|
1
|
Hooda Z, Eisenberg M, Antonoff MB. Role of Pulmonary Metastasectomy in Colorectal Cancer. Thorac Surg Clin 2025; 35:143-153. [PMID: 40246404 DOI: 10.1016/j.thorsurg.2024.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Pulmonary metastasectomy serves as the most efficacious local therapeutic option for stage IV colorectal cancer that has spread to the lungs. In order to properly select patients who will benefit most from pulmonary metastasectomy over other therapeutic options, a multidisciplinary approach should be utilized. The ideal technique is parenchymal-sparing, especially given that there is a high recurrence rate with the most common location being the remainder of the lung. While benefits of pulmonary metastatsectomy are well-documented, further studies are warranted to continue to refine patient selection, timing of surgery, and interplay with other treatment modalities.
Collapse
Affiliation(s)
- Zamaan Hooda
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Michael Eisenberg
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Mara B Antonoff
- Department of Thoracic and Cardiovascular Surgery, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
| |
Collapse
|
|
2
|
Vetto JT. Clinical and Imaging Follow-Up for High-Risk Cutaneous Melanoma: Current Evidence and Guidelines. Cancers (Basel) 2024; 16:2572. [PMID: 39061211 PMCID: PMC11274402 DOI: 10.3390/cancers16142572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/13/2024] [Accepted: 07/15/2024] [Indexed: 07/28/2024] Open
Abstract
The most recent (eighth) edition of the American Joint Committee on Cancer (AJCC) staging system divides invasive cutaneous melanoma into two broad groups: "low-risk" (stage IA-IIA) and "high-risk" (stage IIB-IV). While surveillance imaging for high-risk melanoma patients makes intuitive sense, supporting data are limited in that they are mostly respective and used varying methods, schedules, and endpoints. As a result, there is a lack of uniformity across different dermatologic and oncologic organizations regarding recommendations for follow-up, especially regarding imaging. That said, the bulk of retrospective and prospective data support imaging follow-up for high-risk patients. Currently, it seems that either positron emission tomography (PET) or whole-body computerized tomography (CT) are reasonable options for follow-up, with brain magnetic resonance imaging (MRI) preferred for the detection of brain metastases in patients who can undergo it. The current era of effective systemic therapies (ESTs), which can improve disease-free survival (DFS) and overall survival (OS) beyond lead-time bias, has emphasized the role of imaging in detecting various patterns of EST response and treatment relapse, as well as the importance of radiologic tumor burden.
Collapse
Affiliation(s)
- John T. Vetto
- Department of Surgery, Division of Surgical Oncology, Oregon Health & Science University, Portland, OR 97239, USA; ; Tel.: +1-503-494-5501
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
|
3
|
Zamani-Siahkali N, Mirshahvalad SA, Pirich C, Beheshti M. Diagnostic Performance of [ 18F]F-FDG Positron Emission Tomography (PET) in Non-Ophthalmic Malignant Melanoma: A Systematic Review and Meta-Analysis of More Than 10,000 Melanoma Patients. Cancers (Basel) 2024; 16:215. [PMID: 38201642 PMCID: PMC10778455 DOI: 10.3390/cancers16010215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/12/2024] Open
Abstract
We described the diagnostic performance of [18F]F-FDG-PET in malignant melanoma by conducting a comprehensive systematic review and meta-analysis of the existing literature. The study was designed following PRISMA-DTA. Original articles with adequate crude data for meta-analytic calculations that evaluated [18F]F-FDG-PET and compared it with a valid reference standard were considered eligible. The pooled measurements were calculated based on the data level (patient/lesion-based). Regarding sub-groups, diagnostic performances were calculated for local, regional and distant involvement. The bivariate model was employed to calculate sensitivity and specificity. The initial search resulted in 6678 studies. Finally, 100 entered the meta-analysis, containing 82 patient-based (10,403 patients) and 32 lesion-based (6188 lesions) datasets. At patient level, overall, [18F]F-FDG-PET had pooled sensitivity and specificity of 81% (95%CI: 73-87%) and 92% (95%CI: 90-94%), respectively. To detect regional lymph node metastasis, the pooled sensitivity and specificity were 56% (95%CI: 40-72%) and 97% (95%CI: 94-99%), respectively. To detect distant metastasis, they were 88% (95%CI: 81-93%) and 94% (95%CI: 91-96%), respectively. At lesion level, [18F]F-FDG-PET had a pooled sensitivity and specificity of 70% (95%CI: 57-80%) and 94% (95%CI: 88-97%), respectively. Thus, [18F]F-FDG-PET is a valuable diagnostic modality for melanoma assessment. It was accurate in various clinical scenarios. However, despite its high specificity, it showed low sensitivity in detecting regional lymph node metastasis and could not replace lymph node biopsy.
Collapse
Affiliation(s)
- Nazanin Zamani-Siahkali
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Department of Nuclear Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran 1461884513, Iran
| | - Seyed Ali Mirshahvalad
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
- Joint Department of Medical Imaging, University Medical Imaging Toronto, University Health Network, Sinai Health System, Women’s College Hospital, University of Toronto, Toronto, ON M5G 2N2, Canada
| | - Christian Pirich
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| | - Mohsen Beheshti
- Division of Molecular Imaging and Theranostics, Department of Nuclear Medicine, University Hospital, Paracelsus Medical University, 5020 Salzburg, Austria; (N.Z.-S.); (C.P.); (M.B.)
| |
Collapse
|
|
4
|
Chiappetta M, Salvatore L, Congedo MT, Bensi M, De Luca V, Petracca Ciavarella L, Camarda F, Evangelista J, Valentini V, Tortora G, Margaritora S, Lococo F. Management of single pulmonary metastases from colorectal cancer: State of the art. World J Gastrointest Oncol 2022; 14:820-832. [PMID: 35582100 PMCID: PMC9048528 DOI: 10.4251/wjgo.v14.i4.820] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/26/2021] [Accepted: 03/04/2022] [Indexed: 02/06/2023] Open
Abstract
Colorectal cancer (CRC) is one of the most common causes of death from cancer. Lung seeding occurs in approximately 10% of patients surgically treated for primary CRC with radical intent: the lung is the most common site of metastases after the liver. While surgical treatment of liver metastases is widely accepted to affect long-term outcomes, more controversial and not standardized is the therapy for CRC patients developing lung metastases. Experience suggests the potential curative role of pulmonary metastasectomy, especially in oligometastatic disease. However, the optimal strategy of care and the definition of prognostic factors after treatment still need to be defined. This review focused on the uncommon scenario of single pulmonary metastases from CRC. We explored pertinent literature and provide an overview of the epidemiology, clinical characteristics and imaging of single pulmonary metastases from CRC. Additionally, we identified the best available evidence for overall management. In particular, we analyzed the role and results of locoregional approaches (surgery, radiotherapy or ablative procedures) and their integration with systemic therapy.
Collapse
Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Lisa Salvatore
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Maria Bensi
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Viola De Luca
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Leonardo Petracca Ciavarella
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Floriana Camarda
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Jessica Evangelista
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Vincenzo Valentini
- Department of Radiation Therapy, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Giampaolo Tortora
- Oncologia Medica Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Filippo Lococo
- Department of Thoracic Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS - Università Cattolica del Sacro Cuore, Rome 00168, Italy
| |
Collapse
|
|
5
|
Van de Wiele C, Juanito G, Vander BK, Lawal I, De Spiegeleer B, Sathekge M, Maes A. Practical Considerations When Interpreting FDG PET/CT Imaging for Staging and Treatment Response Assessment in Melanoma Patients. Semin Nucl Med 2021; 51:544-553. [PMID: 34246450 DOI: 10.1053/j.semnuclmed.2021.06.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
While FDG PET/CT bears a high sensitivity and specificity for the staging of stage III and IV melanoma as well as for the purpose of melanoma recurrence detection, overall results tend to vary from one part of the body to another as well as for melanoma from cutaneous or choroidal origin. In this paper, organ or site-related differences in sensitivity and specificity in melanoma patients, both from cutaneous and choroidal origin, as well as their impact on clinical decision making are discussed. Furthermore, with the advent of immunotherapy for the treatment of malignant melanoma, post-treatment related potential false positive findings have emerged, the knowledge of which is essential for accurate treatment response assessment. These post-treatment related potential false positive findings are summarized in this paper so as to help the nuclear medicine physician in avoiding erroneous interpretation of acquired FDG PET/CT images in melanoma patients receiving immuntherapy.
