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Correspondence |

Fluorodeoxyglucose-PET Scanning in the Diagnosis of Pleural Disease FREE TO VIEW

Viswam S. Nair, MD
Author and Funding Information

Correspondence to: Viswam S. Nair, MD, Division of Pulmonary and Critical Care, Stanford University School of Medicine, 300 Pasteur Dr, Stanford, CA 94305; e-mail: viswamnair@stanford.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;139(4):966-967. doi:10.1378/chest.10-2754
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To the Editor:

I thank Battah et al1 for sharing an interesting case and uncommon presentation of ankylosing spondylitis in a recent issue of CHEST (October 2010). Clarification of the authors’ conclusions, however, is required regarding their assertion that fluorodeoxyglucose (FDG)-PET scans showing increased uptake in pleural disease may be reassuring, as stated in the “Clinical Pearls” section of the article.

FDG-PET scanning has been well integrated into the workup for the evaluation of the indeterminate, solitary pulmonary nodule2,3; however, its use in guiding further testing in pleural disease remains less well defined. The general consensus for solitary pulmonary nodule management is that increased FDG uptake should guide the clinician toward a more invasive approach rather than watchful waiting in the case of an unclear clinical diagnosis. Although this guideline cannot be extrapolated to pleural-based diseases, there is increasing evidence to suggest that augmenting clinical data with FDG-PET scanning may be useful in pleural disease management.4-6

Battah et al1 mention “the appropriate clinical setting” as a scenario in which increasing FDG uptake is reassuring enough to defer biopsy, but only a low-probability patient would meet this requirement (not necessarily this patient who was a smoker and construction worker), and even then, an increase in FDG-PET scanning may bias the clinician toward biopsy. In the absence of necessary studies to synthesize data and investigate this topic in more detail, clinicians should be aware that increasing FDG uptake in diagnostic dilemmas of the pleura is worrisome and may require further investigations, perhaps invasive, if necessary.

Battah S, Wu C, Richards A, Crooks L, Hartshorne M, Brown LK. A 41-year-old man with fluorodeoxyglucose-avid thickening on PET scan. Chest. 2010;1384:1010-1013. [CrossRef] [PubMed]
 
Gould MK, Fletcher J, Iannettoni MD, et al; American College of Chest Physicians American College of Chest Physicians Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;1323 suppl:108S-130S. [CrossRef] [PubMed]
 
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC.American College of Chest PhysiciansWahidi MM.Govert JA.Goudar RK.Gould MK.McCrory DC. American College of Chest Physicians Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;1323 suppl:94S-107S. [CrossRef] [PubMed]
 
Nowak AK, Armato SG III, Ceresoli GL, Yildirim H, Francis RJ. Imaging in pleural mesothelioma: a review of imaging research presented at the 9th International Meeting of the International Mesothelioma Interest Group. Lung Cancer. 2010;701:1-6. [CrossRef] [PubMed]
 
Nowak AK, Francis RJ, Phillips MJ, et al. A novel prognostic model for malignant mesothelioma incorporating quantitative FDG-PET imaging with clinical parameters. Clin Cancer Res. 2010;168:2409-2417. [CrossRef] [PubMed]
 
Yildirim H, Metintas M, Entok E, et al. Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study. J Thorac Oncol. 2009;412:1480-1484. [CrossRef] [PubMed]
 

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References

Battah S, Wu C, Richards A, Crooks L, Hartshorne M, Brown LK. A 41-year-old man with fluorodeoxyglucose-avid thickening on PET scan. Chest. 2010;1384:1010-1013. [CrossRef] [PubMed]
 
Gould MK, Fletcher J, Iannettoni MD, et al; American College of Chest Physicians American College of Chest Physicians Evaluation of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;1323 suppl:108S-130S. [CrossRef] [PubMed]
 
Wahidi MM, Govert JA, Goudar RK, Gould MK, McCrory DC.American College of Chest PhysiciansWahidi MM.Govert JA.Goudar RK.Gould MK.McCrory DC. American College of Chest Physicians Evidence for the treatment of patients with pulmonary nodules: when is it lung cancer? ACCP evidence-based clinical practice guidelines (2nd edition). Chest. 2007;1323 suppl:94S-107S. [CrossRef] [PubMed]
 
Nowak AK, Armato SG III, Ceresoli GL, Yildirim H, Francis RJ. Imaging in pleural mesothelioma: a review of imaging research presented at the 9th International Meeting of the International Mesothelioma Interest Group. Lung Cancer. 2010;701:1-6. [CrossRef] [PubMed]
 
Nowak AK, Francis RJ, Phillips MJ, et al. A novel prognostic model for malignant mesothelioma incorporating quantitative FDG-PET imaging with clinical parameters. Clin Cancer Res. 2010;168:2409-2417. [CrossRef] [PubMed]
 
Yildirim H, Metintas M, Entok E, et al. Clinical value of fluorodeoxyglucose-positron emission tomography/computed tomography in differentiation of malignant mesothelioma from asbestos-related benign pleural disease: an observational pilot study. J Thorac Oncol. 2009;412:1480-1484. [CrossRef] [PubMed]
 
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