1
|
Gupta KK, Khan H, Mughal Z, De M, Sharma N, Garas G. Primary Tumour Detection in Carcinoma of Unknown Primary with Transoral Robotic Surgery (TORS) Tongue Base Mucosectomy: A Meta-analysis. Ann Surg Oncol 2024; 31:6065-6076. [PMID: 38980583 DOI: 10.1245/s10434-024-15758-z] [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] [Received: 04/01/2024] [Accepted: 06/24/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND Head and neck carcinoma of unknown primary (CUP) represents a challenging diagnostic process when standard work-up fails to identify the primary tumour site. The aim of this systematic review and meta-analysis was to evaluate the diagnostic utility and complication profile of transoral robotic surgery (TORS) tongue base mucosectomy (TBM) in the management of CUP. PATIENTS AND METHODS An electronic database search was performed in the EMBASE, MEDLINE, PubMed and Cochrane databases. A meta-analysis of proportions was performed to obtain an estimate of the overall proportion for the detection and complication rates. RESULTS Nine studies representing 235 patients with CUP who had TORS TBM were included in the final analysis. The overall pooled tumour detection rate was 66.2% [95% confidence interval (CI) 56.1-75.8]. The incidence of tumour detection in human papilloma virus (HPV)-positive cases (81.5%, 95% CI 60.8-96.4) was significantly higher than HPV-negative cases (2.3%, 95% CI 0.00-45.7). Weighted overall complication rate was 11.4% (95% CI 7.2-16.2). The majority were grade I or II (80%) according to the Clavien-Dindo classification. CONCLUSIONS This meta-analysis suggests TORS to be safe and effective in localising the primary tumour site in patients with CUP. While the current data supports the use of TORS in patients who are HPV positive, larger numbers of HPV-negative cases are required to determine the true diagnostic effect with TORS before any valid conclusions can be inferred in this particular subgroup. Further research should focus on high quality prospective trials with stringent methodological work-up to minimise heterogeneity and allow for more accurate statistical analysis.
Collapse
Affiliation(s)
- Keshav Kumar Gupta
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK.
| | - Hamad Khan
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Zahir Mughal
- Department of Otorhinolaryngology and Head and Neck Surgery, Walsall Manor Hospital, Walsall, UK
| | - Mriganka De
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Neil Sharma
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - George Garas
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology and Head and Neck Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
- Department of Surgery and Cancer, Imperial College London, St. Mary's Hospital, London, UK
| |
Collapse
|
2
|
Ko Y, Tobino K, Hiramatsu Y, Sueyasu T, Nishizawa S, Yoshimatsu Y. Nodular pulmonary amyloidosis diagnosed by ultrasound-guided percutaneous needle biopsy. Respir Med Case Rep 2024; 50:102025. [PMID: 38745726 PMCID: PMC11091706 DOI: 10.1016/j.rmcr.2024.102025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/05/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Pulmonary amyloidosis is characterized by extracellular deposition of fibrous protein called amyloid in the lungs and has three subtypes: nodular, diffuse, and tracheobronchial amyloidosis. Pulmonary nodular amyloidosis can mimic other lung diseases including infectious diseases, metastatic lung tumors, sarcoidosis, and pulmonary hyalinizing granuloma. A biopsy of the lesion is essential for a definitive diagnosis. Herein, we report the case of a 66-year-old man who presented for shortness of breath on exertion and was diagnosed with nodular pulmonary amyloidosis on ultrasound-guided percutaneous needle biopsy. A chest X-ray and computed tomography (CT) revealed bilateral slowly growing multiple calcified pulmonary nodules and cavities. Malignancy was suspected based on 18F-fluoro-deoxyglucose (18F-FDG) positron emission tomography/CT (PET/CT) images. An ultrasound-guided percutaneous needle biopsy was performed, and histopathologic examination of the lesion confirmed nodular pulmonary amyloidosis. This case highlights the importance of considering nodular pulmonary amyloidosis in the differential diagnosis of pulmonary nodules with increased uptake of 18F-FDG on PET/CT and the utility of ultrasound-guided needle biopsy in the definitive diagnosis.
Collapse
Affiliation(s)
- Yuki Ko
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Kazunori Tobino
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Yuri Hiramatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Takuto Sueyasu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
- Department of Respiratory Medicine, Juntendo University, School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan
| | - Saori Nishizawa
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| | - Yuki Yoshimatsu
- Department of Respiratory Medicine, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka, Fukuoka, 820-8505, Japan
| |
Collapse
|
3
|
Huang R, Hu Y, Zhang Y. Utility of 18F-FDG PET/CT in Treatment Strategies for Patients With Cancer of Unknown Primary: A Single-Center, Retrospective Change-in-Management Study. Clin Med Insights Oncol 2024; 18:11795549241245691. [PMID: 38655397 PMCID: PMC11036913 DOI: 10.1177/11795549241245691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/20/2024] [Indexed: 04/26/2024] Open
Abstract
Background Cancer of unknown primary (CUP) is difficult to diagnose and classify clinically, and the disease develops rapidly. Therefore, the primary tumor detected in patients with CUP plays a profound role in the diagnosis and treatment of patients. The search for the primary tumor of CUP is also one of the indications for 18F-fluoro-2-deoxyglucose-positron emission tomography and computed tomography (FDG-PET/CT). Our objective was to evaluate the role of 18F-FDG PET/CT imaging in primary tumor detection and treatment formulation in patients with CUP. Methods Sixty-two patients with CUP were selected from a database consisting of 18 802 cases in the Jiangsu Cancer Hospital PET/CT center from May 18, 2016 to November 18, 2022. Clinical data and changes in treatment strategies before and after PET/CT were collected. Results A total of 42 primary tumors (42/62, 67.7%) were identified by PET/CT examination. The tumor staging of patients before conventional PET/CT imaging (such as CT/magnetic resonance imaging [MRI]/US) and after PET/CT did not change in 28 patients (28/62, 45.2%), whereas for 34 patients (34/62, 54.8%), tumor staging changed. Forty-five patients (45/62, 72.6%) had not developed treatment plans before PET/CT examination, but treatment plans were clarified after PET/CT examination. Thirteen patients (13/62, 21.0%) underwent changes in treatments before and after PET/CT examination. Among the 20 patients (20/62, 32.3%) whose primary tumors were not detected, 16 patients (16/20, 80.0%) had no treatment plans before PET/CT and the treatment plans were defined after PET/CT, 3 patients (3/20, 15.0%) changed the treatment plans before and after PET/CT, and 1 patient (1/20, 5.0%) did not change the treatment plan. Conclusions The 18F-FDG PET/CT plays an important role in the detection and staging of primary tumors in patients with CUP. The PET/CT findings can not only help clinicians develop appropriate treatment plans for patients with CUP but also serve as an effective approach to improve real-life treatment strategies for these patients.
Collapse
Affiliation(s)
- Rong Huang
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yuxiao Hu
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Zhang
- Department of PET/CT Center, Jiangsu Cancer Hospital and Jiangsu Institute of Cancer Research and The Affiliated Cancer Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Lee J, Davis SJ, Amin SN, Rohde SL, Kim YJ. Utility of PET-CT in Newly Diagnosed HPV-Associated Oropharyngeal Squamous Cell Carcinoma. Ann Otol Rhinol Laryngol 2023; 132:1133-1139. [PMID: 36453776 DOI: 10.1177/00034894221135934] [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: 08/23/2023]
Abstract
OBJECTIVE To compare the utility of positron emission tomography-computed tomography (PET-CT) versus contrasted CT neck combined with routine chest imaging for disease staging and treatment planning in human papillomavirus (HPV) associated oropharyngeal squamous cell carcinoma (OPSCC) with clinically evident sites of primary disease. METHODS All adult patients with primary HPV-associated OPSCC at a single quaternary care cancer center from 2018 to 2019 were reviewed, and those with images available for re-review were included. Primary outcomes included concordance in clinical staging between the 2 imaging modalities of interest (PET-CT vs CT), as well as independent agreement of each with pathologic staging. Analysis was performed via ordinal logistic regression. A secondary outcome was treatment selection after diagnostic imaging, analyzed via chi-squared testing. RESULTS In total, 100 patients were included for evaluation, of which 89% were male, 91% Caucasian, and mean age was 61.2 years (SD 9.6). Clinical disease staging agreed between imaging modalities in 95% of cases (54 of 57 patients). Pathologic staging agreed with clinical staging from CT neck in 93% of cases (25 of 27 patients; P = .004), and with PET-CT in 82% (14 of 17 patients; P =.003). No differences were observed between the 2 imaging modalities for subsequent treatment selection (P = .39). CONCLUSION In uncomplicated HPV-associated OPSCC, CT offers equivalent diagnostic accuracy to that of combined whole-body PET-CT for clinical staging, and has no appreciable impact on treatment selection. A reduced reliance on routine PET-CT during initial workup of HPV-associated OPSCC may be favorable for otherwise healthy patients with clinically evident sites of primary disease.
