Positron Emission Tomography-computed Tomography Findings Research Articles

Evaluation of the Prognostic Value of Positron Emission Tomography-Computed Tomography (PET-CT) at Diagnosis and Follow-up in Transplant-Eligible Newly Diagnosed Multiple Myeloma (TE NDMM) Patients Treated in the Phase 3 Cassiopeia Study: Results of the Cassiopet Companion Study

Evaluation of the Prognostic Value of Positron Emission Tomography-Computed Tomography (PET-CT) at Diagnosis and Follow-up in Transplant-Eligible Newly Diagnosed Multiple Myeloma (TE NDMM) Patients Treated in the Phase 3 Cassiopeia Study: Results of the Cassiopet Companion Study

HIV status does not have an impact on positron emission tomography-computed tomography (PET-CT) findings or radiotherapy treatment recommendations in patients with locally advanced cervical cancer

IntroductionPositron emission tomography-computed tomography (PET-CT) imaging is commonly used to identify nodal involvement in locally advanced cervical carcinoma, but its appropriateness for that purpose among HIV-positive patients has rarely been...

Adenoid cystic carcinoma of trachea: Findings on 18F FDG positron emission tomography-computed tomography

Adenoid cystic carcinoma (ACC) of the trachea is the second most common tumor of trachea after squamous cell carcinomas. It arises from the submucosal layer and predominantly has a rapid locoregional spread. We describe the 18F FDG positron emission tomography-computed tomography findings of a 51-year-old woman, a biopsy-proven case of ACC of trachea who underwent the scan for initial staging.

Pheochromocytoma: Positive on 131I-MIBG single-photon emission computed tomography-computed tomography and negative on 68Ga DOTANOC positron emission tomography-computed tomography

Pheochromocytomas are tumors arising from sympathetic lineage-derived cells in adrenal medulla, and 68Ga DOTANOC positron emission tomography-computed tomography (PET-CT) has been found to be superior than 131I MIBG single-photon emission computed tomography-computed tomography (SPECT-CT) for initial localization/diagnosis of the adrenal lesion. We discuss the 68DOTANOC PET-CT and 131I MIBG SPECT-CT findings of a 24-year-old male who presented with clinical and biochemical findings suspicious of pheochromocytoma.

Prognostic Relevance of Medullary Abnormalities in the Appendicular Skeleton Detected By Positron Emission Tomography-Computed Tomography in Patients with Newly Diagnosed Multiple Myeloma

