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Inicio Medicina Clínica (English Edition) A PET-CT score for discriminating malignant from benign pleural effusions
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Vol. 161. Issue 10.
Pages 422-428 (November 2023)
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Vol. 161. Issue 10.
Pages 422-428 (November 2023)
Original article
A PET-CT score for discriminating malignant from benign pleural effusions
Desarrollo de una categorización de la PET-TAC para la diferenciación entre derrames pleurales benignos y malignos
Marc Simóa,
Corresponding author
marc.simo@vallhebron.cat

Corresponding author.
, Oscar Persivab, Leire Sánchezc, Bruno Montorod, Ana Vázqueze, Irene Sansanof, Carmen Alemáne
a Department of Nuclear Imaging, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Department of Radiology, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
c Department of Thoracic Surgery, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
d Department of Pharmacy, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
e Department of Internal Medicine, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
f Department of Pathology, Universitat Autònoma de Barcelona, Hospital Universitari Vall d’Hebron, Barcelona, Spain
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Tables (3)
Table 1. Clinical, chest X-ray and pleural analysis findings according to cohort.
Table 2. PET-CT data and semi-quantitative analysis according to the diagnosis of PE in the referral cohort.
Table 3. PET-CT score after logistic regression analysis for the diagnosis of malignant PE in the referral cohort.
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Abstract
Background and objectives

The results of previous PET-CT studies are contradictory for discriminating malignant from benign pleural effusions. We purpose to develop a PET-CT score for differentiating between benign and malignant effusions.

Patients and methods

We conducted a prospective study of consecutive patients with pleural effusions undergoing PET-CT from October 2013 to October 2019 (referral cohort). PET-CT scan features evaluated using the SUV were: linear thickening; nodular thickening; nodules; masses; circumferential thickening; mediastinal and fissural pleural involvement; intrathoracic lymph nodes; pleural loculation; inflammatory consolidation; pleural calcification; cardiomegaly; pericardial effusion; bilateral effusion; lung mass; liver metastasis and other extra-pleural malignancy. The results were validated in an independent prospective cohort from November 2019 to June 2021.

Results

One hundred and ninety-nine patients were enrolled in the referral cohort (91 with malignant effusions and 108 benign). The most useful parameters for the development of a PET-CT score were: nodular pleural thickening, pleural nodules with SUV>7.5, lung mass or extra pleural malignancy (10 points each), mammary lymph node with SUV>4.5 (5 points) and cardiomegaly (−1 point). With a cut-off value of >9 points in the referral cohort, the score established the diagnosis of malignant pleural effusion with sensitivity 87.9%, specificity 90.7%, positive predictive value 88.9%, negative predictive value 89.9%, positive likelihood ratio 7.81 and negative likelihood ratio 0.106. These results were validated in an independent prospective cohort of 75 patients.

Conclusions

PET-CT score was shown to provide relevant information for the identification of malignant pleural effusion.

Keywords:
Benign pleural effusion
PET-CT
Malignant pleural effusion
Resumen
Antecedentes y objetivos

Los estudios PET-TAC previos en el análisis del derrame pleural son contradictorios. Nuestro objetivo es desarrollar una puntuación mediante PET-TAC para diferenciar entre derrames benignos y malignos.

Pacientes y métodos

Estudio prospectivo en pacientes con derrame pleural a los que se realizó una PET-TAC desde octubre de 2013 hasta octubre de 2019 (cohorte de referencia). Los datos analizados fueron: engrosamiento lineal; engrosamiento nodular; nódulos; masas; engrosamiento circunferencial; afectación pleural mediastínica y cisural; ganglios linfáticos torácicos; loculación pleural; consolidación; calcificación pleural; cardiomegalia; derrame pericárdico; derrame bilateral; masa pulmonar; metástasis hepáticas y otras neoplasias malignas extrapleurales. Se calculó el SUV de todos estos parámetros. Los resultados se validaron en una cohorte independiente.

Resultados

Se incluyó a 199 pacientes en la cohorte de referencia (91 derrames malignos y 108 benignos). Los parámetros que mostraron más utilidad para discriminar ambos derrames y desarrollar una puntuación fueron: engrosamiento pleural nodular, nódulos pleurales con SUV > 7,5, masa pulmonar o malignidad extrapleural (10 puntos cada uno), ganglio en cadena mamaria con SUV > 4,5 (5 puntos) y cardiomegalia (–1 punto). Con un punto de corte > 9 en la cohorte de derivación, se estableció el diagnóstico de derrame pleural maligno con una sensibilidad del 87,9%, especificidad del 90,7%, valor predictivo positivo del 88,9%, valor predictivo negativo del 89,9% razón de verosimilitud positiva del 7,81 y razón de verosimilitud negativa del 0,106. Estos resultados fueron validados en una cohorte prospectiva independiente de 75 pacientes.

Conclusiones

Una puntuación basada en PET-TAC proporciona información relevante para el diagnóstico del derrame pleural maligno.

Palabras clave:
Derrame pleural benigno
PET-TAC
Derrame pleural maligno

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