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1.
A First-in-Human Study of 68Ga-Nanocolloid PET/CT Sentinel Lymph Node Imaging in Prostate Cancer Demonstrates Aberrant Lymphatic Drainage Pathways.
Doughton, JA, Hofman, MS, Eu, P, Hicks, RJ, Williams, S
Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2018;(12):1837-1842
Abstract
Our goal was to assess the feasibility, safety, and utility of a novel 68Ga-nanocolloid radiotracer with PET/CT lymphoscintigraphy for identification of sentinel lymph nodes (SLNs). Methods: This was a pilot study of patients from a tertiary cancer hospital who required insertion of gold fiducials for prostate cancer radiation therapy. Participation did not affect cancer management. Ultrasound-guided transperineal intraprostatic injection of a PET tracer (iron oxide nanocolloid labeled with 68Ga) was performed after placement of the fiducials. PET/CT lymphoscintigraphy imaging took place at approximately 45 and 100 min after injection of the tracer. The study was monitored using a Bayesian design with the assumption that at least 1 SLN could be identified in at least two thirds of cases with more than 80% confidence. Results: SLN identification was successful in all 5 participants, allowing completion of the pilot study as per protocol. No adverse effects were observed. Unexpected potential pathways for transit of malignant cells, as well as the expected regional drainage pathways, were discovered. Rapid tracer drainage to pelvic bone, perivesicular, mesorectal, inguinal, and Virchow nodes was identified. Conclusion: SLN identification using 68Ga-nanocolloid PET/CT can be successfully performed. Nontraditional pathways of disease spread were identified, including drainage to pelvic bone and to perivesicular, mesorectal, inguinal, and Virchow nodes. The prevalence of both aberrant and nonlymphatic pathways of spread should be further investigated with this technique.
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Accuracy of 18F-FDOPA Positron Emission Tomography and 18F-FET Positron Emission Tomography for Differentiating Radiation Necrosis from Brain Tumor Recurrence.
Yu, J, Zheng, J, Xu, W, Weng, J, Gao, L, Tao, L, Liang, F, Zhang, J
World neurosurgery. 2018;:e1211-e1224
Abstract
BACKGROUND Distinguishing radiation necrosis from brain tumor recurrence remains challenging. We performed a meta-analysis to assess the diagnostic accuracy of 2 different amino acid tracers used in positron emission tomography/computed tomography scans: 18F-FDOPA (6-[18F]-fluoro-L-3,4-dihydroxyphenylalanine) and 18F-FET (O-(2-18F-fluoroethyl)-L-tyrosine). METHODS We searched for studies in 3 databases: PubMed, Embase, and Chinese Biomedical databases. The data were extracted from eligible studies and then processed with heterogeneity test, threshold effect test, and calculations of sensitivity, specificity, and area under the summary receiver operating characteristic curve. Meta-regression and subgroup analyses were performed to explore the source of heterogeneity. RESULTS A total of 48 studies (18F-FDOPA, n = 21; 18F-FET, n = 27) were included. Quantitative synthesis determined pooled weight values in the 18F-FDOPA and 18F-FET groups: sensitivity, 0.85 versus 0.82; specificity, 0.77 versus 0.80; diagnostic odds ratio, 21.7 versus 23.03; area under the curve (AUC) values, 0.8771 versus 0.8976 (P = 0.46). Moreover, the type of tumor was identified as the possible source of the significant heterogeneity (I2 = 52%; P = 0.003) found in the 18F-FDOPA group. In meta-regression and subgroup analyses, 18F-FDOPA showed better diagnostic accuracy in patients with glioma compared with patients with brain metastases (AUC values, 0.9691 vs. 0.837; P < 0.01). 18F-FDOPA also showed a significant advantage in the diagnosis of glioma recurrence compared with 18F-FET (AUC values, 0.9691 vs. 0.9124; P = 0.015). CONCLUSIONS Both 18F-FDOPA and 18F-FET exhibit moderate overall accuracy in diagnosing brain tumor recurrence from radiation necrosis. However, 18F-FDOPA is more adept at diagnosing glioma recurrence compared with brain metastases, and it is more effective than 18F-FET in diagnosing glioma recurrence.
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3.
PET/CT in the Diagnosis and Workup of Sarcoidosis: Focus on Atypical Manifestations.
