant Pleural Mesothelioma, by H. Corbin, C.D. Packer (Curēus, 2021).

The study

• Authors: H. Corbin, C.D. Packer
• Journal: Curēus
• Published: 2021;13(8):e17263
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

We report a diagnostically challenging case of a 77-year-old man who presented with shortness of breath and was found to have a large right hydropneumothorax with collapse of the right lung. A malignancy was suspected, but pleural fluid cytology and 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT imaging were negative. He then underwent video-assisted thoracoscopy with biopsies of the pleura and chest wall which revealed malignant pleural mesothelioma (MPM). Older patients with early stage MPM are more likely to have false-negative FDG PET/CT results. Pleural biopsy is essential when there is clinical suspicion for mesothelioma, even with negative initial FDG PET imaging.

Copyright © 2021, Corbin et al.

In plain English

This article was a case report of a 77-year-old man with one month of worsening shortness of breath. His occupational history was given as welding; the article did not mention asbestos exposure. A chest CT scan showed a large collection of fluid and air around the right lung (a right hydropneumothorax) with collapse of that lung. Nearly 2 liters of fluid were drained, and cytology found no malignant cells. An 18F-fluorodeoxyglucose (FDG) PET/CT scan was unremarkable. Because suspicion of mesothelioma remained high, he had video-assisted thoracoscopic surgery, and biopsies of the right chest wall, parietal pleura and pleural rind all showed malignant mesothelioma, epithelioid type. A repeat fluid test and three lymph node needle samples were negative. The tumor, described as stage IB, was judged surgically unresectable because it encased and trapped the right lung, and chemotherapy with cisplatin and pemetrexed was planned. The authors concluded that a biopsy should be obtained when mesothelioma is still suspected despite negative pleural fluid cytology and PET/CT results, especially in older patients with early stage disease.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (one patient)
• Who was studied: one 77-year-old man with a history of hypertension, hyperlipidemia, psoriasis and osteoarthritis, who presented with one month of progressively worsening shortness of breath
• Exposure: No asbestos exposure is reported in the article; the only occupational history given is welding
• Main results:
  • Chest CT showed a large right hydropneumothorax with collapse of the right lung and a 23 mm subcarinal lymph node
  • Cytology of nearly 2 L of pleural fluid removed by thoracentesis was negative for malignant cells
  • FDG PET/CT was unremarkable, with no convincing evidence of FDG-avid malignancy or metastases
  • Biopsies of the right chest wall, parietal pleura and pleural rind taken at video-assisted thoracoscopic surgery all showed malignant mesothelioma, epithelioid type
  • A repeat thoracentesis was again negative for malignant cells, and 3 of 3 lymph node fine needle aspirations were negative
  • The tumor was described as a T3 tumor with no evidence of metastases or lymph node involvement (stage IB)
  • The tumor was judged surgically unresectable because it encased and trapped the right lung
  • The patient was discharged with a PleurX catheter and a plan for outpatient chemotherapy with cisplatin and pemetrexed
• The authors' conclusion: The authors concluded that the case shows the importance of obtaining a biopsy despite negative pleural fluid cytology and PET/CT results when clinical suspicion for mesothelioma remains, especially in older patients with early stage disease

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Fluid Cytology, Thoracoscopy, Pleura, Pleural Biopsy, Mesothelioma.

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