PURPOSE: To show the PET/CT role in reducing the exploratory procedures with an early diagnosis, in a better staging of disease and in a postoperative follow-up in MPM.
METHODS: Sixty-seven potentially extrapleural pneumonectomy (EPP) submitted patients (range age of 31-79 years) were observed between 1999 and 2009. All patients underwent PET/CT scan: median preoperative SUV was 6.8 (range 3-20). The same surgeon team operated 45 patients (29 male - 16 female), 23 right-sided lesions and 22 left-sided. Forty patients underwent EPP, 1 pleural decortications, 3 exploratory thoracotomies for chest wall or inferior vena cava invasion, and 1 laparoscopy for peritoneal metastases. One patient were no surgical proposed for macroscopically evidence of extended diseases and received chemotherapy. Thirty-seven patients had epithelioid subtype, 3 sarcomatous and 6 biphasics. Eighteen tumors were pStage I-II, 24 pStage III and 4 pStage IV according IMIG staging system.
RESULTS: All T4 or M1 cases were detected by PET/CT preoperative scan. The follow-up study reported a PET/TC sensibility of 95% with a diagnostic accuracy of 92% regarding the local recurrences or distant metastases. The analysis correlation in patients with high and low SUV and epithelioid and non-epithelioid histotype showed a better prognosis in both low SUV and epithelioid tumor. The median follow-up for all surviving patients was 36 months. Disease free survival were 11 and 21 months for the high and low SUV groups, respectively. Median survivals were 16 and 29 months for the high and low SUV groups, respectively. In a multivariable analysis, high SUV tumors were associated with a 4.1 times greater risk of death than low SUV tumors (p = 0.04).
CONCLUSIONS: There is an association between patients with high SUVmax values and a lower survival. PET/CT gives a good support in staging and prognosis. A systematic use of PET/CT could be anticipate the recurrence of MPM in EPP submitted patients.
CLINICAL IMPLICATIONS: PET/CT in MPM avoids exploratory procedures with a better staging of disease and play a role in follow-up.
DISCLOSURE: The following authors have nothing to disclose: Cosimo Lequaglie, Gabriella Giudice, Christian Diego Rolfo Cervetto, Rita Marasco, Aniello Della Morte
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