Background: Positron emission tomography-computed tomography (PET-CT) is a valuable tool in the initial evaluation of myeloma and related disorders. However, the prognostic value of PET-CT has not been fully elucidated. We recently reported the prognostic significance of medullary abnormalities in the appendicular skeleton (AS) detected by multidetector computed tomography (MDCT) in patients with multiple myeloma (MM) [Blood Adv, 2018. 2(9): p.1032-39].The study reported that medullary abnormalities in AS detected by MDCT showed different fluourodeoxyglucose-avidity ranging from entirely negative to diffusely positive on concurrently performed PET-CT, despite the presence of unequivocal infiltration of abnormal lesions in AS on MDCT. We further investigate the prognostic relevance of medullary abnormalities in AS by PET-CT in symptomatic MM.Methods: We identified a total of 211 consecutive patients with newly diagnosed, symptomatic MM diagnosed and treated between April 2008 and February 2018 at Kameda Medical Center, Kamogowa-shi, Japan. They were evaluated with pretreatment whole-body PET-CT. We included only patients who had been treated with novel agents. PET-CT imaging was performed as previously reported [Blood, 2011. 118(23): p.5989-95]. PET-CT positivity and negativity were also defined as previously described.Results: Median age of the patients was 73.5 years [interquartile range (IQR): 66.3-80.3 years). There were 129 (61.1%) patients who showed abnormal findings on PET-CT. Consistent with previous reports, known high-risk PET-CT findings including the presence of >3 systemic focal lesions (FLs), maximum standardized uptake value (SUVmax) >4.2, and extramedullary disease were observed in 91 (43.1%), 97 (46.0%), and 11 (5.2%) patients, respectively. Receiver operating characteristic analysis determined the optimal cutoff value of AS focal lesions (AS-FLs) on PET-CT as 3. We then divided patients into two groups with ≤3 or >3 AS-FLs (Fig. 1). There were 35 (16.6%) patients with >3 AS-FLs, and their levels of clonal circulating plasma cells and prevalence of del(17p) and t(14;16) were higher than those in patients without AS-FLs. Patients with >3 AS-FLs showed significantly shorter progression-free survival (PFS) and overall survival (OS) than those without [median PFS: 12.8 and 35.6 months, respectively; P < 0.001, and median OS: 33.4 months and not reached (NR), respectively; P < 0.001]. Patients with 1-3 AS-FLs did not show significant differences in PFS and OS compared to patients with no AS-FL (Fig. 2). In addition, this finding retained its prognostic value for PFS and OS in multivariate analysis [hazard ratio (HR); 2.35, 95% confidence interval (CI); 1.42-3.88; P < 0.001 for PFS, and HR; 2.86, 95% CI; 1.60-5.09; P < 0.001 for OS] (Table 1). As previously described, we observed that the known high-risk PET findings including the presence of >3 systemic FLs and SUVmax> 4.2 had an unfavorable prognostic impact. Patients with >3 AS-FLs showed significantly shorter PFS and OS than those without, even among patients with >3 systemic FLs (Fig. 3) or SUVmax> 4.2 (Fig. 4). Furthermore, we identified 108 and 42 patients with focal/scattered and diffuse marrow pattern on MDCT, respectively. There were 16 (14.8%) and 19 (45.2%) patients with >3 AS-FLs observed on PET-CT with focal/scattered and diffuse marrow pattern on MDCT, respectively. These patients showed shorter PFS and OS than those without AS-FLs among patients with the same AS marrow pattern on MDCT.Conclusions: To the best of our knowledge, ours is the first study to demonstrate that the presence of >3 FLs in AS detected by pretreatment PET-CT was robustly predictive of unfavorable survival independent of known risk factors, including existing high-risk PET-CT findings in patients with newly diagnosed MM. The findings in AS may potentially complement and improve the prognostic performance of PET-CT. Further systematic studies are warranted for the validation of our results and development of more accurate prognostic systems incorporating cross-sectional imaging. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

P2.01-64 Prognostic Value of PET-CT after Induction Chemoradiotherapy and Curative Surgery in IIIA-N2 NSCLC: A Multi-Institutional Analysis

We evaluate the correlation of clinical staging on positron emission tomography-computed tomography (PET-CT) and pathologic staging and the prognostic value of PET-CT after induction chemotherapy in patients with locally advanced Non-Small Cell Lung Cancer (NSCLC). We analyzed 42 cases of clinical stage IIIA-N2 NSCLC who receive 2 to 4 cycles of pre-operative chemotherapy with or without radiation followed by curative resection. The maximum standard uptake value (SUVmax) of the suspected lesion on PET-CT was recorded. PET-CT findings after induction chemotherapy were compared with those of initial PET-CT and pathology after surgery. The accuracy of PET-CT in restaging of the primary tumor after induction chemotherapy was 50.0%. 18 (42.8%) of 42 patients were underestimated ycT stage, and 3 (7.1%) of 42 patients was overestimated ycT stage by PET-CT scan. The accuracy of PET-CT in restaging of the nodal disease was 71.4%. 6 (14.3%) of 42 patients were underestimated ycN stage, and 6 (14.3%) of 42 patients were overestimated ycN stage as compared with pathologic staging. The 2-year overall survival (OS) and relapse-free survival (RFS) rate were 68.5% and 40.9%, respectively. Complete responders (ycT0N0M0) on PET-CT after induction chemotherapy had a significantly longer RFS time than did incomplete responders (28.3 months versus 9.1 months, P = 0.021). Complete response on PET-CT after induction chemotherapy with or without radiation was a good prognosticator for RFS in stage IIIA-N2 NSCLC patients who received surgery. However, response evaluation on PET-CT after induction chemotherapy should be interpreted with caution due to its unacceptable accuracy.

Mediastinal node staging by positron emission tomography-computed tomography and selective endoscopic ultrasound with fine needle aspiration for patients with upper gastrointestinal cancer: Results from a regional centre.

