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Pak K, Yoon HJ. Impact of 18 F-FDG PET on the Management in Patients With Recurrent Gynecologic cancer : A Meta-analysis. Clin Nucl Med 2023; 48:945-949. [PMID: 37756472 DOI: 10.1097/rlu.0000000000004839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
PURPOSE Gynecological cancer is the most prevalent cancer among women worldwide. We performed a meta-analysis to assess the impact of 18 F-FDG PET on the management of patients with recurrent gynecological cancers, including cervical, uterine, and ovarian cancers. METHODS We systematically searched MEDLINE and EMBASE databases for English-language publications. All published studies on the impact of PET scans on the management of patients with recurrent gynecological cancers were reviewed. The proportion of management change (%), defined as the percentage of patients whose management changed after FDG PET to those who underwent FDG PET, was calculated. The data from each study were analyzed using MedCalc Statistical Software version 14.12.0 (MedCalc Software, Ostend, Belgium). RESULTS Nineteen studies including 6191 patients were eligible for inclusion. The impact of FDG PET scan for detecting recurrence/metastasis in patients with gynecologic cancer was evaluated using management change rates, ranging from 9.4% to 60.7% with a pooled effect of 42.0% (95% confidence interval [CI], 34.5%-49.6%; I2 = 92.9%). In the subtype analysis, FDG PET scanning resulted in changes in the management in 48.5% (95% CI, 37.8%-59.3%; I2 = 67.8%) of cervical cancer, 34.7% (95% CI, 33.4%-36.0%; I2 = 0%) of uterine cancer, and 40.3% (95% CI, 26.7%-54.7%; I2 = 95.2%) of ovarian cancer cases. CONCLUSIONS FDG PET has a significant impact on the restaging of patients with gynecological cancer. These findings suggest that FDG PET should be performed, especially in cases of suspected recurrence/metastasis in the main gynecologic cancer types, including cervical, ovarian, and uterine cancers.
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Affiliation(s)
| | - Hai-Jeon Yoon
- Department of Nuclear Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
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FDG PET-CT as an important diagnostic tool and prognostic marker in suspected recurrent cervical carcinoma after radiotherapy: comparison with MRI. Radiol Oncol 2022; 56:453-460. [PMID: 36317553 PMCID: PMC9784362 DOI: 10.2478/raon-2022-0042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Recurrent disease in post-irradiation patients with cervical cancer is often difficult to delineate on magnetic resonance imaging (MRI), because posttreatment changes can have a similar appearance, and further evaluation is often required. The aims of the study were to evaluate positron emission tomography/computed tomography with 18F-fluorodeoxyglucose (FDG PET-CT) diagnostic role in suspected recurrent cervical cancer after radiotherapy, compare it to MRI, and assess their prognostic impact in these patients. PATIENTS AND METHODS This cohort retrospective study included patients previously treated with radiotherapy for carcinoma of uterine cervix with suspected recurrence, who had undergone MRI of abdomen and pelvis, and were subsequently evaluated on FDG PET-CT, with minimum follow-up period of 12 months. RESULTS In the total of 84 patients included in analysis, MRI vs. FDG PET-CT showed sensitivity, specificity and accuracy of 80.1%, 52.4% and 66.7%, vs. 97.6%, 61.9% and 79.8%, respectively. Patients with positive findings on MRI (Log Rank, p = 0.003) and PET-CT (Log Rank, p < 0.001) had shorter progression-free survival (PFS) than those with negative results. In univariate Cox regression models, MRI and FDG PET-CT results were found to be related to PFS (p = 0.005 and p < 0.001, respectively). However, multivariate analysis proved only FDG PET-CT to be independent prognostic factor, where patients with positive FDG PET-CT results had almost nine times higher risk of progression (p < 0.001). CONCLUSION FDG PET-CT represents useful diagnostic tool in suspected recurrent cervical cancer after radiotherapy, showing high sensitivity in its detection. In addition, it is an independent factor in predicting progression-free survival in these patients.
