Impact Of 18F-FDG Research Articles

Impact of 18F-FDG PET/CT staging on management and prognostic stratification in head and neck squamous cell carcinoma: A prospective observational study

BackgroundAccurate assessment of the extent of cancer is essential for appropriate treatment planning and outcome prediction. This study prospectively evaluated whether adding 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) to the routine initial staging practice in head and neck squamous cell carcinoma (HNSCC) improved management and prognosis. MethodsAll consecutive patients with newly diagnosed HNSCC who presented in October 2010 – December 2012 underwent conventional workups (CWU) followed by PET/CT. The clinical stage and management plans before and after PET/CT were compared. PET/CT was deemed to have no/low, moderate, and high impact on management planning depending on whether PET/CT changed the treatment modality or goal. The appropriateness of PET/CT staging and management impact was confirmed by histopathology and clinical follow-up, and its association with survival was analysed. FindingsOf the 248 patients, PET/CT changed the Tumour Node Metastasis (TNM) classification in 79 (31.9%). In the patients with discordant staging, PET/CT staging was significantly more sensitive and accurate than CWU staging (both P < 0.001). PET/CT had high or moderate impact on management in 39 (15.7%) patients. Patients with PET/CT upstaged disease had significantly worse progression-free survival (PFS) and overall survival (OS) than patients with no CWU-stage changes (3-year PFS = 56.8% versus 74.5%, P = 0.043; 3-year OS = 61.3% versus 85.3%, P = 0.006). Multivariate analyses revealed that PET/CT staging and second primary cancer were independent predictive factors for both PFS and OS (P < 0.05, each). Interpretations18F-FDG PET/CT added important staging information that improved management and prognostic stratification in HNSCC.

Te impact of 18F-FDG PET/CT in staging of non-small cell lung cancer patients: the key to improve patient treatment strategy

Te impact of 18F-FDG PET/CT in staging of non-small cell lung cancer patients: the key to improve patient treatment strategy

Impact of ¹⁸F-FDG PET/CT on the management of adrenocortical carcinoma: analysis of 106 patients.

Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy. Limited data are available about on value of (18)F-FDG PET/CT in ACC. We evaluated the impact of PET/CT on the management of ACC. We performed a retrospective review in patients with ACC who had undergone PET/CT. The impact of PET/CT on the management plan was evaluated by comparing the findings on PET/CT to the findings on contrast-enhanced CT. The sensitivity, specificity, and accuracy of each form of imaging were calculated. The correlations between PET/CT parameters, including maximum standardized uptake value (SUVmax), total lesion glycolysis, and decline in SUVmax after chemotherapy, and clinical outcome were evaluated. Included in the analysis were 106 patients with 180 PET/CT scans. Of the 106 patients, 7 underwent PET/CT only for initial staging, 84 underwent PET/CT only for restaging, and 15 underwent PET/CT for both initial staging and restaging. PET/CT changed the management plan in 1 of 22 patients (5%) at initial staging and 9 of 99 patients (9%) at restaging. In 5 of the patients in whom PET/CT changed the management plan, PET/CT showed response to chemotherapy but contrast-enhanced CT showed stable disease. Sensitivity, specificity, and accuracy were 100%, 100%, and 100% for PET/CT at initial staging; 92.6%, 100%, and 96.4% for CT at initial staging; 98.4%, 100%, and 99.5% for PET/CT at restaging; and 96.8%, 98.6%, and 98.0% for CT at restaging, respectively. No PET/CT parameters were associated with survival at either initial diagnosis or recurrence. PET/CT findings could substantially change the management plan in a small proportion of patients with ACC. Although lesion detection was similar between PET/CT and CT, PET/CT may be preferred for chemotherapeutic response assessment because it may predict response before anatomic changes are detected on CT.

Impact of 18F FDG PET/CT on staging of non-small cell lung cancer.

e22105 Background: The best option for treatment of non-small cell lung cancer (NSCLC) depends on optimal initial staging. FDG PET/CT could play an important role for staging of NSCLC by reducing t...