AIMTo investigate the impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and positron emission tomography-computed tomography (PET-CT) in the nodal staging of upper gastrointestinal (GI) cancer in a tertiary referral centre.METHODSWe performed a retrospective review of prospectively recorded data held on all patients with a diagnosis of upper GI cancer made between January 2009 and December 2015. Only those patients who had both a PET-CT and EUS with FNA sampling of a mediastinal node distant from the primary tumour were included. Using a positive EUS-FNA result as the gold standard for lymph node involvement, the sensitivity, specificity, positive and negative predictive values (PPV and NPV) and accuracy of PET-CT in the staging of mediastinal lymph nodes were calculated. The impact on therapeutic strategy of adding EUS-FNA to PET-CT was assessed.RESULTSOne hundred and twenty one patients were included. Sixty nine patients had a diagnosis of oesophageal adenocarcinoma (Thirty one of whom were junctional), forty eight had oesophageal squamous cell carcinoma and four had gastric adenocarcinoma. The FNA results were inadequate in eleven cases and the PET-CT findings were indeterminate in two cases, therefore thirteen patients (10.7%) were excluded from further analysis. There was concordance between PET-CT and EUS-FNA findings in seventy one of the remaining one hundred and eight patients (65.7%). The sensitivity, specificity, PPV and NPV values of PET-CT were 92.5%, 50%, 52.1% and 91.9% respectively. There was discordance between PET-CT and EUS-FNA findings in thirty seven out of one hundred and eight patients (34.3%). MDT discussion led to a radical treatment pathway in twenty seven of these cases, after the final tumour stage was altered as a direct consequence of the EUS-FNA findings. Of these patients, fourteen (51.9%) experienced clinical remission of a median of nine months (range three to forty two months).CONCLUSIONEUS-FNA leads to altered staging of upper GI cancer, resulting in more patients receiving radical treatment that would have been the case using PET-CT staging alone.

Application of positron emission tomography-computed tomography in the diagnosis of pulmonary ground-glass nodules.

The aim of the present study was to investigate the value of positron emission tomography-computed tomography (PET-CT) using 18F-fluorodeoxyglucose in the clinical diagnosis of pulmonary ground-glass nodule. In total, 54 patients with pulmonary GGN that were identified by PET-CT examination were selected and confirmed by pathology and clinical diagnosis in hospital between April 2014 and April 2015. The association between PET-CT findings and pathology, and the value of PET-CT were then evaluated. In the 54 patients, solitary pulmonary GGN with a nodule diameter of between 0.6 and 2.0 cm were detected. Amongst them, the PET-CT examination of 42 patients revealed hyper metabolic nodules, and were all mixed GGN type nodules with a diameter >1 cm. The PET-CT examination of the remaining 12 patients demonstrated no evidence of metabolic abnormalities and the nodules in these patients were pure or mixed GGN with a diameter <1 cm (except 2 cases with a diameter ≥1 cm). Furthermore, the diagnoses for all patients were pathologically confirmed by CT-guided needle biopsy or thoracoscopic surgical resection. Amongst them, there were 41 cases of lung adenocarcinoma, 4 cases of fungal infection, 7 cases of inflammation and 2 cases of adenomatoid hyperplasia. Additionally, PET-CT has a lower detection rate for smaller GGN exhibits no clear advantage for pure GGN, but has a higher detection rate for larger GGN. In conclusion, to a certain extent, PET-CT makes up for the shortcomings of traditional imaging and has some clinical value for the diagnosis of GGN.

Real-life Experience for Integration of PET-CT inthe Treatment of Hodgkin Lymphoma inLebanon.

