Suspected Disease Recurrence Research Articles

FDG-PET Scanning has a High Impact on the Management of Patients With Merkel Cell Carcinoma

Merkel cell carcinoma (MCC) is a rare but aggressive skin cancer in which there is a paucity of published evidence regarding the role of FDG-PET scanning. The primary aim of this study is to assess the impact of staging, post-therapy response assessment and ‘re-staging’ PET scans (performed for suspected disease recurrence) in the management of MCC.

Risk-adapted FDG–PET/CT-based follow-up in patients with diffuse large B-cell lymphoma after first-line therapy

BackgroundThe purpose of this study was to evaluate the impact of 2-[fluorine-18]fluoro-2-deoxy-D-glucose–positron emission tomography/computed tomography (FDG–PET/CT) during follow-up of patients with diffuse large B-cell lymphoma (DLBCL) being in complete remission or unconfirmed complete remission after first-line therapy.Patients and methods: DLBCL patients receiving FDG–PET/CT during follow-up were analyzed retrospectively. Confirmatory biopsy was mandatory in cases of suspected disease recurrence. ResultsSeventy-five patients were analyzed and 23 (30%) had disease recurrence. The positive predictive value (PPV) of FDG–PET/CT was 0.85. Patients >60 years [P = 0.036, hazard ratio (HR) = 3.82, 95% confidence interval (CI) 1.02–7.77] and patients with symptoms indicative of a relapse (P = 0.015; HR = 4.1; 95% CI 1.20–14.03) had a significantly higher risk for relapse. A risk score on the basis of signs of relapse, age >60 years, or a combination of these factors identified patients at high risk for recurrence (P = 0.041). ConclusionsFDG–PET/CT detects recurrent DLBCL after first-line therapy with high PPV. However, it should not be used routinely and if only in selected high-risk patients to reduce radiation burden and costs. On the basis of our retrospective data, FDG–PET/CT during follow-up is indicated for patients <60 years with clinical signs of relapse and in patients >60 years with and without clinical signs of relapse.

Suspected Anastomotic Recurrence of Crohn Disease after Ileocolic Resection: Evaluation with CT Enteroclysis

Suspected Anastomotic Recurrence of Crohn Disease after Ileocolic Resection: Evaluation with CT Enteroclysis

Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients

The objective of this study was to evaluate the validity and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) using 18-fluoro-2-deoxy-D-glucose in the posttherapy surveillance of patients with endometrial carcinoma. Eighty-eight patients previously treated for histopathologically diagnosed endometrial adenocarcinoma underwent 99 PET or PET/CT scans at follow-up visits at Asan Medical Center, Seoul, Korea, between 2001 and 2007. The standard of reference for tumor recurrence consisted of histopathologic confirmation or follow-up information at least 6 months after PET or PET/CT. Of the 88 patients, 24 underwent PET (n = 11) and/or PET/CT (n = 14) scans due to suspected disease recurrence. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of PET and/or PET/CT in detecting recurrence in these patients were 100%, 83.3%, 96%, 95%, and 100%, respectively. Especially, PET/CT revealed true-positive findings in three patients with elevated tumor markers but negative CT findings. The remaining 64 patients underwent PET (n = 8) and/or PET/CT (n = 66) as part of routine posttherapy surveillance; these patients were asymptomatic, with no evidence of disease. The sensitivity, specificity, accuracy, PPV, and NPV of PET and/or PET/CT in detecting recurrence in these patients were all 100%. Clinical decisions on treatment were changed in 14 (21.9%) patients by introducing PET or PET/CT into their conventional posttherapy surveillance program. PET and/or PET/CT were highly effective in discriminating true recurrence in patients with suspected recurrence, highly sensitive in detecting recurrence in asymptomatic patients, and had impacts on clinical decisions in a considerable portion of patients.

