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Value of positron emission tomography in full-thickness chest wall resections for malignancies

^a Divisions of Thoracic and Vascular Surgery, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, CH-1011 Lausanne, Switzerland
^b Department of Nuclear Medicine, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
^c Department of Radiology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland
^d Department of Pathology, Centre Hospitalier Universitaire Vaudois (CHUV) and University of Lausanne, Lausanne, Switzerland

*Corresponding author. Tel.: +41 21 314 20 45 (business)/+ 41 79 613 61 29 (home); fax: +41 21 314 23 58.

E-mail address: david.petermann{at}bluewin.ch (D. Petermann).

Preoperative imaging for resection of chest wall malignancies is generally performed by computed tomography (CT). We evaluated the role of ¹⁸F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in planning full-thickness chest wall resections for malignancies. We retrospectively included 18 consecutive patients operated from 2004 to 2006 at our institution. Tumor extent was measured by CT and PET, using the two largest perpendicular tumor extensions in the chest wall plane to compute the tumor surface assuming an elliptical shape. Imaging measurements were compared to histopathology assessment of tumor borders. CT assessment consistently overestimated the tumor size as compared to PET (+64% vs. +1%, P<0.001). Moreover, PET was significantly better than CT at defining the size of lesions >24 cm² corresponding to a mean diameter >5.5 cm or an ellipse of >4 cmx7.6 cm (positive predictive value 80% vs. 44% and specificity 93% vs. 64%, respectively). Metabolic PET imaging was superior to CT for defining the extent of chest wall tumors, particularly for tumors with a diameter >5.5 cm. PET can complement CT in planning full-thickness chest wall resection for malignancies, but its true value remains to be determined in larger, prospective studies.

Key Words: Chest wall; Positron emission tomography; Computed tomography; Cancer