• Marc Simó, Oscar Persiva, Leire Sánchez, Bruno Montoro, Ana Vázquez, Irene Sansano, and Carmen Alemán.
• Department of Nuclear Imaging, Universitat Autònoma de Barcelona, Hospital Universitari Vall d'Hebron, Barcelona, Spain. Electronic address: marc.simo@vallhebron.cat.
• Med Clin (Barc). 2023 Nov 24; 161 (10): 422428422-428.

Background And ObjectivesThe 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 MethodsWe 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.ResultsOne 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.ConclusionsPET-CT score was shown to provide relevant information for the identification of malignant pleural effusion.Copyright © 2023 Elsevier España, S.L.U. All rights reserved.

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