Is there an impact of 18F-FDG PET/CT on the surveillance and clinical management of recurrent ovarian cancer? Research based on a large sample in a single PET/CT center

The aim of the study was to evaluate the use of F-fluorodeoxyglucose ((18)F-FDG) PET/computed tomography (CT) in the follow-up and clinical management of ovarian cancer patients after therapy. A total of 152 ovarian cancer patients who had undergone therapy were evaluated. Clinical information, CA-125 levels, and traditional imaging findings were analyzed. According to the indication for PET/CT the patients were divided into five groups for assessing the role of (18)F-FDG PET/CT in the clinical management of ovarian cancer patients after therapy. A comparison was made between the PET/CT findings and the results of clinical follow-up. Of the 152 patients, 137 had follow-up results and 15 were lost to follow-up. A total of 105 patients were found to have recurrent tumor and 32 were found to be disease-free after long-term follow-up. The diagnostic sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 98.3, 91.2, 96.8, 97.5, and 93.9%, respectively. PET/CT was especially useful in patients when indications were to diagnose suspected recurrence, assess disease progression, and evaluate therapeutic response. PET/CT has been proven to be extremely valuable in the evaluation of patients with recurrent ovarian cancer and is particularly helpful in guiding treatment planning.

Impact of 18F-FDG PET/CT on the Treatment of Patients With Non-Small Cell Lung Cancer

IntroductionDisease stage is the most important prognostic factor in lung cancer, and optimal staging is important to determine the best therapeutic option. FDG-PET/CT has demonstrated its value in the treatment of early stage non-small cell lung cancer (NSCLC), but there is still insufficient data to define its role in other stages. HypothesisInformation provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC. MethodsA retrospective review was made of patients who underwent FDG-PET/CT between January 2008 and December 2010 for the diagnosis of NSCLC. Clinical stage before and after FDG-PET/CT and information about any change in therapeutic decision due to information provided by FDG-PET/CT were collected. Using pathologic evaluation as the gold standard, sensitivity, specificity, and positive and negative predictive values for CT and FDG-PET/CT were calculated. ResultsOf the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 patients (47.1%). In 85 cases (34.6%) FDG-PET/CT led to stage migration. Treatment was modified in 60 patients (24.4% of all FDG-PET/CT performed), avoiding a futile thoracotomy in 13 cases (5.2%), and allowing treatment with curative intent in 26 (10.5%). Of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For 133 cases (54%) with pathological assessment of the mediastinal lymph nodes, sensitivity, specificity, positive predictive value and negative predictive value were 0.57, 0.64, 0.48 and 0.72 for CT, and 0.68, 0.86, 0.75 and 0.81 for FDG-PET/CT. DiscussionOur data support previous reports that FDG-PET/CT is essential in the staging process not only for patients with potentially operable NSCLC, but also for stage iii patients, as demonstrated by our data.

Therapeutic impact of 18F-FDG PET/CT in recurrent differentiated thyroid carcinoma

(18)F-fluorodeoxyglucose-positron emission tomography/computed tomography (PET/CT) has proved effective in detecting recurrent or metastatic differentiated thyroid carcinoma (DTC) in the follow-up of operated DTC patients with high thyroglobulin (Tg) levels and negative findings on radioiodine whole-body scan. The aim of this retrospective study was to assess the impact of PET/CT on the planning of appropriate treatment for known recurrent disease in operated DTC patients. The study concerned 44 consecutive DTC patients (36 papillary, 8 follicular), who underwent total thyroidectomy and thyroid remnant ablation with (131)I and PET/CT. All patients had proven or strongly suspected recurrent disease judging from neck ultrasound (US) and fine-needle aspiration cytology, and detectable basal Tg levels. PET/CT findings were positive in 25/44 patients (56.81%) and negative in 19. A positive PET/CT result predicted resectable tumour recurrences in 19/25 patients, but also detected additional tumour sites that prompted changes to the treatment plan in 6/25 patients (24%). A negative PET/CT result led to clinical monitoring for 11/19 patients (57.89%). PET/CT can help select patients, who might benefit from a tailored therapy by improving the detection of local recurrences not apparent on neck US or metastases.