Hodgkin lymphoma (HL) is a highly curable disease;< 80% of patients will achieve long-term survival. Positron emission tomography-computed tomography (PET-CT) has played a major role in the evaluation of both disease staging and response and has become an essential component in tailoring patients' treatment. We report the effect of integrating PET-CT into the management of HL in Lebanon. We analyzed the data regarding the usage of PET-CT at diagnosis, during treatment (interim PET), and at the end of treatment. We also analyzed the PET-CT findings from 2009 to2015. The first PET-CT system was introduced in Lebanon in April 2002 but was not used for the evaluation of HL. Early in 2009, we started to incorporate PET-CT into the treatment of HL. By the end of 2009, 70% of patients were undergoing PET-CT at diagnosis and at the end of treatment. This proportion remained constant until 2013, when an increase occurred, with≤ 94% of patients undergoing PET-CT at diagnosis. The usage of CT at diagnosis decreased significantly from 70% before 2009 to 52% after 2015. In contrast, CT usage at the end of treatment has fluctuated from 10% in 2009 to 0% in 2012, 2013, and 2014 and 11.76% in2015. Functional imaging techniques are increasing in popularity compared with anatomic imaging. The usage of PET-CT has emerged as a highly valuable staging and follow-up method in the treatment of HL 8 years after the introduction of PET in Lebanon. PET was used first to improve the staging, then to evaluate the treatment response, and, recently, to tailor therapy according to the response.

76P - Interpretation and prognostic value of PET-CT after induction chemotherapy with or without radiation in IIIA-N2 non-small cell lung cancer patients who receive curative surgery

Background: We evaluated the correlation of clinical staging on positron emission tomography-computed tomography (PET-CT) and pathologic staging and the prognostic value of PET-CT after induction chemotherapy in patients with locally advanced non-small cell lung cancer (NSCLC). Methods: We analyzed 42 cases of clinical stage IIIA-N2 NSCLC who received 2 to 4 cycles of pre-operative chemotherapy with or without radiation followed by curative resection. The maximum standard uptake value (SUVmax) of the suspected lesion on PET-CT was recorded. PET-CT findings after induction chemotherapy were compared with those of initial PET-CT and pathology after surgery. Results: The accuracy of PET-CT in restaging of the primary tumor after induction chemotherapy was 50.0%. 18 (42.8%) of 42 patients were underestimated ycT stage, and 3 (7.1%) of 42 patients was overestimated ycT stage by PET-CT scan. The accuracy of PET-CT in restaging of the nodal disease was 71.4%. 6 (14.3%) of 42 patients were underestimated ycN stage, and 6 (14.3%) of 42 patients were overestimated ycN stage as compared with pathologic staging. The 2-year overall survival (OS) and relapse-free survival (RFS) rate were 68.5% and 40.9%, respectively. Complete responders (ycT0N0M0) on PET-CT after induction chemotherapy had a significantly longer RFS time than did incomplete responders (28.3 months versus 9.1 months, P = 0.021). Conclusions: Complete response on PET-CT after induction chemotherapy with or without radiation was a good prognostic indicator for RFS in stage IIIA-N2 NSCLC patients who received surgery. However, response evaluation on PET-CT after induction chemotherapy should be interpreted with caution due to its unacceptable accuracy. Legal entity responsible for the study: Jong Hoon Lee Funding: None Disclosure: The author has declared no conflicts of interest.

Variations in positron emission tomography-computed tomography findings for patients receiving neoadjuvant and non-neoadjuvant therapy for non-small cell lung cancer.

