Sensitivity Of Positron Emission Tomography-computed Tomography Research Articles

Diagnostic accuracy and clinical impact of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) in Positron Emission Tomography - Computed Tomography (PET-CT)-positive mediastinal lymphadenopathies in patients with thoracic or extra-thoracic malignancies

BackgroundThe high sensitivity of PET-CT can identify hypermetabolic mediastinal adenopathies during cancer management, but specificity is low and a biopsy is sometimes required to eliminate benign adenopathies. MethodsThis prospective diagnostic accuracy study included patients with hypermetabolic mediastinal lymphadenopathies revealed on PET-CT during either the initial management of a cancer, treatment evaluation, or monitoring. All patients underwent EUS-FNA. Diagnoses of malignancy based on cytological analysis following EUS-FNA were compared with clinical and radiological follow-up information. The treatment strategy decided before the results of the EUS-FNA pathology reports (Multidisciplinary Team Meeting [MTM-1]) was recorded and compared to the treatment strategy decided once pathological data from EUS-FNA were available (MTM-2). Main findingsBetween 2013 and 2018, 75 patients were included with 47 eligible and evaluable patients. Sensitivity, specificity, and positive and negative predictive values of EUS-FNA were 93%, 100%, 100% and 90%, respectively. The concordance value between the therapeutic strategies determined for MTM-1 and MTM-2 was 44.7%. There were no significant differences in the intensity of fixation on PET-CT between malignant and benign lesions. ConclusionThe diagnostic accuracy of the minimally invasive EUS-FNA procedure is sufficiently robust to avoid the need for diagnostic surgery. The combination of PET-CT and EUS-FNA may alter the therapeutic strategy that would be considered after PET-CT alone. REGISTRATIONNCT01892501

Assessment of Lymph Node Involvement with PET-CT in Advanced Epithelial Ovarian Cancer. A FRANCOGYN Group Study.

The objective of our study is to evaluate the diagnostic performance of positron emission tomography/computed tomography (PET-CT) for the assessment of lymph node involvement in advanced epithelial ovarian, fallopian tubal or peritoneal cancer (EOC). This was a retrospective, bicentric study. We included all patients over 18 years of age with a histological diagnosis of advanced EOC who had undergone PET-CT at the time of diagnosis or prior to cytoreduction surgery with pelvic or para-aortic lymphadenectomy. We included 145 patients with primary advanced EOC. The performance of PET-CT was calculated from the data of 63 patients. The sensitivity of PET-CT for preoperative lymph node evaluation was 26.7%, specificity was 90.9%, PPV was 72.7%, and NPV was 57.7%. The accuracy rate was 60.3%, and the false-negative rate was 34.9%. In the case of primary cytoreduction (n = 16), the sensitivity of PET-CT was 50%, specificity was 87.5%, PPV was 80%, and NPV was 63.6%. The accuracy rate was 68.8%, and the false negative rate was 25%. After neoadjuvant chemotherapy (n = 47), the sensitivity of PET-CT was 18.2%, specificity was 92%, PPV was 66.7%, and NPV was 56.1%. The accuracy rate was 57.5%, and the false negative rate was 38.3%. Due to its high specificity, the performance of a preoperative PET-CT scan could contribute to the de-escalation and reduction of lymphadenectomy in the surgical management of advanced EOC in a significant number of patients free of lymph node metastases.

Bone marrow involvement in pediatric malignancies: a comparison study of Positron emission tomographycomputed tomography and bone marrow biopsy

The comparison of Positron emission tomography- computed tomography (PETCT) and bone marrow biopsy (BMB) modalities in detecting bone marrow disease is an up to date research topic. In this study, we aimed to compare the results of PET-CT and BMB procedures in detecting bone marrow involvement in pediatric malignancies. At the time of diagnosis, PET-CT imaging and BMB performed patients` data were evaluated, retrospectively. Malign diagnoses were Hodgkin's lymphoma in 23 (30.7%), non-Hodgkin's lymphoma in 20 (26.7%), neuroblastoma in 11 (14.7%), Ewing sarcoma in 10 (13.7%), Langerhans cell histiocytosis in 6 (8%), and rhabdomyosarcoma in 5 (6.6%) patients. Bone marrow involvement was detected in 39 (52%) of 75 patients. Bone marrow involvement was identified by both PET-CT and BMB in 18 (46.1%) patients, by only PET-CT in 12 (30.7%) patients, by only BMB in 9 (23%) patients. The sensitivity of PET-CT was 66%, specificity was 75%, positive predictive value was 60%, and negative predictive value was 80%. Sensitivity, spesificity, positive and negative predictive values of PETCT were different in before mentioned malignancy groups. PET-CT may not have high sensitivity and specificity to identify bone marrow involvement for each type of cancer. The approach of using bone marrow biopsy and PET-CT as complementary modalities seems reliable.