Collapse
Affiliation(s)
- Jaclyn Lee
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Seth J Davis
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Shaunak N Amin
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA
| | - Sarah L Rohde
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Young J Kim
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
- Division of Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
5
|
Veit-Haibach P, Ahlström H, Boellaard R, Delgado Bolton RC, Hesse S, Hope T, Huellner MW, Iagaru A, Johnson GB, Kjaer A, Law I, Metser U, Quick HH, Sattler B, Umutlu L, Zaharchuk G, Herrmann K. International EANM-SNMMI-ISMRM consensus recommendation for PET/MRI in oncology. Eur J Nucl Med Mol Imaging 2023; 50:3513-3537. [PMID: 37624384 PMCID: PMC10547645 DOI: 10.1007/s00259-023-06406-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/16/2023] [Indexed: 08/26/2023]
Abstract
PREAMBLE The Society of Nuclear Medicine and Molecular Imaging (SNMMI) is an international scientific and professional organization founded in 1954 to promote the science, technology, and practical application of nuclear medicine. The European Association of Nuclear Medicine (EANM) is a professional non-profit medical association that facilitates communication worldwide between individuals pursuing clinical and research excellence in nuclear medicine. The EANM was founded in 1985. The merged International Society for Magnetic Resonance in Medicine (ISMRM) is an international, nonprofit, scientific association whose purpose is to promote communication, research, development, and applications in the field of magnetic resonance in medicine and biology and other related topics and to develop and provide channels and facilities for continuing education in the field.The ISMRM was founded in 1994 through the merger of the Society of Magnetic Resonance in Medicine and the Society of Magnetic Resonance Imaging. SNMMI, ISMRM, and EANM members are physicians, technologists, and scientists specializing in the research and practice of nuclear medicine and/or magnetic resonance imaging. The SNMMI, ISMRM, and EANM will periodically define new guidelines for nuclear medicine practice to help advance the science of nuclear medicine and/or magnetic resonance imaging and to improve the quality of service to patients throughout the world. Existing practice guidelines will be reviewed for revision or renewal, as appropriate, on their fifth anniversary or sooner, if indicated. Each practice guideline, representing a policy statement by the SNMMI/EANM/ISMRM, has undergone a thorough consensus process in which it has been subjected to extensive review. The SNMMI, ISMRM, and EANM recognize that the safe and effective use of diagnostic nuclear medicine imaging and magnetic resonance imaging requires specific training, skills, and techniques, as described in each document. Reproduction or modification of the published practice guideline by those entities not providing these services is not authorized. These guidelines are an educational tool designed to assist practitioners in providing appropriate care for patients. They are not inflexible rules or requirements of practice and are not intended, nor should they be used, to establish a legal standard of care. For these reasons and those set forth below, the SNMMI, the ISMRM, and the EANM caution against the use of these guidelines in litigation in which the clinical decisions of a practitioner are called into question. The ultimate judgment regarding the propriety of any specific procedure or course of action must be made by the physician or medical physicist in light of all the circumstances presented. Thus, there is no implication that an approach differing from the guidelines, standing alone, is below the standard of care. To the contrary, a conscientious practitioner may responsibly adopt a course of action different from that set forth in the guidelines when, in the reasonable judgment of the practitioner, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology subsequent to publication of the guidelines. The practice of medicine includes both the art and the science of the prevention, diagnosis, alleviation, and treatment of disease. The variety and complexity of human conditions make it impossible to always reach the most appropriate diagnosis or to predict with certainty a particular response to treatment. Therefore, it should be recognized that adherence to these guidelines will not ensure an accurate diagnosis or a successful outcome. All that should be expected is that the practitioner will follow a reasonable course of action based on current knowledge, available resources, and the needs of the patient to deliver effective and safe medical care. The sole purpose of these guidelines is to assist practitioners in achieving this objective.
Collapse
Affiliation(s)
- Patrick Veit-Haibach
- Joint Department Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, Toronto General Hospital, 1 PMB-275, 585 University Avenue, Toronto, Ontario, M5G 2N2, Canada
- Joint Department of Medical Imaging, University of Toronto, Toronto, Canada
| | - Håkan Ahlström
- Department of Surgical Sciences, Uppsala University, 751 85, Uppsala, Sweden
- Antaros Medical AB, BioVenture Hub, 431 53, Mölndal, Sweden
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
- Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Roberto C Delgado Bolton
- Department of Diagnostic Imaging (Radiology) and Nuclear Medicine, University Hospital San Pedro and Centre for Biomedical Research of La Rioja (CIBIR), Logroño, La Rioja, Spain
| | - Swen Hesse
- Department of Nuclear Medicine, University of Leipzig Medical Center, Leipzig, Germany
| | - Thomas Hope
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA, USA
| | - Martin W Huellner
- Department of Nuclear Medicine, University Hospital Zürich, University of Zürich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Andrei Iagaru
- Department of Radiology, Division of Nuclear Medicine, Stanford University Medical Center, Stanford, CA, USA
| | - Geoffrey B Johnson
- Division of Nuclear Medicine, Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Andreas Kjaer
- Department of Clinical Physiology, Nuclear Medicine & PET and Cluster for Molecular Imaging, Rigshospitalet and University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine & PET, Rigshospitalet, Copenhagen, Denmark
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Mount Sinai Hospital and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Harald H Quick
- High-Field and Hybrid MR Imaging, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Erwin L. Hahn Institute for MR Imaging, University of Duisburg-Essen, Essen, Germany
| | - Bernhard Sattler
- Department of Nuclear Medicine, University Hospital Leipzig, Leipzig, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Greg Zaharchuk
- Division of Neuroradiology, Department of Radiology, Stanford University, 300 Pasteur Drive, Room S047, Stanford, CA, 94305-5105, USA
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany.
| |
Collapse
|
6
|
Röhrich M. [Positron emission tomography in CUP syndrome]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:354-357. [PMID: 37079059 DOI: 10.1007/s00117-023-01144-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/21/2023]
Abstract
CLINICAL/METHODOLOGICAL ISSUE In approximately 2% of all cancers, no primary tumor can be detected and cancer of unknown primary (CUP) syndrome, a diagnosis of exclusion, is made. STANDARD RADIOLOGICAL METHODS In CUP syndrome, computed tomography (CT) and/or magnetic resonance imaging (MRI) do not lead to the detection of primary tumors. METHODOLOGICAL INNOVATIONS In the advanced diagnostic workup of CUP syndrome, 18F‑fluordeoxyglucose positron emission tomography/computed tomography (18F‑FDG PET/CT) can be used. In addition, 68Ga-fibroblast activation protein inhibitor (FAPI) PET/CT as a novel, experimental imaging technique may be considered. PERFORMANCE 18F‑FDG PET/CT is clinically established for the detection of primary tumors of cervical CUP syndrome. High detection rates have also been reported for 18F‑FDG-PET/CT in extracervical CUP syndrome. 68Ga-FAPI PET/CT has not yet been clinically established, but remarkably high detection rates have been shown for 18F‑FDG-negative cervical CUP syndrome due to its low background activity. ACHIEVEMENTS The benefit of 18F‑FDG PET in CUP syndrome has been documented in several meta-analyses. To date, the evidence for the use of 68Ga-FAPI PET/CT in CUP syndrome is still rudimentary. PRACTICAL RECOMMENDATIONS 18F‑FDG PET should be applied regularly in cervical CUP syndrome and can be individually considered in extracervical CUP syndrome.
Collapse
Affiliation(s)
- Manuel Röhrich
- , Im Neuenheimer Feld 400, 69120, Heidelberg, Deutschland.
| |
Collapse
|
7
|
Essibayi MA, Abdallah A, Özek E, Coban G. Multiple recurrences of unknown primary tumor in a meningioma: A case report. Neuroradiol J 2022; 35:763-767. [PMID: 35488191 PMCID: PMC9626840 DOI: 10.1177/19714009221096836] [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: 11/15/2022] Open
Abstract
Metastasis of a systemic tumor into a primary brain tumor has been rarely reported in the literature. These metastases could be seen mostly in meningiomas and in less frequently in the other intracranial tumors. Carcinoma of an unknown primary site (CUP) metastasizing into an intracranial meningioma is not a common occasion. According to the best of our knowledge, in this report, we present the first case with multiple recurrent CUP, which metastasized to intracranial meningioma, reported in the literature. The whole body was investigated with FDG PET/CT and biomarkers of the most common carcinomas for primary cancer. However, these tests showed no primary affected region. Despite all adjuvant therapies, the tumor had multiple recurrences. Such cases are still a challenge to offer optimal management.
Collapse
Affiliation(s)
- Muhammed Amir Essibayi
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
- Equal contribution
| | - Anas Abdallah
- Osmaniye State Hospital, D400 Karayolu Üzeri Akyar Mevkii,
Osmaniye
- Equal contribution
| | - Erdinç Özek
- Department of Neurosurgery, Bezmialem Vakif University, Istanbul, Turkey
| | - Ganime Coban
- Department of Pathology, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
8
|
Morand GB. [Metabolic Tumor Imaging in Head and Neck Oncology]. PRAXIS 2022; 111:878-883. [PMID: 36415988 DOI: 10.1024/1661-8157/a003926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Metabolic Tumor Imaging in Head and Neck Oncology Abstract. Fluorodeoxyglucose with position emission tomography combined with CT or MRI (FDG-PET) has become an important diagnostic and staging method in head and neck squamous cell carcinoma. Some regard FDG-PET merely as a tool able of displaying cancer cells as bright spots on imaging. However, quantification of FDG uptake can be used as a surrogate marker for tumor aggressiveness and predict tumor response before (chemo)-radiation. The FDG uptake of the primary tumor can also predict surgical outcome measures such as depth of invasion, occult nodal metastasis, or bone invasion for oral cancer and/or organ preservation in hypopharyngeal cancer.
Collapse
|
9
|
Nikolova PN, Hadzhiyska VH, Mladenov KB, Ilcheva MG, Veneva S, Dineva SE, Mladenov BS. Detection of Ureteral Stump Transitional Cell Carcinoma, Presenting as Bone Metastases from Unknown Primary by 18F-FDG PET/CT: A Case Report with Review of Literature. Indian J Radiol Imaging 2022; 31:1065-1069. [PMID: 35136531 PMCID: PMC8817789 DOI: 10.1055/s-0041-1741101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A case of occult carcinoma of the ureteral stump is reported. A 67-year-old man presented with pain syndrome due to multiple bone metastases from unknown primary origin detected by previous imaging studies as magnetic resonance imaging, whole body contrast-enhanced computed tomography (CT), and technetium-99m methyldiphosphonate bone scan. He had undergone a right nephrectomy for a benign disease previously. He was referred to our department for an 18F-fluoro-2-deoxy-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) to help localize possible primary tumor. Our observations in this case show that the use of 18F-FDG PET/CT successfully and more accurately evaluated the overall tumor burden and led to a rapid decision of an adequate therapeutic approach.
Collapse
Affiliation(s)
- Petya N. Nikolova
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | - Valeria H. Hadzhiyska
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | - Kiril B. Mladenov
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | - Mihaela G. Ilcheva
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | - Stefani Veneva
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | - Svetla E. Dineva
- Clinic of Nuclear Medicine, 1Clinic of Imaging Diagnostics, University Hospital “Alexandrovska,” Sofia, Bulgaria
| | | |
Collapse
|
10
|
Vlachos DE, Thomakos N, Haidopoulos D, Pergialiotis V, Theodoulidis V, Protopapas A, Rodolakis A. Ocular metastasis of primary gynecological malignancies, a rare but not insignificant entity: A systematic review. Niger J Clin Pract 2022; 25:739-746. [DOI: 10.4103/njcp.njcp_1763_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
11
|
Nissan E, Amit U, Baron L, Zabatani A, Urban D, Barshack I, Davidson T. The usefulness of [18F]FDG-PET/CT in detecting and managing cancers with unknown primary site depends on histological subtype. Sci Rep 2021; 11:17732. [PMID: 34489490 PMCID: PMC8421436 DOI: 10.1038/s41598-021-96451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 08/05/2021] [Indexed: 11/09/2022] Open
Abstract
We assessed the role of [18F]FDG-PET/CT in identifying and managing cancer of unknown primary site (CUP syndrome). We reviewed [18F]FDG-PET/CT scans of individuals with CUP syndrome recorded in clinical referral letters from 2012 to 2019. We evaluated the identification of primary tumor (PT) by [18F]FDG-PET/CT, according to histological subtype, and the impact on clinical management. The median age was 65 years, 36/64 males (56%). PTs were detected in 28/64 (44%) patients. Detection was significantly lower in patients with squamous cell carcinoma (SCC) than with other histologies combined, p = 0.034. Mean age, mean SUVmax (10.6 ± 6.0) and organ involvement were similar between patients with and without discovered PTs; and between patients with SCC and with other histologies combined. However, those with SCC were less likely than the others to present with multi-lesion involvement, p < 0.001. [18F]FDG-PET/CT interpretations apparently affected treatment of 8/28 (29%) patients with PT detected, and in none of the 35 whose PT was not discovered, p < 0.001. [18F]FDG-PET/CT appeared helpful in detecting PT in almost half the patients with CUP syndrome; the lowest rate was for patients with SCC pathology. PET/CT showed limited overall value in guiding clinical management, however benefited those with discovered PT.