The aims of this study were to predict locoregional lymph node (LN) metastases using positron emission tomography-computed tomography (PET-CT) and investigate variations in PET-CT findings for patients receiving neoadjuvant (NT) and non-neoadjuvant (non-NT) for non-small cell lung cancer (NSCLC). Data from 578 consecutive patients from January 2010 to December 2015 who met this study inclusion criteria were retrospectively reviewed. All patients underwent curative and complete resections for NSCLC in a Korean hospital. We analyzed the associations between maximum standard uptake value (SUVmax) and pathological stage, compared disease-free survival (DFS) and overall survival (OS), investigated relationships among SUVmax values, evaluated LN status and compared pathologically negative and positive LNs by SUVmax, and assessed the influence of neoadjuvant therapy on SUVmax. All LNs were analyzed separately for N1 and N2. (I) For non-NT, we found significantly positive associations between pathological stage and SUVmax (tumor, N1 LN, and N2 LN, all P<0.001). For NT, we found positive correlations between pathological stage and tumor and N2 LN SUVmax, except for N1 LN (tumor P=0.005, N1 LN P=0.981, N2 LN P=0.045); (II) for non-NT, the low SUVmax group had higher DFS and OS than the high SUVmax group (DFS: tumor SUVmax P<0.001, N1 LN SUVmax P=0.002, N2 LN SUVmax P=0.027; OS: tumor SUVmax P<0.001, N1 LN SUVmax P=0.006, N2 LN SUVmax P=0.006). For NT, the low SUVmax group had nonsignificantly higher DFS and OS than the high SUVmax group. When age, sex, and SUVmax were equal, pathological stages were significantly higher for NT than non-NT (P<0.001). Non-NT had significantly higher DFS (P=0.001) and OS (P=0.024) than NT; (III) for non-NT, tumor, N1 LN, and N2 SUVmax were positively associated (all P<0.001). For NT, tumor and N2 SUVmax (P<0.001), and N1 and N2 SUVmax (P=0.025) correlated positively; tumor and N1 LN SUVmax did not (P=0.911); (IV) for non-NT, there was significant cutoff values for prediction of LN metastases using both tumor and LN SUVmax (N1 LN: tumor SUVmax cutoff 5.95, sensitivity 66.3%, specificity 66.0%, area =0.748, P<0.001; N1 LN SUVmax cutoff 2.05, sensitivity 57.83%, specificity 66.43%, area =0.676, P<0.001) (N2 LN: tumor SUVmax cutoff 5.95, sensitivity 63.04%, specificity 63.95%, area =0.726, P<0.001; N2 LN SUVmax cutoff 2.05, sensitivity 65.22%, specificity 69.96%, area =0.678, P<0.001). For NT, no SUVmax values significantly predicted LN metastases; () Pathologically malignant and benign LN SUVmax after neoadjuvant therapy were not different (N1 LN P=0.570, N2 LN P=0.105). For non-NT, pathologically malignant LN SUVmax was significantly higher than pathologically benign LN SUVmax (N1 LN P<0.001, N2 LN P=0.001). This study showed variations in PET-CT findings for NT and non-NT, which should be verified for evaluation and management, especially for surgery planning. SUV max is not a reliable predictor of lymphatic involvement after neoadjuvant therapy in patients with NSCLC. Surgery should not be withheld or delayed based on lack of knowledge about variations in PET-CT findings, which must be interpreted in conjunction with other conditions. Further studies on interpretation of PET-CT findings, especially for NT, are needed for better management and prognosis.

Pulmonary actinomycosis mimicking lung cancer on positron emission tomography.

Pulmonary actinomycosis frequently mimics lung malignancy on radiologic imaging studies. Positron emission tomography-computed tomography (PET-CT) is a useful diagnostic modality for differentiating lung malignancy from benign diseases. However, few studies evaluated PET-CT findings of pulmonary actinomycosis. Therefore, it is unclear whether PET-CT is helpful to distinguish lung malignancy from benign lung disease when pulmonary actinomycosis is clinically suspected. We investigated PET-CT findings in 11 patients with pathologically confirmed pulmonary actinomycosis. The median maximal standardized uptake value (SUV) on PET-CT of pulmonary actinomycosis was increased to 5.5 (interquartile range, 4.2–8.8), which was higher than the threshold value of 2.5 indicating malignancy. Pulmonary actinomycosis without central necrosis demonstrated higher maximal SUV of 7.5 (4.9–12.2) compared to 4.8 (3.2–5.6) of ones with central necrosis. PET-CT might be not helpful in differentiating lung malignancy from benign lesions when pulmonary actinomycosis is clinically suspected.

18-F-FDG PET-CT in Monitoring of Chemotherapeutic Effect in a Case of Metastatic Hepatic Epithelioid Hemangioendothelioma.

Hepatic epithelioid hemangioendothelioma is a rare variant of mesenchymal tumor. Surgical resection or partial hepatectomy is the treatment of choice in the case of localized disease. However, in metastatic cases, chemotherapeutic drugs targeting the tyrosine kinase are being used. We hereby present 18-F-fludeoxyglucose positron emission tomography-computed tomography findings in a case of a 35-year old woman with metastatic HEHE showing significant response to Sorafenib therapy after 6 months.