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Abstract
Since the publication of the 2018 FIGO Cancer Report, giant strides have been made in the global effort to reduce the burden of cervical cancer, with the World Health Organization (WHO) rolling out a global strategy for cervical cancer elimination, aiming for implementation by 2030. In over 130 countries, including low- and middle-income countries, HPV vaccination is now included in the national program. Screening has seen major advances with wider implementation of HPV testing. These interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. FIGO's revised staging of cervical cancer (2018) has been widely implemented and retrospective analyses of data based on the new staging have been published. Minimally invasive surgery has been shown to be disadvantageous in women with cervical cancer. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and GynecologyAll India Institute of Medical SciencesNew DelhiIndia
| | - Daisuke Aoki
- Department of Obstetrics and GynecologyKeio University School of MedicineTokyoJapan
| | - Daya Nand Sharma
- Department of Radiation OncologyAll India Institute of Medical SciencesNew DelhiIndia
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Jiang Y, Hou G, Huo L, Li F, Zhu Z, Cheng W. 18F-FDG PET/computed tomography scan in patients with suspicion of recurrent neuroendocrine carcinoma of the cervix. Nucl Med Commun 2021; 42:1151-1156. [PMID: 33927154 PMCID: PMC8445361 DOI: 10.1097/mnm.0000000000001432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/23/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the value of [18F]fluoro-2-deoxy-D-glucose (18F-FDG) PET/computed tomography (CT) to detect recurrent cervical neuroendocrine carcinoma and its subsequent impact on patient management. METHODS A total of 25 patients who had undergone 30 18F-FDG PET/CT studies for suspected recurrent cervical neuroendocrine carcinoma (18 small cells, 2 large cells, 1 atypical carcinoid, and 4 unclassified) were retrospectively analyzed. The findings of the PET/CT images were compared with the histopathologic results in 8 scans and with clinical follow-up in 22 scans. RESULTS Of the 30 PET/CT studies, 63.3% (19/30) were positive for recurrence while 36.7% (11/30) were negative. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG PET/CT for detecting recurrent disease of cervical neuroendocrine carcinomas were 90.0, 90.0, 94.7, 81.8, and 90.0%, respectively. Metastasis to distant organs was the most common (89.4%), followed by lymph node recurrence (52.6%). Lungs were the most frequent site of distant metastasis (63.1%). 18F-FDG PET/CT findings led to the change of the management in 10 out of 25 patients (40%) by introducing the use of previously unplanned therapeutic procedures. CONCLUSIONS 18F-FDG PET/CT is an efficient technique for detecting recurrent cervical neuroendocrine carcinoma, and may thus contribute to improving patient management.
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Affiliation(s)
- Yuanyuan Jiang
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Guozhu Hou
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Li Huo
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Fang Li
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Zhaohui Zhu
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
| | - Wuying Cheng
- Department of Nuclear Medicine, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College
- Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China
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Pirasteh A, Lovrec P, Pedrosa I. Imaging and its Impact on Defining the Oligometastatic State. Semin Radiat Oncol 2021; 31:186-199. [PMID: 34090645 DOI: 10.1016/j.semradonc.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Successful treatment of oligometastatic disease (OMD) is facilitated through timely detection and localization of disease, both at the time of initial diagnosis (synchronous OMD) and following the initial therapy (metachronous OMD). Hence, imaging plays an indispensable role in management of patients with OMD. However, the challenges and complexities of OMD management are also reflected in the imaging of this entity. While innovations and advances in imaging technology have made a tremendous impact in disease detection and management, there remain substantial and unaddressed challenges for earlier and more accurate establishment of OMD state. This review will provide an overview of the available imaging modalities and their inherent strengths and weaknesses, with a focus on their role and potential in detection and evaluation of OMD in different organ systems. Furthermore, we will review the role of imaging in evaluation of OMD for malignancies of various primary organs, such as the lung, prostate, colon/rectum, breast, kidney, as well as neuroendocrine tumors and gynecologic malignancies. We aim to provide a practical overview about the utilization of imaging for clinicians who play a role in the care of those with, or at risk for OMD.
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Affiliation(s)
- Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI
| | - Petra Lovrec
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - Ivan Pedrosa
- Departments of Radiology, Urology, and Advanced Imaging Research Center. University of Texas Southwestern, Dallas, TX.
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Value of Intratumoral Metabolic Heterogeneity and Quantitative18F-FDG PET/CT Parameters in Predicting Prognosis for Patients With Cervical Cancer. AJR Am J Roentgenol 2020; 214:908-916. [DOI: 10.2214/ajr.19.21604] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Brito AET, Matushita C, Esteves F, Gomes G, Bernardo WM, Amorim BJ. Cervical cancer - staging and restaging with 18F-FDG PET/CT. ACTA ACUST UNITED AC 2019; 65:568-575. [PMID: 31066810 DOI: 10.1590/1806-9282.65.4.568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/22/2022]
Abstract
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
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Affiliation(s)
- Ana Emília T Brito
- Brazilian Society of Nuclear Medicine, - Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil
| | - Cristina Matushita
- Brazilian Society of Nuclear Medicine, - Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil
| | - Fabio Esteves
- Brazilian Society of Nuclear Medicine, - Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil
| | - Gustavo Gomes
- Brazilian Society of Nuclear Medicine, - Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil
| | - Wanderley M Bernardo
- Brazilian Medical Association, Rua São Carlos do Pinhal, 324 - Bela Vista, São Paulo - SP, Brasil
| | - Barbara Juarez Amorim
- Brazilian Society of Nuclear Medicine, - Rua Real Grandeza, 108 sala 101 - Botafogo, Rio de Janeiro - RJ, Brasil
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Abstract
Since the publication of the last FIGO Cancer Report there have been giant strides in the global effort to reduce the burden of cervical cancer, with WHO announcing a call for elimination. In over 80 countries, including LMICs, HPV vaccination is now included in the national program. Screening has also seen major advances with implementation of HPV testing on a larger scale. However, these interventions will take a few years to show their impact. Meanwhile, over half a million new cases are added each year. Recent developments in imaging and increased use of minimally invasive surgery have changed the paradigm for management of these cases. The FIGO Gynecologic Oncology Committee has revised the staging system based on these advances. This chapter discusses the management of cervical cancer based on the stage of disease, including attention to palliation and quality of life issues.