Collapse
Affiliation(s)
- Ella Nissan
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Uri Amit
- Radiation Oncology Department, Chaim Sheba Medical Center, Tel Hashomer, Israel.,The Dr. Pinchas Borenstein Talpiot Medical Leadership Program, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Leo Baron
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Amit Zabatani
- Department of Orthopedic Surgery, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Damien Urban
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Oncology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Iris Barshack
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Pathology, Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Tima Davidson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Nuclear Medicine, Chaim Sheba Medical Center, Tel Hashomer, Israel.
| |
Collapse
|
12
|
Breast Carcinoma Presentation as Acute Small Intestinal Obstruction: Carcinoma of Unknown Primary. Indian J Surg 2021. [DOI: 10.1007/s12262-021-02763-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
13
|
Huasong H, Shurui S, Shi G, Bin J. Performance of 18F-FDG-PET/CT as a next step in the search of occult primary tumors for patients with head and neck squamous cell carcinoma of unknown primary: a systematic review and meta-analysis. Clin Transl Imaging 2021. [DOI: 10.1007/s40336-021-00429-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
14
|
Chen B, Zhang H, Liu D, Wang X, Ji B, Gao S. Diagnostic performance of 18F-FDG PET/CT for the detection of occult primary tumors in squamous cell carcinoma of unknown primary in the head and neck: a single-center retrospective study. Nucl Med Commun 2021; 42:523-527. [PMID: 33481505 DOI: 10.1097/mnm.0000000000001365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To investigate the diagnostic performance of 18F-FDG PET/computed tomography (CT) for the detection of occult primary tumors in patients with squamous cell carcinoma of unknown primary (SCCUP) in the head and neck. PATIENTS From March 2016 to January 2020, 37 patients diagnosed as SCCUP before PET/CT were retrospectively reviewed. The diagnosis of SCCUP was made when an overt primary tumor location could not be found for histologically proven squamous cell cervical lymphadenopathy after a complete diagnostic workup which includes full medical history, physical examinations, flexible rhinolaryngoscopy and CT or MRI. The PET/CT images were visually assessed by two nuclear medicine radiologists. Histopathological investigations after the PET scan served as the reference standard. RESULTS The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of PET/CT for SCCUP were 71.4, 43.8, 62.5, 53.9 and 59.5%, respectively. PET/CT allowed identification of previously undetected lesions in 40.5% of the SCCUP patients. A total of 24 PET/CT scans indicated a positive result. Among them, nine were categorized into false-positive because of negative results from subsequent targeted and random biopsies. There were 13 PET/CT scans with a negative result, six of which, however, were revealed to have a primary site by subsequent random biopsies. CONCLUSION 18F-FDG PET/CT was shown to be useful in detecting a primary tumor for SCCUP, but had limitations in terms of both false-positive cases and false-negative cases. Therefore, histopathological investigations such as targeted and random biopsy should be viewed as necessary practice irrespective of PET/CT results.
Collapse
Affiliation(s)
- Bin Chen
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
| | - Haoran Zhang
- Department of Nuclear Medicine, Changchun Center Hospital
| | - Dezhi Liu
- Department of Radiation Oncology, Jilin Cancer Hospital
| | - Xueju Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Bin Ji
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
| | - Shi Gao
- Department of Nuclear Medicine, China-Japan Union Hospital of Jilin University
- NHC Key Laboratory of Radiobiology, School of Public Health of Jilin University
| |
Collapse
|
15
|
Yeung AM, Wells JR, Grossniklaus HE. Secondary ocular malignancies: A review. Clin Exp Ophthalmol 2021; 49:161-168. [PMID: 33426794 DOI: 10.1111/ceo.13889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 01/23/2023]
Abstract
Secondary ocular malignancies most commonly spread to the choroid. Previously, the prognosis was poor however, with newer treatments including immunotherapy, patient's life expectancy have increased. It is therefore, important that ophthalmologists diagnose this condition in a timely manner and offer treatment to maximize visual potential and refer them on to oncology colleagues in order to optimize their systemic treatment for their primary cancer.
Collapse
Affiliation(s)
- Aaron M Yeung
- Ocular Oncology & Ophthalmic Pathology, Emory Eye Center, Atlanta, Georgia, USA
| | - Jill R Wells
- Ocular Oncology & Ophthalmic Pathology, Emory Eye Center, Atlanta, Georgia, USA
| | - Hans E Grossniklaus
- Ocular Oncology & Ophthalmic Pathology, Emory Eye Center, Atlanta, Georgia, USA
| |
Collapse
|
16
|
Abstract
PURPOSE This retrospective study aimed to investigate the clinical value of -deoxy-2-(F)-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) in detecting primary lesions of hepatic metastases. METHODS A total of 124 patients with hepatic metastatic carcinoma of unknown primary underwent whole body F-FDG PET/CT imaging. According to the final diagnoses for both primary sites and hepatic metastases that were confirmed either histopathologically or by clinical follow up, all patients were divided into 4 groups: a true positive group (TP, 95 cases), a false positive group (FP, 9), a true negative group (TN, 8) and a false negative group (FN, 12). RESULTS The TP rate of primary lesions, detected by F-FDG PET/CT, was 76.61%, the FP rate 7.26%, the TN rate 6.45% and the FN rate 9.68%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of F-FDG PET/CT in the detection of primary tumors were 88.78%, 52.94%, 91.35%, 40%, and 83.06%, respectively. Accurate diagnosis groups (TP, TN) showed a significantly higher SUVmax (standard uptake maximum value) level than that in error diagnosis groups (FP, FN). The SUVmax between hepatic metastases and primary lesions had a positive correlation. The primary tumor sites of hepatic metastases were mainly located in the gastrointestinal organs and the lungs. CONCLUSIONS Whole body F-FDG PET/CT imaging was sensitive for detecting primary sites/lesions with hepatic metastatases of unknown primary, especially when the SUVmax of hepatic metastases were greater than 4.7.
Collapse
Affiliation(s)
- Yuekai Li
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Fengcai Li
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Li
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Lili Qu
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Jiankui Han
- Department of Nuclear Medicine, Cheeloo College of Medicine
| |
Collapse
|
17
|
Zytoon AA, Elsayed EE, Nassar AI, Murakami K. Pivotal role of PET/CT in characterization of occult metastasis with undetermined origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this multicenter diagnostic accuracy test study was conducted to assess the role of positron emission tomography/computed tomography in the detection of primary tumor in cases of metastasis of undetermined primary site, to estimate its capability in detecting additional lesions as well as evaluating disease burden and staging. This multicentric diagnostic accuracy test study included 175 patients with pathologically proven, radiologically, and/or clinically suspected metastatic lesions of undetermined primary site. Clinical, surgical, and histopathologic findings and correlative imaging modalities were used to assess the results of PET/CT; the accuracy of PET/CT was expressed in terms of sensitivity and specificity, positive and negative predictive values.
Results
The study included 175 patients; PET-CT-positive lesions suggestive of primary malignant tumors were detected in 105 out of 175 patients. These lesions were pathologically proven to be malignant (true positive) in 100/175 patients (57.1%). Five out of 175 patients (2.9%) proved to be falsely positive after pathologic assessment; 70 out of 175 patients (40%) were negative for detection of primary malignancy all over the body by PET/CT (true negative) with no false negative results. PET/CT achieved a sensitivity of 100%, and specificity of 93.3% in detection of unknown primary tumor location.
Conclusion
PET/CT is an effective modality for early detection of the primary tumor site in patients with cancer of undetermined primary (CUP) which facilitates early selection of appropriate treatment protocols that will improve patients’ prognosis.
Collapse
|
18
|
The Additional Value of Ultrafast DCE-MRI to DWI-MRI and 18F-FDG-PET to Detect Occult Primary Head and Neck Squamous Cell Carcinoma. Cancers (Basel) 2020; 12:cancers12102826. [PMID: 33007978 PMCID: PMC7600235 DOI: 10.3390/cancers12102826] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/22/2020] [Accepted: 09/29/2020] [Indexed: 12/27/2022] Open
Abstract
Simple Summary Patients with cervical lymph node metastasis from squamous cell carcinoma undergo extensive irradiation or surgery of the head and neck with higher treatment morbidity, recurrence rate and lower overall survival than patients with overt primary tumor. In order to enhance treatment efficiency and morbidity reduction, the primary tumor detection accuracy was evaluated by using Ultrafast-Dynamic Contrast-Enhancement (DCE-)MRI in addition to Diffusion-Weighted (DW-)MRI and 18F-FDG-PET/CT imaging. Ultrafast-DCE, with a temporal resolution of 4 s, enabled capturing lesions with increased neoangiogenesis or perfusion compared to normal tissue. The use of Ultra-fast DCE resulted in higher confidence for suspicious locations and high observer agreement. Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity. Abstract To evaluate diagnostic accuracy of qualitative analysis and interobserver agreement of single ultrafast-DCE, DWI or 18F-FDG-PET and the combination of modalities for the detection of unknown primary tumor (UPT) in patients presenting with cervical lymph node metastasis from squamous cell carcinoma (SCC). Between 2014–2019, patients with histologically proven cervical lymph node metastasis of UPT SCC were prospectively included and underwent DWI, ultrafast-DCE, and 18F-FDG-PET/CT. Qualitative assessment was performed by two observers per modality. Interobserver agreement was calculated using the proportion specific agreement. Diagnostic accuracy of combined use of DWI, ultrafast-DCE and 18F-FDG-PET/CT was assessed. Twenty-nine patients were included (20 males. [68%], median age 60 years). Nine (31%) primary tumors remained occult. Ultrafast-DCE added reader confidence for suspicious locations (one additional true positive (5%), 2 decisive true malignant (10%). The per-location analysis showed highest specific positive agreement for ultrafast-DCE (77.6%). The per-location rating showed highest sensitivity (95%, 95%CI = 75.1–99.9, YI = 0.814) when either one of all modalities was scored positive, and 97.4% (95%CI = 93.5–99.3, YI = 0.774) specificity when co-detected on all. The per-patient analysis showed highest sensitivity (100%) for 18F-FDG-PET/CT (YI = 0.222) and either DWI or PET (YI = 0.111). Despite highest trends, no significant differences were found. The per-patient analysis showed highest specific positive agreement when co-detected on all modalities (55.6%, 95%CI = 21.2–86.3, YI = 0.456). Ultrafast-DCE showed potential to improve detection of unknown primary tumors in addition to DWI and 18F-FDG-PET/CT in patients with cervical squamous cell carcinoma lymph node metastasis. The combined use of ultrafast-DCE, DWI and 18F-FDG-PET/CT yielded highest sensitivity.