Ultrasound‐guided transcutaneous Tru‐Cut biopsy to diagnose laryngopharyngeal masses

Patients with bulky laryngopharyngeal masses and a relative or absolute contraindication to general anesthesia present diagnostic difficulties. In the current study, the authors assessed the utility of transcutaneous ultrasound-guided Tru-Cut biopsy (USGTCB) under local anesthesia in such individuals. The current report was a prospective, nonrandomized study. Patients meeting the inclusion criteria underwent USGTCB as outpatients. Ten patients were recruited, 4 of whom had an untreated mass obstructing the laryngeal lumen and 6 of whom were previously treated for laryngeal cancer. All tolerated the procedure well. The only adverse event noted was spontaneously resolving near-syncope in 1 patient. In 9 patients the biopsy was diagnostic: invasive squamous cell carcinoma in 7 patients and chondronecrosis in 2 patients. In the remaining patient, radiologically suspected cricoid chondrosarcoma was confirmed based on the surgical specimen. The results of this pilot study are encouraging. USGTCB of laryngopharyngeal masses was found to produce no local morbidity, was diagnostic in each of the 5 patients with suspected disease recurrence after radiotherapy, was feasible in the outpatient setting, and had high sensitivity and specificity. The procedure is particularly useful for patients contraindicated for general anesthesia or those with a risk of tracheotomy due to intubation difficulties.

Utility of gallium-67 scintigraphy in low-grade non-Hodgkin's lymphoma.

Low-grade non-Hodgkin's lymphoma (LGNHL) has traditionally been considered non-gallium-avid. The sensitivity of gallium 67 (67Ga) scintigraphy when using modern equipment and techniques in patients with LGNHL was investigated. Fifty-seven consecutive patients with LGNHL underwent 67Ga scintigraphy at initial presentation (n = 40), when tumor progression occurred during treatment (n = 3), and at suspected disease recurrence after continuous clinical remission (CCR) (n = 14). Planar and tomographic images were obtained with either a very large field-of-view or a dual-head digital camera. Of 45 patients with Ga-avid LGNHL, 30 underwent 93 follow-up scans (one to six studies per patient). Scan findings were correlated with clinical and computed tomographic (CT) findings and with patient outcomes. 67Ga scintigraphy was positive in 45 of 57 patients (sensitivity, 79%) and in 113 of 164 disease sites (sensitivity, 69%). The sensitivity was higher in the more common types of LGNHL: follicular, predominantly small cleaved cell (FSC), and follicular, mixed small cleaved and large cell (FM) (84% and 91% in patients and 72% and 71% in disease sites, respectively). Sensitivity was lower in patients with mucosa-associated lymphoid tissue lymphoma (MALT) and small lymphocytic lymphoma (SL). Among 28 patients with disease recurrence after CCR (14 with and 14 without baseline studies), 67Ga scan was positive in 25, for a sensitivity of 89% for detection of disease recurrence. When modern technology is used, 67Ga scintigraphy has good sensitivity in patients with LGNHL. It therefore can be used to monitor response to therapy and to provide early detection of disease recurrence in these patients.

Postoperative radiotherapy of supratentorial low-grade gliomas

Forty-nine patients with supratentorial low-grade gliomas underwent surgery (biopsy or subtotal resection) and postoperative radiotherapy at the Mayo Clinic between 1976 and 1983. The median, 5-, and 10-year overall survivals for the total group were 6.5 years, 62%, and 14%, respectively. Nine prognostic variables were examined for their possible association with survival, including age, sex, site, size, Cr enhancement, histologic type, extent of resection, radiation volume, and radiation dose. Of these variables, only histologic type was significantly associated with survival. The estimated 5-year survival was 100% for the 5 patients with pilocytic astrocytomas, 83% for the 20 patients with oligodendrogliomas or mixed oligo-astrocytomas, and 40% in the 24 patients with ordinary astrocytomas (log rank p = 0.001). Other possible prognostic variables, such as radiation volume or total dose, showed no association with survival. Twenty-seven patients had a documented treatment failure. For the 20 patients in whom the pattern of failure could be determined, all failed within their radiation portals. Eleven patients had additional tissue obtained following suspected disease recurrence. Tumor was found in ten of these patients, and radionecrosis in one.