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Affiliation(s)
- Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Daisuke Aoki
- Department of Obstetrics and Gynecology, Keio University School of Medicine, Tokyo, Japan
| | - Daya Nand Sharma
- Department of Radiation Oncology, All India Institute of Medical Sciences, New Delhi, India
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Diagnostic value of 18F-FDG PET/MRI in recurrent pelvis malignancies of female patients: a systematic review and meta-analysis. Nucl Med Commun 2018; 39:479-485. [PMID: 29634659 DOI: 10.1097/mnm.0000000000000839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to assess the diagnostic performance of fluorine-18-fluorodeoxyglucose (F-FDG) PET/MRI for suspected recurrence of pelvis malignancies of female patients using a meta-analysis. We performed a systematical literature search for relevant studies in PubMed, Cochrane Library, Google Scholar, and several Chinese databases. Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) was used to assess the quality of all included studies. Pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were calculated per patient and per lesion. Summary receiver operating characteristic curves were also constructed. All procedures involving human participants in this study were performed in conformity with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments. Finally, seven articles comprising 257 patients and 695 lesions were included in this meta-analysis. On patient-based analysis, the pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio of F-FDG PET/MRI in detecting recurrence of pelvis malignancies were 0.96 [95% confidence interval (CI): 0.93-0.99], 0.95 (95% CI: 0.87-0.99), 9.85 (95% CI: 4.62-21.00), 0.07 (95% CI: 0.04-0.13), and 201.41 (95% CI: 62.89-645.03), respectively. On lesion-based analysis, the corresponding estimates were 0.99 (95% CI: 0.97-1.00), 0.94 (95% CI: 0.89-0.97), 17.11 (95% CI: 4.46-65.60), 0.02 (95% CI: 0.01-0.05), and 1125.24 (95% CI: 211.46-5987.79), respectively. The results of our meta-analysis indicate that F-FDG PET/MRI has excellent diagnostic performance in restaging female patients with suspected recurrence of gynecological pelvic malignancies.
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10
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Abstract
The incidence of gynecological malignancies is on the rise partly because of the availability of screening programmes, awareness, higher technological advancements, and availability of better medical care. Early diagnosis of any malignancy leads to prompt treatment. Use of 18Fluorine-Fluorodeoxyglucose (F-FDG) PET/CT in the treatment and follow-up of patients with Ca cervix considerably improves patient management. The primary diagnosis of Ca cervix is made either by biopsy of a visible tumor on the cervix or by a cone biopsy of a nonvisible malignant cervical focus. The staging procedure is purely clinical (i.e. gynecologic examination under general anesthesia) according to the International Federation of Gynaecology and Obstetrics classification. Earlier, with the nonavailability of sophisticated medical equipment and imaging specialists, oncologists relied heavily on clinical examination. However, anatomical and functional imaging has been proven to be considerably superior in understanding parametrial involvement and nodal/distant metastases in the cancer cervix than clinical examination alone. Data are evolving on the usage of F-FDG PET/CT in initial staging, treatment planning, and monitoring therapy response for gynecological malignancies. Prognostic information derived from the primary lesion such as the maximum standardized uptake value, metabolic tumor volume, and extent of para-aortic nodal metastatic disease plays a critical role in tailoring therapy on the basis of patient tumor-specific factors rather than on International Federation of Gynaecology and Obstetrics stage alone. Thus, F-FDG PET/CT needs to be listed not only under the panel of pretherapy investigations for Ca cervix but also for recurrence and therapy response assessments. It allows a more confident approach to patient management at initial staging, especially in terms of the decision to choose surgical versus palliation measures.
