Pleural Effusions

The ability of 18FDG PET to characterize the nature of pleural effusions is less clear. Encouraging results were obtained in a preliminary report on the ability of 18FDG PET to distinguish between malignant and benign pleural effusions (16). However, in a subsequent study which included 25 NSCLC patients who had pleural effusion on staging CT,18FDG had a sensitivity of 95% and a specificity of only 67% (17). Nevertheless, both studies showed 18FDG PET to be more accurate than cytological evaluation and as accurate as thoracoscopic biopsy. False positive results will probably limit the utility of 18FDG PET to provide a definitive diagnosis but it may be able to complement thoracoscopy by highlighting areas most likely to provide a positive biopsy. The ability of a negative 18FDG PET to exclude malignancy is unknown because of the small number of benign effusions studied so far.

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