1
|
Neelsen C, Elgeti T, Meyer T, Grittner U, Mödl L, Furth C, Geisel D, Hamm B, Sack I, Marticorena Garcia SR. Multifrequency Magnetic Resonance Elastography Detects Small Abdominal Lymph Node Metastasis by High Stiffness. Invest Radiol 2024:00004424-990000000-00228. [PMID: 38948965 DOI: 10.1097/rli.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVES Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 is a clinical and research standard for evaluating malignant tumors and lymph node metastasis. However, quantitative analysis of nodal status is limited to measurement of short axis diameter (SAD), and metastatic lymph nodes below 10 mm in SAD are often not detected. The purpose of this study was to evaluate the value of multifrequency magnetic resonance elastography (MRE) when added to RECIST 1.1 for detection of lymph node metastasis. MATERIALS AND METHODS Twenty-five benign and 82 metastatic lymph nodes were prospectively examined by multifrequency MRE at 1.5 T using tomoelastography postprocessing at 30, 40, 50, and 60 Hz (total scan time of 4 minutes). Shear wave speed as a surrogate of soft tissue stiffness was provided in m/s. Positron emission tomography-computed tomography was used as reference standard for identification of abdominal lymph node metastasis from histologically confirmed primary tumors. The diagnostic performance of MRE was compared with that of SAD according to RECIST 1.1 and evaluated by receiver operating characteristic curve analysis using generalized linear mixed models and binary logistic mixed models. Sensitivity, specificity, and predictive values were calculated for different cutoffs. RESULTS Metastatic lymph nodes (1.90 ± 0.57 m/s) were stiffer than benign lymph nodes (0.98 ± 0.20 m/s, P < 0.001). An area under the curve of 0.95 for a cutoff of 1.32 m/s was calculated. Using a conservative approach with 1.0 specificity, we found sensitivity (SAD/MRE/MRE + SAD, 0.56/0.84/0.88), negative predictive values (0.41/0.66/0.71), and overall accuracy (0.66/0.88/0.91) to be improved using MRE and even higher for combined MRE and SAD. CONCLUSIONS Multifrequency MRE improves metastatic abdominal lymph node detection by 25% based on higher tissue stiffness-even for lymph nodes with an SAD ≤10 mm. Stiffness information is quick to obtain and would be a promising supplement to RECIST.
Collapse
Affiliation(s)
- Christian Neelsen
- From the Department of Radiology, Campus Mitte, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (C.N., T.E., T.M., B.H., I.S., S.R.M.G.); Division of Radiology, German Cancer Research Center, Heidelberg, Germany (C.N.); Department of Nuclear Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (T.E., C.F.); Institute for Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (U.G., L.M.); and Department of Radiology, Campus Virchow Klinikum, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany (D.G., B.H.)
| | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Melemenidis S, Knight JC, Kersemans V, Perez-Balderas F, Zarghami N, Soto MS, Cornelissen B, Muschel RJ, Sibson NR. In Vivo PET Detection of Lung Micrometastasis in Mice by Targeting Endothelial VCAM-1 Using a Dual-Contrast PET/MRI Probe. Int J Mol Sci 2024; 25:7160. [PMID: 39000268 PMCID: PMC11241628 DOI: 10.3390/ijms25137160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Revised: 06/21/2024] [Accepted: 06/26/2024] [Indexed: 07/16/2024] Open
Abstract
Current clinical diagnostic imaging methods for lung metastases are sensitive only to large tumours (1-2 mm cross-sectional diameter), and early detection can dramatically improve treatment. We have previously demonstrated that an antibody-targeted MRI contrast agent based on microparticles of iron oxide (MPIO; 1 μm diameter) enables the imaging of endothelial vascular cell adhesion molecule-1 (VCAM-1). Using a mouse model of lung metastasis, upregulation of endothelial VCAM-1 expression was demonstrated in micrometastasis-associated vessels but not in normal lung tissue, and binding of VCAM-MPIO to these vessels was evident histologically. Owing to the lack of proton MRI signals in the lungs, we modified the VCAM-MPIO to include zirconium-89 (89Zr, t1/2 = 78.4 h) in order to allow the in vivo detection of lung metastases by positron emission tomography (PET). Using this new agent (89Zr-DFO-VCAM-MPIO), it was possible to detect the presence of micrometastases within the lung in vivo from ca. 140 μm in diameter. Histological analysis combined with autoradiography confirmed the specific binding of the agent to the VCAM-1 expressing vasculature at the sites of pulmonary micrometastases. By retaining the original VCAM-MPIO as the basis for this new molecular contrast agent, we have created a dual-modality (PET/MRI) agent for the concurrent detection of lung and brain micrometastases.