Collapse
Affiliation(s)
- Christophe Van de Wiele
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Diagnostic Sciences, University Ghent, Ghent, Belgium.
| | | | - Borght K Vander
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Ismaheel Lawal
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Bart De Spiegeleer
- DRUQUAR, Laboratory of Drug Quality and Registration, Department of Pharmaceutical Sciences, University Ghent, Ghent, Belgium
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria, Pretoria, South-Africa
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium; Department of Morphological Sciences, University Leuven, Leuven, Belgium
| |
Collapse
|
|
6
|
ŞAHUTOĞLU G, YEĞİNGİL Z, ATILGAN Hİ. Soliter Pulmoner Lezyonların Değerlendirilmesinde Atenüasyon Düzeltilmiş ve Düzeltilmemiş Pozitron Emisyon Tomografisi/Bilgisayarlı Tomografi Görüntülerinin SUVmax Değerleri ile Karşılaştırılması. MUSTAFA KEMAL ÜNIVERSITESI TIP DERGISI 2020. [DOI: 10.17944/mkutfd.766618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
|
7
|
Bisschop C, de Heer EC, Brouwers AH, Hospers GAP, Jalving M. Rational use of 18F-FDG PET/CT in patients with advanced cutaneous melanoma: A systematic review. Crit Rev Oncol Hematol 2020; 153:103044. [PMID: 32673997 DOI: 10.1016/j.critrevonc.2020.103044] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/13/2020] [Accepted: 06/29/2020] [Indexed: 02/07/2023] Open
Abstract
18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is increasingly used in patients with advanced melanoma. Immune checkpoint inhibitors and BRAF/MEK-targeted therapy have transformed the therapeutic landscape of metastatic melanoma. Consequently, a need for markers predicting (early) response to treatment and for monitoring treatment (toxicity) has arisen. This systematic review appraises the current literature evidence for rational use of 18F-FDG PET/CT scans in staging, clinical decision-making, treatment monitoring and follow-up in advanced melanoma. 18F-FDG PET/CT has high overall accuracy for detection of distant metastases and is, combined with cerebral MRI, the preferred imaging strategy for staging metastatic melanoma. In contrast, strong evidence supporting the standard use of 18F-FDG PET/CT for predicting and monitoring therapy response and toxicity is currently lacking. Essential for determining the position of 18F-FDG PET/CT during treatment course in advanced melanoma are well-designed studies with standardized scanning protocols, incorporation of clinical parameters and comparison with contrast-enhanced CT alone.
Collapse
Affiliation(s)
- C Bisschop
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - E C de Heer
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - A H Brouwers
- University of Groningen, University Medical Center Groningen, Department of Nuclear Medicine and Molecular Imaging, Groningen, the Netherlands
| | - G A P Hospers
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands
| | - M Jalving
- University of Groningen, University Medical Center Groningen, Department of Medical Oncology, Groningen, the Netherlands.
| |
Collapse
|
|
8
|
Taralli S, Scolozzi V, Triumbari EK, Carleo F, Di Martino M, De Massimi AR, Ricciardi S, Cardillo G, Calcagni ML. Is 18F-fluorodeoxyglucose positron emission tomography/computed tomography useful to discriminate metachronous lung cancer from metastasis in patients with oncological history? THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF RADIOPHARMACEUTICAL CHEMISTRY AND BIOLOGY 2019; 64:291-298. [PMID: 30654605 DOI: 10.23736/s1824-4785.19.03140-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Solitary pulmonary nodules detected during follow-up in patients with previous cancer history have a high probability of malignancy being either a metachronous lung cancer or a metastasis. This distinction represents a crucial issue in the perspective of "personalized medicine," implying different treatments and prognosis. Aim, to evaluate the role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in distinguishing whether solitary pulmonary nodules are metachronous cancers or metastases and the relationship between the nodule's characteristics and their nature. METHODS From a single-institution database, we retrospectively selected all patients with a previous cancer history who performed 18F-FDG PET/CT to evaluate pulmonary nodules detected during follow-up, ranging from 5 mm to 40 mm, and histologically diagnosed as malignant. RESULTS Between September 2009 and August 2017, 127 patients (80 males; mean age=70.2±8.5years) with 127 malignant nodules were included: 103/127 (81%) metachronous cancers, 24/127 (19%) metastases. In both groups, PET/CT provided good and equivalent detection rate of malignancy (81% vs. 83%). No differences between metachronous cancers and metastases were found in: patient's age (70.3±8.1 years vs. 69.5±9.7years), gender (males=63.1% vs. 62.5%), interval between previous cancer diagnosis and nodules' detection (median time=4years vs. 4.5years), location (right-lung=55% vs. 54%; upper-lobes=64% vs. 67%; central-site=31% vs. 25%), size (median size=17mm vs. 19.5mm), 18F-FDG standardized uptake value (median SUVmax=5.2 vs. 5.9). CONCLUSIONS In oncological patients, despite its high detection rate, 18F-FDG PET/CT, as well as any other clinico-anatomical features, cannot distinguish whether a malignant solitary pulmonary nodule is a metachronous lung cancer or a metastasis, supporting the need of histological differential diagnosis.
Collapse
Affiliation(s)
- Silvia Taralli
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Scolozzi
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elizabeth K Triumbari
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco Carleo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Marco Di Martino
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | | | - Sara Ricciardi
- Unit of Thoracic Surgery, University Hospital of Pisa, Pisa, Italy
| | - Giuseppe Cardillo
- Unit of Thoracic Surgery, San Camillo Forlanini Hospital, Rome, Italy
| | - Maria L Calcagni
- UOC di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy - .,Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
|
9
|
Shiono S, Endo M, Suzuki K, Yarimizu K, Hayasaka K. The prognostic value of positron emission tomography/computed tomography in pulmonary metastasectomy. J Thorac Dis 2018; 10:1738-1746. [PMID: 29707328 DOI: 10.21037/jtd.2018.02.61] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Although positron emission tomography/computed tomography (PET/CT) findings are prognostic in lung cancer patients, the prognostic value of PET/CT findings in patients with pulmonary metastases has neither been comprehensively investigated nor clarified. The aims of this retrospective study were to evaluate the value of PET/CT and identify novel prognostic indicators for pulmonary metastasectomy. Methods Between May 2004 and February 2017, 178 patients underwent PET/CT and resection of pulmonary metastases. After exclusion of patients who underwent biopsy only or duplicate cases, 142 patients were analyzed. Prognostic indicators, including PET/CT findings and outcomes were investigated. Results The median follow-up time was 42 months. The primary tumor site was colorectal in 76, kidney in 14, head and neck in 13, breast in 12, stomach in 8, urinary tract in 7, and other organs in 12 patients. The median maximal standardized uptake value (SUVmax) was 4.6. The optimal cut-off value, determined by receiver operating characteristic (ROC) analysis, identified the following cut-off values: disease-free interval (DFI) (12 months; SUVmax =4.5). Univariable analysis revealed that DFI ≤12 months, incomplete resection, and SUVmax ≥4.5 were significant for poor outcome. Multivariable analysis revealed incomplete resection and SUVmax ≥4.5 were significant for poor outcome. The 5-year survival rates of patients with SUVmax ≥4.5 and SUVmax <4.5 were 51.6% and 74.0%, respectively. Conclusions Analysis of patients undergoing pulmonary metastasectomy demonstrated that incomplete resection and an SUVmax ≥4.5 are significant prognostic indicators. PET/CT findings should be included in estimations of these patients' prognosis.
Collapse
Affiliation(s)
- Satoshi Shiono
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Makoto Endo
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Katsuyuki Suzuki
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kei Yarimizu
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Kazuki Hayasaka
- Department of Thoracic Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| |
Collapse
|
|
10
|
Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. PET Clin 2017; 13:113-126. [PMID: 29157382 DOI: 10.1016/j.cpet.2017.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
Collapse
|
|
11
|
Diagnostic Imaging and Newer Modalities for Thoracic Diseases: PET/Computed Tomographic Imaging and Endobronchial Ultrasound for Staging and Its Implication for Lung Cancer. Surg Clin North Am 2017; 97:733-750. [PMID: 28728712 DOI: 10.1016/j.suc.2017.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Modalities to detect and characterize lung cancer are generally divided into those that are invasive [endobronchial ultrasound (EBUS), esophageal ultrasound (EUS), and electromagnetic navigational bronchoscopy (ENMB)] versus noninvasive [chest radiography (CXR), computed tomography (CT), positron emission tomography (PET), and magnetic resonance imaging (MRI)]. This chapter describes these modalities, the literature supporting their use, and delineates what tests to use to best evaluate the patient with lung cancer.