Collapse
|
19
|
Stefano A, Comelli A, Bravatà V, Barone S, Daskalovski I, Savoca G, Sabini MG, Ippolito M, Russo G. A preliminary PET radiomics study of brain metastases using a fully automatic segmentation method. BMC Bioinformatics 2020; 21:325. [PMID: 32938360 PMCID: PMC7493376 DOI: 10.1186/s12859-020-03647-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 07/09/2020] [Indexed: 12/20/2022] Open
Abstract
Background Positron Emission Tomography (PET) is increasingly utilized in radiomics studies for treatment evaluation purposes. Nevertheless, lesion volume identification in PET images is a critical and still challenging step in the process of radiomics, due to the low spatial resolution and high noise level of PET images. Currently, the biological target volume (BTV) is manually contoured by nuclear physicians, with a time expensive and operator-dependent procedure. This study aims to obtain BTVs from cerebral metastases in patients who underwent L-[11C]methionine (11C-MET) PET, using a fully automatic procedure and to use these BTVs to extract radiomics features to stratify between patients who respond to treatment or not. For these purposes, 31 brain metastases, for predictive evaluation, and 25 ones, for follow-up evaluation after treatment, were delineated using the proposed method. Successively, 11C-MET PET studies and related volumetric segmentations were used to extract 108 features to investigate the potential application of radiomics analysis in patients with brain metastases. A novel statistical system has been implemented for feature reduction and selection, while discriminant analysis was used as a method for feature classification. Results For predictive evaluation, 3 features (asphericity, low-intensity run emphasis, and complexity) were able to discriminate between responder and non-responder patients, after feature reduction and selection. Best performance in patient discrimination was obtained using the combination of the three selected features (sensitivity 81.23%, specificity 73.97%, and accuracy 78.27%) compared to the use of all features. Secondly, for follow-up evaluation, 8 features (SUVmean, SULpeak, SUVmin, SULpeak prod-surface-area, SUVmean prod-sphericity, surface mean SUV 3, SULpeak prod-sphericity, and second angular moment) were selected with optimal performance in discriminant analysis classification (sensitivity 86.28%, specificity 87.75%, and accuracy 86.57%) outperforming the use of all features. Conclusions The proposed system is able i) to extract 108 features for each automatically segmented lesion and ii) to select a sub-panel of 11C-MET PET features (3 and 8 in the case of predictive and follow-up evaluation), with valuable association with patient outcome. We believe that our model can be useful to improve treatment response and prognosis evaluation, potentially allowing the personalization of cancer treatment plans.
Collapse
Affiliation(s)
- Alessandro Stefano
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | - Albert Comelli
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.,Ri.MED Foundation, Palermo, Italy
| | - Valentina Bravatà
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.
| | | | - Igor Daskalovski
- Department of Physics and Astronomy, University of Catania, Catania, Italy
| | - Gaetano Savoca
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy
| | | | - Massimo Ippolito
- Nuclear Medicine Department, Cannizzaro Hospital, Catania, Italy
| | - Giorgio Russo
- Institute of Molecular Bioimaging and Physiology, National Research Council (IBFM-CNR), Cefalù, Italy.,Medical Physics Unit, Cannizzaro Hospital, Catania, Italy
| |
Collapse
|
20
|
Shinya T, Otomi Y, Nishisho T, Beuthien-Baumann B, Kubo M, Otsuka H, Bando Y, Yanagawa H, Sairyo K, Harada M. Preliminary clinical assessment of dynamic carbon-11 methionine positron-emission tomography/computed tomography for the diagnosis of the pathologies in patients with musculoskeletal lesions: a prospective study. Eur J Hybrid Imaging 2020; 4:15. [PMID: 34191157 PMCID: PMC8218133 DOI: 10.1186/s41824-020-00083-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/21/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study prospectively assessed the diagnostic capacity of dynamic carbon-11 methionine (C-11 MET) positron-emission tomography (PET)/computed tomography for the diagnosis of pathologies in patients with primary unknown musculoskeletal lesions (MSLs). In total, 13 patients with MSLs underwent dynamic scans (5–10 [phase 1], 10–15 [phase 2], 15–20 [phase 3], 20–25 [phase 4], 25–30 [phase 5], and 30–35 [phase 6] min post-injection of C-11 MET). We statistically compared the maximum standardised uptake values (SUVmax) and corresponding retention index for dynamic scans (RI-SUV) for five benign MSLs (BMSLs), five primary malignant musculoskeletal tumours (PMMSTs), four metastatic musculoskeletal tumours (MMSTs), and three malignant lymphoma (ML) cases and explored their diagnostic capacities using receiver operating characteristic (ROC) curve analyses. Results SUVmax gradually decreased or remained similar with minimal fluctuations in all BMSL cases and four of five PMMST cases. In contrast, SUVmax increased over time in one case of PMMST and in all cases of MMST and ML. Significant differences were observed in SUVmax for all time phases and RI-SUV between BMSLs and MMSLs, in SUVmax for all time phases between PMMSTs and BMSLs, in SUVmax for all time phases and RI-SUV between non-PMMST-malignant tumours and BMSL, and in RI-SUV between non-PMMST-malignant tumours and PMMST. In ROC analyses, the areas under the curve yielded the highest values at 1.00 for differentiating most intergroup comparisons. Conclusions Dynamic C-11 MET PET scans have the potential to be good predictors of discriminating MSLs in patients with primary unknown MSLs in clinical practice.
Collapse
Affiliation(s)
- Takayoshi Shinya
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan. .,Division of Radiology, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany. .,Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School General Medical Centre, 2-6-2 Nakasange, Kita-ku, Okayama City, Okayama, 700-8505, Japan.
| | - Yoichi Otomi
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Toshihiko Nishisho
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Bettina Beuthien-Baumann
- Division of Radiology, German Cancer Research Centre (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Michiko Kubo
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Hiroaki Yanagawa
- Clinical Trial Center for Developmental Therapeutics, Tokushima University Hospital, 2 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Koichi Sairyo
- Department of Orthopedics, Institute of Biomedical Sciences, Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| |
Collapse
|
21
|
He B, Dai C, Lang J, Bing P, Tian G, Wang B, Yang J. A machine learning framework to trace tumor tissue-of-origin of 13 types of cancer based on DNA somatic mutation. Biochim Biophys Acta Mol Basis Dis 2020; 1866:165916. [PMID: 32771416 DOI: 10.1016/j.bbadis.2020.165916] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/20/2020] [Accepted: 08/03/2020] [Indexed: 12/13/2022]
Abstract
Carcinoma of unknown primary (CUP), defined as metastatic cancers with unknown cancer origin, occurs in 3-5 per 100 cancer patients in the United States. Heterogeneity and metastasis of cancer brings great difficulties to the follow-up diagnosis and treatment for CUP. To find the tissue-of-origin (TOO) of the CUP, multiple methods have been raised. However, the accuracies for computed tomography (CT) and positron emission tomography (PET) to identify TOO were 20%-27% and 24%-40% respectively, which were not enough for determining targeted therapies. In this study, we provide a machine learning framework to trace tumor tissue origin by using gene length-normalized somatic mutation sequencing data. Somatic mutation data was downloaded from the Data Portal (Release 28) of the International Cancer Genome Consortium (ICGC), and 4909 samples for 13 cancers was used to identify primary site of cancers. Optimal results were obtained based on a 600-gene set by using the random forest algorithm with 10-fold cross-validation, and the average accuracy and F1-score were 0.8822 and 0.8886 respectively across 13 types of cancer. In conclusion, we provide an effective computational framework to infer cancer tissue-of-origin by combining DNA sequencing and machine learning techniques, which is promising in assisting clinical diagnosis of cancers.
Collapse
Affiliation(s)
- Bingsheng He
- Academician Workstation, Changsha Medical University, Changsha 410219, China.
| | - Chan Dai
- Geneis Beijing Co., Ltd., Beijing 100102, China
| | - Jidong Lang
- Geneis Beijing Co., Ltd., Beijing 100102, China
| | - Pingping Bing
- Academician Workstation, Changsha Medical University, Changsha 410219, China
| | - Geng Tian
- Geneis Beijing Co., Ltd., Beijing 100102, China
| | - Bo Wang
- Geneis Beijing Co., Ltd., Beijing 100102, China.
| | - Jialiang Yang
- Academician Workstation, Changsha Medical University, Changsha 410219, China; Geneis Beijing Co., Ltd., Beijing 100102, China.
| |
Collapse
|
22
|
Liu X, Li L, Peng L, Wang B, Lang J, Lu Q, Zhang X, Sun Y, Tian G, Zhang H, Zhou L. Predicting Cancer Tissue-of-Origin by a Machine Learning Method Using DNA Somatic Mutation Data. Front Genet 2020; 11:674. [PMID: 32760423 PMCID: PMC7372518 DOI: 10.3389/fgene.2020.00674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
Patients with carcinoma of unknown primary (CUP) account for 3-5% of all cancer cases. A large number of metastatic cancers require further diagnosis to determine their tissue of origin. However, diagnosis of CUP and identification of its primary site are challenging. Previous studies have suggested that molecular profiling of tissue-specific genes could be useful in inferring the primary tissue of a tumor. The purpose of this study was to evaluate the performance somatic mutations detected in a tumor to identify the cancer tissue of origin. We downloaded the somatic mutation datasets from the International Cancer Genome Consortium project. The random forest algorithm was used to extract features, and a classifier was established based on the logistic regression. Specifically, the somatic mutations of 300 genes were extracted, which are significantly enriched in functions, such as cell-to-cell adhesion. In addition, the prediction accuracy on tissue-of-origin inference for 3,374 cancer samples across 13 cancer types reached 81% in a 10-fold cross-validation. Our method could be useful in the identification of cancer tissue of origin, as well as the diagnosis and treatment of cancers.
