Detection Of Primary Malignancies Research Articles

Detection of Primary Malignancy With Contrast-Enhanced Mammography.

Detection of Primary Malignancy With Contrast-Enhanced Mammography.

Role of 18F-FDG PET/CT in the detection of primary malignancy in patients with bone metastasis of unknown origin

ObjectiveThe present study investigates the role of 18F-FDG PET/CT in the detection of primary malignancy in patients with bone metastasis of unknown primary origin (BMUO). Material and MethodsThis retrospective study considered histopathological examination findings or clinical follow-up data as the standard reference in the diagnosis of primary tumors, and results were compared with results of PET/CT scans. ResultsThe study included 100 patients with BMUO (74 males, 26 females, mean age 61 years). The primary origin was identified in 92 of the 100 patients. Adenocarcinoma was the most common histopathological subtype in patients in whom the primary origin of tumor was detected (65.2%). The most common primary tumor was lung carcinoma (n = 52) followed by prostate (n = 13), breast (n = 7), colon (n = 4), gastric (n = 3), ovarian (n = 2), renal cell (n = 2), adrenal(n = 1), thyroid (n = 1), endometrial (n = 1) and parotid (n = 1) carcinoma, hepatobiliary cancers (n = 2), leiomyosarcoma (n = 2) and maxillary sinus tumor (n = 1). The numbers of patients in whom PET/CT showed true positive, true negative, false positive (FP) and false negative (FN) results were 72, 7, 8 and 13, respectively. The sensitivity, specificity, accuracy and detection rate of PET/CT in detecting the primary tumor were 84.7%, 46%, 79% and 72%, respectively. The overall survival was significantly lower in lung cancer group when compared to non-lung cancer group, whereas it was significantly higher in prostate cancer group than in non-prostate cancer group. ConclusionsPET/CT, as a non-invasive method, can be preferred as the first choice in the detection of primary tumor in patients with BMUO.

Detection of Primary Malignancy and Metastases with FDG PET/CT in Patients with Cholangiocarcinomas: Lesion-based Comparison with Contrast Enhanced CT.

The current National Comprehensive Cancer Network (NCCN) Guidelines consider the role of 2-deoxy-2-18F-fluoro-d-glucose positron emission tomography/computer tomography (FDG PET/CT) in the evaluation of cholangiocarcinoma (CCA) as "uncertain," and have recommended contrast enhanced computed tomography (CECT) but not FDG PET/CT as a routine imaging test for CCA workup. We set out to compare the diagnostic performance of FDG PET/CT and CECT in patients with CCA. The retrospective study included patients with CCA who underwent FDG PET/CT and CECT within 2-month interval between 2011 and 2013 in our hospital. Lesion-based comparison was conducted. Final diagnoses were made based on the composite clinical and imaging data with minimal 6-month follow-up. A total of 18 patients with 28-paired tests were included. There is a total of 142 true malignant lesions as revealed by the 6-paired pre-treatment and 22-paired post-treatment tests. On a lesion-based analysis, the sensitivities, specificities, positive predictive values (PPVs), negative predictive values (NPVs), and accuracies of PET/CT and CECT for detection of CCA were 96.5%, 55.5%, 97.2%, 50.0%, 94.1% and 62.2%, 66.7%, 96.7%, 10.0%, 62.5%, respectively. FDG PET/CT detected more intrahepatic malignant and extrahepatic metastases; and had significant higher sensitivity, NPV, and accuracy than CECT, while similar in specificity and PPV. No true positive lesion detected on CECT that was missed on PET/CT, and none of the false negative lesions on PET/CT were detected on CECT. Six patients had paired pretreatment tests, and FDG PET/CT results changed planned management in three patients. Our data suggest that FDG PET/CT detect more primary and metastatic lesions and lead to considerable changes in treatment plan in comparison with CECT.

Orbital Metastases as Presenting Sign of Lung Carcinoma: Detection of Primary Malignancy and Disease Burden by F-18 FDG PET/CT.

Metastases to orbit occur rarely but are the most common form of malignant orbital tumors. Usually the orbital metastases occur in disseminated disease. Very rarely orbital metastases can be the presenting feature of systemic malignancy. We report here a case with orbital metastases as the presenting feature of lung malignancy and describe the utility of FDG PET/CT as one-stop-shop imaging modality in this setting.

Diagnosis and therapy of carcinoid tumors—current state of the art and future directions

Abstract Carcinoid tumors account for less than 1% of all malignancies and the majority arise in the gastrointestinal system. These tumors are slow growing compared with adenocarcinomas and they differ from the other neuroendocrine malignancies by their protean clinical presentation. Carcinoid tumors were previously considered indolent, but they can manifest malignant characteristics with metastatic spread which often results in a poor prognosis. Although there have been advances in diagnostic and treatment modalities, carcinoid tumors are still often diagnosed late, often when the tumor has metastasized and patients develop carcinoid syndrome. Diagnosis, prognosis and treatment options are based on biochemical markers and imaging investigations. High concentration of urinary 5-HIAA, elevated plasma serotonin and chromogranin A levels help to establish the initial diagnosis of carcinoid tumors. In addition to the CT and MRI, molecular imaging modalities such as OctreoScan, MIBG imaging and more recently PET imaging are vital in detection of primary malignancy and metastatic involvement. Surgery is the mainstay of treatment of nonmetastatic carcinoid tumors. Cytotoxic chemotherapy is not beneficial due to the chemoresistant nature of these tumors. Because carcinoid tumors express somatostatin receptors, somatostatin analogues, which inhibit the release of serotonin and other neuroendocrine peptides, are often used, but their use is limited to symptom control. Treatment using high doses of radionuclides such as radiolabeled somatostatin analogues and MIBG is a more recent option which offers a definite advantage in management. In this article, we review typical features of the carcinoid tumors, examine contemporary methods of detecting and assessing carcinoid tumors and discuss the role of various diagnostic and therapeutic options.

Various image findings of skeletal muscle metastases with clinical correlation

The purpose of this article is to describe the image findings of distant metastases to skeletal muscle with clinical correlation. The records of nine consecutive patients with biopsy-proven metastases to skeletal muscle from primary malignancies were retrospectively reviewed for clinical history and findings from magnetic resonance imaging (MRI) (eight cases) or computed tomography (CT) (one case). Clinical history, interval between detection of primary tumor and metastases, multiplicity, primary cell type of malignancy, site of metastases, and nature of masses on MRI or CT were evaluated by two musculoskeletal radiologists. The most common symptom was a painful mass (78%), and the most common site was the thigh (78%). Four patients showed a single mass (44%). There was previous malignancy in five patients (56%), but four patients had no prior malignancy (44%). The time interval between the detection of primary malignancy and metastases was 8 months to 15 years. Mean size of metastases was 5.1 +/- 2.2 cm. The most common primary tumor was of the lung (two patients) and kidney (two patients), and the most common cell type was adenocarcinoma. On images, necrosis and peritumoral edema were relatively frequent. All cases showed good enhancement. of contrast medium. Skeletal muscle metastases show good enhancement of contrast medium and frequent edema and necrosis. The possibility of skeletal muscle metastases should be borne in mind for patients with painful and multiple muscle masses.