Akaike, G, Itani, M, Shah, H, Ahuja, J, Yilmaz Gunes, B, Assaker, R, Behnia, F
Radiographics : a review publication of the Radiological Society of North America, Inc. 2018;(5):1536-1549
Abstract
Sarcoidosis is a multisystem disease characterized by the formation of noncaseating granulomas. Lung and intrathoracic lymph nodes are classic sites of involvement; however, sarcoidosis can affect any site in the body. The clinical course is extremely variable, and the imaging features are diverse and dependent on the affected site, degree of inflammation, and treatment the patient receives. Atypical manifestations and imaging findings can make diagnosis and/or management challenging. In addition, assessment of treatment response can be difficult in the setting of chronic disease. Fluorine 18 fluorodeoxyglucose (FDG) PET/CT is sensitive for assessment of the inflammatory activity of sarcoidosis in any organ. Although FDG PET/CT is not included in the standard workup for sarcoidosis, there has been growing evidence that supports the value of this examination in guiding diagnosis and management. FDG PET/CT may be especially useful for assessing reversible granuloma, treatment response, disease extent, occult disease, and cardiac or osseous sarcoidosis, and determining the most suitable biopsy site. Capability to image the entire body during a single examination is advantageous in cases of systemic disease such as sarcoidosis. The authors review the use of FDG PET/CT, providing up-to-date evidence and describing various cases of sarcoidosis in which FDG PET/CT has an important role in diagnosis and/or management. They also discuss the usefulness of FDG PET/CT in cases of selective manifestations of sarcoidosis. ©RSNA, 2018.
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PET/CT for Lymphoma Post-therapy Response Assessment in Hodgkin Lymphoma and Diffuse Large B-cell Lymphoma.
Kobe, C, Dietlein, M, Hellwig, D
Seminars in nuclear medicine. 2018;(1):28-36
Abstract
Over the course of many decades, combined chemotherapy and radiotherapy adapted to the stage of disease have become the optimal and standard treatment for Hodgkin lymphoma (HL) and diffuse large B-cell lymphoma. Besides achieving optimized cure rates of the underlying disease, reduction of toxicity has become a major goal. Since the introduction of FDG-PET for the staging and restaging of patients with lymphoma, a high predictive value of F-18-FDG-PET in response assessment has been observed. Several PET-response-guided therapy regimens have already been established, and even more PET-adapted study designs are being tested in large study groups. PET has a very high negative predictive value following chemotherapy, and radiotherapy can be safely omitted in PET-negative patients with HL after effective chemotherapy with regimens such as bleomycin, etoposide, doxorubicin, cyclophosphamide, vincristine, procarbazine, and prednisone in advanced stages. As "state-of-the-art" PET-guided therapy is based on the results of large clinical trials, the reliability of end-of-treatment PET as a basis for abandoning radiotherapy in early and intermediate HL stages remains to be shown. As in HL, the predictive value of FDG-PET after induction therapy of diffuse large B-cell lymphoma is higher than that of CT alone so that we obtain relevant prognostic information unavailable through anatomical imaging. Recent results from trials in aggressive non-HL with a de-escalating strategy suggest that radiotherapy may be safely omitted if FDG-PET is negative after standard chemoimmunotherapy. Since 2007, FDG-PET at end of treatment is integrated into the International Working Group criteria and became the imaging tool of choice for response assessment in aggressive lymphoma. Robust and reproducible interpretation criteria are being used both in the ongoing clinical trials and in daily routine. The recommended five-point scale has become the standard in PET response assessment, with the caveat that the consequence of a PET scan may be influenced by foregoing and following treatments.
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Prospective comparative study of 18F-sodium fluoride PET/CT and planar bone scintigraphy for treatment response assessment of bone metastases in patients with prostate cancer.