Collapse
Affiliation(s)
- Stavros Melemenidis
- Department of Radiation Oncology, Stanford School of Medicine, Cancer Institute, Stanford University, Stanford, CA 94305, USA;
| | - James C. Knight
- School of Natural and Environmental Sciences, Newcastle University, Newcastle upon Tyne NE1 7RU, UK;
| | - Veerle Kersemans
- Clinical Nuclear Medicine Imaging, Siemens Healthineers, 2595 BN The Hague, The Netherlands;
| | | | - Niloufar Zarghami
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Manuel Sarmiento Soto
- Department of Biochemistry and Molecular Biology, University of Seville, 41004 Seville, Spain;
| | - Bart Cornelissen
- Department of Nuclear Medicine, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands;
| | - Ruth J. Muschel
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| | - Nicola R. Sibson
- Department of Oncology, University of Oxford, Oxford OX3 7DQ, UK; (N.Z.); (R.J.M.)
| |
Collapse
|
3
|
Lin YH, Su AC, Ng SH, Shen MR, Wu YJ, Chen AC, Lee CW, Lin YC. Insights about cervical lymph nodes: Evaluating deep learning-based reconstruction for head and neck computed tomography scan. Eur J Radiol Open 2024; 12:100534. [PMID: 39022614 PMCID: PMC467078 DOI: 10.1016/j.ejro.2023.100534] [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: 05/16/2023] [Revised: 10/14/2023] [Accepted: 10/20/2023] [Indexed: 07/20/2024] Open
Abstract
Purpose This study aimed to investigate differences in cervical lymph node image quality on dual-energy computed tomography (CT) scan with datasets reconstructed using filter back projection (FBP), hybrid iterative reconstruction (IR), and deep learning-based image reconstruction (DLIR) in patients with head and neck cancer. Method Seventy patients with head and neck cancer underwent follow-up contrast-enhanced dual-energy CT examinations. All datasets were reconstructed using FBP, hybrid IR with 30 % adaptive statistical IR (ASiR-V), and DLIR with three selectable levels (low, medium, and high) at 2.5- and 0.625-mm slice thicknesses. Herein, signal, image noise, signal-to-noise ratio, and contrast-to-noise ratio of lymph nodes and overall image quality, artifact, and noise of selected regions of interest were evaluated by two radiologists. Next, cervical lymph node sharpness was evaluated using full width at half maximum. Results DLIR exhibited significantly reduced noise, ranging from 3.8 % to 35.9 % with improved signal-to-noise ratio (11.5-105.6 %) and contrast-to-noise ratio (10.5-107.5 %) compared with FBP and ASiR-V, for cervical lymph nodes (p < 0.001). Further, 0.625-mm-thick images reconstructed using DLIR-medium and DLIR-high had a lower noise than 2.5-mm-thick images reconstructed using FBP and ASiR-V. The lymph node margins and vessels on DLIR-medium and DLIR-high were sharper than those on FBP and ASiR-V (p < 0.05). Both readers agreed that DLIR had a better image quality than the conventional reconstruction algorithms. Conclusion DLIR-medium and -high provided superior cervical lymph node image quality in head and neck CT. Improved image quality affords thin-slice DLIR images for dose-reduction protocols in the future.