Collapse
|
|
12
|
Stodell M, Thompson JF, Emmett L, Uren RF, Kapoor R, Saw RPM. Melanoma patient imaging in the era of effective systemic therapies. Eur J Surg Oncol 2017. [PMID: 28625798 DOI: 10.1016/j.ejso.2017.05.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Imaging plays a critical role in the current multi-disciplinary management of patients with melanoma. It is used for primary disease staging, surgical planning, and surveillance in high-risk patients, and for monitoring the effects of systemic or loco-regional therapies. Several different imaging modalities have been utilised in the past. Contemporary imaging practises vary geographically depending on clinical guidelines, physician preferences, availability and cost. Targeted therapies and immunotherapies have revolutionised the treatment of patients with metastatic melanoma over the last few years. With this have come new patterns of disease that were not observed after conventional therapies, and new criteria to assess therapeutic responses. In this article we review the role of imaging for patients with melanoma in the era of effective systemic therapies and discuss likely future developments.
Collapse
Affiliation(s)
- M Stodell
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - J F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia; Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - L Emmett
- Garvan Institute of Medical Research, Discipline of Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - R F Uren
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Alfred Nuclear Medicine and Ultrasound, Newtown, NSW, Australia
| | - R Kapoor
- Mater Imaging, The Mater Hospital Sydney, North Sydney, NSW, Australia
| | - R P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia; Sydney Medical School, The University of Sydney, Sydney, NSW, Australia; Discipline of Surgery, The University of Sydney, Sydney, NSW, Australia; Division of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
| |
Collapse
|
|
13
|
Nakamura T, Matsumine A, Matsusaka M, Mizumoto K, Mori M, Yoshizaki T, Matsubara T, Asanuma K, Sudo A. Analysis of pulmonary nodules in patients with high-grade soft tissue sarcomas. PLoS One 2017; 12:e0172148. [PMID: 28182790 PMCID: PMC5300188 DOI: 10.1371/journal.pone.0172148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/31/2017] [Indexed: 11/18/2022] Open
Abstract
Nowadays, small pulmonary nodules are easily detectable in patients with soft tissue sarcomas (STSs) because of highly improved computed tomography (CT) technologies. The purpose of this study was to determine the frequency and significance of the pulmonary nodules detected by CT in high-grade STS patients. 124 patients with high-grade STS were retrospectively reviewed. There were 72 males (57%) and 52 females (43%). Patients’ average age was 61 years (median (quartiles) 66 years (48–75), range 8–94 years). Pulmonary nodules were detected in 49 (39.5%) of 124 patients by CT scanning at first presentation. Of 49 patients with nodules at first presentation, 34 (69.4%) had benign lesions, and 13 (26.5%) had metastatic nodules. One patient (2%) had primary lung cancer and the remaining one with one nodule could not be definitively diagnosed due to a short follow-up time. 30 patients (24.1%) of 124 patients developed pulmonary nodules during their clinical progression. Seven (23.3%) had benign lesions, whereas 21 (70%) had metastatic lesions. Primary lung cancer was detected in two patients (6.7%). The size and timing of detection of a pulmonary nodule significantly affected the final clinical diagnosisby multivariate analysis. We conclude that pulmonary nodules can be detected highly frequently in patients with high-grade STSs because of improved CT technologies. Careful follow-up is needed if nodules are detected after initial treatment or during the clinical course of the disease.
Collapse
Affiliation(s)
- Tomoki Nakamura
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
- * E-mail:
| | - Akihiko Matsumine
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Miki Matsusaka
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Keitaro Mizumoto
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Mayuko Mori
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Tomoya Yoshizaki
- Medical student, Mie University School of Medicine, Tsu-city, Mie, Japan
| | - Takao Matsubara
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Kunihiro Asanuma
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| | - Akihiro Sudo
- Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu-city, Mie, Japan
| |
Collapse
|
|
14
|
Şahin E, Kara A, Elboğa U. Contribution of nonattenuation-corrected images on FDG-PET/CT in the assessment of solitary pulmonary nodules. LA RADIOLOGIA MEDICA 2016; 121:944-949. [PMID: 27567614 DOI: 10.1007/s11547-016-0681-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Abstract
In this study, we aim to determine the diagnostic performance of nonattenuation-corrected (NAC) and attenuation-corrected (AC) FDG-PET/CT images in the assessment of solitary pulmonary nodule (SPN). We reviewed the images of 41 patients who underwent FDG-PET/CT to diagnose SPNs. The visual analysis of FDG uptake intensity in SPN on AC and NAC PET images was made using a four-point score from 1 to 4 on both AC and NAC PET images. The cutoff value of SUVmax and visual uptake scores for malignancy were defined as ≥2.5 and ≥3, respectively. The significant visual uptake (≥2 visual point score) on AC and NAC PET images was considered to be positive 18F-FDG PET findings for lesion detectability. The sensitivity, specificity and diagnostic accuracy were calculated for AC and NAC PET images. Based on the histopathology and imaging data, 22 of the SPNs (54 %) were malignant and 19 of them (46 %) were benign. The sensitivity and NPV were found to be 100 % in the detection of SPNs for AC and NAC PET images. For all SPNs and SPNs ≤2 cm, NAC PET image had a higher diagnostic performance for the SPN characterization as malignant or benign, when compared with AC PET image. The success rates of AC and NAC PET images were found to be similar for the detection of SPNs. NAC PET image had a higher diagnostic performance for the SPN characterization. It is thought that NAC PET image may provide additional contributions for characterization of SPNs.
Collapse
Affiliation(s)
- Ertan Şahin
- Department of Nuclear Medicine, Namık Kemal University Hospital, Tekirdağ, Turkey.
| | - Ahmet Kara
- Department of Nuclear Medicine, Private OSM-Ortadoğu Hospital, Şanlıurfa, Turkey
| | - Umut Elboğa
- Department of Nuclear Medicine, Gaziantep University Hospital, Gaziantep, Turkey
| |
Collapse
|
|
15
|
Senft A, Hoekstra OS, Witte BI, Leemans CR, de Bree R. Screening for distant metastases in head and neck cancer patients using FDG-PET and chest CT: validation of an algorithm. Eur Arch Otorhinolaryngol 2016; 273:2643-50. [PMID: 26350882 PMCID: PMC4974282 DOI: 10.1007/s00405-015-3773-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 08/28/2015] [Indexed: 11/06/2022]
Abstract
In patients with head and neck squamous cell carcinoma and high-risk factors, the combination of whole body FDG-PET and contrast-enhanced chest CT has the highest sensitivity and accuracy when screening for distant metastases. The aim of the present study was to retrospectively validate an earlier developed algorithm for interpreting the combination of screening PET and CT. The test cohort consisted of 47 consecutive HNSCC patients with high-risk factors for distant metastases, who had previously undergone FDG-PET and CT and had a minimum 12 months of follow-up. In 12 (26 %) patients, distant metastases were detected during screening or within 12-month follow-up. In patients with locoregional control during follow-up, the sensitivity and specificity were 55 % (95 % CI 23-83 %) and 97 % (95 % CI 82-99 %), respectively, for chest CT, 55 % (95 % CI 23-83 %) and 100 % (95 % CI 88-100 %), respectively, for PET and 73 % (95 % CI 39-94 %) and 100 % (95 % CI 88-100 %), respectively, for the combination of PET and CT. The proposed algorithm was considered to have been validated. In this algorithm, all FDG-PET positive scans for distant metastases (regardless of interpretation of a solid lung lesion on CT) and CT scans with suspicious pulmonary lesions of less than 5-mm diameter (regardless of FDG-PET findings) are considered positive for distant metastases.