Fonager, RF, Zacho, HD, Langkilde, NC, Fledelius, J, Ejlersen, JA, Hendel, HW, Haarmark, C, Moe, M, Mortensen, JC, Jochumsen, MR, et al
Acta oncologica (Stockholm, Sweden). 2018;(8):1063-1069
Abstract
AIM: To compare 18F-sodium fluoride positron emission tomography/computed tomography (NaF PET/CT) and 99mTc-labelled diphosphonate bone scan (BS) for the monitoring of bone metastases in patients with prostate cancer undergoing anti-cancer treatment. MATERIAL AND METHODS Data from 64 patients with prostate cancer were included. The patients received androgen-deprivation therapy (ADT), next-generation hormonal therapy (NGH) or chemotherapy. The patients had a baseline scan and 1-3 subsequent scans during six months of treatment. Images were evaluated by experienced nuclear medicine physicians and classified for progressive disease (PD) or non-PD according to the Prostate Cancer Working Group 2 (PCWG-2) criteria. The patients were also classified as having PD/non-PD according to the clinical and prostate-specific antigen (PSA) responses. RESULTS There was no difference between NaF PET/CT and BS in the detection of PD and non-PD during treatment (McNemar's test, p = .18). The agreement between BS and NaF PET/CT for PD/non-PD was moderate (Cohen's kappa 0.53, 95% confidence interval 0.26-0.79). Crude agreement between BS and NaF PET/CT for the assessment of PD/non-PD was 86% (89% for ADT, n = 28; 88% for NGH, n = 16, and 80% for chemotherapy, n = 20). In most discordant cases, BS found PD when NaF PET/CT did not, or BS detected PD on an earlier scan than NaF PET/CT. Biochemical progression (27%) occurred more frequently than progression on functional imaging (BS, 22% and NaF PET/CT, 14%). Clinical progression was rare (11%), and almost exclusively seen in patients receiving chemotherapy. CONCLUSION There was no difference between NaF PET/CT and BS in the detection of PD and non-PD; however, BS seemingly detects PD by the PCWG-2 criteria earlier than NaF-PET, which might be explained by the fact that NaF-PET is more sensitive at the baseline scan.
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Evaluating the Use of 18F-FDG PET CT for External Beam Radiotherapy Planning in Gynaecological Malignancies.
Kerr, A, Reed, N, Harrand, R, Graham, K, Sadozye, AH
Current oncology reports. 2018;(10):84
Abstract
PURPOSE OF REVIEW To evaluate the evidence for the use of fluorine-18-fluorodeoyglucose (18F-FDG) PET CT in external beam radiotherapy planning for treatment of gynaecological malignancies. RECENT FINDINGS Our review confirms that the incorporation of 18F-FDG PET CT during radiotherapy planning may decrease inter-observer variability during target delineation. It can also provide useful functional information regarding the tumour, which may facilitate the development of techniques for dose escalation and 'dose painting' not only for primary disease, especially in cervical cancer, but also nodal metastasis. The utilisation of this functional modality in external beam radiotherapy planning, particularly in locally advanced cervical malignancy, is an exciting topic that warrants further prospective research. Perhaps the most valuable role may be the potential to deliver dose escalation to 18F-FDG PET CT avid targets previously limited by organ at risk constraints, now that we have significantly more advanced radiotherapy planning tools at our disposal.
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Role of FDG PET/CT in the Eighth Edition of TNM Staging of Non-Small Cell Lung Cancer.
Kandathil, A, Kay, FU, Butt, YM, Wachsmann, JW, Subramaniam, RM
Radiographics : a review publication of the Radiological Society of North America, Inc. 2018;(7):2134-2149
Abstract
Lung cancer is the leading cause of cancer-related mortality in the United States, and accurate staging plays a vital role in determining prognosis and treatment. The recently revised eighth edition of the TNM staging system for lung cancer defines new T and M descriptors and updates stage groupings on the basis of substantial differences in survival. There are new T descriptors that are based on the findings at histopathologic examination, and T descriptors are reassigned on the basis of tumor size and extent. No changes were made to the N descriptors in the eighth edition of the TNM staging of lung cancer, because the four N categories that are based on the location of the diseased nodes can be used to consistently predict prognosis. The eighth edition includes a new M1b descriptor for patients with a single extrathoracic metastatic lesion in a single organ (M1b), because they have better survival and different treatment options, compared with those with multiple extrathoracic lesions (M1c). Examination with fluorine 18 fluorodeoxyglucose (FDG) PET/CT is the standard of care and is an integral part of the clinical staging of patients with lung cancer. To provide the treating physicians with accurate staging information, radiologists and nuclear medicine physicians should be aware of the updated classification system and should be cognizant of the site-specific strengths and limitations of FDG PET/CT. In this article, the eighth edition of the TNM staging system is reviewed, as well as the role of FDG PET/CT in the staging of non-small cell lung carcinoma. ©RSNA, 2018.