Collapse
Affiliation(s)
- Yu-Han Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - An-Chi Su
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shu-Hang Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Min-Ru Shen
- Department of Diagnostic Radiology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Yu-Jie Wu
- Department of Radiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | | | | | - Yu-Chun Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, Taiwan
| |
Collapse
|
4
|
Snee M, Cheeseman S, Thompson M, Riaz M, Sopwith W, Lacoin L, Chaib C, Daumont MJ, Penrod JR, Hall G. Treatment patterns and survival outcomes for patients with non-small cell lung cancer in the UK in the preimmunology era: a REAL-Oncology database analysis from the I-O Optimise initiative. BMJ Open 2021; 11:e046396. [PMID: 34526333 PMCID: PMC8444261 DOI: 10.1136/bmjopen-2020-046396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 07/15/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES To report characteristics, treatment and overall survival (OS) trends, by stage and pathology, of patients diagnosed with non-small cell lung cancer (NSCLC) at Leeds Teaching Hospital NHS Trust in 2007-2018. DESIGN Retrospective cohort study based on electronic medical records. SETTING Large NHS university hospital in Leeds. PARTICIPANTS 3739 adult patients diagnosed with incident NSCLC from January 2007 to August 2017, followed up until March 2018. MAIN OUTCOME MEASURES Patient characteristics at diagnosis, treatment patterns and OS. RESULTS 34.3% of patients with NSCLC were clinically diagnosed (without pathological confirmation). Among patients with known pathology, 45.2% had non-squamous cell carcinoma (NSQ) and 33.3% had squamous cell carcinoma (SQ). The proportion of patients diagnosed at stage I increased (16.4%-27.7% in 2010-2017); those diagnosed at stage IV decreased (57.0%-39.1%). Surgery was the most common initial treatment for patients with pathologically confirmed stage I NSCLC. Use of radiotherapy alone increased over time in patients with clinically diagnosed stage I NSCLC (39.1%-60.3%); chemoradiation increased in patients with stage IIIA NSQ (21.6%-33.3%) and SQ (24.2%-31.9%). Initial treatment with systemic anticancer therapy (SACT) increased in patients with stages IIIB-IV NSQ (49.0%-67.5%); the proportion of untreated patients decreased (30.6%-15.0%). Median OS improved for patients diagnosed with stage I NSQ and SQ and stage IIIA NSQ over time. Median OS for patients with stages IIIB-IV NSQ and SQ remained stable, <10% patients were alive 3 years after diagnosis. Median OS for clinically diagnosed stages IIIB-IV patients was 1.2 months in both periods. CONCLUSIONS OS for stage I and IIIA patients improved over time, likely due to increased use of stereotactic ablative radiation, surgery (stage I) and chemoradiation (stage IIIA). Conversely, OS outcomes remained poor for stage IIIB-IV patients despite increasing use of SACT for NSQ. Many patients with advanced-stage disease remained untreated.
Collapse
Affiliation(s)
- Michael Snee
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sue Cheeseman
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Majid Riaz
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Will Sopwith
- REAL Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Carlos Chaib
- Research & Development Medical Affairs, Bristol Myers Squibb, Madrid, Spain
| | - Melinda J Daumont
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Braine-l'Alleud, Belgium
| | - John R Penrod
- Worldwide Health Economics & Outcomes Research, Bristol Myers Squibb, Princeton, New Jersey, USA
| | - Geoff Hall
- Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Min SK, Myoung H, Lee JH, Kim MJ. Muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge is associated with cervical lymph node metastasis. J Korean Assoc Oral Maxillofac Surg 2016; 42:133-8. [PMID: 27429934 PMCID: PMC4940197 DOI: 10.5125/jkaoms.2016.42.3.133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/11/2016] [Accepted: 01/15/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess the association between muscle invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis on the basis of preoperative magnetic resonance imaging (MRI). Materials and Methods Twenty-six patients with oral squamous cell carcinoma of the posterior mandibular alveolar ridge were evaluated by MRI. The associations between cervical lymph node metastasis and independent factors evaluated by MRI were analyzed. Overall survival was also analyzed in this manner. Representative biopsy specimens were stained with anti-podoplanin and anti-CD34 antibodies. Results Mylohyoid muscle invasion was associated with cervical lymph node metastasis. A combinational factor of mylohyoid and/or buccinator muscle invasion was also associated with cervical lymph node metastasis. Cervical lymph node metastasis and masticator space invasion had a negative effect on overall survival. No lymphatic vessels were identified near the tumor invasion front within the mandible. In contrast, lymphatic vessels were identified near the front of tumor invasion in the muscles. Conclusion This study demonstrates an association between muscular invasion by oral squamous cell carcinoma of the posterior mandibular alveolar ridge and cervical lymph node metastasis.