Collapse
Affiliation(s)
- Asaf Senft
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Otto S Hoekstra
- Department of Radiology & Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Birgit I Witte
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Remco de Bree
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| |
Collapse
|
|
16
|
Calcagni ML, Taralli S, Cardillo G, Graziano P, Ialongo P, Mattoli MV, Di Franco D, Caldarella C, Carleo F, Indovina L, Giordano A. Diagnostic Performance of 18F-Fluorodeoxyglucose in 162 Small Pulmonary Nodules Incidentally Detected in Subjects Without a History of Malignancy. Ann Thorac Surg 2016; 101:1303-9. [DOI: 10.1016/j.athoracsur.2015.10.072] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 02/09/2023]
|
|
17
|
Assessing Cutaneous Psoriasis Activity Using FDG-PET: Nonattenuation Corrected Versus Attenuation Corrected PET Images. Clin Nucl Med 2016; 40:727-9. [PMID: 26053710 DOI: 10.1097/rlu.0000000000000851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Psoriasis is a chronic inflammatory skin condition characterized by well-circumscribed erythematous plaques with thick silvery scale. Infiltration of inflammatory cells such as lymphocytes, neutrophils, and macrophages and epidermal cell proliferation within psoriatic lesions may result in selective FDG accumulation. We present a 55-year-old patient with a 30-year history of psoriasis. Nonattenuation corrected PET/CT images demonstrated significant cutaneous FDG uptake corresponding to clinically apparent psoriatic lesions. However, in attenuation corrected (AC) FDG-PET images, the signal was substantially diminished and minimally detectable. Nonattenuation corrected FDG-PET images may be useful and preferable to AC images in assessing skin inflammation in psoriasis.
Collapse
|
|
18
|
The Evolving Role of Molecular Imaging in Non–Small Cell Lung Cancer Radiotherapy. Semin Radiat Oncol 2015; 25:133-42. [DOI: 10.1016/j.semradonc.2014.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
|
19
|
Ripley RT, Downey RJ. Pulmonary metastasectomy. J Surg Oncol 2013; 109:42-6. [PMID: 24301202 DOI: 10.1002/jso.23450] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 09/10/2013] [Indexed: 12/11/2022]
Affiliation(s)
- Robert T Ripley
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | |
Collapse
|
|
20
|
Emad-Eldin S, Abdelaziz O, Harth M, Hussein M, Nour-Eldin NE, Vogl TJ. The clinical utility of FDG-PET/CT in follow up and restaging of breast cancer patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2013. [DOI: 10.1016/j.ejrnm.2013.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
|
|
21
|
Fujioka S, Nakamura H, Miwa K, Takagi Y, Yurugi Y, Taniguchi Y, Ishiguro K. Thymic metastasis of breast cancer 22 years after surgery: a case report. Asian J Endosc Surg 2013; 6:330-2. [PMID: 24308597 DOI: 10.1111/ases.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 07/23/2013] [Accepted: 07/24/2013] [Indexed: 12/01/2022]
Abstract
We report a rare case of thymic metastasis of breast cancer. A 68-year-old woman, who had undergone surgery for cancer in her right breast and had been free of recurrence for 22 years, was noted to have an abnormal shadow on a chest X-ray at a regular medical checkup. Further workup, including chest CT, revealed a 22 × 18-mm mass in the anterior mediastinum. Fluorine-18-fluorodeoxyglucose-PET showed increased fluorine-18-fluorodeoxyglucose uptake that was highly suggestive of thymoma. Thoracoscopic thymothymectomy was performed. The tumor had invaded the pericardium, which was also resected. A small nodule was found in the right lung, and it was also resected. The intraoperative frozen-section diagnosis was breast cancer metastasis to the thymus and lung. The pathological diagnosis was luminal A solid tubular carcinoma (strongly estrogen receptor and progesterone receptor positive, HER2 negative) with an MIB-1 index of less than 5%. After surgery, the patient was treated with an aromatase inhibitor. As of August 2013, she has been free of recurrence for more than 36 months. It is extremely rare for breast cancer to metastasize to the thymus more than 20 years after surgery.
Collapse
Affiliation(s)
- Shinji Fujioka
- Division of General Thoracic Surgery, Tottori University Hospital, Yonago, Japan
| | | | | | | | | | | | | |
Collapse
|
|
22
|
|
|
23
|
Dieguez A. Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging. Cancer Imaging 2013; 13:277-97. [PMID: 23876415 PMCID: PMC3719056 DOI: 10.1102/1470-7330.2013.0028] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2013] [Indexed: 12/14/2022] Open
Abstract
High-resolution (HR) magnetic resonance imaging (MRI) has become an indispensable tool for multidisciplinary teams (MDTs) addressing rectal cancer. It provides anatomic information for surgical planning and allows patients to be stratified into different groups according to the risk of local and distant recurrence. One of the objectives of the MDT is the preoperative identification of high-risk patients who will benefit from neoadjuvant treatment. For this reason, the correct evaluation of the circumferential resection margin (CRM), the depth of tumor spread beyond the muscularis propria, extramural vascular invasion and nodal status is of the utmost importance. Low rectal tumors represent a special challenge for the MDT, because decisions seek a balance between oncologic safety, in the pursuit of free resection margins, and the patient's quality of life, in order to preserve sphincter function. At present, the exchange of information between the different specialties involved in dealing with patients with rectal cancer can rank the contribution of colleagues, auditing their work and incorporating knowledge that will lead to a better understanding of the pathology. Thus, beyond the anatomic description of the images, the radiologist's role in the MDT makes it necessary to know the prognostic value of the findings that we describe, in terms of recurrence and survival, because these findings affect decision making and, therefore, the patients' life. In this review, the usefulness of HR MRI in the initial staging of rectal cancer and in the evaluation of neoadjuvant treatment, with a focus on the prognostic value of the findings, is described as well as the contribution of HR MRI in assessing patients with suspected or confirmed recurrence of rectal cancer.
Collapse
Affiliation(s)
- Adriana Dieguez
- Diagnóstico Médico, Junín 1023 (C1113AAE), Ciudad Autónoma de Buenos Aires, Argentina.
| |
Collapse
|
|
24
|
Kidner TB, Yoon J, Faries MB, Morton DL. Preoperative imaging of pulmonary metastases in patients with melanoma: implications for minimally invasive techniques. ACTA ACUST UNITED AC 2012; 147:871-4. [PMID: 22987185 DOI: 10.1001/archsurg.2012.1667] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
HYPOTHESIS Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection. DESIGN Retrospective review of a prospectively maintained database. SETTING Tertiary referral center. PATIENTS A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma. MAIN OUTCOME MEASURES Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation. RESULTS The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%. CONCLUSIONS Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.
Collapse
Affiliation(s)
- Travis B Kidner
- Department of Surgical Oncology, John Wayne Cancer Institute at Saint John’s Health Center, Santa Monica, CA 90404, USA
| | | | | | | |
Collapse
|
|
25
|
Evangelista L, Panunzio A, Cervino AR, Vinante L, Al-Nahhas A, Rubello D, Muzzio PC, Polverosi R. Indeterminate pulmonary nodules on CT images in breast cancer patient: the additional value of 18F-FDG PET/CT. J Med Imaging Radiat Oncol 2012; 56:417-24. [PMID: 22883649 DOI: 10.1111/j.1754-9485.2012.02408.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIM To assess the potential role of 18F-Fluorodeoxiglucose (FDG) Positron Emission Tomography (PET)/Computed Tomography (CT) in characterizing indeterminate lung nodules detected at CT scan in patients previously treated for a breast cancer (BC). MATERIALS AND METHODS Twenty-nine consecutive BC patients (28 females, mean age 65 ± 12 years) with evidence of indeterminate lung nodules at contrast-enhanced CT (CECT) scan (lesions with axial diameter ≥8 mm) were retrospectively analysed: all patients underwent 18F-FDG PET/CT within a mean 2 ± 1 months from CECT imaging. PET/CT was considered positive in the presence of abnormal FDG uptake in the pulmonary nodules and/or in other organs. The nature of lung nodules was defined at histopathology and/or imaging follow-up. RESULTS Fourteen (48%) patients showed negative and 15 (52%) positive PET/CT scan in the lungs: of these 15 patients, 7 (47%) had pathologic FDG-uptake in lungs only, whereas 8 (53%) showed abnormal FDG-uptake also in sites different from lungs. At histology and/or imaging follow-up, five (17%) patients were considered positive for BC lung metastases while in seven (24%) a second cancer was diagnosed. In this subset of patients, the sensitivity and specificity for FDG PET/CT in revealing lung lesions were 17% and 100%, respectively, for nodules <8 mm in diameter, and 77% and 85%, respectively, for nodules with diameter ≥8 mm. The therapeutic planning was changed to surgery in seven patients, chemotherapy in one patient and continued hormonal therapy in five. The inclusion of PET/CT in the diagnostic algorithm of the evaluated patients helped avoid unnecessary over-treatment in 12 of 29 patients. CONCLUSION FDG PET/CT appears useful in characterizing indeterminate lung nodules found at CECT scan in BC patients, with a sensitivity that is proportional to nodule size. In addition, PET/CT helped in avoiding over-treatment in a significant proportion of patients.
