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J Thorac Cardiovasc Surg 2005;129:1364-1370
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Integrated computed tomography-positron emission tomography in patients with potentially resectable malignant pleural mesothelioma: Staging implications

^a Departments of Diagnostic Imaging, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
^b Department of Cardiothoracic Surgery, Texas A & M University Health Science Center, Scott and White Memorial Hospital, Temple, Tex
^c Department of Thoracic and Cardiovascular Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
^d Department of Biostatistics and Applied Mathematics, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
^e Department of Radiation Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex
^f Department of Thoracic Medical Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Tex

Received for publication August 18, 2004; revisions received October 7, 2004; accepted for publication October 28, 2004.

^_* Address for reprints: Jeremy Erasmus, MD, Department of Diagnostic Radiology, Unit 57, The University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030. (Email: jerasmus{at}di.mdacc.tmc.edu).

BACKGROUND: Integrated computed tomography-positron emission tomography imaging with coregistration of anatomic and functional imaging data may improve the accuracy of malignant pleural mesothelioma staging. We evaluate the use of integrated computed tomography-positron emission tomography in patients with malignant pleural mesothelioma who are being considered for extrapleural pneumonectomy.

METHODS: Twenty-nine patients with malignant pleural mesothelioma who were judged to be candidates for extrapleural pneumonectomy after clinical and conventional radiologic evaluation underwent whole-body integrated computed tomography-positron emission tomography and pathologic staging. Two reviewers blinded to the results of clinical and pathologic staging retrospectively evaluated computed tomography, positron emission tomography, and coregistered computed tomography-positron emission tomography images. Staging was performed according to the International Mesothelioma Interest Group TNM staging system. Histopathology and/or results of further radiologic evaluation or follow-up served as the reference standard.

RESULTS: Integrated computed tomography-positron emission tomography provided additional information in 11 of 29 patients that precluded extrapleural pneumonectomy. The overall tumor stage was correctly classified in 21 of 29 patients. The tumor stage was correctly determined in 15 of 24 patients, 6 of whom had T4 (nonresectable) disease. The node stage was accurately determined in 6 of 17 patients. Extrathoracic metastases not identified by routine clinical and conventional radiologic evaluation were detected in 7 of 29 patients and were found to be diffuse (n = 2) or solitary (n = 5).

CONCLUSIONS: Integrated computed tomography-positron emission tomography increases the accuracy of malignant pleural mesothelioma staging and is important in determining the appropriate therapy in patients being considered for extrapleural pneumonectomy.

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