Collapse
Affiliation(s)
- Seung-Ki Min
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Hoon Myoung
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Jong-Ho Lee
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| | - Myung-Jin Kim
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Seoul National University, Seoul, Korea
| |
Collapse
|
6
|
Integrated PET/MRI for whole-body staging of patients with primary cervical cancer: preliminary results. Eur J Nucl Med Mol Imaging 2015. [PMID: 26199113 DOI: 10.1007/s00259-015-3131-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To assess the diagnostic value of integrated PET/MRI for whole-body staging of cervical cancer patients, as well as to investigate a potential association between PET/MRI derived functional parameters and prognostic factors of cervical cancer. METHODS The present study was approved by the local institutional review board. Twenty-seven patients with histopathologically confirmed cervical cancer were prospectively enrolled in our study. All patients underwent a whole-body PET/MRI examination after written informed consent was obtained. Two radiologists separately evaluated the PET/MRI data sets regarding the determination of local tumor extent of primary cervical cancer lesions, as well as detection of nodal and distant metastases. Furthermore, SUV and ADC values of primary tumor lesions were analyzed and correlated with dedicated prognostic factors of cervical cancer. Results based on histopathology and cross-sectional imaging follow-up served as the reference standard. RESULTS PET/MRI enabled the detection of all 27 primary tumor lesions of the uterine cervix and allowed for the correct determination of the T-stage in 23 (85 %) out of the 27 patients. Furthermore, the calculated sensitivity, specificity and diagnostic accuracy for the detection of nodal positive patients (n = 11) were 91 %, 94 % and 93 %, respectively. PET/MRI correctly identified regional metastatic disease (N1-stage) in 8/10 (80 %) patients and non-regional lymph node metastases in 5/5 (100 %) patients. In addition, quantitative analysis of PET and MRI derived functional parameters (SUV; ADC values) revealed a significant correlation with pathological grade and tumor size (p < 0.05). CONCLUSIONS The present study demonstrates the high potential of integrated PET/MRI for the assessment of primary tumor and the detection of lymph node metastases in patients with cervical cancer. Providing additional prognostic information, PET/MRI may serve as a valuable diagnostic tool for cervical cancer patients in a pretreatment setting.
Collapse
|
7
|
Niu G, Chen X. Lymphatic imaging: focus on imaging probes. Am J Cancer Res 2015; 5:686-97. [PMID: 25897334 PMCID: PMC4402493 DOI: 10.7150/thno.11862] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/10/2015] [Indexed: 01/10/2023] Open
Abstract
In view of the importance of sentinel lymph nodes (SLNs) in tumor staging and patient management, sensitive and accurate imaging of SLNs has been intensively explored. Along with the advance of the imaging technology, various contrast agents have been developed for lymphatic imaging. In this review, the lymph node imaging agents were summarized into three groups: tumor targeting agents, lymphatic targeting agents and lymphatic mapping agents. Tumor targeting agents are used to detect metastatic tumor tissue within LNs, lymphatic targeting agents aim to visualize lymphatic vessels and lymphangionesis, while lymphatic mapping agents are mainly for SLN detection during surgery after local administration. Coupled with various signal emitters, these imaging agents work with single or multiple imaging modalities to provide a valuable way to evaluate the location and metastatic status of SLNs.
Collapse
|
8
|
Heusch P, Sproll C, Buchbender C, Rieser E, Terjung J, Antke C, Boeck I, Macht S, Scherer A, Antoch G, Heusner TA, Handschel J. Diagnostic accuracy of ultrasound, ¹⁸F-FDG-PET/CT, and fused ¹⁸F-FDG-PET-MR images with DWI for the detection of cervical lymph node metastases of HNSCC. Clin Oral Investig 2013; 18:969-78. [PMID: 23892450 DOI: 10.1007/s00784-013-1050-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE This study aimed to compare (18)F-fluorodesoxyglucose positron emission tomography/MRI ((18)F-FDG-PET-MRI) fusion images, including diffusion-weighted imaging (DWI), (18)F-FDG-PET/CT, and ultrasound (US) regarding their performance in nodal staging of patients with head and neck squamous cell carcinoma (HNSCC). MATERIALS AND METHODS Eighteen patients prospectively underwent ultrasound examination, (18)F-FDG- PET/CT, and MRI before oral tumor resection and bilateral neck dissection. PET data sets were fused with contrast-enhanced T1-weighted MR images. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for nodal detection were calculated for all the imaging modalities. Furthermore, the accuracy of the correct N-staging was calculated for all methods. Detailed histopathology served as the standard of reference. RESULTS The sensitivity, specificity, PPV, NPV, and accuracy for detection of lymph node metastases were 63, 99, 86, 96, and 95 % for ultrasound; 30, 97, 56, 92, and 90 % for (18)F-FDG-PET/CT; 52, 96, 59, 94, and 91 % for (18)F-FDG-PET-MRI; and 53, 97, 67, 95, and 92 % for (18)F-FDG-PET-MRI plus DWI, respectively. There was no significant difference in the diagnostic accuracy for lymph node metastasis detection between (18)F-FDG-PET-MRI and (18)F-FDG-PET/CT (p = 0.839) and between (18)F-FDG-PET-MRI plus DWI and (18)F-FDG-PET/CT (p = 0.286), respectively. US was significantly more accurate than (18)F-FDG-PET/CT (p = 0.009), whereas no significant difference was seen between (18)F-FDG-PET-MRI and US (p = 0.223) or (18)F-FDG-PET-MRI plus DWI and US (p = 0.115). The nodal stage was correctly rated by (18)F-FDG-PET-MRI in eight patients, (18)F-FDG-PET-MRI plus DWI in nine patients, US in 12 patients, and (18)F-FDG-PET/CT in five out of 18 patients. CONCLUSION Software-based fusion of (18)F-FDG-PET-MRI and (18)F-FDG-PET-MRI plus DWI may not increase nodal detection and N-staging performance in patients with oral malignancies compared to US and (18)F-FDG-PET/CT. CLINICAL RELEVANCE Surgical staging of cervical lymph nodes will not be replaced even by advanced imaging modalities in the near future.
