Fluorodeoxyglucose versus Choline Positron Emission Tomography/Computed Tomography Response Evaluation in Two Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Neoadjuvant Chemotherapy

Our plain-English summary of Fluorodeoxyglucose versus Choline Positron Emission Tomography/Computed Tomography Response Evaluation in Two Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Neoadjuvant Chemotherapy, by K. Kitajima, T. Nakamichi, S. Hasegawa, et al (Curēus, 2018).

The study

• Authors: K. Kitajima, T. Nakamichi, S. Hasegawa, K. Kuribayashi, K. Yamakado
• Journal: Curēus
• Published: 2018;10(11):e3654
• Type of article: Case report
• Cited by: 6 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Talc pleurodesis has been reported to increase fluorodeoxyglucose (FDG) uptake in the high attenuation areas of pleural thickening, making it difficult to distinguish between benign granulomatous inflammatory processes and malignancies, which may therefore interfere with the post-chemotherapy disease evaluation on FDG-positron emission tomography/computed tomography (PET/CT). We present two cases of malignant pleural mesothelioma treated with talc pleurodesis and neoadjuvant chemotherapy (NAC) before pleurectomy/decortication in which post-NAC FDG-PET/CT showed intense FDG uptakes in the high attenuation areas of pleural thickening with false positive result, whereas post-NAC 11C-choline PET/CT showed mild choline uptake of pleural talc deposit, which did not interfere with the post-chemotherapy disease evaluation. Thus we suggest choline-PET/CT may show little choline uptake to granulomatous inflammation and evaluate treatment response in malignant pleural mesothelioma patients treated with talc pleurodesis and NAC.

In plain English

This case report described two patients with epithelial malignant pleural mesothelioma at Hyogo College of Medicine in Japan. One was a 68-year-old man who had worked as a building housebreaker and at a plastics processing company and had been exposed to asbestos; no fiber type was given. The other was a 77-year-old woman who had not been exposed to asbestos. Both had talc pleurodesis and three courses of cisplatin and pemetrexed chemotherapy before surgery (pleurectomy/decortication). After chemotherapy, FDG-PET/CT scans showed intense uptake in dense areas of thickened pleura: maximum standardized uptake values were 5.53 in the man and 5.74 in the woman. The authors described this as a false-positive result. Choline PET/CT showed mild uptake in the same areas (2.75 and 2.97). Neither patient had a choline scan before treatment. At surgery, both showed a mild treatment response (grade 1a). The authors concluded that choline PET/CT may show little uptake in talc-related inflammation. They added that its usefulness still has to be assessed in larger prospective studies.

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 of two patients
• Who was studied: Two patients with epithelial malignant pleural mesothelioma at Hyogo College of Medicine, Nishinomiya, Japan: a 68-year-old man (patient 1) and a 77-year-old woman (patient 2), both diagnosed during talc pleurodesis; dates of treatment not given
• Exposure: The study compared two kinds of PET/CT scan after talc pleurodesis and chemotherapy. Asbestos exposure was reported for patient 1 only, who had worked as a building housebreaker and at a plastics processing company; no fiber type or dose was given.
• Main results:
  • Patient 2 (the woman) had not been exposed to asbestos.
  • Both patients received three courses of cisplatin and pemetrexed before surgery (shown here for patient 2).
  • In patient 1, FDG-PET/CT before talc pleurodesis showed left pleural effusion and no FDG uptake of the left pleura.
  • Patient 1 did not have a choline PET/CT scan before pleurodesis and chemotherapy.
  • Patient 2 had neither FDG-PET/CT nor choline PET/CT before pleurodesis and chemotherapy.
  • Patient 1, after talc pleurodesis and chemotherapy: FDG-PET/CT showed intense uptake (maximum standardized uptake value 5.53) in the high attenuation area of left pleural thickening.
  • Patient 1, after talc pleurodesis and chemotherapy: choline PET/CT showed mild uptake (maximum standardized uptake value 2.75) in the same high attenuation area.
  • Patient 2, after talc pleurodesis and chemotherapy: FDG-PET/CT showed intense uptake (maximum standardized uptake value 5.74) in high attenuation areas of right pleural thickening, and mild uptake (2.47) in non-high attenuation areas.
  • Patient 2, after talc pleurodesis and chemotherapy: choline PET/CT showed mild uptake (maximum standardized uptake value 2.97) in high attenuation areas, and faint uptake (2.19) in non-high attenuation areas of right pleural thickening.
  • The authors described the FDG-PET/CT findings as a false-positive result that made the response to chemotherapy hard to judge, while choline PET/CT did not interfere with the evaluation (stated for patient 1; the same statement was made for patient 2).
  • At pleurectomy/decortication, the disease in each patient was categorized as T3N1M0 with a mild treatment response (grade 1a).
• The authors' conclusion: The authors concluded that treatment response is difficult to evaluate by FDG-PET/CT in these patients. They suggested that choline PET/CT may show little uptake in granulomatous (talc-related) inflammation and may be able to evaluate treatment response.
• Limitations the authors state:
  • The authors stated that the clinical usefulness of choline PET/CT for this purpose still has to be assessed in larger prospective studies.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Talc Pleurodesis, Neoadjuvant Therapy, Pleural Thickening, Chemotherapy, Pleurectomy/Decortication (P/D), Talc, Inflammation.

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