Cardiac and Skeletal Muscle Metastases From Squamous Cell Carcinoma of the Bladder: Positron Emission Tomography-Computed Tomography Findings

We describe the positron emission tomography-computed tomography (PET-CT) findings of a patient who presented to the emergency room with chest pain and palpitations and underwent a radical cystectomy 6 months earlier because of a squamous cell carcinoma of the bladder (SCCB). Cardiac catheterization ruled out coronary artery occlusion, but PET-CT showed multiple F-18-fluorodeoxyglucose-avid lesions involving multiple skeletal muscles and the heart, consistent with metastases. A CT-guided biopsy of 1 skeletal muscle lesion confirmed a metastasis with the same pathologic features as the SCCB. To our knowledge, this is the first reported case of an SCCB with metastases to multiple skeletal muscles and myocardium detected with PET-CT.

Sarcoid reaction in the spleen after sigmoid colon cancer resection: a case report.

BackgroundA sarcoid reaction is a phenomenon characterized by histologically proven granulomatous lesions without evidence of sarcoidosis. This pathology is a benign tumor itself, but several reports have described sarcoid reactions accompanying malignant tumors. Sarcoid reactions occur in various cancers, such as skin, lung, ovary, stomach, and breast cancers. However, only a few published reports have described sarcoid reactions in patients with colorectal cancer.Case presentationA 76-year-old woman underwent laparoscopic sigmoidectomy for sigmoid colon cancer. The postoperative follow-up computed tomography and 18-fluorodeoxyglucose positron emission tomography–computed tomography findings were suspicious for splenic metastasis of the sigmoid colon cancer. The patient then underwent laparoscopic splenectomy. Histopathological examination of the resected lymph nodes and spleen showed a non-caseating epithelioid cell granuloma. The patient was diagnosed with a sarcoid reaction.ConclusionsTo our knowledge, this is the first report of a sarcoid reaction in the spleen and regional lymph nodes after colon cancer resection. The effect of a sarcoid reaction on the prognosis in patients with colorectal cancer has not been fully determined because of the small number of such cases. Further analyses involving a larger number of cases are necessary to evaluate the relationship between sarcoid reactions and prognosis in patients with colorectal cancer. We herein present an extremely rare case of a sarcoid reaction in the spleen and regional lymph nodes.

A study about different findings of PET-CT between neoadjuvant and non-neoadjuvant therapy: SUVmax is not a reliable predictor of lymphatic involvement after neoadjuvant therapy for esophageal cancer.

No definitive findings or established guidelines have been published for the evaluation of esophageal tumors (tumor) and regional lymph nodes (LN) using positron emission tomography computed tomography (PET-CT) in patients with esophageal cancer. In addition, it remains unclear whether PET-CT findings vary between neoadjuvant (NT) and non-neoadjuvant (non-NT) therapy cases. Therefore, preoperative evaluation using PET-CT might provide unreliable information and influence the management plan for esophageal cancer. The purpose of the present study is to clarify the different findings of PET-CT between NT and non-NT in surgical esophageal cancer cases and to predict LN metastasis. We retrospectively reviewed the medical records of 192 consecutive cases that met this study's inclusion criteria from January 2009 to December 2014. All patients underwent curative and complete esophagectomy for intra-thoracic esophageal cancer at the department of thoracic and cardiovascular surgery in a single tertiary Korean hospital. We compiled and analyzed maximum standard uptake values (SUVmax) of tumor and LNs with other clinical information (chronic lung disease, history of previous other primary cancer, sex, pathological findings, NT, and other clinical data). (I) In NT, a positive correlation between T stage and SUVmax was found (tumor SUVmax P<0.001, LN SUVmax P=0.010); however, no relationship between N stage and SUVmax was found. In non-NT, a positive correlation between pathological stage (T and N stage) and SUVmax was found (T stage, tumor SUVmax P<0.001, LN SUVmax P=0.001; N stage, tumor SUVmax P=0.003, LN SUVmax P=0.021); (II) In NT, the low SUVmax group had higher disease-free survival (DFS) and overall survival (OS) than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.142; OS, tumor SUVmax P<0.001, LN SUVmax P=0.002). In non-NT, the low SUVmax group also had higher DFS and OS than the high SUVmax group (DFS, tumor SUVmax P<0.001, LN SUVmax P=0.008; OS, tumor SUVmax P=0.029, LN SUVmax P=0.016). SUVmax values being equal, non-NT had significantly higher DFS and OS than NT (P=0.011, P=0.009, respectively), despite the absence of significant differences in pathological stage; (III) Tumor SUVmax had a positive correlation with LN SUVmax in both NT and non-NT (P=0.006, P<0.001, respectively); (IV) In NT, there were no diagnostic findings of LN metastases using SUVmax. However, in non-NT, significant cutoff values for diagnosis of LN metastases using both tumor and LN SUVmax were found (tumor SUVmax cutoff value 4.9, P=0.008; LN SUVmax cutoff value 2.5, P=0.045); (V) In NT, there was no significant difference in LN SUVmax between pathologically negative and positive LNs. However, in non-NT, the LN SUVmax of pathologically positive LNs was significantly higher than that of pathologically negative LNs (P=0.042); (VI) There were no significant differences in tumor and LN SUVmax according to various factors, including chronic lung disease (COPD, bronchiectasis), age, previous cancers, and sex, regardless of NT. This study showed that there were some different findings of PET-CT using SUVmax between NT and non-NT. These findings should be clarified for further evaluation and management, especially of surgery, which should not be withheld out of ignorance of these different PET-CT findings and should be considered carefully in conjunction with other conditions. In addition, further studies about the effects of NT on PET-CT findings are required to improve the utility of PET-CT to evaluate the LNs in esophageal cancer.