Collapse
Affiliation(s)
- Philipp Heusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Dusseldorf, 40225, Dusseldorf, Germany
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Yen TJ, Chung CS, Wu YW, Yen RF, Cheng MF, Lee JM, Hsu CH, Chang YL, Wang HP. Comparative study between endoscopic ultrasonography and positron emission tomography-computed tomography in staging patients with esophageal squamous cell carcinoma. Dis Esophagus 2012; 25:40-7. [PMID: 21595776 DOI: 10.1111/j.1442-2050.2011.01204.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Treatment strategy of esophageal cancer mainly depends on accurate staging. At present, no single ideal staging modality is superior to another in preoperative tumor-node-metastasis (TNM) staging of patients with esophageal cancer. We aimed to investigate the efficacy of endoscopic ultrasonography (EUS) and positron emission tomography-computed tomography (PET-CT) for staging of esophageal cancer. We retrospectively studied 118 consecutive patients with esophageal squamous cell carcinoma who underwent esophagectomy with or without neoadjuvant chemoradiotherapy (CRT) over a near 3-year period between January 2005 and November 2008 at a tertiary hospital in Taiwan. Patients were separated into two groups: without neoadjuvant CRT (group 1, n= 28) and with CRT (group 2, n= 90). Medical records of demographic data and reports of EUS and PET-CT of patients before surgery were reviewed. A database of clinical staging by EUS and PET-CT was compared with one of pathological staging. The accuracies of T staging by EUS in groups 1 and 2 were 85.2% and 34.9%. The accuracies of N staging by EUS in groups 1 and 2 were 55.6% and 39.8%. The accuracies of T and N staging by means of PET-CT scan were 100% and 54.5% in group 1, and were 69.4% and 86.1% in group 2, respectively. In group 2, 38 of 90 patients (42.2%) achieved pathologic complete remission. Among them, two of 34 (5.9%) and 12 of 17 (70.6%) patients were identified as tumor-free by post-CRT EUS and PET-CT, respectively. EUS is useful for initial staging of esophageal cancer. PET-CT is a more reliable modality for monitoring treatment response and restaging. Furthermore, the accuracy of PET-CT with regard to N staging is higher in patients who have undergone CRT than those who have not.
Collapse
Affiliation(s)
- T-J Yen
- Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Hahn S, Bauer S, Heusner TA, Ebeling P, Hamami ME, Stahl A, Forsting M, Bockisch A, Antoch G. Postoperative FDG-PET/CT staging in GIST: Is there a benefit following R0 resection? Eur J Radiol 2011; 80:670-4. [DOI: 10.1016/j.ejrad.2010.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/18/2010] [Accepted: 09/20/2010] [Indexed: 11/16/2022]
|
11
|
Abstract
Noninvasive in vivo imaging of lymphatic vessels and lymphatic nodes is expected to fulfill the purpose of analyzing lymphatic vessels and their function, understanding molecular mechanisms of lymphangiogenesis and lymphatic spread of tumors, and utilizing lymphatic molecular markers as a prognostic or diagnostic indicator. In this review, we provide a comprehensive summary of in vivo imaging modalities for detecting lymphatic vessels, lymphatic drainage, and lymphatic nodes, which include conventional lymphatic imaging techniques such as dyes and radionuclide scintigraphy as well as novel techniques for lymphatic imaging such as optical imaging, computed tomography, magnetic resonance imaging, ultrasound, positron emission tomography using lymphatic biomarkers, photoacoustic imaging, and combinations of multiple modalities. The field of lymphatic imaging is ever evolving, and technological advances, combined with the development of new contrast agents, continue to improve the research of lymphatic vascular system in health and disease states as well as to improve the accuracy of diagnosis in the relevant diseases.