Collapse
Affiliation(s)
- Xiaojun Liu
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
| | | | - Lihong Peng
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
| | - Bo Wang
- Genesis Beijing Co., Ltd., Beijing, China
| | | | | | | | - Yi Sun
- Chifeng Municipal Hospital, Chifeng, China
| | - Geng Tian
- Genesis Beijing Co., Ltd., Beijing, China
| | - Huajun Zhang
- College of Mathematics and Computer Science, Zhejiang Normal University, Jinhua, China
| | - Liqian Zhou
- School of Computer Science, Hunan University of Technology, Zhuzhou, China
| |
Collapse
|
23
|
Shao Y, Liu X, Hu S, Zhang Y, Li W, Zhou X, Wang Q, Hou Y, Chen Y, Wang Y, Wang Y, Luo Z, Hu X. Sentinel node theory helps tracking of primary lesions of cancers of unknown primary. BMC Cancer 2020; 20:639. [PMID: 32646508 PMCID: PMC7350562 DOI: 10.1186/s12885-020-07042-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 06/04/2020] [Indexed: 11/24/2022] Open
Abstract
Background Sentinel lymph node is the first stop of lymphatic spreading of cancer with known primary. The lymph node metastasis pattern of cancer of unknown primary (CUP) is unclear and has been presumed to follow the same pathway. To test this hypothesis, data of all 716 patients clinically diagnosed as CUP in our center were collected. Methods Diagnoses of lymph node metastasis were established by 18F-FDG PET-CT and/or biopsy pathology. Three hundred and forty-seven cases meeting the criteria were divided into three groups: pathology-confirmed primary with invasive biopsy or surgery of the suspicious lesion (group A, n = 64), primary still unknown even with invasive biopsy or surgery of the suspicious lesion (group B, n = 204), and others with no suspicious lesion or lesions who had not been sampled due to medical or other reasons (group C, n = 79). We assessed the clinicopathological features between these groups, and the relationship between lymph node metastasis pattern and confirmed primary site. Results In group A, the primary sites of 61 cases were compatible with sentinel node theory, resulting in a positive predictive value of 95%. No significant differences in age, sex, bone metastasis, or visceral metastasis observed between group A and group B, except that group A had a higher ratio of differentiated carcinoma (94% vs. 77%, P = 0.003). Conclusion To our knowledge, this is the first evidence indicating that the majority of clinical CUP cases follow the sentinel node theory to spread in lymph nodes, which helps tracking the primary, especially for differentiated carcinoma.
Collapse
Affiliation(s)
- Yilin Shao
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xin Liu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Silong Hu
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yingjian Zhang
- Department of Nuclear Medicine, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Wentao Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xiaoyan Zhou
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Qifeng Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yifeng Hou
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yong Chen
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Yanli Wang
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, 200032, China
| | - Yaohui Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China.,Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Zhiguo Luo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China. .,Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| | - Xichun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dong-an Rd, Shanghai, 200032, China. .,Shanghai Medical College, Fudan University, Shanghai, 200032, China.
| |
Collapse
|
24
|
Preliminary clinical assessment of dynamic 18F-fluorodeoxyglucose positron-emission tomography/computed tomography for evaluating the clinicopathological grade in patients with non-Hodgkin's lymphoma: a prospective study. Nucl Med Commun 2020; 41:26-33. [PMID: 31800508 DOI: 10.1097/mnm.0000000000001120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We prospectively assessed the diagnostic capacity of dynamic and dual-time-point F-fluorodeoxyglucose PET/computed tomography and explored the most appropriate scan timing for clinicopathological discrimination of non-Hodgkin's lymphoma. METHODS Thirteen patients underwent dynamic scans dynamic scans (5-15, 15-25, and 25-35 minute postinjection) and consecutive dual-time-point scans (1- and 2-hour postinjection). For five indolent and 16 aggressive lymphomas, we statistically compared the maximum standardized uptake value (SUVmax) and the retention index of the SUVmax (RI-SUVmax) for each scan and explored the diagnostic capacities using receiver operating characteristic (ROC) curve analyses. RESULTS SUVmax increased progressively over time in all lymphomas and was significantly higher for aggressive lymphoma than for indolent lymphoma in each timephase. RI-SUVmax of dynamic scans (RI-SUV-dynamic) was significantly higher in aggressive than in indolent lymphoma. The cutoff values obtained a sensitivity of 94%, positive-predictive value of 94%, and accuracy of 91% for SUVmax analyses of the dynamic second and third phases, 1-hour early phase, and 2-hour delayed phase, and a sensitivity of 88%, positive-predictive value of 93%, and accuracy of 86% for RI-SUV-dynamic. In contrast, for the dynamic first phase, the cutoff value of SUVmax yielded moderate sensitivity of 69%, a positive-predictive value of 92%, and an accuracy of 71%. The area under the ROC curve (AUC) of the RI-SUV-dynamic had the highest value (0.938), whereas the AUCs of the other ROC analyses were not significantly different. CONCLUSION The dynamic second and third phase could potentially provide good predictors of clinicopathological discrimination, as can the early and delayed phases.
Collapse
|
25
|
He B, Lang J, Wang B, Liu X, Lu Q, He J, Gao W, Bing P, Tian G, Yang J. TOOme: A Novel Computational Framework to Infer Cancer Tissue-of-Origin by Integrating Both Gene Mutation and Expression. Front Bioeng Biotechnol 2020; 8:394. [PMID: 32509741 PMCID: PMC7248358 DOI: 10.3389/fbioe.2020.00394] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 04/08/2020] [Indexed: 02/05/2023] Open
Abstract
Metastatic cancers require further diagnosis to determine their primary tumor sites. However, the tissue-of-origin for around 5% tumors could not be identified by routine medical diagnosis according to a statistics in the United States. With the development of machine learning techniques and the accumulation of big cancer data from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO), it is now feasible to predict cancer tissue-of-origin by computational tools. Metastatic tumor inherits characteristics from its tissue-of-origin, and both gene expression profile and somatic mutation have tissue specificity. Thus, we developed a computational framework to infer tumor tissue-of-origin by integrating both gene mutation and expression (TOOme). Specifically, we first perform feature selection on both gene expressions and mutations by a random forest method. The selected features are then used to build up a multi-label classification model to infer cancer tissue-of-origin. We adopt a few popular multiple-label classification methods, which are compared by the 10-fold cross validation process. We applied TOOme to the TCGA data containing 7,008 non-metastatic samples across 20 solid tumors. Seventy four genes by gene expression profile and six genes by gene mutation are selected by the random forest process, which can be divided into two categories: (1) cancer type specific genes and (2) those expressed or mutated in several cancers with different levels of expression or mutation rates. Function analysis indicates that the selected genes are significantly enriched in gland development, urogenital system development, hormone metabolic process, thyroid hormone generation prostate hormone generation and so on. According to the multiple-label classification method, random forest performs the best with a 10-fold cross-validation prediction accuracy of 96%. We also use the 19 metastatic samples from TCGA and 256 cancer samples downloaded from GEO as independent testing data, for which TOOme achieves a prediction accuracy of 89%. The cross-validation validation accuracy is better than those using gene expression (i.e., 95%) and gene mutation (53%) alone. In conclusion, TOOme provides a quick yet accurate alternative to traditional medical methods in inferring cancer tissue-of-origin. In addition, the methods combining somatic mutation and gene expressions outperform those using gene expression or mutation alone.
Collapse
Affiliation(s)
- Binsheng He
- Academician Workstation, Changsha Medical University, Changsha, China
| | | | - Bo Wang
- Geneis Beijing Co., Ltd., Beijing, China
| | | | | | - Jianjun He
- Academician Workstation, Changsha Medical University, Changsha, China
| | - Wei Gao
- Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Pingping Bing
- Academician Workstation, Changsha Medical University, Changsha, China
| | - Geng Tian
- Geneis Beijing Co., Ltd., Beijing, China
| | | |
Collapse
|
26
|
Reinert CP, Sekler J, la Fougère C, Pfannenberg C, Gatidis S. Impact of PET/CT on clinical management in patients with cancer of unknown primary—a PET/CT registry study. Eur Radiol 2019; 30:1325-1333. [DOI: 10.1007/s00330-019-06518-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/28/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
|
27
|
Rassy E, Zanaty M, Azoury F, Pavlidis N. Advances in the management of brain metastases from cancer of unknown primary. Future Oncol 2019; 15:2759-2768. [PMID: 31385529 DOI: 10.2217/fon-2019-0108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Cancer of unknown primary accounts for 3-5% of all cancers for which an adequate investigation does not identify the primary tumor. The particular subset of brain metastasis in cancer of unknown primary (BMCUP) is a clinical challenge that lacks standardized diagnostic and therapeutic options. It is diagnosed predominantly in male patients in the sixth decade of age with complaints of headache, neurological dysfunction, cognitive and behavioral disturbances and seizures. The therapeutic approach to patients with BMCUP relies on local control and systemic treatment. Surgery or stereotactic radiosurgery and/or whole brain radiation therapy seems to be the cornerstone of the treatment approach to BMCUP. Systemic therapy remains essential as cancers of unknown primary are conceptually metastatic tumors. The benefits of chemotherapy were disappointing whereas those of targeted therapies and immune checkpoint inhibitors remain to be evaluated. In this Review, we address the advances in the diagnosis and treatment of BMCUP.
