Use Of Fluorodeoxyglucose Positron Emission Tomography Research Articles

Influence of [ 18F] fluorodeoxyglucose positron emission tomography on salvage treatment decision making for locally persistent nasopharyngeal carcinoma

The purpose of this study was to evaluate the role of [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) in influencing salvage treatment decision making for locally persistent nasopharyngeal carcinoma (NPC). A total of 33 NPC patients with histologic persistence at nasopharynx 1 to 6 weeks after a full course of radiotherapy underwent both computed tomography (CT) and FDG-PET/CT simulation at the same treatment position. The salvage treatment decisions, with regard to the decision to offer salvage treatment and the definition of gross tumor volume (GTV), were made before knowledge of the FDG-PET findings. Subsequently the salvage treatment decisions were made again based on the FDG-PET findings and compared with the pre-FDG-PET decisions. All 33 patients were referred for salvage treatment in the pre-FDG-PET decision. After knowledge of the FDG-PET results, the decision to offer salvage treatment was withdrawn in 4 of 33 patients (12.1%), as no abnormal uptake of FDG was found at nasopharynx. Spontaneous remission was observed in repeat biopsies and no local recurrence was found in these 4 cases. For the remaining 29 patients, GTV based on FDG-PET was smaller than GTV based on CT in 24 (82.8%) cases and was greater in 5 (17.2%) cases, respectively. The target volume had to be significantly modified in 9 of 29 patients (31%), as GTV based on FDG-PET images failed to be enclosed by the treated volume in the salvage treatment plan performed based on GTV based on CT simulation images. Use of FDG-PET was found to influence the salvage treatment decision making for locally persistent NPC by identifying patients who were not likely to benefit from additional treatment and by improving accuracy of GTV definition in salvage treatment planning.

Role of FDG-PET in surgical management of patients with colorectal liver metastases.

[(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) is reported to change the management in 20-56% of patients with recurrent or metastatic colorectal cancer. It is not clear if FDG-PET has a role in all such patients or only a subgroup. The aim of the present study was to assess the influence of FDG-PET on the surgical management of patients with known or suspected colorectal liver metastases. Patients undergoing FDG-PET for investigation of known or suspected colorectal liver metastases were identified from a South Australian database. Case notes were reviewed retrospectively to determine the influence of FDG-PET findings on patient management. Findings from FDG-PET scanning were compared with findings from conventional diagnostic investigations and operative findings. Overall, in four of 16 patients (25%) management was influenced by FDG-PET findings. FDG-PET altered management in four of eight (50%) patients with non-diagnostic liver lesions on computed tomography (CT) or with elevated carcinoembryonic antigen levels but no liver lesion on CT. In all eight patients with CT diagnosed resectable liver metastases, the addition of FDG-PET did not influence the management. The findings support the use of FDG-PET in the assessment of selected patients with suspected colorectal liver metastases and equivocal findings on conventional diagnostic investigation.

1094-154 Utility of fluorodeoxyglucose-positron emission tomography for predicting left ventricular functional recovery in patients with acute myocardial infarction after successful revascularization: Comparison with technetium-99m tetrofosmin SPECT

1094-154 Utility of fluorodeoxyglucose-positron emission tomography for predicting left ventricular functional recovery in patients with acute myocardial infarction after successful revascularization: Comparison with technetium-99m tetrofosmin SPECT

Staging of head and neck squamous cell cancer with extended-field FDG-PET.

Accurate baseline staging is necessary to appropriately treat head and neck squamous cell carcinoma. [F-18]-fluorodeoxyglucose positron emission tomography (FDG-PET) is valuable for locoregional staging of primary head and neck disease. The effectiveness of FDG-PET for the detection of distant metastatic or synchronous disease remains unproven. To investigate the utility of FDG-PET extended into the abdomen (extended-field FDG-PET) for wide-field staging of head and neck tumors. This is a prospective institutional study of 35 consecutive patients diagnosed with American Joint Committee on Cancer (AJCC)-defined stage II-IV squamous cell carcinoma of the oral cavity, oropharynx, or larynx between September 2000 and June 2002. Thirty-three patients (94%) were eligible for analysis. All patients were routinely staged with chest radiography, liver function tests, and extended-field FDG-PET. Chest or abdominal computed tomographic scans were used as corroborative studies and were obtained only when one of the above tests indicated distant disease. Of 33 patients, 7 (21%) had evidence of distant disease by extend-field FDG-PET-4 with metastases and 3 with synchronous primary cancers of the aerodigestive tract. [F-18]-fluorodeoxyglucose PET detected hepatic, bone, gastrointestinal, and mediastinal disease not identified by chest radiography or liver function tests. Two of the 7 patients with FDG-avid distant disease had false-negative staging by all other tests, including computed tomography. Extended-field FDG-PET is feasible and may improve staging of primary head and neck squamous cell carcinoma. Use of staging FDG-PET must be explicitly described in reports from centers engaged in prospective research to facilitate comparison with historical results.