Collapse
Affiliation(s)
- Fan Zhang
- Laboratory of Molecular Imaging and Nanomedicine (LOMIN), National Institute of Biomedical Imaging and Bioengineering (NIBIB), National Institutes of Health (NIH), Bethesda, MD 20892, USA
| | | | | | | |
Collapse
|
12
|
Bansal R, Agrawal V, Mandhani A. Tuberculosis in postchemotherapy residual masses in germ cell tumor of the testis. Indian J Urol 2011; 27:274-5. [PMID: 21814322 PMCID: PMC3142842 DOI: 10.4103/0970-1591.82850] [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] [Indexed: 11/06/2022] Open
Abstract
Residual masses following chemotherapy in testicular tumors have been characterized as necrosis, mature or immature teratoma, and malignant tumors. Twenty four patients had retroperitoneal lymph node dissection for postchemotherapy residual masses between January 2000 and December 2008. We report two patients; one with late relapse and other with postchemotherapy residual mass, who had tuberculosis. Tumor markers were normal, and PET scan showed increased uptake in residual mass. There are no previous reports of tuberculosis in postchemotherapy residual masses.
Collapse
Affiliation(s)
- Rajesh Bansal
- Department of Urology and Renal Transplantation, SGPGI, Lucknow - 226014, India
| | | | | |
Collapse
|
13
|
Dual-Time-Point Fluorodeoxyglucose Positron Emission Tomography for Diagnosis of Cervical Lymph Node Metastases in Patients With Head and Neck Squamous Cell Carcinoma. J Comput Assist Tomogr 2011; 35:303-7. [DOI: 10.1097/rct.0b013e31820a0af2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
14
|
Inoue K, Moriya E, Suzuki T, Ohnuki Y, Sato T, Kitamura H, Sasaki T, Fukushi M, Moriyama N, Fujii H. The usefulness of fully three-dimensional OSEM algorithm on lymph node metastases from lung cancer with 18F-FDG PET/CT. Ann Nucl Med 2011; 25:277-87. [DOI: 10.1007/s12149-010-0462-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 12/07/2010] [Indexed: 11/29/2022]
|
15
|
|
16
|
Klode J, Dissemond J, Grabbe S, Hillen U, Poeppel T, Boeing C. Sentinel Lymph Node Excision and PET-CT in the Initial Stage of Malignant Melanoma. Dermatol Surg 2010; 36:439-45. [DOI: 10.1111/j.1524-4725.2010.01479.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
17
|
Imai H, Doi R, Kanazawa H, Kamo N, Koizumi M, Masui T, Iwanaga Y, Kawaguchi Y, Takada Y, Isoda H, Uemoto S. Preoperative assessment of para-aortic lymph node metastasis in patients with pancreatic cancer. Int J Clin Oncol 2010; 15:294-300. [PMID: 20232101 DOI: 10.1007/s10147-010-0066-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 02/04/2010] [Indexed: 12/12/2022]
Abstract
BACKGROUND Para-aortic lymph node (PALN) metastasis is an important prognostic factor in patients with pancreatic cancer, but accurate preoperative diagnosis is difficult. The objective of this study was to assess the accuracy of diagnosis of PALN by computed tomography (CT), magnetic resonance imaging (MRI), and (18)F-fluorodeoxyglucose positron-emission tomography (FDG-PET). METHODS From August 2005 to July 2008, 119 patients with invasive ductal adenocarcinoma of the pancreas were included in this study. PALNs with a longer diameter >10 mm on CT or MRI were suspected of being involved by metastasis, whereas FDG uptake exceeding that of the adjacent normal tissue was considered to be positive for metastasis on FDG-PET studies. The imaging findings were compared with the pathological diagnosis of PALN metastasis. RESULTS PALN dissection was performed in 71 patients (60.0%). Although histopathological examination revealed metastasis in 6 patients (8.5%), none of these patients was positive in any of the preoperative imaging studies. The longer diameter, the shorter diameter, the ratio of the two diameters, and the calculated lymph node volume showed no significant differences between patients with and without PALN metastasis. CONCLUSIONS Preoperative detection of PALN metastasis in patients with pancreatic cancer is very difficult. Intraoperative histopathological examination of frozen sections is necessary if radical resection is contemplated.
