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Clinical Role of F-18 Fluorodeoxyglucose Positron Emission Tomography Imaging in Patients With Lung Cancer and Suspected Malignant Pleural Effusion^*

^* From the West Virginia University - Departments of Nuclear Medicine (Dr. Gupta), Medicine (Dr. Rogers), Surgery (Drs. Graeber and Waheed), and School of Medicine (Ms. Gregory, Mr. Mullet, and Ms. Atkins), Morgantown, WV.

Correspondence to: Naresh C. Gupta, MD, West Virginia University PET Center, Robert C. Byrd Health Sciences Center-South, Morgantown, WV 26506; e-mail address: ngupta{at}wvu.edu

Study objectives: The goals of this study were to determine the sensitivity, specificity, and predictive accuracy of F-18 fluorodeoxyglucose positron emission tomography (PET-FDG) imaging in detecting metastatic disease involvement of pleura and/or presence of malignant pleural effusion in patients with proven lung cancer. We wanted to compare efficacy of PET-FDG imaging to CT scanning in differentiating benign pleural effusion from malignant effusion and/or pleural involvement in patients with lung cancer.

Methods: We studied 35 patients with biopsy-proven lung cancer and abnormal findings on CT scanning for presence of pleural effusion (n = 34) and/or pleural thickening or nodular involvement (n = 4). The results of positron emission tomography and CT scanning were compared to pleural cytology (n = 31), histologic findings of pleural biopsy (n = 3), and/or clinical follow-up (n = 3) for at least 1 year for presence or absence of malignant pleural effusion.

Results: PET-FDG imaging correctly detected the presence of malignant pleural effusion and malignant pleural involvement in 16 of 18 patients and excluded malignant effusion or pleural metastatic involvement in 16 of 17 patients (sensitivity, specificity, and accuracy of 88.8%, 94.1%, and 91.4% respectively).

Conclusion: PET-FDG imaging is a highly accurate and reliable noninvasive test to differentiate malignant from benign pleural effusion and/or pleural involvement in patients with lung cancer and findings of suspected malignant pleural effusion on CT scanning.

Key Words: F-18 fluorodeoxyglucose positron emission tomography • lung cancer • pleural effusion

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