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11
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Sookha RR, Zhi W, Shen Y, Lazare C, Wang L, Meng Y, Cao C, Hu J, Wu P. Clinical Value of Combining 18F-FDG PET/CT and Routine Serum Tumor Markers in The Early Detection of Recurrence Among Follow-up Patients Treated for Cervical Squamous Cell Carcinoma. J Cancer 2018; 9:3101-3108. [PMID: 30210633 PMCID: PMC6134808 DOI: 10.7150/jca.27206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/28/2018] [Indexed: 01/27/2023] Open
Abstract
Objective: The purpose of this retrospective study was to investigate the role of 18F-Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET/CT) and evaluate if combined elevated serum tumor markers levels improve the accuracy of 18F-FDG PET/CT in detecting recurrence of cervical squamous cell carcinoma. Methods: A total number of 42 patients who were treated for cervical squamous cell carcinoma and had underwent 18F-FDG PET/CT for suspected recurrence of cervical cancer were retrospectively reviewed in this study and their clinical, pathological and serological data were collected and analyzed. The clinical value of combining 18F-FDG PET/CT with serum tumor markers was investigated. Results: Among the 42 patients, 18F-FDG PET/CT was true positive in 25 (59.5%), false positive in 5 (11.9%), true negative in 12 (28.5%) and false negative in none. The overall patient-based sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 18F-FDG PET/CT in detecting recurrent cervical cancer were 100%, 70.6, 88.1%, 83.3%, and 100%, respectively. The accuracy of 18F-FDG PET/CT with combined squamous cell carcinoma antigen (SCC Ag) and carcinoembryonic antigen (CEA) elevation was 100% compared to only SCC Ag elevation and only CEA elevation, 90% and 33.3%, respectively. The positive predictive value of a positive 18F-FDG PET/CT with combined SCC Ag and CEA elevation was 100% for detection of recurrent cervical cancer. Also, the negative predictive value of a negative 18F-FDG PET/CT combined with normal SCC Ag and CEA levels was 100%. Conclusion:18F-FDG PET/CT is highly sensitive in the diagnosis of recurrent cervical cancer. When 18F-FDG PET/CT is associated with both SCC Ag and CEA elevation or only SCC Ag elevation, the accuracy is increased but not when associated with only CEA elevation. Positive 18F-FDG PET/CT associated with both tumor markers elevation can precisely predict recurrence. Moreover, normal levels of both tumor markers with a negative 18F-FDG PET/CT result may clinically reassure that a recurrence is absent.
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Affiliation(s)
- Rajiv Rai Sookha
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Wenhua Zhi
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yanxia Shen
- Department of Nuclear medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, P. R. China
| | - Cordelle Lazare
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Ling Wang
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Yifan Meng
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Canhui Cao
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Junbo Hu
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
| | - Peng Wu
- The Key Laboratory of Cancer Invasion and Metastasis of the Ministry of Education of China, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, P. R. China
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Zhou Z, Liu X, Hu K, Zhang F. The clinical value of PET and PET/CT in the diagnosis and management of suspected cervical cancer recurrence. Nucl Med Commun 2018; 39:97-102. [DOI: 10.1097/mnm.0000000000000775] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Bowen SR, Yuh WTC, Hippe DS, Wu W, Partridge SC, Elias S, Jia G, Huang Z, Sandison GA, Nelson D, Knopp MV, Lo SS, Kinahan PE, Mayr NA. Tumor radiomic heterogeneity: Multiparametric functional imaging to characterize variability and predict response following cervical cancer radiation therapy. J Magn Reson Imaging 2017; 47:1388-1396. [PMID: 29044908 DOI: 10.1002/jmri.25874] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 09/27/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Robust approaches to quantify tumor heterogeneity are needed to provide early decision support for precise individualized therapy. PURPOSE To conduct a technical exploration of longitudinal changes in tumor heterogeneity patterns on dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI) and FDG positron emission tomography / computed tomography (PET/CT), and their association to radiation therapy (RT) response in cervical cancer. STUDY TYPE Prospective observational study with longitudinal MRI and PET/CT pre-RT, early-RT (2 weeks), and mid-RT (5 weeks). POPULATION Twenty-one FIGO IB2 -IVA cervical cancer patients receiving definitive external beam RT and brachytherapy. FIELD STRENGTH/SEQUENCE 1.5T, precontrast axial T1 -weighted, axial and sagittal T2 -weighted, sagittal DWI (multi-b values), sagittal DCE MRI (<10 sec temporal resolution), postcontrast axial T1 -weighted. ASSESSMENT Response assessment 1 month after completion of treatment by a board-certified radiation oncologist from manually delineated tumor volume changes. STATISTICAL TESTS Intensity histogram (IH) quantiles (DCE SI10% and DWI ADC10% , FDG-PET SUVmax ) and distribution moments (mean, variance, skewness, kurtosis) were extracted. Differences in IH features between timepoints and modalities were evaluated by Skillings-Mack tests with Holm's correction. Area under receiver-operating characteristic curve (AUC) and Mann-Whitney testing was performed to discriminate treatment response using IH features. RESULTS Tumor IH means and quantiles varied significantly during RT (SUVmean : ↓28-47%, SUVmax : ↓30-59%, SImean : ↑8-30%, SI10% : ↑8-19%, ADCmean : ↑16%, P < 0.02 for each). Among IH heterogeneity features, FDG-PET SUVCoV (↓16-30%, P = 0.011) and DW-MRI ADCskewness decreased (P = 0.001). FDG-PET SUVCoV was higher than DCE-MRI SICoV and DW-MRI ADCCoV at baseline (P < 0.001) and 2 weeks (P = 0.010). FDG-PET SUVkurtosis was lower than DCE-MRI SIkurtosis and DW-MRI ADCkurtosis at baseline (P = 0.001). Some IH features appeared to associate with favorable tumor response, including large early RT changes in DW-MRI ADCskewness (AUC = 0.86). DATA CONCLUSION Preliminary findings show tumor heterogeneity was variable between patients, modalities, and timepoints. Radiomic assessment of changing tumor heterogeneity has the potential to personalize treatment and power outcome prediction. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1388-1396.
