PET: other thoracic malignancies

Our plain-English summary of PET: other thoracic malignancies, by L.E. Quint (Cancer Imaging, 2006).

The study

• Author: L.E. Quint
• Journal: Cancer Imaging
• Published: 2006;6(Spec No A):S82-8
• Cited by: 2 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

The vast majority of esophageal cancers are fluorodeoxyglucose (FDG) avid; the primary use for positron emission tomography (PET) in patients with esophageal cancer is in the detection of distant metastases, because known distant metastatic disease precludes surgical resection. High standardized uptake values (SUVs) may be predictive of poor prognosis. PET findings may be used to assess therapy response and evaluate for esophageal tumor recurrence after treatment. PET findings may be non-specific in different types of thymic lesions, although thymic carcinomas tend to be extremely FDG avid. PET can be helpful in detecting distant spread from invasive thymomas and thymic carcinomas. Similarly, PET may be used to assess the extent of disease in patients with malignant pleural mesothelioma, thereby facilitating optimal therapy approaches.

(c) International Cancer Imaging Society.

In plain English

This article was a short narrative review, written for a 2006 imaging mini symposium. It described how PET scanning with the tracer fluorodeoxyglucose (FDG) had been used in chest cancers other than lung cancer, based on published studies. It reported no new patient data. It covered esophageal cancer, thymic lesions and malignant pleural mesothelioma (MPM). Asbestos was not discussed. For esophageal cancer, the author reported that, according to published reports, PET found previously unsuspected distant disease in approximately 10–30% of patients. The author also reported PET was not useful for judging tumor invasion depth. PET was described as possibly helpful in telling a normal from an abnormal thymus, but generally unhelpful in distinguishing thymic carcinoma, thymoma and thymic hyperplasia. For MPM, the author cited preliminary reports that PET before surgery was better than CT and MR for staging the tumor. Other preliminary studies linked high tracer uptake (SUV) with poor survival. Pleural inflammation, including reaction after talc pleurodesis, could give false-positive results. The author concluded that preliminary reports suggested PET may add useful information in patients with known or suspected MPM.

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: narrative review (mini symposium paper) of published studies on PET in thoracic cancers other than lung cancer
• Who was studied: No patients studied directly; the review covered published work on patients with esophageal cancer, thymic lesions and malignant pleural mesothelioma
• Exposure: Not applicable: the article concerns FDG PET imaging; no asbestos or other exposure is discussed
• Main results:
  • Esophageal cancer (from published reports): PET detected previously unsuspected distant disease in approximately 10–30% of patients
  • Esophageal cancer: PET was not useful for gauging the depth of tumor invasion
  • Thymic lesions: because thymic lesions are frequently FDG avid, PET may be useful in differentiating the normal from the abnormal thymus
  • Thymic lesions: although thymic carcinomas tend to show higher SUVs, thymomas and thymic hyperplasia occasionally also show intense uptake, so PET was generally unhelpful in distinguishing among these three
  • Malignant pleural mesothelioma: approximately one-quarter of patients were found to have unresectable disease at exploratory thoracotomy after conventional preoperative imaging
  • Malignant pleural mesothelioma: preliminary reports suggested preoperative FDG PET was superior to CT and MR for staging
  • Malignant pleural mesothelioma: preliminary studies suggested high SUV was associated with poor survival
  • Pleural disease: inflammatory processes, including pleural reaction after talc pleurodesis, could be extremely FDG avid and give false-positive results
  • Malignant pleural mesothelioma: PET's limited spatial resolution made it hard to tell pleural disease from adjacent disease near the diaphragm, mediastinum or chest wall
• The authors' conclusion: The author concluded that a growing body of data suggested PET is helpful in new, treated or recurrent esophageal cancer, and that preliminary reports suggested PET may add useful information in patients with thymic lesions and known or suspected MPM

Topics

Medical terms in this study, explained in our Lexicon: Esophageal Cancer, Surgical Resection, Prognosis, Carcinoma, Pleural Mesothelioma.

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• ¹⁸F-FDG uptake on PET could be a predictive marker of excision repair cross-complementation group 1 (ERCC1) expression in patients with thoracic neoplasms? — K. Kaira, M. Endo, et al. (2012)
• ¹⁸F-FDG uptake on PET is a predictive marker of thymidylate synthase expression in patients with thoracic neoplasms — K. Kaira, N. Yamamoto, et al. (2014)
• Eighth Edition Staging of Thoracic Malignancies: Implications for the Reporting Pathologist — A.G. Nicholson, M.S. Tsao, et al. (2018)
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