Collapse
Affiliation(s)
- Hisashi Imai
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University, 54 Shogoinkawaracho, Sakyoku, Kyoto, 606-8507, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Leijte JA, Graafland NM, Valdés Olmos RA, van Boven HH, Hoefnagel CA, Horenblas S. Prospective evaluation of hybrid18F-fluorodeoxyglucose positron emission tomography/computed tomography in staging clinically node-negative patients with penile carcinoma. BJU Int 2009; 104:640-4. [DOI: 10.1111/j.1464-410x.2009.08450.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
19
|
Value of diffusion-weighted MR imaging in the differentiation between benign and malignant cervical lymph nodes. Eur J Radiol 2008; 72:381-7. [PMID: 18995981 DOI: 10.1016/j.ejrad.2008.09.034] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 06/14/2008] [Accepted: 09/24/2008] [Indexed: 12/23/2022]
Abstract
PURPOSE To evaluate echo-planar diffusion-weighted MR imaging (DWI) in the differentiation between benign and malignant cervical lymph nodes. MATERIALS AND METHODS 35 consecutive patients with 55 enlarged (>10mm) cervical lymph nodes underwent MR imaging at 1.5-T. DWI was performed using a single-shot echo-planar (SSEPI) MR imaging sequence with b values (b: diffusion factor) of 0, 500 and 1000 s/mm(2). Apparent diffusion coefficient (ADC) maps were reconstructed for all patients and ADC values were calculated for each lymph node. Imaging results were correlated with histopathologic findings after neck dissection or surgical biopsy, findings in PET/CT or imaging follow-up. Mann-Whitney test was used for statistical analysis and a receiver operating characteristic (ROC) curve analysis was performed. RESULTS Cervical lymph node enlargement was secondary to metastases from squamous cell carcinomas [n=25], non-Hodgkin's lymphoma [n=6], reactive lymphadenitis [n=20], cat scratch lymphadenitis [n=2] and sarcoidosis [n= 2]. The mean ADC values (x10(-3) mm(2)/s) were 0.78+/-0.09 for metastatic lymph nodes, 0.64+/-0.09 for lymphomatous nodes and 1.24+/-0.16 for benign cervical lymph nodes. ADC values of malignant lymph nodes were significantly lower than ADC values of benign lymph nodes. 94.3% of lesions were correctly classified as benign or malignant using a threshold ADC value of 1.02 x 10(-3) mm(2)/s. CONCLUSION According to our first experience, DWI using a SSEPI sequence allows reliable differentiation between benign and malignant cervical lymph nodes.
Collapse
|
20
|
Kim H, Hyung WJ, Lim JS, Park MS, Choi JY, Chung YE, Kim MJ, Kim KW. Laparoscopic ultrasonography-assisted retroperitoneal lymph node sampling in patients evaluated for stomach cancer recurrence. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2008; 27:1229-1233. [PMID: 18645082 DOI: 10.7863/jum.2008.27.8.1229] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVE The precise localization of target lymph nodes during laparoscopic biopsy can often be technically challenging. The purpose of this series was to report 2 patients who successfully underwent laparoscopic para-aortic lymph node sampling with the assistance of laparoscopic ultrasonography (LUS). METHODS We describe 2 patients previously treated for gastric cancer who later had suspicious retroperitoneal lymphadenopathy detected by computed tomography. They received LUS-assisted lymph node biopsies for histologic evaluation. RESULTS Laparoscopic ultrasonography precisely localized the target lymph nodes, which measured 1.4 and 1.5 cm, respectively, in both patients. A transperitoneal laparoscopic approach and target lymph node sampling were successfully performed. No procedure-related technical difficulties or immediate complications occurred. The 2 patients were histologically proven to have nodal tumor recurrence and tuberculous lymphadenopathy, respectively. CONCLUSIONS Precise localization of a small lymph node located deep in the abdomen can be readily performed by intraoperative LUS.