Impact of 18F-FDG PET/CT Imaging in Therapeutic Decisions for Malignant Solitary Fibrous Tumor of the Pelvis

The decision to give neoadjuvant chemotherapy in patients with localized high-risk soft tissue sarcoma is often based on tumor grade evaluated from biopsies, but biopsies can have the inherent issue of sampling bias. Incorporation of SUVmax and heterogeneity assessed by F-FDG PET/CT could be other crucial components in the effort to tailor treatment to an individual patient, providing valuable parameters to guide the selection of the most appropriate management schedule for an individual. We present 1 representative case describing how FDG PET/CT can assist in clinical management decisions for treatment of malignant solitary fibrous tumor of the pelvis.

Clinical impact of 18F-FDG–PET in breast cancer: Survival analysis and comparison of intrinsic subtypes with standardized uptake value.

e12005 Background: [18F] fluorodeoxyglucose positron emission tomography (18F-FDG–PET) scans are known as an important imaging study with their reflection biological activity in various malignancies. To investigate clinical impact of 18F-FDG–PET in breast cancer, we performed survival analysis with maximum standardized uptake values (SUVmax), and compared SUVmax according to breast cancer subtypes. Methods: We reviewed the medical records of 462 patients with breast cancer who underwent primary surgery between April 2004 and December 2008 at single institute. Patients were classified as 4 subtypes: luminal A, luminal B, HER2 and triple negative. The entire patients were randomly assigned as training set (n=220) and validation set (n=242). Results: High SUVmax vs. low SUVmax group was defined with cut-off points of 4 in a training set.At a median follow-up of 6.03 years, the patients with high SUVmax had a shorter disease-free survival in a validation set (p = 0.018, log-rank test). Using multivariate analysis for disease-free survival in the entire patients, high SUVmax was demonstrated as a poor prognostic factor (hazard ratio 2.34, 95% confidence interval 1.18-4.67). In the comparison among subtypes, mean of SUVmax was higher in triple negative type and HER2 type. Also, high SUVmax was significantly associated with larger tumor size, positive node, high Ki67 (≥14%), ER negative, and high histologic grade, and HER2 positive. Conclusions: In breast cancer, the patients with higher SUVmax showed a shorter disease-free survival. Higher SUVmax found in HER-2 and triple negative type suggests that 18F-FDG PET could reflect molecular signature.

Impact of 18F-FDG PET/CT on therapeutic decisions in patients with colorectal cancer and liver metastases

ObjectivesSurgical resection and radio-frequency ablation (RFA) are standard therapeutic procedures for colorectal metastases confined to the liver. The presence of extrahepatic disease has a significant effect on the management of these patients. The goal of this study is to assess the value of positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (18F-FDG PET/CT) in the decision making whether to perform RFA or surgical resection of liver metastases in patients with metastatic colorectal cancer. Material and methodsThirty-five consecutive patients (23 men, 12 women; age range: 46–78 years) with colorectal carcinoma and liver metastases were prospectively enrolled. Nineteen of them were considered candidates for surgical resection and 16 for RFA. All underwent 18F-FDG PET/CT, helical computed tomography of the chest and abdomen and, some of them, magnetic resonance imaging of the abdomen. The 18F-FDG PET/CT studies were performed within 4 weeks from conventional imaging, and additional findings were later confirmed or not, either by histology or follow up. ResultsIn the surgical candidate group, 18F-FDG PET/CT detected extrahepatic disease, missed by conventional imaging, in 9/19 patients (47.3%). These findings directly altered the management in 7 patients (36.8%). In the group of RFA candidates, 18F-FDG PET/CT detected additional extrahepatic disease in 4/16 patients (25%) and directly altered management in all of them. Overall, in 11/35 patients (31.4%), 18F-FDG PET/CT detected extrahepatic metastatic disease. ConclusionIn patients with colorectal cancer and liver metastases, 18F-FDG PET/CT provides relevant additional information that has significant impact on management.