The diagnostic accuracy of integrated positron emission tomography/computed tomography in the evaluation of pulmonary mass lesions in a tuberculosis-endemic area.

Integrated positron emission tomography/computed tomography (PET-CT) is a well-validated modality for assessing pulmonary mass lesions and specifically for estimating risk of malignancy. Tuberculosis (TB) is known to cause false-positive PET-CT findings. To investigate the utility of PET-CT in the evaluation of pulmonary mass lesions and nodules in a high TB prevalence setting. All patients referred for the evaluation of a solitary pulmonary nodule or mass and who underwent PET-CT scanning over a 3-year period were included. The PET-CT findings, including maximum standardised uptake value (SUVmax), were compared with the gold standard (tissue or microbiological diagnosis). The sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for malignant disease were calculated according to the SUVmax cut-off of 2.5 and a proposed cut-off obtained from a receiver operating characteristic (ROC) curve. Forty-nine patients (mean (standard deviation) age 60.1 (10.2) years; 29 males) were included, of whom 30 had malignancy. Using an SUVmax cut-off of 2.5, PET-CT had a sensitivity, specificity, positive and negative predictive value and diagnostic accuracy for malignancy of 93.3%, 36.8%, 70.0%, 77.8% and 71.4%, respectively. After a ROC curve analysis, a suggested SUVmax cut-off of 5.0 improved the specificity to 78.9% and the diagnostic accuracy to 86.7%, with a small reduction in sensitivity to 90.0%. The diagnostic accuracy of PET-CT in the evaluation of pulmonary mass lesions using the conventional SUVmax cut-off of 2.5 was reduced in a TB-endemic area. An SUVmax cut-off of 5.0 has a higher specificity and diagnostic accuracy for malignancy, with a comparable sensitivity.

Interpretation and Prognostic Value of Positron Emission Tomography-Computed Tomography After Induction Chemotherapy With or Without Radiation in IIIA-N2 Non-small Cell Lung Cancer Patients Who Receive Curative Surgery.

We evaluate the correlation of clinical staging on positron emission tomography-computed tomography (PET-CT) and pathologic staging and the prognostic value of PET-CT after induction chemotherapy in patients with locally advanced nonsmall cell lung cancer (NSCLC).We analyzed 42 cases of clinical stage IIIA-N2 NSCLC who receive 2 to 4 cycles of preoperative chemotherapy with or without radiation followed by curative resection. The maximum standard uptake value (SUVmax) of the suspected lesion on PET-CT was recorded. PET-CT findings after induction chemotherapy were compared with those of initial PET-CT and pathology after surgery.The accuracy of PET-CT in restaging of the primary tumor after induction chemotherapy was 50.0%. Eighteen (42.8%) of 42 patients were underestimated ycT stage, and 3 (7.1%) of 42 patients was overestimated ycT stage by PET-CT scan. The accuracy of PET-CT in restaging of the nodal disease was 71.4%. Six (14.3%) of 42 patients were underestimated ycN stage, and 6 (14.3%) of 42 patients were overestimated ycN stage as compared with pathologic staging. The 2-year overall survival (OS) and relapse-free survival (RFS) rate were 68.5% and 40.9%, respectively. Complete responders (ycT0N0M0) on PET-CT after induction chemotherapy had a significantly longer RFS time than did incomplete responders (28.3 vs 9.1 months, P = 0.021).Complete response on PET-CT after induction chemotherapy with or without radiation was a good prognosticator for RFS in stage IIIA-N2 NSCLC patients who received surgery. However, response evaluation on PET-CT after induction chemotherapy should be interpreted with caution due to its unacceptable accuracy.