Collapse
Affiliation(s)
- Elie Rassy
- Department of Hematology-Oncology, Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Mario Zanaty
- Department of Neurosurgical Surgery, University of Ioawa, Ioawa City, IA, USA
| | - Fares Azoury
- Department of Radiation Oncology, Hotel Dieu de France University Hospital, Faculty of Medicine, Saint Joseph University, Lebanon
| | | |
Collapse
|
28
|
Fatima N, Zaman MU, Zaman A, Zaman U, Zaman S, Tahseen R. Detection efficiency of 18F-flourodeoxyglucose positron emission tomography/computed tomography for primary tumors in patients with carcinoma of unknown primary. World J Nucl Med 2019; 19:47-51. [PMID: 32190022 PMCID: PMC7067129 DOI: 10.4103/wjnm.wjnm_93_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/20/2018] [Indexed: 11/13/2022] Open
Abstract
Carcinoma of unknown primary (CUP) is defined as biopsy proven tumor metastases that remains unidentified after a thorough diagnostic evaluation. The purpose of this study was to find the detection efficiency of 18F-flourodeoxyglucose positron emission tomography/computed tomography (18FDG PET/CT) in patients with CUP. This prospective study was conducted at PET/CT Section of Department of Radiology, Aga Khan University Hospital Karachi, Pakistan from August 2017 to January 2018. Patients with a history of CUP referred for 18FDG PET/CT scan for detection of primary sites during the study were recruited. 18FDG PET/CT scan was acquired using standardized protocol, and patients with suspected primary sites underwent biopsies. Scan findings and biopsy results were analyzed to find the detection rate, sensitivity, area under curve (AUC), and positive predictive value (PPV). As no biopsy was performed in negative scan, true negative, and specificity could not be calculated. During the study, 46 consecutive patients with CUP were included. Mean age of cohort was 58 ± 17 years (63% male and 37% female) having a mean body mass index of 24.70 ± 4.97 kg/m2. Thirty-four patients (34/46) found to have a hypermetabolic focus suggestive of the primary tumor with known metastatic sites and subjected to biopsy which turned out to be positive in 26/34 patients (true positive). The primary tumor was detected in gastrointestinal and hepatobiliary in 8 (17%), head and neck in 6 (13%), genitourinary 4 (09%), lung 3 (06%), and miscellaneous sites in 5 (11%) patients. Detection rate, sensitivity and PPV of 18FDG PET/CT were 57%, 68%, and 76%, respectively. Remaining 12/46 patients with negative 18FDG PET/CT for primary focus did not have biopsy. Receiver operating character curve revealed fair diagnostic strength of 18FDG PET/CT for detecting unknown primary (AUC 0.667; P = 0.054; standard error = 0.083; confidence interval: 0.504–0.830). We conclude that 18FDG PET/CT is an effective tool for detecting primary tumor in patients with CUP and its upfront use could preclude the use of many futile diagnostic procedures. Furthermore, higher resolution scanners and acquiring delayed images in patients with negative study could reduce false-negative results in patients with CUP.
Collapse
Affiliation(s)
- Nosheen Fatima
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Maseeh Uz Zaman
- Department of Radiology, Aga Khan University Hospital, Karachi, Pakistan
| | - Areeba Zaman
- Department of Medicine, Dow Medical College, Ruth Pfau Hospital, Karachi, Pakistan
| | - Unaiza Zaman
- Department of Medicine, Dow Medical College, Ruth Pfau Hospital, Karachi, Pakistan
| | - Sidra Zaman
- Department of Medicine, Dow Medical College, Ruth Pfau Hospital, Karachi, Pakistan
| | - Rabia Tahseen
- Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| |
Collapse
|
29
|
A Stepwise Approach to Identify the Clinical Role of 18F-FDG PET/CT in Patients With Suspicious Bone Metastasis From an Unknown Primary Site. Clin Nucl Med 2019; 44:e524-e525. [DOI: 10.1097/rlu.0000000000002687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
|
31
|
Shinya T, Otomi Y, Kubo M, Kinoshita M, Takechi K, Uyama N, Yamanaka M, Terazawa K, Toba H, Bando Y, Otsuka H, Harada M. Preliminary clinical assessment of dynamic 18F-fluorodeoxyglucose positron emission tomography/computed tomography for evaluating lymph node metastasis in patients with lung cancer: a prospective study. Ann Nucl Med 2019; 33:414-423. [PMID: 30911883 DOI: 10.1007/s12149-019-01350-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 03/09/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE We assessed the diagnostic capacity of dynamic fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and dual-time-point (DTP) PET/CT to explore the optimal scan timing for nodal staging in lung cancer. METHODS Thirty-four patients with lung cancer underwent dynamic and consecutive DTP PET/CT scans. Two readers visually evaluated FDG uptake within each lymph node (LN) and pulmonary artery (metastatic LN: n = 10; nonmetastatic LN: n = 121). For each dynamic and DTP scan, we compared the maximum standardized uptake value (SUVmax) and the retention index of the SUVmax (RI-SUVmax) between metastatic and nonmetastatic LNs. We compared the diagnostic capacity of the dynamic and DTP scans using receiver operating characteristic (ROC) analyses. RESULTS In the visual analyses of LN metastases, a sensitivity of 20.0-60.0% and specificity of 97.5-100.0% were identified for the first to third dynamic scans. The sensitivity of the 1-h early and 2-h delayed scans was 80.0% and 90.0%, respectively, whereas the specificity was 66.9% and 47.9%, respectively. The visual analysis of the dynamic second phase had the highest accuracy. Semiquantitative analyses revealed that the SUVmax was significantly higher for metastatic LNs than for nonmetastatic LNs in the dynamic second and third phases and the 1-h early and 2-h delayed phases (p < 0.05 for all). The RI-SUVmax was higher in metastatic LNs than in nonmetastatic LNs for the dynamic scan (p = 0.004) and the DTP scan (p = 0.002). The ROC analyses showed that SUV2 and SUV3 had higher performances with high specificity, high negative predictive value, and high accuracy than the other parameters. The area under the ROC curve of the RI-SUV-dual-time-point had the highest value (0.794) without any significant differences between the area under the ROC curves for all parameters (p > 0.05 for all). CONCLUSIONS Based on the visual and semiquantitative analyses, 18F-FDG dynamic PET/CT exhibited excellent performance with extremely high specificity in the dynamic second phase.
Collapse
Affiliation(s)
- Takayoshi Shinya
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan.
| | - Yoichi Otomi
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Michiko Kubo
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Mitsuhiro Kinoshita
- Department of Radiology, Tokushima Red Cross Hospital, 103, Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Katsuya Takechi
- Department of Radiology, Tokushima Red Cross Hospital, 103, Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Naoto Uyama
- Department of Radiology, Tokushima Red Cross Hospital, 103, Irinokuchi Komatsushima-cho, Komatsushima City, Tokushima, 773-8502, Japan
| | - Moriaki Yamanaka
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Kaori Terazawa
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Hiroaki Toba
- Department of Thoracic and Endocrine Surgery and Oncology, Institute of Health Biosciences, Tokushima University Graduate School, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Yoshimi Bando
- Division of Pathology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Institute of Biomedical Sciences, Tokushima University Graduate School, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| | - Masafumi Harada
- Department of Radiology, Tokushima University Hospital, 2-50-1, Kuramoto-cho, Tokushima City, Tokushima, 770-8503, Japan
| |
Collapse
|
32
|
Liu Y. FDG PET/CT for metastatic squamous cell carcinoma of unknown primary of the head and neck. Oral Oncol 2019; 92:46-51. [PMID: 31010622 DOI: 10.1016/j.oraloncology.2019.03.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 01/22/2019] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The role of FDG PET/CT is uncertain in squamous cell carcinoma of unknown primary (SCCUP). Published data are limited by heterogeneity of pathology, varied diagnostic criteria, and small sample size. MATERIALS/METHODS This retrospective study was conducted in 40 patients who had FDG PET/CT for SCCUP. Prior to PET/CT, patients had underwent standard clinical evaluations including flexible rhinolaryngoscopy. The majority of the patients had anatomic imaging. All subjects had histopathological investigations, and follow-up data after PET/CT. RESULTS FDG PET/CT detected the primary in 16 of 40 patients (40%), and the most common locations of the primary were in the base of the tongue, palatine tonsil, and hypopharynx. There were 10 false positive and 6 false negative PET/CT scans. There was no difference in the mean SUVs of the suspected primary lesions between true and false positive groups. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of FDG PET/CT for SCCUP in this patient cohort were 72.7% (16/22), 44.4% (8/18), 61.5% (16/26), 57.1% (8/14), and 60% (24/40), respectively. The tonsil was the site with the most false positive and false negative findings. CONCLUSIONS FDG PET/CT might be an effective single shot of whole-body imaging for detection of the primary in SCCUP. Low specificity remained the most notable weakness of FDG-PET in work-up for SCCUP. In addition to varied physiologic uptake or inflammatory related uptake in the common locations of the primary, the image indication bias might be another significant contributor of high false positive rate.
Collapse
Affiliation(s)
- Yiyan Liu
- Nuclear Medicine Service, Department of Radiology, New Jersey Medical School, Rutgers University, Newark, NJ, USA.
| |
Collapse
|
33
|
Transoral tongue base mucosectomy for the identification of the primary site in the work-up of cancers of unknown origin: Systematic review and meta-analysis. Oral Oncol 2019; 91:97-106. [PMID: 30926070 DOI: 10.1016/j.oraloncology.2019.02.018] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The use of transoral robotic surgery (TORS) and laser microsurgery (TLM) in the diagnosis and identification of the site of the unknown primary has become increasingly common. This systematic review and meta-analysis aims to assess the use and efficacy of TORS and TLM for this indication. METHOD Systematic review and meta-analysis of studies employing TORS or TLM in diagnosis of the unknown primary tumor site in patients with cervical nodal metastases of squamous cell origin. MEDLINE, EMBASE and CINHAL were searched from inception to July 2018 for all studies that used TORS and or TLM in identifying the unknown primary. RESULTS 251 studies were identified, of which 21 were eligible for inclusion. The primary tumour was identified by TORS/TLM in 78% of patients (433 out of 556). Tongue base mucosectomy (TBM) identified the primary in 222 of 427 cases (53%). In patients with negative physical examination, diagnostic imaging and PETCT, TBM identified the primary in 64% (95% CI 50, 79) cases. In patients who had negative CT/MRI imaging, negative PETCT and negative EUA and tonsillectomy, TBM identified a tongue base primary in 78% (95% CI 41, 92) cases. Haemorrhage, the commonest complication, was reported in 4.9% cases. Mean length of stay varied between 1.4 and 6.3 days. CONCLUSION Tongue base mucosectomy, performed by TORS or TLM, is highly efficacious in identifying the unknown primary in the head and neck region.