Use of fluorodeoxyglucose positron emission tomography scans in patients with advanced germ cell tumour following chemotherapy: single-centre experience with long-term follow up.

Fluorodeoxyglucose positron emission tomography (FDG-PET) may detect residual or recurrent malignancy in patients with germ cell tumours (GCT) following chemotherapy. The objective of the present study was to evaluate the use of FDG-PET in the setting of advanced GCT, and to determine the influence of FDG-PET on subsequent patient management. A computerized search of the patient database of the Department of Medical Oncology, Guy's Hospital, London, United Kingdom, and a manual search of medical records, were conducted. All male patients with metastatic or extragonadal GCT treated with chemotherapy between July 1996 and June 1999 inclusive were identified. Data from patients that had a PET scan following chemotherapy were analysed. Reported PET scan findings were compared with subsequent clinical management and patient outcome. A total of 30 patients with metastatic testicular GCT and three patients with extragonadal GCT were treated with chemotherapy. Of these, 15 patients (12 testicular; three extragonadal; 10 non-seminoma; and five seminoma) were investigated following chemo-therapy with at least one FDG-PET scan. Seven patients had two or more PET scans, and a total of 26 FDG-PET scans was performed. The most frequent indication for PET scan was evaluation of a residual mass (11 patients). Three patients had an FDG-PET to evaluate thymic prominence. Minimum follow up from first PET scan was 18 months. Three of 26 PET scans had false positive findings. Four PET scans yielded findings of equivocal significance with repeat PET scan recommended. Relapse of disease occurred in three patients; two of whom had normal previous PET scans and one had a previous equivocal result. PET had an impact on patient management in only one case where it 'prompted' surgical excision of a residual mass. Normal PET scans provided reassurance in patients with residual small masses but did not alter their subsequent -management. A residual mass was the most common indication for PET. For the majority of patients PET did not have a discernible influence on clinical management. Oncologists should exercise caution in their interpretation of PET scan findings and guidelines for the appropriate use of PET in testicular cancer management need to be developed. Prospective trials are required to define the clinical role of PET in this setting.

Fluorodeoxyglucose-positron emission tomography and sentinel lymph node biopsy in staging primary cutaneous melanoma

Aim: We report the value of sentinel lymph node (SLN) biopsy and fluorodeoxyglucose-positron emission tomography (FDG-PET) in relation to SLN biopsy in staging primary cutaneous melanoma. Methods: Fifty-five patients with primary cutaneous melanoma >1.0 mm. Breslow thickness and no palpable regional lymph nodes underwent a FDG-PET scan before SLN biopsy. Results: SLN's were retrieved in 53 patients. Melanoma metastases were found in the SLN of 13 patients. FDG-PET detected the lymph node metastases in two of the 13 patients with SLN metastases. In five patients FDG accumulation was recorded in a regional lymph node basin, while no tumour positive SLN was found. In eight patients FDG-PET showed increased activity at a site of possible distant metastasis. Metastatic disease was confirmed in one patient. No explanation for the positive FDG-PET result could be found in five cases. Conclusion: FDG-PET should not be considered in this group. SLN biopsy reveals regional metastases that are too small to be detected by FDG-PET. The prevalence of distant metastases is too small to justify routine use of FDG-PET.

Positron emission tomography defines metastatic disease but not locoregional disease in patients with malignant pleural mesothelioma