Collapse
Affiliation(s)
- Laura Evangelista
- Department of Nuclear Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy
| | | | | | | | | | | | | | | |
Collapse
|
|
26
|
Mayerhoefer ME, Prosch H, Herold CJ, Weber M, Karanikas G. Assessment of pulmonary melanoma metastases with 18F-FDG PET/CT: which PET-negative patients require additional tests for definitive staging? Eur Radiol 2012; 22:2451-7. [DOI: 10.1007/s00330-012-2499-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Revised: 04/04/2012] [Accepted: 04/05/2012] [Indexed: 12/19/2022]
|
|
27
|
Calcagni ML, Taralli S, Maggi F, Rufini V, Treglia G, Leccisotti L, Bonomo L, Giordano A. ¹⁸F-fluoro-deoxy-glucose focal uptake in very small pulmonary nodules: fact or artifact? Case reports. World J Surg Oncol 2012; 10:71. [PMID: 22540935 PMCID: PMC3488528 DOI: 10.1186/1477-7819-10-71] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2011] [Accepted: 04/28/2012] [Indexed: 11/12/2022] Open
Abstract
Background 18F-fluoro-deoxy-glucose (18 F-FDG) positron emission tomography integrated/combined with computed tomography (PET-CT) provides the best diagnostic results in the metabolic characterization of undetermined solid pulmonary nodules. The diagnostic performance of 18 F-FDG is similar for nodules measuring at least 1 cm and for larger masses, but few data exist for nodules smaller than 1 cm. Case presentation We report five cases of oncologic patients showing focal lung 18 F-FDG uptake on PET-CT in nodules smaller than 1 cm. We also discuss the most common causes of 18 F-FDG false-positive and false-negative results in the pulmonary parenchyma. In patient 1, contrast-enhanced CT performed 10 days before PET-CT did not show any abnormality in the site of uptake; in patient 2, high-resolution CT performed 1 month after PET showed a bronchiole filled with dense material interpreted as a mucoid impaction; in patient 3, contrast-enhanced CT performed 15 days before PET-CT did not identify any nodules; in patients 4 and 5, contrast-enhanced CT revealed a nodule smaller than 1 cm which could not be characterized. The 18 F-FDG uptake at follow-up confirmed the malignant nature of pulmonary nodules smaller than 1 cm which were undetectable, misinterpreted, not recognized or undetermined at contrast-enhanced CT. Conclusion In all five oncologic patients, 18 F-FDG was able to metabolically characterize as malignant those nodules smaller than 1 cm, underlining that: 18 F-FDG uptake is not only a function of tumor size but it is strongly related to the tumor biology; functional alterations may precede morphologic abnormalities. In the oncologic population, especially in higher-risk patients, PET can be performed even when the nodules are smaller than 1 cm, because it might give an earlier characterization and, sometimes, could guide in the identification of alterations missed on CT.
Collapse
Affiliation(s)
- Maria Lucia Calcagni
- Institute of Nuclear Medicine, Università Cattolica del Sacro Cuore, Largo A, Gemelli, 8, 00168 Rome, Italy.
| | | | | | | | | | | | | | | |
Collapse
|
|
28
|
Callahan J, Kron T, Schneider-Kolsky M, Hicks RJ. The clinical significance and management of lesion motion due to respiration during PET/CT scanning. Cancer Imaging 2011; 11:224-36. [PMID: 22201582 PMCID: PMC3266588 DOI: 10.1102/1470-7330.2011.0031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Lesion movement during positron emission tomography (PET) scan acquisition due to normal respiration is a common source of artefact. A PET scan is acquired in multiple couch positions of between 2 and 5 min duration with the patient breathing freely. A PET-avid lesion will become blurred if affected by respiratory motion, an effect similar to that created when a person moves in a photograph. This motion also frequently causes misregistration between the PET and computed tomography (CT) scan acquired for attenuation correction and anatomical correlation on hybrid scanners. The compounding effects of blurring and misregistration in whole-body PET/CT imaging make accurate characterization of PET-avid disease in areas of high respiratory motion challenging. There is also increasing interest in using PET quantitatively to assess disease response in both clinical reporting and trials. However, at this stage, no response criteria take the effect of respiratory motion into account when calculating the standardized uptake value on a PET scan. A number of different approaches have been described in the literature to address the issue of respiratory motion in PET/CT scanning. This review details the clinical significance of lesion movement due to respiration and discusses various imaging techniques that have been investigated to manage the effects of respiratory motion in PET/CT scanning.
Collapse
Affiliation(s)
- Jason Callahan
- Peter MacCallum Cancer Centre, Centre for Molecular Imaging, St Andrews Place, East Melbourne, Victoria, Australia.
| | | | | | | |
Collapse
|
|
29
|
Hunter CJ, Garant A, Vuong T, Artho G, Lisbona R, Tekkis P, Abulafi M, Brown G. Adverse features on rectal MRI identify a high-risk group that may benefit from more intensive preoperative staging and treatment. Ann Surg Oncol 2011; 19:1199-205. [PMID: 21913017 DOI: 10.1245/s10434-011-2036-1] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Indexed: 12/16/2022]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) is highly accurate in local staging of rectal cancer. It can identify features known to be associated with increased risk of metastatic disease. We evaluated the incidence of synchronous metastatic disease on fludeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) and contrast-enhanced multiple-row detector computed tomography (ceMDCT) in MRI-stratified high- and low-risk rectal cancers. The aim was to determine the incidence of synchronous metastatic disease according to MRI risk features. METHODS A total of 236 patients with rectal cancer were recruited to a study evaluating FDG-PET/CT. All patients underwent MRI staging and were stratified into high and low risk (high risk: extramural venous invasion, extramural spread of >5 mm or T4, involved circumferential resection margin or intersphincteric plane involved for low rectal tumors). Confirmed metastases were those identified on FDG-PET/CT and ceMDCT. RESULTS Imaging data were available for 230 (97.5%) of 236 patients. Incidence of confirmed distant metastases was significantly greater in the MRI high-risk group, with 28 (20.7%) of 135 (95% confidence interval [CI] 14.8-28.3), versus the low-risk group, with 4 (4.2%) of 95 (95% CI 1.7-10.3) (odds ratio 6.0, 95% CI 2.0-17.6, P<0.001). CONCLUSIONS Adverse features found on rectal MRI identify patients at increased risk of synchronous metastatic disease. This group may benefit from additional preoperative investigation for synchronous metastases such as FDG-PET/CT or liver MRI and from alternative neoadjuvant chemotherapy regimens including induction chemotherapy.
Collapse
Affiliation(s)
- Chris J Hunter
- Department of Colorectal Surgery, Croydon University Hospital, Croyden, UK
| | | | | | | | | | | | | | | |
Collapse
|
|
30
|
|
|
31
|
Murrell Z, Dickie B, Dasgupta R. Lung nodules in pediatric oncology patients: a prediction rule for when to biopsy. J Pediatr Surg 2011; 46:833-7. [PMID: 21616236 DOI: 10.1016/j.jpedsurg.2011.02.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 02/11/2011] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of the study was to develop a prediction rule regarding the factors that most accurately predict the diagnosis of a malignancy in a lung nodule in the pediatric oncology patient. METHODS A retrospective review of pediatric oncology patients that underwent lung nodule resection between 1998 and 2007 was performed. Multivariable logistic regression was used to create a prediction rule. RESULTS Fifty pediatric oncology patients underwent 21 thoracotomies and 48 thoracoscopies to resect discrete lung nodules seen on computed tomographic scans during workup for metastasis or routine surveillance. The mean nodule size was 10.43 ± 7.08 mm. The most significant predictors of malignancy in a nodule were peripheral location (odds ratio [OR], 9.1); size between 5 and 10 mm (OR, 2.78); location within the right lower lobe (OR, 2.43); and patients with osteosarcoma (OR, 10.8), Ewing sarcoma (OR, 3.05), or hepatocellular carcinoma (OR, 2.38). CONCLUSIONS Lesions that are between 5 and 10 mm in size and peripherally located in patients with osteosarcoma, Ewing sarcoma, or hepatocellular carcinoma are most likely to be malignant. Use of a prediction rule can help guide clinical practice by determining which patients should undergo surgical resection of lung nodules and which patients may be closely observed with continued radiologic studies.