Collapse
|
34
|
Marković B, Šobić-Šaranović D. The role of 18FDG PET/CT in evaluation of unknown primary tumors. MEDICINSKI PODMLADAK 2019. [DOI: 10.5937/mp70-17831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
|
35
|
Thapa P, Kalshetty A, Basu S. 18F-fluorodeoxyglucose positron emission tomography/computed tomography in carcinoma of unknown primary: A subgroup-specific analysis based on clinical presentation. World J Nucl Med 2018; 17:219-222. [PMID: 30505217 PMCID: PMC6216728 DOI: 10.4103/wjnm.wjnm_62_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to explore the clinical efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in tumor detection in patients with proven or suspected carcinoma of unknown primary origin (CUP) and making a subgroup-specific analysis. This was a retrospective, cross-sectional survey of patients with CUP syndrome who were referred for 18F-FDG PET-CT studies over a 2-year period. FDG-PET-CT scans were performed in compliance with the standard whole-body protocol, i.e., at least 6 h of fasting and were carried out with injected FDG radioactivity dose between 259 MBq and 370 MBq. The time from FDG injection to PET data acquisition was between 60 and 90 min. PET/CT scanning was acquired from the skull base to the upper third of the thighs. Nonenhanced, low-dose attenuation correction CT (110/70 kV/mAs) was performed for all patients. Twenty-one patients of clinically designated with CUP (male:female = 7:14; age range: 42–70 years; mean age: 57.95 years) fulfilling the inclusion criteria were enrolled in this analysis. The patients were subdivided into two groups: A - Those with histopathological proof (n = 12); B - Those with clinical/tumor markers/radiological suspicion of malignancy (n = 9). Among the first group, the sites of metastases in decreasing order of frequency were lymph nodes (n = 9/20; 75%), brain (n = 2; 16.67%), and liver (n = 1; 8.33%). In group B, six patients (66.7%) presented with hypodense/enhancing lesions in the brain and three (33.3%) had altered marrow signal intensity of spine. Overall, hypermetabolic lesions on FDG-PET/CT indicating the primary tumor sites were identified in 14 patients (66.7%). Twelve out of 14 primary sites were subsequently proven by histopathology, whereas two patients with biopsy-proven metastatic lesions in brain, with suspicious primary site in lung had been corroborated by FDG-PET/CT revealing multiple other metastatic sites, were not biopsied and were subsequently enrolled for palliative chemotherapy. When the results were examined individually in each of the Group A and Group B, the primary tumor detection rate was 58.3% and 77.7%, respectively. The identified primary tumor sites were lung 9/14 (64.4%), uterus/cervi 2/14 (14.3%), breast 1/14 (7.1%), esophagus 1/14 (7.1%), and aryepiglottic fold 1/14 (7.1%). In conclusion, FDG-PET/CT is not only helpful in histologically proven cases of CUP (irrespective of the metastatic sites), this modality also demonstrates high tumor detection rate in patients with clinical/radiological suspicion of malignancy. Being a whole body technique, it can additionally aid in disease staging in these patients which could be potentially helpful in their clinical management.
Collapse
Affiliation(s)
- Pradeep Thapa
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Kalshetty
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sandip Basu
- Radiation Medicine Centre, Bhabha Atomic Research Centre, Tata Memorial Centre Annexe, Parel, Maharashtra, India.,Homi Bhabha National Institute, Mumbai, Maharashtra, India
| |
Collapse
|
36
|
Cengiz A, Göksel S, Yürekli Y. Diagnostic Value of 18F-FDG PET/CT in Patients with Carcinoma of Unknown Primary. Mol Imaging Radionucl Ther 2018; 27:126-132. [PMID: 30317849 PMCID: PMC6191738 DOI: 10.4274/mirt.64426] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective: The aim of this study is to investigate the clinical role of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in patients with carcinoma of unknown primary (CUP). Methods: One hundred twenty one patients with a diagnosis of CUP who underwent whole body 18F-FDG PET/CT imaging were included in this retrospective study. The final diagnoses were confirmed either histopathologically or by clinical follow-up. Results: The 18F-FDG-PET/CT successfully detected the primary tumor in 59 out of 121 (49%) patients. The most common primary tumor as detected by 18F-FDG PET/CT was lung cancer (n=31). In a patient, two primary tumors (colon and prostate) were detected on PET/CT imaging. Bone marrow biopsy revealed prostate cancer in this patient and the colon cancer was accepted as a synchronous second primary tumor. 18F-FDG PET/CT findings were false-positive in 11 patients. 18F-FDG PET/CT could not detect any primary lesion in 51 patients, whose conventional work-up detected a primary tumor in 11 and thus considered as false-negative. The sensitivity, specificity rate and accuracy of 18F-FDG PET/CT in detection of primary tumor were identified as 84%, 78% and 82%, respectively. Conclusion: Whole body 18F-FDG PET/CT is an effective method for detecting the primary tumor in patients with CUP. In addition to detecting the primary tumor, it can also help determine disease extent and contribute to patient management.
Collapse
Affiliation(s)
- Arzu Cengiz
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
| | - Sibel Göksel
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
| | - Yakup Yürekli
- Adnan Menderes University Faculty of Medicine, Department of Nuclear Medicine, Aydın, Turkey
| |
Collapse
|
37
|
Cetin Avci N, Hatipoglu F, Alacacıoglu A, Bayar EE, Bural GG. FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning. Nucl Med Mol Imaging 2018; 52:438-444. [PMID: 30538775 DOI: 10.1007/s13139-018-0544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP). Methods A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up. Results The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients. Conclusion FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.
Collapse
Affiliation(s)
- Neslihan Cetin Avci
- 1Department of Nuclear Medicine, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Filiz Hatipoglu
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Ahmet Alacacıoglu
- 3Department of Internal Medicine and Oncology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Emine Ebru Bayar
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Gonca Gul Bural
- 4Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
38
|
Cancer of unknown primary origin: Can FDG PET/CT have a role in detecting the site of primary? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
39
|
Cerebral Abscesses and Osteomyelitis Caused by Fish Bone Impaction on FDG PET/CT Imaging. Clin Nucl Med 2017; 43:209-212. [PMID: 29261635 DOI: 10.1097/rlu.0000000000001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 50-year-old woman complained postprandial vomiting for 5 days and drowsiness for 3 days. Possible central nervous pathology was suspected clinically. Brain MRI suggested likely brain metastases. For this reason, FDG PET/CT was performed to search the primary malignancy. The images showed abnormal activity not only in the brain, but also in the retropharyngeal region and in the thoracic vertebral body. The lesions were eventually confirmed as infection caused by fish bone impaction that occurred 1 month earlier.
Collapse
|
40
|
Kennedy A, Allan K, Rajak S. A primary squamous cell carcinoma of the orbit. Can J Ophthalmol 2017; 52:e230-e233. [DOI: 10.1016/j.jcjo.2017.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 03/27/2017] [Accepted: 04/05/2017] [Indexed: 11/27/2022]
|
41
|
Sundermann B, Schröder JB, Warnecke T, Heindel W, Schäfers M, Weckesser M, Buerke B. Imaging Workup of Suspected Classical Paraneoplastic Neurological Syndromes: A Systematic Review and Retrospective Analysis of 18F-FDG-PET-CT. Acad Radiol 2017; 24:1195-1202. [PMID: 28551401 DOI: 10.1016/j.acra.2017.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 03/29/2017] [Accepted: 03/30/2017] [Indexed: 11/17/2022]
Abstract
RATIONALE AND OBJECTIVES This study aimed to assess the clinical efficacy of positron emission tomography (PET) or combined PET-computed tomography (CT) with 18F-fluorodeoxyglucose (FDG) for whole-body cancer screening in patients with suspected paraneoplastic neurological syndromes (PNS). The following main research questions were addressed: What is the percentage of positive findings to be expected in whole-body FDG-PET-CT in adult patients with PNS? How many false positives can be expected as assessed by clinical and histopathological workup? Are there patients who present with a tumor despite initially negative findings? MATERIALS AND METHODS This is a systematic review of the literature and retrospective analysis of FDG-PET-CT and clinical follow-up data from 45 consecutive patients (age: 56.6 ± standard deviation 15.8 years, 14 female, 31 male). Suspicious lesions were identified and correlated with immediate workup and clinical follow-up. RESULTS Fourteen studies were included in the review. Eleven malignancies (24.4% of patients) were identified by FDG-PET-CT in this sample. This is a higher percentage of positive findings compared to most previous reports. There was one initially negative finding. CONCLUSIONS Whole-body FDG-PET-CT is suitable to identify additional malignancies in patients with suspected classical PNS referred to a tertiary medical center. The utility by means of true-positive findings is higher in classical PNS than suggested by studies in less select patient populations.
Collapse
Affiliation(s)
- Benedikt Sundermann
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany.
| | | | - Tobias Warnecke
- University Hospital Münster, Department of Neurology, 48149 Münster, Germany
| | - Walter Heindel
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| | - Michael Schäfers
- University Hospital Münster, Department of Nuclear Medicine, 48149 Münster, Germany; University of Münster, DFG EXC 1003 "Cells in Motion" Cluster of Excellence, 48149 Münster, Germany; University of Münster, European Institute of Molecular Imaging, 48149 Münster, Germany
| | - Matthias Weckesser
- University Hospital Münster, Department of Nuclear Medicine, 48149 Münster, Germany
| | - Boris Buerke
- University Hospital Münster, Department of Clinical Radiology, Albert-Schweitzer-Campus 1, Gebäude A1, 48149 Münster, Germany
| |
Collapse
|
42
|
Abstract
BACKGROUND To compare the diagnostic accuracy of PET/MR and PET/CT in patients with suspected occult primary tumors. METHODS This prospective study was approved by the institutional review board. Sequential PET/CT-MR was performed in 43 patients (22 male subjects; median age, 58 years; range, 20-86 years) referred for suspected occult primary tumors. Patients were assessed with PET/CT and PET/MR for the presence of a primary tumor, lymph node metastases, and distant metastases. Wilcoxon signed-rank test was performed to compare the diagnostic accuracy of PET/CT and PET/MR. RESULT According to the standard of reference, a primary lesion was found in 14 patients. In 16 patients, the primary lesion remained occult. In the remaining 13 patients, lesions proved to be benign. PET/MR was superior to PET/CT for primary tumor detection (sensitivity/specificity, 0.85/0.97 vs 0.69/0.73; P = 0.020) and comparable to PET/CT for the detection of lymph node metastases (sensitivity/specificity, 0.93/1.00 vs 0.93/0.93; P = 0.157) and distant metastases (sensitivity/specificity, 1.00/0.97 vs 0.82/1.00; P = 0.564). PET/CT tended to misclassify physiologic FDG uptake as malignancy compared with PET/MR (8 patients vs 1 patient). CONCLUSIONS PET/MR outperforms PET/CT in the workup of suspected occult malignancies. PET/MR may replace PET/CT to improve clinical workflow.