Background Computed tomography and magnetic resonance imaging often fail to predict resectability in patients with malignant pleural mesothelioma. Small studies suggest that fluorodeoxyglucose-positron emission tomography may improve staging. We analyzed our experience to determine more definitively the potential utility of fluorodeoxyglucose-positron emission tomography. Methods Patients with malignant pleural mesothelioma who underwent fluorodeoxyglucose-positron emission tomography scanning were identified from an institutional database. All patients fasted and received a minimum of 10 mCi of F-18-fluorodeoxyglucose. Whole-body emission studies were acquired, followed by whole-body transmission studies, allowing iterative reconstruction. Blinded review of positron emission tomography scans was performed for clinical staging, which was then correlated with surgical and pathologic findings. Sensitivity and specificity were determined for tumor and nodal status. Results From 1998 to 2002, 63 patients underwent positron emission tomography scans, 60 preoperatively and 3 to assess disease recurrence after surgery. Increased fluorodeoxyglucose uptake was seen in all but 1 tumor, which was very early stage (IA). Positron emission tomography findings yielded sensitivities of only 19% and 11% for tumor and nodal status, respectively. However, a high standard uptake value in the primary tumor correlated with the presence of N2 disease. Positron emission tomography correctly identified supraclavicular N3 or M1 disease in 6 patients. Conclusions Positron emission tomography does not identify the local extent of tumor or mediastinal nodal metastases reliably but detects extrathoracic metastases, thereby obviating inappropriate thoracotomy. Further studies of the association between tumor standard uptake value and the presence of N2 disease are warranted.

Should FDG PET be used to Decide Whether a Patient with an Abnormal Mammogram or Breast Finding at Physical Examination should Undergo Biopsy?

Rationale and Objectives The purpose of this systematic review was to assess the performance of fluorodeoxyglucose positron emission tomography (PET) in the differential diagnosis of benign from malignant lesions among patients with abnormal mammograms or a palpable breast mass and to examine the effects of PET findings on patient care and health outcomes. Materials and Methods A search of the MEDLINE and CancerLit databases covered articles entered between January 1966 and March 2001. Thirteen articles met the selection criteria. Each article was assessed for study quality characteristics. Meta-analysis was performed with a random effects model and a summary receiver operating characteristic curve. Results A point on the summary receiver operating characteristic curve was selected that reflected average performance, with an estimated sensitivity of 89% and a specificity of 80%. When the prevalence of malignancy is 50%, 40% of all patients would benefit by avoiding the harm of a biopsy with negative biopsy results. The risk of a false-negative result, leading to delayed diagnosis and treatment, is 5.5%. The negative predictive value is 87.9%; thus, the false-negative risk is 12.1%. For a patient with a negative PET scan, a 12% chance of missed or delayed diagnosis of breast cancer is probably too high to make it worth the 88% chance of avoiding biopsy of a benign lesion. Conclusion The evidence does not favor the use of fluorodeoxyglucose PET to help decide whether to perform biopsy. Available studies omit a critical segment of the biopsy population with indeterminate mammograms or nonpalpable masses, for which no conclusions can be reached.

The role of FDG PET in the clinical management of head and neck cancer.

Positron emission tomography (PET) with fluorodeoxyglucose (FDG) allows the visualization of metabolic tissue activity. Use of FDG in in-vivo cancer imaging is based on enhanced glycolysis in tumor cells. In vivo experiments have demonstrated the potential use of FDG PET in squamous-cell head and neck tumors and the detection of tumor involvement in lymph nodes. Since its introduction in this area, several papers have appeared on the use of this imaging modality. Indications for the use of FDG PET in patients with head and neck cancer are discussed.

Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study.

Experimental traumatic brain injury studies have shown that cerebral hyperglycolysis is a pathophysiological response to injury-induced ionic and neurochemical cascades. This finding has important implications regarding cellular viability, vulnerability to secondary insults, and the functional capability of affected regions. Prior to this study, posttraumatic hyperglycolysis had not been detected in humans. The characteristics and incidence of cerebral hyperglycolysis were determined in 28 severely head injured patients using [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET). The local cerebral metabolic rate of glucose (CMRG) was calculated using a standard compartmental model. In six of the 28 patients, the global cerebral metabolic rate of oxygen (CMRO2) was determined by the simultaneous measurements of arteriovenous differences of oxygen and cerebral blood flow (xenon-133). Hyperglycolysis, defined as an increase in glucose utilization that measures two standard deviations above expected levels, was documented in all six patients in whom both FDG-PET and CMRO2 determinations were made within 8 days of injury. Five additional patients were found to have localized areas of hyperglycolysis adjacent to focal mass lesions. Within the 1st week following the injury, 56% of patients studied had presumptive evidence of hyperglycolysis. The results of this study indicate that the metabolic state of the traumatically injured brain should be defined differentially in terms of glucose and oxygen metabolism. The use of FDG-PET demonstrates that hyperglycolysis occurs both regionally and globally following severe head injury in humans. The results of this clinical study directly complement those previously reported in experimental brain-injury studies, indicating the capability of imaging a fundamental component of cellular pathophysiology characteristic of head injury.