Collapse
Affiliation(s)
- Zaria Murrell
- Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
| | | | | |
Collapse
|
|
32
|
Kaira K, Okumura T, Ohde Y, Takahashi T, Murakami H, Oriuchi N, Endo M, Kondo H, Nakajima T, Yamamoto N. Correlation between 18F-FDG uptake on PET and molecular biology in metastatic pulmonary tumors. J Nucl Med 2011; 52:705-11. [PMID: 21498541 DOI: 10.2967/jnumed.111.087676] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED (18)F-FDG PET can help in predicting therapeutic response and outcome in patients with metastatic pulmonary tumors. However, no satisfactory biologic explanation exists for this phenomenon. The aim of this study was to investigate the underlying biologic mechanisms of (18)F-FDG uptake in metastatic pulmonary tumors. METHODS One hundred forty-six patients with metastatic pulmonary tumors who underwent (18)F-FDG PET before treatment were included in this study. Tumor sections were stained by immunohistochemistry for glucose transporter 1 (Glut1), glucose transporter 3 (Glut3), hexokinase I, hypoxia-inducible factor-1α (HIF-1α), vascular endothelial growth factor (VEGF), and microvessel density determined by CD34. (18)F-FDG uptake and the expression of these biomarkers were correlated in primary lung cancer and benign pulmonary lesions. RESULTS (18)F-FDG uptake in metastatic pulmonary tumors correlated significantly with the expression of Glut1 (γ = 0.4579, P < 0.0001), HIF-1α (γ = 0.3654, P < 0.0001), hexokinase I (γ = 0.3921, P < 0.0001), VEGF (γ = 0.5528, P < 0.0001), and CD34 (γ = 0.2342, P = 0.0044). (18)F-FDG uptake in metastatic pulmonary tumors was significantly lower than in primary lung cancer but higher than in benign pulmonary lesions. High uptake of (18)F-FDG was significantly associated with poor outcome after pulmonary metastasectomy. In patients with metastatic pulmonary tumors, (18)F-FDG uptake and the expression of Glut1, HIF-1α, and VEGF were significantly higher in adenocarcinoma and squamous cell carcinoma than in sarcoma. (18)F-FDG uptake was significantly correlated with tumor size (P < 0.0001), but there was no significant relationship between tumor size and the expression of these biomarkers. CONCLUSION The amount of (18)F-FDG uptake in metastatic pulmonary tumors is determined by the presence of glucose metabolism (Glut1), phosphorylation of glucose (hexokinase I), hypoxia (HIF-1α), and angiogenesis (VEGF and microvessel density).
Collapse
Affiliation(s)
- Kyoichi Kaira
- Division of Thoracic Oncology, Shizuoka Cancer Center, Shizuoka, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
33
|
The utility of the nonattenuation corrected 18F-FDG PET images in the characterization of solitary pulmonary lesions. Nucl Med Commun 2011; 31:945-51. [PMID: 20739905 DOI: 10.1097/mnm.0b013e32833ed57d] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the accuracy of nonattenuation corrected (NAC) F-fluorodeoxyglucose positron emission tomography (F-FDG PET) images in the evaluation of solitary pulmonary lesion as compared with more established methods. METHODS Fifty-six patients received F-FDG PET/CT for diagnosing solitary pulmonary nodules or mass lesions based on histopathology (n=39) and clinical follow-up (n=17). Visual pulmonary lesion FDG uptake was graded by consensus of two nuclear medicine physicians on both attenuation corrected (AC) [absent, less than mediastinal blood pool (MBP), equal to MBP, greater than MBP] and NAC (absent, less than skin, equal to skin, greater than skin) images. Standardized uptake values (SUV) were also measured from AC images. SUV, visual AC, and visual NAC methods' diagnostic performances were compared, distinguishing benign from malignant pulmonary nodules. RESULTS There were 34 malignant and 22 benign lesions. Lesion diameter varied from 5 to 100 mm (mean ± SD, 24.0 ± 17.9 mm). The NAC, AC, and SUV method sensitivities and specificities were 100/64%, 91/59%, and 79/77%, respectively. For lesions less than 3 cm, NAC, AC, and SUV methods yielded accuracies of 85%, 78%, and 73%, respectively. The NAC method was the most sensitive and accurate especially for small nodules. CONCLUSION Visual assessment of NAC F-FDG PET images alone may provide a more accurate characterization of solitary pulmonary lesions.
Collapse
|
|
34
|
Lal G, Fairchild T, Howe JR, Weigel RJ, Sugg SL, Menda Y. PET-CT scans in recurrent or persistent differentiated thyroid cancer: is there added utility beyond conventional imaging? Surgery 2011; 148:1082-9; discussion 1089-90. [PMID: 21134537 DOI: 10.1016/j.surg.2010.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2010] [Accepted: 09/16/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND Integrated positron emission tomography (PET)-computed tomography (CT) may have advantages over conventional imaging in localizing recurrent or persistent differentiated thyroid cancer. METHODS A retrospective review of patients who underwent PET-CT scans was performed. Results were compared with contrast CT, magnetic resonance imaging, ultrasonography, and radioactive iodine (RAI) scans. RESULTS Thirty patients (mean age, 49.9 ± 17 years) underwent 36 PET-CT scans, mostly for elevated thyroglobulin levels and negative RAI scans (30 scans). Fifty percent (18/36) of PET-CT scans showed increased uptake in the neck, 11 of 36 (31%) in the chest, 3 of 36 (8.3%) in bone, and 6 of 36 (16.6%) in other areas. PET-CT had overall sensitivity, specificity, and positive predictive values of 73.9%, 61.5%, and 77.3% respectively. To assess the added value of PET-CT, we focused on the 21 scans performed after conventional imaging in 20 patients. PET-CT provided additional information in 2 (10%) patients, both of whom were spared interventions. However, PET-CT underestimated extent of disease in 3 (15%) patients and led to unnecessary interventions in 3 (15%) additional patients. CONCLUSION PET-CT has reasonable sensitivity in the detection of recurrent thyroid cancer. However, the added value of PET-CT may be seen only in a limited number of patients after good quality, conventional imaging. Further studies are needed to determine the most cost-effective approach to managing these patients.
Collapse
Affiliation(s)
- Geeta Lal
- Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA.
| | | | | | | | | | | |
Collapse
|
|
35
|
Abstract
The primary imaging modality for the detection of pulmonary metastases is computed tomography (CT). Ideally, a helical CT scan with 3- to 5-mm reconstruction thickness or a volumetric thin section scanning should be performed within 4 weeks of pulmonary metastasectomy. A period of observation to see whether further metastases develop does not seem to allow better patient selection. If positron emission tomography is available, it may identify the extrathoracic metastatic sites in 10 to 15% of patients. Despite helical CT scan, palpation identifies the metastases not detected by imaging in 20 to 25% of patients and remains the standard. No data define the optimal interval for follow-up surveillance imaging.