Collapse
|
43
|
Correlation of PET/CT and Image-Guided Biopsies of Pediatric Malignancies. AJR Am J Roentgenol 2017; 208:656-662. [DOI: 10.2214/ajr.15.15914] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
44
|
Swaid F, Downs D, Rosemurgy AS. A practical approach to liver metastasis from unknown primary cancer: What surgeons need to know. Cancer Genet 2016; 209:559-566. [DOI: 10.1016/j.cancergen.2016.08.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 08/04/2016] [Indexed: 12/18/2022]
|
45
|
Fluorine-18 fluorodeoxyglucose avid thyroid incidentalomas on PET/CT scan in cancer patients. Nucl Med Commun 2016; 37:1069-73. [DOI: 10.1097/mnm.0000000000000557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
46
|
Dale E, Moan JM, Osnes TA, Bogsrud TV. Cervical lymph node metastases of squamous cell carcinoma of unknown origin: the diagnostic value of FDG PET/CT and clinical outcome. Eur Arch Otorhinolaryngol 2016; 274:1015-1019. [DOI: 10.1007/s00405-016-4318-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 09/22/2016] [Indexed: 10/20/2022]
|
47
|
Ruhlmann V, Ruhlmann M, Bellendorf A, Grueneisen J, Sawicki LM, Grafe H, Forsting M, Bockisch A, Umutlu L. Hybrid imaging for detection of carcinoma of unknown primary: A preliminary comparison trial of whole-body PET/MRI versus PET/CT. Eur J Radiol 2016; 85:1941-1947. [PMID: 27776644 DOI: 10.1016/j.ejrad.2016.08.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 07/19/2016] [Accepted: 08/25/2016] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of this study is to evaluate and compare the diagnostic potential of integrated whole-body [18F]FDG-PET/MRI to [18F]FDG-PET/CT for detection of a potential primary cancer and metastases in patients suspected for cancer of unknown primary (CUP). METHODS A total of 20 patients (15 male, 5 female, age 53±13 years) suspect for CUP underwent a dedicated head and neck & whole-body [18F]FDG-PET/CT (Biograph mCT 128, Siemens Healthcare) and a subsequent simultaneous [18F]FDG-PET/MRI examination (Biograph mMR, Siemens Healthcare). Two readers rated the datasets (PET/CT; PET/MRI) regarding the detection of the primary cancer and metastases, lesion conspicuity (4-point ordinal scale) and diagnostic confidence (3-point ordinal scale). PET analysis comprised the assessment of maximum standardized uptake values (SUVmax) of all PET-positive lesions using volume of interest (VOI) analysis derived from the PET/CT and PET/MR datasets. All available data considering histology and imaging including prior and clinical follow-up examinations served as reference standard. Statistical analysis included comparison of mean values using Mann-Whitney U test and correlation of SUVmax using Pearson's correlation. RESULTS In 14 out of 20 patients 49 malignant lesions were present. The primary cancer could be correctly identified in 11/20 patients with both PET/CT and PET/MRI. PET/CT enabled the detection of a total 38 metastases, PET/MR respectively of 37 metastases (one lung metastasis <5mm was missed). PET/CT and PET/MRI showed comparably high lesion conspicuity (2.6±0.6 each), with superior assessment of cervical lesions in PET/MRI and an indicated superior assessment of pulmonary lesions in PET/CT. Diagnostic confidence was rated comparably high in PET/CT and PET/MRI (2.7±0.5 each). The mean values of SUVmax of all PET-positive lesions (PET/MRT 7.9±4.2 vs. PET/CT 7.2±3.5) showed a strong positive correlation between the SUVs derived from both hybrid imaging systems (Pearson's correlation r=0.927). CONCLUSIONS Both hybrid imaging techniques provide a comparable diagnostic ability for detection of primary cancer and metastases in patients with CUP, with comparably high lesion conspicuity and diagnostic confidence, offering superior assessment of cervical lesions in PET/MRI and potentially of pulmonary lesions in PET/CT. Furthermore, due to the significantly lower dose of ionizing radiation, PET/MRI may serve as a powerful alternative to PET/CT, particularly for therapy monitoring and/or surveillance considering the long-term cumulative dose.
Collapse
Affiliation(s)
- Verena Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Marcus Ruhlmann
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Alexander Bellendorf
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Johannes Grueneisen
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, University of Dusseldorf, Moorenstraße 5, 40225 Dusseldorf, Germany
| | - Hong Grafe
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Michael Forsting
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Andreas Bockisch
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany
| | - Lale Umutlu
- Department of Nuclear Medicine, University Hospital Essen, University Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany.
| |
Collapse
|
48
|
Tamam C, Tamam M, Mulazimoglu M. The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin. World J Nucl Med 2016; 15:124-9. [PMID: 27134563 PMCID: PMC4809153 DOI: 10.4103/1450-1147.176885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
Collapse
Affiliation(s)
- Cuneyt Tamam
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Muge Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mulazimoglu
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
| |
Collapse
|
49
|
Chen R, Chen Y, Liu L, Zhou X, Liu J, Huang G. The Role of ¹⁸F-FDG PET/CT in the Evaluation of Peritoneal Thickening of Undetermined Origin. Medicine (Baltimore) 2016; 95:e3023. [PMID: 27082546 PMCID: PMC4839790 DOI: 10.1097/md.0000000000003023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to assess the value of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for the differentiation of peritoneal thickening of undetermined origin. This retrospective study included 103 patients (44 men and 59 women, age 59.2 ± 14.8 years) who had undergone 18F-FDG PET/CT for the evaluation of peritoneal thickening of undetermined origin. All 18F-FDG PET/CT images were visually interpreted, and the maximal standardized uptake values (SUVmax) were measured. We compared the role of 18F-FDGPET/CT with that of CT alone in detecting peritoneal thickening of undetermined origin. We also compared the differences between malignant and tuberculous peritoneal thickening in PET/CT parameters and clinical characteristics. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting the primary cause of the peritoneal thickening were 76.2%, 78.9%, 94.1%, 42.9%, and 81.2%, respectively, for 18F-FDG PET/CT, and 58.3%, 84.2%, 94.2%, 31.4%, and 63.1%, respectively, for CT imaging. Malignant peritoneal thickening had significantly higher SUVmax than nontuberculous benign peritoneal thickening. However, tuberculous peritoneal thickening also had a high SUVmax. There were some factors that were significantly different between patients with tuberculous peritoneal thickening and those with malignant peritoneal thickening in our study; these included age, pattern of peritoneal thickening, and presence of ascites. 18F-FDG PET/CT is useful for detecting the underlying cause of peritoneal thickening. Special attention should be paid to peritoneal tuberculosis, which has a high SUVmax and may mimic malignant peritoneal thickening. Multiple PET/CT parameters which were different in patients with tuberculous and malignant causes could be taken into consideration to make the differential diagnosis.
Collapse
Affiliation(s)
- Ruohua Chen
- From the Department of Nuclear Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University (RHC, YMC, LL, XZ, JJL, GH); and Department of Cancer Metabolism, Institute of Health Sciences, Chinese Academy of Sciences and Shanghai Jiao Tong University School Medicine, Shanghai, China (GH); Shanghai University of Medicine & Health Sciences (SHMHS) (GH)
| | | | | | | | | | | |
Collapse
|
50
|
Ross JS, Wang K, Gay L, Otto GA, White E, Iwanik K, Palmer G, Yelensky R, Lipson DM, Chmielecki J, Erlich RL, Rankin AN, Ali SM, Elvin JA, Morosini D, Miller VA, Stephens PJ. Comprehensive Genomic Profiling of Carcinoma of Unknown Primary Site: New Routes to Targeted Therapies. JAMA Oncol 2016; 1:40-49. [PMID: 26182302 DOI: 10.1001/jamaoncol.2014.216] [Citation(s) in RCA: 167] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
IMPORTANCE For carcinoma of unknown primary site (CUP), determining the primary tumor site may be uninformative and often does not improve outcome. OBJECTIVE To discover opportunities for targeted therapies in patients with CUP not currently searched for in routine practice. DESIGN, SETTING, AND PARTICIPANTS Comprehensive genomic profiling on 200 CUP formalin-fixed paraffin-embedded specimens (mean, 756× coverage) using the hybrid-capture-based FoundationOne assay at academic and community oncology clinics. MAIN OUTCOMES AND MEASURES Presence of targetable genomic alterations (GAs) in CUP and responses to targeted therapies. RESULTS There were 125 adenocarcinomas of unknown primary site (ACUPs) and 75 carcinomas of unknown primary site without features of adenocarcinoma (non-ACUPs). At least 1 GA was found in 192 (96%) of CUP specimens, with a mean (SD) of 4.2 (2.8) GAs per tumor. The most frequent GAs were in TP53 (110 [55%]), KRAS (40 [20%]), CDKN2A (37 [19%]), MYC (23 [12%]), ARID1A (21 [11%]), MCL1 (19 [10%]), PIK3CA (17 [9%]), ERBB2 (16 [8%]), PTEN (14 [7%]), EGFR (12 [6%]), SMAD4 (13 [7%]), STK11 (13 [7%]), SMARCA4 (12 [6%]), RB1 (12 [6%]), RICTOR (12 [6%]), MLL2 (12 [6%]), BRAF (11 [6%]), and BRCA2 (11 [6%]). One or more potentially targetable GAs were identified in 169 of 200 (85%) CUP specimens. Mutations or amplifications of ERBB2 were more frequent in ACUPs (13 [10%]) than in non-ACUPs (3 [4%]). Alterations of EGFR (10 [8%] vs 2 [3%]) and BRAF (8 [6%] vs 3 [4%]) were more common in ACUPs than in non-ACUPs. Strikingly, clinically relevant alterations in the receptor tyrosine kinase (RTK)/Ras signaling pathway including alterations in ALK, ARAF, BRAF, EGFR, FGFR1, FGFR2, KIT, KRAS, MAP2K1, MET, NF1, NF2, NRAS, RAF1, RET, and ROS1 were found in 90 (72%) ACUPs but in only 29 (39%) non-ACUPs (P < .001). CONCLUSIONS AND RELEVANCE Almost all CUP samples harbored at least 1 clinically relevant GA with potential to influence and personalize therapy. The ACUP tumors were more frequently driven by GAs in the highly druggable RTK/Ras/mitogen-activated protein kinase (MAPK) signaling pathway than the non-ACUP tumors. Comprehensive genomic profiling can identify novel treatment paradigms to address the limited options and poor prognoses of patients with CUP.
Collapse
Affiliation(s)
- Jeffrey S Ross
- Foundation Medicine Inc, Cambridge, Massachusetts.,Department of Pathology and Laboratory Medicine, Albany Medical College, Albany, New York
| | - Kai Wang
- Foundation Medicine Inc, Cambridge, Massachusetts
| | - Laurie Gay
- Foundation Medicine Inc, Cambridge, Massachusetts
| | - Geoff A Otto
- Foundation Medicine Inc, Cambridge, Massachusetts
| | - Emily White
- Foundation Medicine Inc, Cambridge, Massachusetts
| | - Kiel Iwanik
- Foundation Medicine Inc, Cambridge, Massachusetts
| | - Gary Palmer
- Foundation Medicine Inc, Cambridge, Massachusetts
| | | | | | | | | | | | - Siraj M Ali
- Foundation Medicine Inc, Cambridge, Massachusetts
| | | | | | | | | |
Collapse
|