Clinical utility of F-18 FDG PET-CT in the initial evaluation of lung cancer.

Positron emission tomography-computed tomography (PET-CT) is a resource-demanding imaging modality with increasing popularity in the workup of patients with suspected or proven lung cancer. To review the clinical usefulness of this imaging modality in the diagnosis, staging, and pre-operative evaluation, we conducted a systematic literature search, review, and quality assessment using the rapid evidence assessment toolkit and the Oxford Centre for Evidence-Based Medicine methodology. The literature search resulted in 4,208 records including 918 reviews, of which 139 met the predefined criteria and were read in full to identify relevant original articles on F-18 FDG PET-CT (1) in the evaluation of solitary pulmonary nodules (n = 14), (2) in curative-intent treatment trials (n = 9), and (3) in planning of invasive procedures (n = 18). We found the following important results from the literature review: 1) PET-CT can rule out malignancy in most solitary pulmonary nodules due to high sensitivity (recommendation level A). 2) PET-CT reduces the number of futile treatment trials (recommendation level A). 3) The sensitivity of PET-CT in general is insufficient to rule out mediastinal lymph node metastasis (recommendation level A). ᅟ 1) With few exceptions, solitary pulmonary nodules can safely be considered benign if the PET-CT scan is negative. Exceptions consist of small (<1cm) and non-solid, solitary pulmonary nodules. These abnormalities should be followed up by CT in a structured programme. 2) No curative-intent treatment should be commenced until a PET-CT scan has excluded occult distant metastases. 3) In general, lymph node metastasis in the mediastinum cannot be ruled out on the basis of a negative PET-CT, and confirmative invasive staging should be performed in most patients before mediastinal metastasis is confirmed or ruled out.

18F-FDG PET-CT as a supplement to CT/MRI for detection of nodal metastasis in hypopharyngeal SCC with palpably negative neck.

To determine the diagnostic value of (18) F-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) compared with CT or magnetic resonance (MR) imaging for the detection of nodal metastasis in patients with hypopharyngeal squamous cell carcinoma (SCC) with palpably negative neck and to assess the role of PET-CT as a supplement to CT/MR. Retrospective analysis. A total of 39 patients with palpably negative neck (36 men and 3 women; average age 65.4 years) underwent tumor resection and neck dissection as primary treatment. All patients were preoperatively evaluated with PET-CT and CT and/or MR, and imaging data were retrospectively reviewed. The diagnostic performance of PET-CT, CT/MR, and a combination of PET-CT and CT/MR was assessed using histopathologic results as a gold standard. Twenty (51.3%) of the 39 patients were found to have neck metastases. On a level-based analysis, the sensitivity of PET-CT, CT/MR, and combined interpretation of PET-CT and CT/MR was 65.7%, 57.1%, and 65.7%, respectively, but without statistical significance. Of the six patients who showed false negative neck findings based on CT/MR in addition to palpation, four cases were still missed with additional PET-CT. The addition of PET-CT examination to anatomic imaging involving CT and MR did not provide additional benefit for the preoperative evaluation of cervical nodal metastasis in patients with hypopharyngeal SCC with nonpalpable neck, yielding insufficient data to spare elective neck dissection.