A preliminary report on the impact of 18F-FDG PET/CT in the management of paediatric head and neck cancer

Paediatric head and neck malignancy accounts for 5% of all paediatric cancers. The choice of treatment and prediction of prognosis depend on the histological type of tumour, initial staging, evaluating treatment response and detection of early recurrence. Conventional imaging modalities have many limitations. Positron emission tomography/computed tomography (PET/CT) is more accurate; however, so far, the literature lacks reports of large groups of paediatric patients. To report the role of PET/CT in factors affecting the choice of treatment at the newly established Children Cancer Hospital in Cairo, Egypt, which is one of the busiest dedicated paediatric oncology centres in the world. All findings were proven by histopathology, radiology and by clinical follow-up. Thirty-six paediatric patients (30 boys and six girls) with various histologically proven head and neck cancers were included in this study. Their age ranged from 2 to 17 years. High-resolution diagnostic CT and/or MRI of the head and neck, and in relevant cases also of the chest and the abdomen, were performed in all patients at a mean interval of 1.6 weeks (range, 1-3 months) before the PET/CT study. Results of PET/CT were compared with the findings of these conventional imaging modalities. The sensitivity, specificity, accuracy, positive and negative predictive values of PET/CT against the conventional imaging were as follows: sensitivity 100 and, 53%, specificity 89.5 and 47%, accuracy 94.5 and 50%, positive predictive value 89.5 and 47% and negative predictive value 100 and 53% respectively. PET/CT changed patient management in 50% of the cases. PET/CT in paediatric head and neck carcinoma is more accurate than conventional imaging. Therefore, it also has a significant impact on further patient management. We recommend that it should be the first imaging modality for all purposes in initial staging, evaluating treatment response and follow-up in paediatric head and neck carcinoma.

Impact of 18F-FDG PET/CT for detecting recurrence of medullary thyroid carcinoma

The aim of this study was to evaluate the value of fluorine-18 (¹⁸F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in the detection of recurrent medullary thyroid carcinoma (MTC) in patients with elevated calcitonin levels. Thirty-three patients (nine men, 24 women; mean age: 50.3 ± 12 years) who were referred to undergo ¹⁸F-FDG PET/CT for restaging of MTC in patients with high calcitonin levels were included in this study. Five patients also had suspected lymph nodes detected by neck ultrasonography. The results of ¹⁸F-FDG PET/CT and clinical follow-up data were reviewed retrospectively. Histological analysis has been accepted as the gold standard in the confirmation of ¹⁸F-FDG PET/CT results. Patients were followed up for 45.6 ± 4.2 months. There were 14 negative and 19 positive scans for possible recurrence of MTC. In the positive scans, the possible recurrence sites were neck lymph nodes, thyroid bed, mediastinal lymph nodes, and the lung in 14, two, two, and one patient, respectively. Disease recurrence in 13 patients was confirmed histologically by surgical excision or fine-needle aspiration biopsy. In the remaining six patients, recurrence was excluded as it was reactive as a result of pathological examination. However, one patient had a negative scan, underwent neck lymph node excision after ¹⁸F-FDG PET/CT examination, and lymph node recurrence was detected histologically. According to these results, the sensitivity and specificity of PET/CT were calculated as 93 and 68%, respectively. According to the recommended calcitonin level by the American Thyroid Association (calcitonin levels higher than 150 pg/ml), sensitivity was calculated as 90%. Although the mean maximum standardized uptake values of the true-positive and false-positive groups were calculated as 4.72 ± 2.17 and 4.22 ± 1.02, respectively, the difference between the two groups was not statistically significant (P>0.05). PET/CT is a sensitive imaging tool in the detection of MTC recurrence, especially in patients with high calcitonin levels, and it gives additional information in one third of all patients on an average by detecting an occult disease or confirming findings of other imaging tools.

