Sharif Sumera, Zahid Imran, Routledge Tom, Scarci Marco
Imperial College London, South Kensington Campus, London SW7 2AZ, UK.
Interact Cardiovasc Thorac Surg. 2011 May;12(5):806-11. doi: 10.1510/icvts.2010.255901. Epub 2011 Jan 25.
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether positron emission tomography is useful in the diagnosis and prognosis of malignant pleural mesothelioma (MPM). Altogether 136 papers were found using the reported search, of which 15 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that fluorodeoxyglucose-positron emission tomography (FDG-PET) accurately differentiates benign from malignant pleural disease, helps detect recurrence and provides prognostic information in terms of staging, survival and mortality. Eleven studies evaluated the role of FDG-PET in the diagnosis and prognosis of MPM. Malignant disease had a higher standardised uptake value (SUV) (6.5 ± 3.4 vs. 0.8 ± 0.6; P < 0.001) than benign pleural disease. Shorter median survival (9.7 vs. 21 months; P = 0.02) was associated with high SUV (>10) than low SUV (<10). PET accurately upstaged 13% and downstaged 27% of cases initially staged with computed tomography (CT). In patients undergoing chemotherapy, higher total glycolytic volume led to a lower median survival (4.9 vs. 11.5 months; P = 0.09), while a decline in FDG uptake was associated with a longer time to tumour progression (14 vs. 7 months; P = 0.02). Four studies observed the role of FDG-PET-CT in the diagnosis and prognosis of MPM. SUV was found to be higher in MPM compared to benign pleural disease (6.5 vs. 0.8; P < 0.001). A higher SUV(max) was observed in primary pleural lesions of metastatic (7.1 vs. 4.7; P = 0.003) compared to non-metastatic disease. Patients who underwent surgery had equivalent survival to those excluded based on scan results (20 vs. 12 months; P = 0.3813). One study compared the utility of PET and PET-CT in the diagnosis and prognosis of mesothelioma. PET-CT was found to be more accurate than PET in terms of staging (P < 0.05) disease. Overall, PET accurately diagnoses MPM, predicts survival and disease recurrence. It can guide further management by predicting the response to chemotherapy and excluding surgery in patients with extrathoracic disease. Combined PET-CT has additional benefits in accurately staging disease.
根据结构化方案撰写了一篇胸外科最佳证据主题。所探讨的问题是正电子发射断层扫描在恶性胸膜间皮瘤（MPM）的诊断和预后评估中是否有用。通过报告的检索共找到136篇论文，其中15篇代表了回答该临床问题的最佳证据。这些论文的作者、期刊、出版日期和国家、研究的患者群体、研究类型、相关结局及结果均列表呈现。我们得出结论，氟脱氧葡萄糖 - 正电子发射断层扫描（FDG - PET）能准确区分良性与恶性胸膜疾病，有助于检测复发，并在分期、生存和死亡率方面提供预后信息。11项研究评估了FDG - PET在MPM诊断和预后中的作用。恶性疾病的标准化摄取值（SUV）（6.5±3.4 vs. 0.8±0.6；P < 0.001）高于良性胸膜疾病。SUV高（>10）的患者中位生存期短于SUV低（<10）的患者（9.7 vs. 21个月；P = 0.02）。PET使最初通过计算机断层扫描（CT）分期的病例中13%分期上调，27%分期下调。在接受化疗的患者中，总糖酵解体积较高导致中位生存期较低（4.9 vs. 11.5个月；P = 0.09），而FDG摄取下降与肿瘤进展时间延长相关（14 vs. 7个月；P = 0.02）。4项研究观察了FDG - PET - CT在MPM诊断和预后中的作用。发现MPM的SUV高于良性胸膜疾病（有差异）（6.5 vs. 0.8；P < 0.001）。与非转移性疾病相比，转移性原发性胸膜病变的SUV(max)更高（7.1 vs. 4.7；P = 0.003）。接受手术的患者与基于扫描结果被排除手术的患者生存期相当（20 vs. 12个月；P = 0.3813）。一项研究比较了PET和PET - CT在间皮瘤诊断和预后中的效用。发现PET - CT在疾病分期方面比PET更准确（P < 0.05）。总体而言，PET能准确诊断MPM，预测生存和疾病复发。它可通过预测化疗反应和排除胸外疾病患者的手术来指导进一步治疗。联合PET - CT在准确分期疾病方面有额外益处。