Primary gastric lymphoma: utility of 18F-fluorodeoxyglucose positron emission tomography-computed tomography for detecting relapse after treatment

The purpose of this study was to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography-computed tomography (PET-CT) in detecting relapse in patients with primary gastric lymphoma (PGL) post-treatment. Data of 39 previously treated patients with PGL (age: 50.3 ± 13.8 years; male: 24) who underwent 71 18F-FDG PET-CT studies for suspected relapse (n = 53) or routine follow-up (n = 18) were retrospectively evaluated. PET-CT images were evaluated both qualitatively and quantitatively (standardized uptake value [SUVmax]). A combination of clinical/imaging follow-up, endoscopy and/or histopathology was taken as the reference standard. The per patient based sensitivity of PET-CT was 96%, specificity 91% and accuracy 93%. The lymph node was the commonest site of relapse on PET-CT. Mean lesion SUVmax was 5.9 ± 3.1 (2.3–13.6). Accuracy was similar in suspected relapse and routine follow-up groups (90.5% vs. 100%; p = 0.409). Based on the data, 18F-FDG PET-CT appears to be highly accurate for the detection of relapse in patients with PGL post-treatment.

Positron emission tomography–computed tomography evaluation for recurrent differentiated thyroid carcinoma

Recurrence is observed in 15-20% of patients under surveillance following treatment of differentiated thyroid cancer (DTC). However, due to cell dedifferentiation, the recurrence may be iodine-negative, thereby compromising detection. For this reason, new methods of exploration are indispensable to enable localization of such recurrences. The purpose of this work is to review the contribution of positron emission tomography-computed tomography (PET-CT) in the exploration of iodine-negative recurrent DTC. A comprehensive review and discussion of the medical literature was carried out. Depending on the report, the sensitivity of PET-CT ranged from 70% to 85%, with up to 90% specificity. However, the large number of false negatives, which can reach 40%, is the disadvantage of this examination. PET-CT results lead to change in the therapeutic strategy in approximately 50% of patients with isolated raised serum thyroglobulin levels, and surgical exploration of a precise anatomical area in the neck. As post-treatment recurrence of a DTC can affect patient survival, a thorough diagnostic work-up is required in these cases. Where thyroglobulin levels are elevated with no uptake on 131-iodine scans, PET-CT can be a useful complementary exploration, especially for localizing the site of recurrence.

Role of the standardized uptake value of 18-fluorodeoxyglucose positron emission tomography–computed tomography in detecting the primary tumor and lymph node metastasis in colorectal cancers

To assess the role of positron emission tomography-computed tomography (PET-CT) and multidetector-row CT (MD-CT) in detecting the primary lesion and lymph node metastasis in patients with colorectal cancers. A collective total of 80 lesions resected from 77 patients were examined pathologically. We analyzed the significance of the standardized uptake value (SUV) and its relationship with the clinicopathologic findings of primary lesions and lymph node metastasis. The detectability of primary lesions and lymph node metastases on PET-CT images was compared with that on MD-CT images. The detectability of primary lesions was better on PET-CT images than on MD-CT images (p = 0.0023). We observed no significant differences in the SUV with respect to staging, tumor grade, lymphatic or vessel invasion, and macroscopic type; however, primary tumor size analysis revealed that tumors larger than 3 cm had a higher SUV than those smaller than 3 cm. The sensitivity of PET-CT for detecting lymph node metastasis was lower than that of MD-CT, but the specificity of PET-CT was higher than that of MD-CT. The SUV of primary cancers tends to increase in proportion to tumor size. Although the value of PET-CT in detecting lymph node metastasis is limited, PET -positive lymph nodes can be considered metastatic.

Integrated PET/CT system for staging and surveillance of skull base tumors

The utility of preoperative and postoperative whole body integrated positron emission tomography-computed tomography (PET-CT) scanning for staging and follow-up in patients with skull base tumors is undetermined. We prospectively evaluated PET-CT findings in 47 patients using 57 scans. Most (35/47, 75%) had anterior skull base tumors and the majority (74%) had advanced-stage (III-IV) disease. The scans showed high sensitivity for detection of various types of malignant tumors and provided 39 items of additional information, changing the clinical staging and management of 11 patients (23%). Recurrence of primary tumors was detected in 8 patients, positive regional (neck) metastases in 3, and distant metastases in 3. The positive uptake was due to osteoradionecrosis in 2 other patients. The sensitivity of PET-CT was 0.77 and the specificity was 0.81 (0.83 positive predictive value and 0.76 negative predictive value). PET-CT provides accurate data on anatomy, tumor staging, and early disease recurrence in the skull base.