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Affiliation(s)
- Stephen R Bowen
- University of Washington School of Medicine, Department of Radiation Oncology, Seattle, Washington, USA.,University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA
| | - William T C Yuh
- University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA
| | - Daniel S Hippe
- University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA
| | - Wei Wu
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Department of Radiology, Wuhan, Hubei, P.R. China
| | - Savannah C Partridge
- University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA
| | - Saba Elias
- Ohio State University, Department of Radiology, Columbus, Ohio, USA
| | - Guang Jia
- Louisiana State University, Department of Physics, Baton Rouge, Louisiana, USA
| | - Zhibin Huang
- East Carolina University, Department of Radiation Oncology, Greenville, North Carolina, USA
| | - George A Sandison
- University of Washington School of Medicine, Department of Radiation Oncology, Seattle, Washington, USA
| | | | - Michael V Knopp
- Ohio State University, Department of Radiology, Columbus, Ohio, USA
| | - Simon S Lo
- University of Washington School of Medicine, Department of Radiation Oncology, Seattle, Washington, USA
| | - Paul E Kinahan
- University of Washington School of Medicine, Department of Radiology, Seattle, Washington, USA
| | - Nina A Mayr
- University of Washington School of Medicine, Department of Radiation Oncology, Seattle, Washington, USA
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Affiliation(s)
- Adriana Bermudez
- Gynecologic Oncology Unit, Buenos Aires University Hospital, Buenos Aires, Argentina
| | - Neerja Bhatla
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, India
| | - Eric Leung
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Odette Cancer Centre, Toronto, Ontario, Canada
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15
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Hu YY, Fan W, Zhang X, Liang PY, Lin XP, Zhang YR, Li YH. Complementary Roles of Squamous Cell Carcinoma Antigen and (18)F-FDG PET/CT in Suspected Recurrence of Cervical Squamous Cell Cancer. J Cancer 2015; 6:287-91. [PMID: 25663947 PMCID: PMC4317765 DOI: 10.7150/jca.10819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 12/08/2014] [Indexed: 11/07/2022] Open
Abstract
Purpose: To assess the clinical value of FDG PET/CT and evaluate the complementary roles of serum squamous cell carcinoma antigen (SCCAg) and FDG PET/CT in the diagnosis of suspected recurrent of cervical squamous cell cancer. Methods: Serum SCCAg levels were retrospectively reviewed in patients previously treated for cervical squamous cell carcinoma, who had suspected recurrence of cervical cancer and who had undergone FDG PET/CT scans. The clinical impact of elevated SCCAg (>1.5 ng/ml) and negative SCCAg (≤1.5 ng/ml) levels were analyzed based on the results of PET/CT and final diagnosis. Results: The overall patient-based sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET/CT for the detection of tumor recurrence or malignancy were 100% (86/86), 80.8% (21/26), 95.5% (107/112), 94.5% (86/91) and 100% (21/21), respectively. Of the 112 patients included in this study, recurrence or malignancy was detected by PET/CT in 62 of the 64 patients with elevated SCCAg, compared to 24 of the 48 patients with negative SCCAg levels. The overall patient-based PPV, NPV, sensitivity and accuracy of SCCAg for the detection of tumor recurrence or malignancy were 96.9% (62/64), 50% (24/48), 72.1% (62/86) and 76.8% (86/112), respectively. The five false-positive PET/CT results were all associated with patients with negative SCCAg levels. The PPV of positive PET/CT-associated elevated SCCAg for the detection of tumor recurrence or malignancy was 100% (62/62). The NPV of negative SCCAg-associated negative PET/CT was 100% (19/19). Conclusions: Serum SCCAg evaluation and FDG PET/CT imaging can be complementary techniques in cases of suspected recurrent cervical squamous cancer. Positive PET/CT with elevated SCCAg can predict recurrence. Although PET/CT cannot confidently be deferred due to a negative SCCAg test, the possibility of a false-positive PET/CT in those cases may have diagnostic importance.