Impact of 18F-FDG PET/CT with Retrograde Filling of the Urinary Bladder in Patients with Suspected Pelvic Malignancies

The purpose of this study was to assess the feasibility of selective pelvic PET/CT with retrograde bladder irrigation in evaluating pelvic pathologies. Thirty-eight patients (22 women and 16 men), with a mean age of 61 y (range, 41-81 y) and a neoplastic background (most of them of pelvic pathology), were assessed with PET/CT. The most prevalent findings were urothelial (14 cases), gynecologic (12 cases), and rectal (7 cases) cancers. All but 3 patients had undergone previous surgical procedures or radio- or chemotherapy. Twenty-two patients had suspected pelvic pathology on a previous diagnostic CT scan. All the patients underwent a standard PET/CT protocol (from head to upper thighs) 60 min after the intravenous injection of 370 MBq of (18)F-FDG. Additional delayed pelvic PET/CT images were acquired with a filled-bladder technique. Both series of images were assessed by 2 experienced observers. A lesion was classified as malignant if it showed a standardized uptake value greater than 2.5 or, in the case of subcentimetric lesions, any uptake greater than background activity that persisted or increased on delayed pelvic imaging. All lesions were evaluated histologically or by clinical follow-up. Twenty-seven of 43 studies were categorized as pathologic using PET/CT. Nineteen studies showed abnormalities in the pelvis; the findings of 5 of these studies were false-positive. Ten studies showed pathologic (18)F-FDG uptake in the bladder wall; in 7 of these studies the uptake was found to be true-positive on histopathologic examination. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT in the pelvic assessment were 100%, 83%, 74%, 100%, and 76%, respectively. The retrograde filling reduced the interference with physiologic urinary accumulation of (18)F-FDG in patients with possible pelvic lesions; no false-negative results were documented. In (18)F-FDG PET studies, retrograde filling of the urinary bladder is recommended to assess bladder wall lesions and malignancies in other pelvic locations.

Lista de recomendações do Exame PET/CT com 18F-FDG em Oncologia: consenso entre a Sociedade Brasileira de Cancerologia e a Sociedade Brasileira de Biologia, Medicina Nuclear e Imagem Molecular

Apresentamos uma lista de recomendações sobre a utilização de 18F-FDG PET em oncologia, no diagnóstico, estadiamento e detecção de recorrência ou progressão do câncer. Foi realizada pesquisa para identificar estudos controlados e revisões sistemáticas de literatura composta por estudos retrospectivos e prospectivos. As consequências e o impacto da 18F-FDG PET no manejo de pacientes oncológicos também foram avaliados. A 18F-FDG PET deve ser utilizada como ferramenta adicional aos métodos de imagem convencionais como tomografia computadorizada e ressonância magnética. Resultados positivos que sugiram alteração no manejo clínico devem ser confirmados por exame histopatológico. A 18F-FDG PET deve ser utilizada no manejo clínico apropriado para o diagnóstico de cânceres do sistema respiratório, cabeça e pescoço, sistema digestivo, mama, melanoma, órgão genitais, tireoide, sistema nervoso central, linfoma e tumor primário oculto.

Impact of 18F-FDG PET/CT on therapeutic management in the initial staging of esophageal cancer

ObjectiveThe incidence of esophageal cancer has increased considerably over recent years, it now being the 6th most frequent cause of cancer-related death. Our study has aimed to compare the clinical value of PET/CT and CT scan in the initial staging of patients with esophageal cancer. Material and methodsFifty nine patients (6 women) diagnosed of esophageal cancer were assessed retrospectively. All patients underwent diagnostic CT scan and PET/CT for initial staging within 3 to 15 days following clinical diagnosis. ResultsPET/CT showed intracellular 18F-FDG entrapment having pathological significance in all the tumors (100%), signs of locoregional lymph node infiltration (N1) in 34 and a total of 19 lesions consistent with metastasis (M1) in 14 patients (23.72%). The CT scan detected malignancy in 57 patients (96.6%), abnormal lymph node in 32 patients and 17 N1 in 12 patients (20.33%). In three cases, CT- PET detected synchronous esophageal lesion in staging studies for other neoplastic processes (lung and ear-nose-throat). ConclusionPET/CT showed a higher detection rate of primary malignant lesions, abnormal lymph nodes and distant metastases. A change in stage was only observed in two patients.