Investigating the Impact of Positron Emission Tomography–Computed Tomography Versus Computed Tomography Alone for High-risk Volume Selection in Head and Neck and Lung Patients Undergoing Radiotherapy: Interim Findings

IntroductionThe aim of this study was to quantify the impact of positron emission tomography–computed tomography (PET-CT) on clinical target volume (CTV) selection in non–small cell lung cancer (NSCLC) and head and neck squamous cell cancer (HNSCC) cancer patients. MethodsEight radiation oncologists with expertise in either NSCLC or HNSCC prospectively contoured target volumes with and without PET-CT findings. All volumes were contoured manually, and computed tomography (CT)-alone contours were identified as gross tumour volume CT and clinical target volume (CTV) CT, whereas those contoured with the aid of PET-CT were GTV PET and CTV PET. PET-CT contours were used for actual treatment delivery. Test treatment plans were generated based on the CT-alone volumes and applied to the final PET-CT contours. PET-CT had an impact if the test plans failed department quality assurance guidelines. For each patient, the dose to critical structures and any changes in the treatment plan were recorded. ResultsEighty patients (49 HNSCC and 31 NSCLC) were analyzed. PET-CT impacted 42.9% of HNSCC cases and 45.2% of NSCLC cases. On average, PET-CT volumes were significantly larger than CT-alone volumes for HNSCC cases (P < .01) but not for NSCLC cases (P = .29). For organs at risk, no statistically significant differences were noted, with the exception of mean parotid dose for the right and left parotids (P = .0137and P = .0330, respectively). ConclusionsInterim analysis of data found that the use of PET-CT in the radiation therapy planning process impacted CTV selection, resulting in a major change in radiation therapy plans in 43.7% (HNSCC 42.9% and NSCLC 45.2%) of patients.

Usefulness of positron emission tomography-computed tomography in pre-operative evaluation of intra-thoracic esophageal cancer.

BackgroundThe purpose of the study was to clarify the usefulness of positron emission tomography-computed tomography (PET-CT) for pre-operative evaluation of intra-thoracic esophageal cancer, especially in terms of regional lymph node status.MethodsMedical records of 93 consecutive cases from July 2007 to October 2012 were retrospectively reviewed. All patients underwent curative and complete esophagectomies for intra-thoracic esophageal cancer. We compared pre-operative maximum standard uptake values (SUVmax) of esophageal tumors and regional lymph nodes (LN) with other variables (chronic obstructive pulmonary disease, history of previous other primary cancer, gender, differentiation, and neoadjuvant therapy). In addition, the SUVmax of tumors and LNs were analyzed with pathologic findings.ResultsThere was no significant difference of each tumor and LN SUVmax according to factors including chronic lung disease, age, history of previous other cancer, differentiation, and gender. Pre-operative evaluations by PET-CT were not accurate (tumor sensitivity 76.4%, specificity 25%; LN sensitivity 45.2%, specificity 54.8%). Receiver operating characteristic analysis showed that LN metastasis could not be appropriately diagnosed with SUVmax (P = 0.871). There was no difference in SUVmax between pathologically positive and negative LN subgroups. Tumor SUVmax correlated with the progression of esophageal cancer in patients without neoadjuvant therapy (P < 0.001). However, LN SUVmax had no correlation with overall pathologic stage. After neoadjuvant therapy, there were significant decreases in SUVmax in both pathologically positive and negative LN subgroups (P = 0.043, P = 0.008).Conclusion Surgery should not be withheld in N-stage according to PET-CT findings and carefully considered in conjunction with other conditions.