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Affiliation(s)
- Ying-Ying Hu
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Wei Fan
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xu Zhang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Pei-Yan Liang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Xiao-Ping Lin
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Ya-Rui Zhang
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
| | - Yuan-Hua Li
- 1. Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Guangzhou, P. R. China ; 2. Department of Nuclear Medicine, Cancer Center, Sun Yat-sen University, Guangzhou, P. R. China
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The Role of (18)F-FDG PET/CT as a Prognostic Factor in Patients with Synovial Sarcoma. Nucl Med Mol Imaging 2014; 49:33-41. [PMID: 25774236 DOI: 10.1007/s13139-014-0301-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 09/14/2014] [Accepted: 09/26/2014] [Indexed: 01/27/2023] Open
Abstract
PURPOSE This research aims to investigate the potential of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET) to predict pathologic response after neoadjuvant chemotherapy (NAC) and overall survival (OS) of patients with synovial sarcoma in Korea. METHODS Twenty patients with synovial sarcoma from January 2001 to December 2011 were reviewed retrospectively. All patients underwent pre-treatment FDG PET and tumor removal. Patients were classified with the maximum SUV (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), age, sex, histologic subtype, tumor size, NAC, resection margin, and metastasis at diagnosis. Pathologic response was assessed using the French Federation of Cancer Centers system. Statistical analyses were analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards regression model, and Mann-Whitney test. RESULTS Nine patients (45 %) showed pathologic response, and ten patients survived. Higher SUVmax, higher MTV, higher TLG, monophasic epithelial type, and metastasis at diagnosis were significantly related to poorer OS (p = 0.047, 0.016, 0.016, 0.045, and 0.018, respectively). By multivariate analysis, metastasis at diagnosis was significantly related to poorer OS (p = 0.012/HR = 5.9, 95 % CI 1.47 to 24.1). The SUVmax, MTV, and TLG of the non-responder group were significantly higher than those of the responder group (p = 0.020, 0.020, and 0.020, respectively). There was no significant difference in size between the two groups (p = 0.062). CONCLUSIONS A higher SUVmax on the pre-treatment scan, monophasic epithelial type, and metastasis at diagnosis were significantly associated with a poorer OS, and pathologic responders showed a higher SUVmax before NAC. The PET parameters can be used to predict OS and pathologic response in patients with synovial sarcomas before NAC.
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Xiao Y, Wei J, Zhang Y, Xiong W. Positron emission tomography alone, positron emission tomography-computed tomography and computed tomography in diagnosing recurrent cervical carcinoma: a systematic review and meta-analysis. Arch Med Sci 2014; 10:222-31. [PMID: 24904653 PMCID: PMC4042042 DOI: 10.5114/aoms.2014.42572] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 09/10/2013] [Accepted: 09/14/2013] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION The aim of the study was to assess systematically the accuracies of positron emission tomography (PET), PET/computed tomography (CT), and CT in diagnosing recurrent cervical cancer. MATERIAL AND METHODS We searched for articles published from January 1980 to June 2013 using the following inclusion criteria: articles were reported in English; the use of PET, interpreted with or without the use of CT; use of CT to detect recurrent cervical cancer; and histopathologic analysis and/or close clinical and imaging follow-up for at least 6 months. We extracted data to calculate sensitivity, specificity, summary receiver operating characteristic curves, and the area under the receiver operating characteristic curve (AUC) as well as test for heterogeneity. RESULTS In 23 included studies, PET had the highest pooled specificity at 92% (95% CI: 90-94), whereas PET/CT had the highest pooled sensitivity at 94% (95% CI: 90-97). The area under the curve (AUC) of PET alone, PET/CT, and CT were 0.9594, 0.9508, and 0.9363, respectively. Results of the pairwise comparison between each modality show that the specificity of PET was higher than that of PET/CT (p < 0.05). The difference in the pooled sensitivities and AUC of PET alone and PET/CT showed no statistical significance. No evidence of publication bias was found. However, evidence of heterogeneity was observed. CONCLUSIONS The PET/CT may be a useful supplement to current surveillance techniques, particularly for patients with negative CT imaging. However, in terms of diagnostic accuracy, interpreted CT images may have limited additional value to PET in detecting recurrent cervical cancer.
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Affiliation(s)
- Yi Xiao
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jia Wei
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yicheng Zhang
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Weining Xiong
- Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
PurposeThis study aimed to assess the role of18F-fluorodeoxyglucose positron emission tomography–computed tomography (18F-FDG PET-CT) in response assessment of patients with recurrent carcinoma cervix and in evaluating the predictive value of metabolic response for progression-free survival (PFS) and overall survival (OS).MethodsThirty-six patients with histopathologically or clinically evident recurrent cervical carcinoma underwent a pretherapy and a posttherapy18F-FDG PET-CT for treatment response evaluation. Positron emission tomography–CT images were analyzed by 2 experienced nuclear medicine physicians. Response was categorized using European Organization for Research and Treatment of Cancer (EORTC) criteria into complete metabolic response (CMR), partial metabolic response (PMR), stable metabolic disease (SMD), and progressive metabolic disease (PMD). Clinical/imaging follow-up (minimum of 6 months) and/or histopathologic findings were taken as reference standard. Patients were categorized into 2 groups, those with PMD and those without PMD (ie, CMR, PMR, and SMD). Progression-free survival and OS based on PET-CT response were measured from the date of posttherapy PET-CT to the first documentation of progression of disease and death, respectively.ResultsOn the basis of metabolic response on posttherapy PET-CT, 6 patients had CMR, 12 patients had PMR, 7 patients had SMD, and 11 patients had PMD. Progression-free survival for patients with cervical carcinoma ranged from 0.5 to 26.5 months (mean [SD], 6.7 [6.1] months). Median PFS for patients with PMD was 3.1 months, whereas median PFS for those without PMD was not reached. Patients who did not show PMD on posttherapy PET-CT had a significantly better PFS than those patients who showed PMD (P< 0.0001; HR, 0.14). There was no statistically significant difference in OS between the 2 groups (P= 0.187; HR, 0.39).Conclusions18F-fluorodeoxyglucose PET-CT is an effective tool for treatment response evaluation in recurrent carcinoma cervix. Patients with metabolically progressive disease on posttherapy18F-FDG PET-CT have a significantly shorter PFS.