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Oncologic 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography: What All Physicians Need to Know.
Montilla-Soler, JL, Makanji, RJ, Barron, BJ
The American journal of medicine. 2018;(4):357-364
Abstract
Fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) hybrid examinations (PET/computed tomography, PET/magnetic resonance imaging) have become the most common PET imaging tools in the evaluation of the oncologic patient. Therefore it is of paramount importance that physicians who take care of oncology patients in any capacity are familiar with the basics of when these examinations are indicated, know how to best prepare the patients, and understand the benefits and limitations of the procedure. Additionally, it is important to understand which medical conditions and medications need to be controlled to maintain the diagnostic accuracy of these tests. In this article we aim to explain what 18F-FDG is, how to best prepare our patients, what PET is, and how these examinations are interpreted. Finally, we discuss some of the limitations of these examinations.
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PET in the Diagnostic Management of Soft Tissue Sarcomas of Musculoskeletal Origin.
Katal, S, Gholamrezanezhad, A, Kessler, M, Olyaei, M, Jadvar, H
PET clinics. 2018;(4):609-621
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Abstract
Soft tissue sarcomas (STSs) account for less than 1% of adult solid tumors and about 7% of pediatric malignancies, causing 2% of cancer-related deaths. With the advent of PET-computed tomography (CT), the value of (18) fluorine-2-fluoro-2-deoxy-d-glucose (FDG) PET imaging to improve the management of STSs has been explored. FDG PET imaging has been found useful in restaging and treatment response assessment. This article reviews current knowledge and application of FDG PET-CT in initial diagnosis, staging, restaging, treatment response monitoring, and prognosis, with a brief overview of the most common histologic subtypes of STS.
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Predictive and prognostic potential of volume-based metabolic variables obtained by a baseline 18F-FDG PET/CT in breast cancer with neoadjuvant chemotherapy indication.
Garcia-Vicente, AM, Pérez-Beteta, J, Amo-Salas, M, Molina, D, Jimenez-Londoño, GA, Soriano-Castrejón, AM, Pena Pardo, FJ, Martínez-González, A
Revista espanola de medicina nuclear e imagen molecular. 2018;(2):73-79
Abstract
AIM: To investigate the usefulness of metabolic variables using 18F-FDG PET/CT in the prediction of neoadjuvant chemotherapy (NC) response and the prognosis in locally advanced breast cancer (LABC). MATERIAL AND METHODS Prospective study including 67 patients with LABC, NC indication and a baseline 18F-FDG PET/CT. After breast tumor segmentation, SUV variables (SUVmax, SUVmean and SUVpeak) and volume-based variables, such as metabolic tumor volume (MTV) and total lesion glycolysis (TLG), were obtained. Tumors were grouped into molecular phenotypes, and classified as responders or non-responders after completion of NC. Disease-free status (DFs), disease-free survival (DFS), and overall survival (OS) were assessed. A univariate and multivariate analysis was performed to study the potential of all variables to predict DFs, DFS, and OS. RESULTS Fourteen patients were classified as responders. Median±SD of DFS and OS was 43±15 and 46±13 months, respectively. SUV and TLG showed a significant correlation (p<0.005) with the histological response, with higher values in responders compared to non-responders. MTV and TLG showed a significant association with DFs (p=0.015 and p=0.038 respectively). Median, mean and SD of MTV and TLG for patients with DFs were: 8.90, 13.73, 15.10 and 33.78, and 90.54 and 144.64, respectively. Median, mean and SD of MTV and TLG for patients with non-DFs were: 16.72, 29.70 and 31.09 and 90.89, 210.98 and 382.80, respectively. No significant relationships were observed with SUV variables and DFs. Volume-based variables were significantly associated with OS and DFS, although in multivariate analysis only MTV was related to OS. No SUV variables showed an association with the prognosis. CONCLUSION Volume-based metabolic variables obtained with 18F-FDG PET/CT, unlike SUV based variables, were good predictors of both neoadjuvant chemotherapy response and prognosis.