The impact of 18F-FDG PET/CT in patients with liver metastases

The aim of this study was to assess the performance of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) versus dedicated contrast-enhanced CT (CECT) in the detection of metastatic liver disease. All patients that presented to our Institution with suspected metastatic liver disease who underwent (18)F-FDG PET/CT and CECT within 6 weeks of each other, were retrospectively analyzed, covering a 5-year period. One hundred and thirty-one patients (67 men, 64 women; mean age 62) were identified. Seventy-five had colorectal carcinoma and 56 had other malignancies. The performance of CECT and that of (18)F-FDG-PET/CT in detecting liver metastases were compared. The ability of each to detect local recurrence, extrahepatic metastases and to alter patient management was recorded. The final diagnosis was based on histology, clinical and radiological follow-up (mean 23 months). In detecting hepatic metastases, (18)F-FDG-PET/CT yielded 96% sensitivity and 75% specificity, whilst CECT showed 88% sensitivity and 25% specificity. (18)F-FDG-PET/CT and CECT were concordant in 102 out of 131 patients (78%). In the colorectal group (18)F-FDG-PET/CT showed 94% sensitivity and 75% specificity, whilst CECT had 91% sensitivity and 25% specificity. In the noncolorectal group (18)F-FDG-PET/CT showed 98% sensitivity and 75% specificity whilst CECT had 85% sensitivity and 25% specificity. Overall, (18)F-FDG-PET/CT altered patient management over CECT in 25% of patients. CECT did not alter patient management over (18)F-FDG-PET/CT alone in any patients. (18)F-FDG-PET/CT performed better in detecting metastatic liver disease than CECT in both colorectal and noncolorectal malignancies, and frequently altered patient management. The future role of CECT in these patients may need to be re-evaluated to avoid potentially unnecessary duplication of investigation where (18)F-PET/CT is readily available.

The clinical impact of18F-FDG PET in papillary thyroid carcinoma with a negative131I whole body scan: A single-center study of 108 patients

To assess whether FDG PET could localize the recurrent or metastatic lesions in papillary thyroid cancer patients with negative radioiodine scan. Whole body PET was performed after injecting 370-555 MBq of 18F-FDG in 108 patients, who were suspected of having recurrence or metastasis and whose 131I whole body scans were negative. Recurrence or metastasis occurred in 63 patients by pathology or clinical assessment, whereas 45 patients remained in remission. FDG PET revealed recurrence or metastases in 59 patients (sensitivity 93.7%), whereas thyroglobulin (Tg) levels were elevated in 41 (sensitivity 65.1%). In 35 of 45 patients in remission, FDG PET was negative (specificity 77.8%). When patients positive for antithyroglobulin antibody were excluded, the sensitivity and specificity of serum Tg became 84.8% and 46.9%, respectively. Compared to Tg measurement, FDG PET detected more metastatic lesions in cervical lymph nodes. Of 40 patients with a negative radioiodine scan showing diffuse hepatic uptake, metastases occurred in 23 patients and remission in 17. FDG PET showed 100% sensitivity and 76.5% specificity in the detection of recurrence in these 40 patients. FDG PET is useful for localizing recurrent or metastatic lesions in 131I scan-negative thyroid cancer patients. In particular, it is superior to serum Tg measurement for identifying metastases to cervical lymph nodes. We recommend its use in cases of negative radioiodine scan with diffuse hepatic uptake.