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Meads C, Davenport C, Małysiak S, Kowalska M, Zapalska A, Guest P, Martin-Hirsch P, Borowiack E, Auguste P, Barton P, Roberts T, Khan K, Sundar S. Evaluating PET-CT in the detection and management of recurrent cervical cancer: systematic reviews of diagnostic accuracy and subjective elicitation. BJOG 2013; 121:398-407. [PMID: 24299154 DOI: 10.1111/1471-0528.12488] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Positron emission tomography-computed tomography (PET-CT) is recommended to triage women for exenterative surgery and surveillance after treatment for advanced cervical cancer. OBJECTIVE To evaluate diagnostic accuracy of additional whole body PET-CT compared with CT/magnetic resonance imaging (MRI) alone in women with suspected recurrent/persistent cervical cancer and in asymptomatic women as surveillance. DESIGN Systematic reviews. Subjective elicitation to supplement diagnostic information. SEARCH STRATEGY/SELECTION CRITERIA/DATA COLLECTION AND ANALYSIS Searches of electronic databases were performed to June 2013. Studies in women with suspected recurrent/persistent cervical cancer and in asymptomatic women undergoing follow up with sufficient numeric data were included. We calculated sensitivity, specificity and corresponding 95% confidence intervals. Meta-analyses employed a bivariate model that included a random-effects term for between-study variations (CT studies) and univariate random effects meta-analyses (PET-CT studies) for sensitivity and specificity separately. SUBJECTIVE ELICITATION Prevalence of recurrence and the accuracy of imaging elicited using the allocation of points technique. Coherence of elicited subjective probabilities with estimates in the literature examined. RESULTS We identified 15 relevant studies; none directly compared additional PET-CT with MRI or CT separately. Most CT and MRI studies used older protocols and the majority did not distinguish between asymptomatic and symptomatic women. Meta-analysis of nine PET-CT studies in mostly symptomatic women showed sensitivity of 94.8 (95% CI 91.2-96.9), and specificity of 86.9% (95% CI 82.2-90.5). The summary estimate of the sensitivity of CT for detection of recurrence was 89.64% (95% CI 81.59-94.41) and specificity was 76% (95% CI 43.68-92.82). Meta-analysis for MRI test accuracy studies was not possible because of clinical heterogeneity. The sensitivity and specificity of MRI in pelvic recurrence varied between 82 and 100% and between 78 and 100%, respectively. Formal statistical comparisons of the accuracy of index tests were not possible. Subjective elicitation provided estimates comparable to the literature. Subjective estimates of the increase in accuracy from the addition of PET-CT were less than elicited increases required to justify the use in PET-CT for surveillance. CONCLUSION Evidence to support additional PET-CT is scarce, of average quality and does not distinguish between application for surveillance and diagnosis. Guidelines recommending PET-CT in recurrent cervical cancer need to be reconsidered in the light of the existing evidence base.
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Affiliation(s)
- C Meads
- Health Economics Research Group, Brunel University, Middlesex, UK
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Balleyguier C, Kolesnikov-Gauthier H, Haie-Meder C. Aspects post-thérapeutiques du cancer du col utérin. IMAGERIE DE LA FEMME 2013. [DOI: 10.1016/j.femme.2013.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
ObjectiveThe superiority of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) over computed tomography and magnetic resonance imaging in detecting recurrent cervical cancer and determining the extent of the disease has been demonstrated in several clinical trials. However, there is a lack of data concerning the clinical impact of the extra findings. We report here a prospective clinical study aimed at investigating the clinical impact of FDG-PET findings on the treatment plans in recurrent cervical cancer.Materials and MethodsThirty-six patients with suspected recurrent cervical cancer underwent FDG-PET. Relapses were confirmed in 26 cases, and one case of primary lung cancer was found. The clinical impact of the FDG-PET results was assessed using a systematic scoring system with a 4-grade scale. Median follow-up time after FDG-PET was 33.1 months (range, 5–83 months) for all patients and 22.4 months (range, 5–83 months) for patients with positive PET results.ResultsMore sites of metastases were detected with FDG-PET in 56% of the patients compared to the findings by conventional imaging. The results of FDG-PET led to a change in treatment modality for 33% of the patients; and for 22%, a change in dose or deliverance of treatment was recorded. Treatment intention was changed in 30%, in all but one patient, from curative to palliative. In 48% of the patients, the initially planned treatment was reduced regarding dose or extent, or was withheld.ConclusionIn recurrent cervical cancer, FDG-PET provides clinically valuable information with a high impact on treatment decisions.