Collapse
|
|
36
|
Park JS, Kim HK, Choi YS, Kim K, Shim YM, Jo J, Lee WY, Chun HK, Park YS, Kang WK, Kim J. Outcomes after repeated resection for recurrent pulmonary metastases from colorectal cancer. Ann Oncol 2009; 21:1285-1289. [PMID: 19861579 DOI: 10.1093/annonc/mdp475] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND It remains controversial whether metastasectomy is still feasible in patients with pulmonary recurrence from colorectal cancer, after initial metastasectomy. The aim of this study was to evaluate outcomes of repeated metastasectomy in these patients. MATERIALS AND METHODS From 1995 to 2007, 202 patients had received a pulmonary metastasectomy from colorectal cancer at our institution. Over a median follow-up of 28.9 months, 48 patients received second metastasectomy (29 wedge resections, 5 segmentectomies, 13 lobectomies, and 1 completion pneumonectomy). The median disease-free interval was 9.6 months. Among these 48 patients, 28 showed pulmonary recurrence again and of those, 10 patients received third metastasectomy (two wedge resections, two segmentectomies, four lobectomies, and two completion pneumonectomies). RESULTS There was no postoperative mortality. Of the 48 patients who underwent second metastasectomy, overall and disease-free 5-year survivals were 79% and 49%, respectively, after second operation. Of the 10 patients who received third metastasectomy, overall survival was 78% at 5 years after last operation. CONCLUSIONS Repeated resection after initial metastasectomy can be carried out safely and provides long-term survival in patients with recurrent pulmonary metastasis from colorectal cancer. Our findings indicate that close follow-up for the early detection of recurrence and parenchyma-saving resection can improve the results after repeated resection.
Collapse
Affiliation(s)
- J S Park
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - H K Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Y S Choi
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - K Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Y M Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - J Jo
- Cancer Research Center, Center for Clinical Research, Samsung Biomedical Research Institute
| | | | | | - Y S Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - W K Kang
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - J Kim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine.
| |
Collapse
|
|
37
|
Pinilla I, Gómez León N. [The usefulness of PET/CT in lung cancer]. RADIOLOGIA 2009; 51:248-60. [PMID: 19406442 DOI: 10.1016/j.rx.2009.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 01/09/2009] [Indexed: 12/20/2022]
Abstract
Lung cancer is the leading cause of cancer-related death. Accurate staging is essential for the optimal management and treatment of these patients. Positron emission tomography (PET) and, more recently, PET/CT have been introduced into the diagnostic algorithms for oncologic patients because they provide valuable functional information. The hybrid PET/CT technique acquires both anatomic (CT) and metabolic (PET) images in a single session, combining the benefits of each modality and minimizing their limitations. This article reviews the role of PET/CT in lung cancer staging, with emphasis on non-small cell carcinoma, evaluating the advantages and limitations of the technique. Other applications of the technique, such as planning radiotherapy, are also discussed.
Collapse
Affiliation(s)
- I Pinilla
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, Madrid, España.
| | | |
Collapse
|
|
38
|
Poeppel TD, Krause BJ, Heusner TA, Boy C, Bockisch A, Antoch G. PET/CT for the staging and follow-up of patients with malignancies. Eur J Radiol 2009; 70:382-92. [PMID: 19406595 DOI: 10.1016/j.ejrad.2009.03.051] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Accepted: 03/26/2009] [Indexed: 02/07/2023]
Abstract
Positron emission tomography (PET) and computed tomography (CT) complement each other's strengths in integrated PET/CT. PET is a highly sensitive modality to depict the whole-body distribution of positron-emitting biomarkers indicating tumour metabolic activity. However, conventional PET imaging is lacking detailed anatomical information to precisely localise pathologic findings. CT imaging can readily provide the required morphological data. Thus, integrated PET/CT represents an efficient tool for whole-body staging and functional assessment within one examination. Due to developments in system technology PET/CT devices are continually gaining spatial resolution and imaging speed. Whole-body imaging from the head to the upper thighs is accomplished in less than 20 min. Spatial resolution approaches 2-4mm. Most PET/CT studies in oncology are performed with (18)F-labelled fluoro-deoxy-D-glucose (FDG). FDG is a glucose analogue that is taken up and trapped within viable cells. An increased glycolytic activity is a characteristic in many types of cancers resulting in avid accumulation of FDG. These tumours excel as "hot spots" in FDG-PET/CT imaging. FDG-PET/CT proved to be of high diagnostic value in staging and restaging of different malignant diseases, such as colorectal cancer, lung cancer, breast cancer, head and neck cancer, malignant lymphomas, and many more. The standard whole-body coverage simplifies staging and speeds up decision processes to determine appropriate therapeutic strategies. Further development and implementation of new PET-tracers in clinical routine will continually increase the number of PET/CT indications. This promotes PET/CT as the imaging modality of choice for working-up of the most common tumour entities as well as some of the rare malignancies.
Collapse
Affiliation(s)
- T D Poeppel
- Department of Nuclear Medicine, University Hospital Essen, Hufelandstr. 55, 45122 Essen, Germany.
| | | | | | | | | | | |
Collapse
|
|
39
|
Abstract
Cutaneous melanoma (CM) is a common malignancy and imaging, particularly lymphoscintigraphy (LS), positron-emission tomography with 2-fluoro-2-deoxyglucose (FDG-PET), ultrasound, radiography computed tomography (CT) and magnetic resonance imaging have important roles in staging and restaging, surgical guidance, surveillance and assessment of recurrent disease. This review aims to summarize the available data regarding these and other imaging modalities in CM and provide the basis for subsequent formulation of guidelines regarding the use of imaging in CM. PubMed and Medline searches were performed and reference lists from publications were also searched. The published data were reviewed and tabulated. There is level I evidence supporting the use of LS and sentinel lymph node biopsy in nodal staging for CM. There is level III evidence demonstrating the superiority of ultrasound to palpation in the assessment of lymph nodes in CM. There is level IV evidence supporting FDG-PET in American Joint Committee on Cancer stage III/IV and recurrent CM and that FDG-PET/CT may be superior to FDG-PET. Level IV evidence also supports the use of CT in the same group of patients and the role of CT appears to be complementary to FDG-PET. Various imaging modalities, especially LS/sentinel lymph node biopsy and FDG-PET/CT, add incremental information in the management of CM and the various modalities have complementary roles depending on the clinical situation.
Collapse
|
|
40
|
Bazañez-Borgert M, Bundschuh RA, Herz M, Martínez MJ, Schwaiger M, Ziegler SI. Radioactive spheres without inactive wall for lesion simulation in PET. Z Med Phys 2008; 18:37-42. [PMID: 18524386 DOI: 10.1016/j.zemedi.2007.06.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
With the growing importance of PET and PET/CT in diagnosis, staging, therapy monitoring and radiotherapy planning, appropriate tools to simulate lesions in phantoms are important. Normally hollow spheres, made of plastic or glass, which can be filled with radioactive solutions, are used. As these spheres have an inactive wall they do not reflect the real situation in the patient and lead to quantification errors in the presence of background activity. We propose spheres made of radioactive wax, which are easy to produce, give a high flexibility to the user and a more accurate quantification. These wax spheres were evaluated for their applicability in PET phantoms and it was found that the activity is not diffusing into the surrounding water in relevant quantities, that they show a sufficient homogeneity, and that their attenuation properties are equivalent to water for photons of PET energies. Recovery coefficients for the wax spheres were measured and compared with those obtained for fillable plastic spheres for diameters of 28, 16, 10, and 6 mm in the presence of background activity. Recovery coefficients of the wax spheres were found to be up to 21% higher than for the fillable spheres.
Collapse
Affiliation(s)
- Marisa Bazañez-Borgert
- Klinik und Poliklinik für Nuklearmedizin, Klinikum rechts der Isar der Technischen Universität München, D-81675 München
| | | | | | | | | | | |
Collapse
|
|
41
|
Kloos RT. Approach to the patient with a positive serum thyroglobulin and a negative radioiodine scan after initial therapy for differentiated thyroid cancer. J Clin Endocrinol Metab 2008; 93:1519-25. [PMID: 18463349 DOI: 10.1210/jc.2007-2357] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
The 10-yr survival of differentiated thyroid cancer is about 76-93%, and at least 10% of patients manifest tumor persistence or recurrence, depending on their disease stage, after initial therapy, which typically includes total thyroidectomy and (131)I ablation. Previously the realization of their residual/recurrent cancer often presented simultaneously with the additional surprise that they lacked pathological uptake on their diagnostic whole-body radioiodine image despite their elevated stimulated serum thyroglobulin (Tg) level, a scenario referred to as the scan-negative, Tg-positive patient. Now that serum Tg and neck ultrasonography have supplanted the diagnostic whole-body scan because of its inferior sensitivity, patients are often recognized to harbor residual disease without radioiodine imaging, and a new challenging scenario has emerged: the ultrasonography-negative, Tg-positive patient. Similarities and differences of these two patient populations aside, these Tg-positive patients are frequently encountered, and some are considered for additional (131)I therapy, although now typically after negative anatomic +/- (18)F-fluorodeoxyglucose positron emission tomography imaging or in the setting of known or suspected distant metastases already localized by anatomic imaging. Thus, the scan-negative, Tg-positive patient of today differs from those of the past, but the term still has relevance to current practice. The optimal evaluation and treatment of these patients remain controversial, partly because many of these patients will not die from thyroid cancer, and there are no randomized trials to demonstrate that intervention could have prevented the deaths that do occur. Here a case is presented that adds the complexity of advanced age, and one approach to these challenging patients is offered.