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Affiliation(s)
- Ericka Wiebe
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Lin Y, Lin WY, Liang JA, Lu YY, Wang HY, Tsai SC, Kao CH. Opportunities for 2-[(18)F] fluoro-2-deoxy-D-glucose PET/CT in cervical-vaginal neuroendocrine carcinoma: case series and literature review. Korean J Radiol 2012; 13:760-70. [PMID: 23118575 PMCID: PMC3484297 DOI: 10.3348/kjr.2012.13.6.760] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Accepted: 05/02/2012] [Indexed: 11/15/2022] Open
Abstract
Objective Neuroendocrine cervical carcinoma is a rare subtype of cervical cancer. These tumors exhibit an aggressive behavior with early regional lymph node and distant metastases. The purpose of our study was to describe five cases of neuroendocrine cervical-vaginal carcinoma and to discuss the potential of the 2-[18F] fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan for the detection of this rare malignancy. Materials and Methods Five cases of cervical-vaginal neuroendocrine tumor were retrospectively collected, during a two year (from September 2009 to August 2011) period in our hospital. The clinical staging distributions were International Federation of Gynecology and Obstetrics (FIGO) stage IB2 (1 of 5), stage IIA (3 of 5) and stage IVA (1 of 5). Results Two cases (cases 1 and 4) were restaged after 18F-FDG PET/CT scan in the initial staging process. Post-treatment 18F-FDG PET/CT scans, in three patients, revealed positive findings for tumor recurrence or lymph node metastases. Two patients (cases 2 and 3) died of tumor within two years. Conclusion 18F-FDG PET/CT scan is a useful tool in cervical-vaginal neuroendocrine tumor. In its initial staging, the 18F-FDG PET/CT scan may help assess the possible nodal involvement or early hematogeneous spreading. We can also use the 18F-FDG PET/CT to detect local recurrence and to evaluate the treatment response after clinical manipulation.
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Affiliation(s)
- Yin Lin
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung 404, Taiwan
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¹⁸F-Fluorodeoxyglucose positron emission tomography/computed tomography finds answers in cancer patients with increasing tumor markers and negative or equivocal conventional imaging modalities. Nucl Med Commun 2012; 33:313-21. [PMID: 22237387 DOI: 10.1097/mnm.0b013e32834ee824] [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
BACKGROUND The increase in tumor markers with negative or equivocal conventional imaging modalities represents a serious dilemma in the follow-up of previously treated cancer patients. Positron emission tomography/computed tomography (PET/CT) has emerged as a useful tool in oncological imaging in staging and restaging of most cancers. OBJECTIVE This study explored the potential role of ¹⁸F-fluorodeoxyglucose (FDG) PET/CT in the detection and localization of tumor recurrence in cancer patients with increasing serum tumor markers and negative or equivocal conventional imaging modalities. MATERIALS AND METHODS This prospective study was conducted on 105 previously diagnosed and treated cancer patients with different pathologies. All patients were referred for ¹⁸F-FDG PET/CT scans because of increasing tumor markers with negative or equivocal conventional imaging modalities. All patients underwent whole-body ¹⁸F-FDG PET/CT scans. The findings were confirmed by clinical and/or radiological follow-up of at least 12 months and histopathologically whenever possible. RESULTS PET/CT detected recurrence and/or metastases in 90 patients (85.7%), including 17 recurrences, 50 metastases, and 23 recurrences and metastases. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of PET/CT scans were 95.7, 100, 100, 73.3, and 96.2%, respectively. These parameters were 95, 100, 100, 69, and 95% for PET scans alone and were 91.5, 100, 100, 57.9, and 92.3% for CT scans alone. CONCLUSION ¹⁸F-FDG PET/CT is a powerful diagnostic tool in restaging of cancer patients. In most cases, PET/CT provides accurate results and helps resolve the clinical dilemma encountered in oncological patients with increasing serum tumor markers and negative or equivocal findings in conventional imaging modalities.
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The SUVmax (maximum standardized uptake value for F-18 fluorodeoxyglucose) and serum squamous cell carcinoma antigen (SCC-ag) function as prognostic biomarkers in patients with primary cervical cancer. J Cancer Res Clin Oncol 2011; 138:239-46. [DOI: 10.1007/s00432-011-1092-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Accepted: 11/03/2011] [Indexed: 12/22/2022]
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Bibliography. Lymphoma. Current world literature. Curr Opin Oncol 2011; 23:537-41. [PMID: 21836468 DOI: 10.1097/cco.0b013e32834b18ec] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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