Collapse
Affiliation(s)
- Richard T Kloos
- The Ohio State University, 446 McCampbell Hall, 1581 Dodd Drive, Columbus, OH 43210-1296, USA.
| |
Collapse
|
|
42
|
Joosten J, Bertholet J, Keemers-Gels M, Barendregt W, Ruers T. Pulmonary resection of colorectal metastases in patients with or without a history of hepatic metastases. Eur J Surg Oncol 2008; 34:895-899. [PMID: 18280692 DOI: 10.1016/j.ejso.2008.01.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 01/08/2008] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION In selected patients with isolated colorectal lung or liver metastases resection can provide an increase in overall survival and even cure. Here, we evaluate whether also patients with combined or sequential metastatic disease to liver and lung may still be candidates for surgical resection. METHODS From 1997 till 2006 39 patients underwent pulmonary metastasectomy. Two subgroups were identified: resection of pulmonary metastases only (PM) and resection of hepatic and later pulmonary metastases (LPM). RESULTS Patient characteristics were identical in both groups. Median follow-up in group PM was 35 months and 38 months in group LPM. Two-year survival in group PM was 61%, and in group LPM 81% (p=NS). Five-year survival was 30% and 20% in PM and LPM groups, respectively (p=NS). The median disease free survival was 12 months in the PM group and 13 months in the LPM group. The extent of pulmonary resection had no impact on survival. Complications occurred in seven patients in the PM group and two patients in the LPM group. Complication rate and severity were related to the extent of pulmonary resection. A small group of patients underwent repeated pulmonary resection without serious complications. CONCLUSION Resection of pulmonary colorectal metastases may improve survival, even in patients who underwent hepatic resection for colorectal liver metastases at an earlier stage.
Collapse
Affiliation(s)
- J Joosten
- Department of Surgery, C22, Canisius Wilhelmina Hospital, P.O. Box 9015, 9500 GS, Nijmegen, The Netherlands.
| | | | | | | | | |
Collapse
|
|
43
|
Abstract
Molecular imaging using PET has evolved from a vigorous academic field into the clinical arena. Considerable advances have been made in the design of high-resolution standalone PET and combined PET/CT units dedicated to clinical whole-body scanning. Likewise, much worthwhile research focused on the development of quantitative imaging protocols incorporating accurate data correction techniques and sophisticated image reconstruction algorithms. Since its inception, photon attenuation in biological tissues has been identified as the most important physical degrading factor affecting PET image quality and quantitative accuracy. Various strategies have been devised to determine an accurate attenuation map to enable correction for nonlinear photon attenuation in whole-body PET studies. This article presents the physical and methodological basis of photon attenuation and summarizes state-of-the-art developments in algorithms used to derive the attenuation map aiming at accurate attenuation compensation of PET data. Future prospects, research trends, and challenges are identified, and directions for future research are discussed.
Collapse
Affiliation(s)
- Habib Zaidi
- Division of Nuclear Medicine, Geneva University Hospital, CH-1211 Geneva 4, Switzerland.
| | | | - Abass Alavi
- Division of Nuclear Medicine, Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| |
Collapse
|
|
44
|
The Value of Positron Emission Tomography in the Surgical Management of Recurrent Papillary Thyroid Carcinoma. World J Surg 2008; 32:708-15. [DOI: 10.1007/s00268-007-9361-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
|
45
|
Respiratory Motion Artifact Using Positron Emission Tomography/Computed Tomography. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50077-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
|
46
|
Affiliation(s)
- M J Reinhardt
- Pius-Hospital Klinik für Nuklearmedizin, Oldenburg, Germany
| |
Collapse
|
|
47
|
Imaging of metastatic disease. COLORECTAL CANCER 2007. [DOI: 10.1017/cbo9780511902468.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
|
48
|
Cerfolio RJ, Bryant AS. The Role of Integrated Positron Emission Tomography-Computerized Tomography in Evaluating and Staging Patients with Non-Small Cell Lung Cancer. Semin Thorac Cardiovasc Surg 2007; 19:192-200. [DOI: 10.1053/j.semtcvs.2007.07.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2007] [Indexed: 11/11/2022]
|
|
49
|
Strobel K, Dummer R, Husarik DB, Pérez Lago M, Hany TF, Steinert HC. High-Risk Melanoma: Accuracy of FDG PET/CT with Added CT Morphologic Information for Detection of Metastases. Radiology 2007; 244:566-74. [PMID: 17641374 DOI: 10.1148/radiol.2442061099] [Citation(s) in RCA: 84] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To prospectively determine the accuracy of positron emission tomography (PET)/computed tomography (CT) with added CT morphologic information for depiction of metastases in patients with high-risk melanoma and negative findings for metastases at PET, by using histologic findings or additional imaging and/or follow-up findings as reference standard. MATERIALS AND METHODS Institutional review board approval was obtained. Informed consent was obtained from patients. One hundred twenty-four consecutive high-risk melanoma patients (65 female, 59 male; mean age, 54.4 years; range, 15-82 years) were included. Fluorine 18 fluorodeoxyglucose (FDG) PET/CT was performed. First, PET/CT scans were evaluated for presence of metastases with increased FDG uptake; CT anatomic location was determined. Lesions were considered metastases if there was focal uptake higher than that of background tissue. Second, coregistered CT images of combined PET/CT scans were evaluated for presence of lesions without FDG uptake. Findings were compared with reference standard findings to determine the accuracy of each evaluation. McNemar test was used to assess statistical differences in accuracy. RESULTS In 53 of 124 patients, metastases were found. In 46 of 53 patients with metastases, lesions had increased FDG uptake. In seven patients with metastatic disease, metastases did not have increased FDG uptake (maximum standard uptake value [SUV], <1.5; n = 5) or had faint FDG uptake (maximum SUV, 2.5 and 2.9; n = 2)-findings that were inconclusive with PET alone. These lesions were interpreted as metastases only with coregistered CT images. Lesions missed with PET were located in the lungs, iliac lymph nodes, subcutis, and psoas muscle. Sensitivity, specificity, and accuracy, respectively, of PET/CT for depiction of metastases were 85%, 96%, and 91%, and those of PET/CT with dedicated CT interpretation were 98%, 94%, and 96% (P = .016). CONCLUSION Dedicated analysis of coregistered CT images significantly improves the accuracy of integrated PET/CT for depiction of metastases in patients with high-risk melanoma.
Collapse
Affiliation(s)
- Klaus Strobel
- Division of Nuclear Medicine, Department of Medical Radiology, University Hospital Zurich, Raemistr 100, 8091 Zurich, Switzerland.
| | | | | | | | | | | |
Collapse
|
|
50
|
Abstract
Almost 125 years after the first documented case, pulmonary metastasectomy is still poorly understood. No other organ is subject to the wide histologic variety of metastatic insults, and this fact has complicated a complete exposition of when pulmonary metastasectomy may be beneficial. Many physicians still consider pulmonary metastatic disease to be always incurable, and they may underestimate existing surgical options including the benefits of pulmonary metastasectomy. In addition, technological improvements in radiological screening of pulmonary metastases and thoracoscopic resection are fundamentally altering the management of these patients and their surgery. This article reviews the history, form, and future of pulmonary metastasectomy, the literature that supports or refutes its application in various tumor types, and the screening and surgical evaluation that is needed prior to its performance.
Collapse
Affiliation(s)
- David I Sternberg
- Section of Thoracic Surgery, Columbia University Medical Center, New-York Presbyterian Hospital, New York, NY 10032, USA
| | | |
Collapse
|