Collapse
Affiliation(s)
- Honsoul Kim
- Department of Diagnostic Radiology, Research Institute of Radiological Science, Severance Hospital, Seodaemun-ku, Shinchon-dong 134, Seoul 120-752, Korea
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Inoue K, Sato T, Kitamura H, Ito M, Tsunoda Y, Hirayama A, Kurosawa H, Tanaka T, Fukushi M, Moriyama N, Fujii H. Improvement of the diagnostic accuracy of lymph node metastases of colorectal cancer in 18F-FDG-PET/CT by optimizing the iteration number for the image reconstruction. Ann Nucl Med 2008; 22:465-73. [PMID: 18670852 DOI: 10.1007/s12149-007-0141-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Accepted: 11/01/2007] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Improvement in the diagnostic accuracy of lymph node (LN) metastases of colorectal cancer by optimizing the reconstruction parameters was studied, including a phantom study and clinical studies. METHODS In the experimental study, the contrast ratio was evaluated using a standard image quality phantom, changing the iteration number of ordered subsets expectation maximization algorithm from 2 to 6. In the clinical study, 89 patients with preoperative colorectal cancer who received 18F-2-deoxy-2-fluoro-D: -glucose positron emission tomography/computed tomography (PET/CT) were studied. Their LN metastases were visually assessed when systematically changing the iteration number, and the optimal iteration number was determined. After the appropriate cut-off value of maximum standardized uptake value was determined, the improvement of the diagnostic accuracy of LN metastases was evaluated for the proximal nodes and the distal ones using the reconstructed images with the optimal iteration number. This was compared with the conventional method that had an iteration number of 2. RESULTS In the phantom study, it was confirmed that the contrast ratio improved when the iteration number increased. In clinical evaluation, the optimal iteration number was determined to be 5 by visual assessment. When the cut-off value of 1.5 was used, which happened to be the best number, the sensitivity/specificity/accuracy improved from 52%/91%/72% to 77%/89%/83% for the proximal nodes, and from 63%/90%/84% to 91%85%/87% for the distal nodes, respectively. CONCLUSIONS When the iteration number of the reconstruction algorithm was optimized, the sensitivity of LN metastasis improved by more than 20%, and the accuracy exceeded 80%. Optimization of the image reconstruction parameters in the diagnosis of LN metastases using PET/CT is clinically important.
Collapse
Affiliation(s)
- Kazumasa Inoue
- Graduate School of Health Science, Tokyo Metropolitan University, Tokyo, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Musallam KM, Taher AT, Tawil AN, Chakhachiro ZI, Habbal MZ, Shamseddine AI. Solitary mediastinal lymph node metastasis in rectosigmoid carcinoma: a case report. CASES JOURNAL 2008; 1:69. [PMID: 18671857 PMCID: PMC2515293 DOI: 10.1186/1757-1626-1-69] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Accepted: 07/31/2008] [Indexed: 02/08/2023]
Abstract
Introduction Colorectal cancer most commonly metastasizes to the regional lymph nodes, liver, bone, lung, and brain. Metastases to mediastinal lymph nodes is a rare entity which has never been reported to be solitary. Case report We herein describe a 67-year-old male patient with a solitary mediastinal lymph node metastasis three years following the resection of his primary rectosigmoid carcinoma. Pathological characteristics of the metastatic tissue and technical limitations in imaging modalities resulted in incongruity between follow-up CT and PET scans. Diagnosis of this distant metastasis has been confirmed through a mediastinoscopic biopsy. Conclusion Attention should be paid to the mediastinum when evaluating PET scan or CT films during follow-up of patients with colorectal cancer. Using PET/CT instead of separate morphological and functional data sets favors better detection. Questions still remain concerning the ideal management protocol of such a presentation, the two main options being locoregional or chemotherapeutic.
Collapse
Affiliation(s)
- Khaled M Musallam
- Department of Internal Medicine, Hematology-Oncology Division, American University of Beirut Medical Center, Beirut, Lebanon.
| | | | | | | | | | | |
Collapse
|
23
|
Shin SS, Jeong YY, Min JJ, Kim HR, Chung TW, Kang HK. Preoperative staging of colorectal cancer: CT vs. integrated FDG PET/CT. ACTA ACUST UNITED AC 2008; 33:270-7. [PMID: 17610107 DOI: 10.1007/s00261-007-9262-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Accurate preoperative staging is essential in determining the optimal therapeutic planning for individual patients. The computed tomography (CT) in the preoperative staging of colorectal cancer, even if controversial, may be useful for planning surgery and/or neoadjuvant therapy, particularly when local tumor extension into adjacent organs or distant metastases are detected. There have been significant changes in the CT technology with the advent of multi-detector row CT (MDCT) scanner. Advances in CT technology have raised interest in the potential role of CT for detection and staging of colorectal cancer. In recent studies, MDCT with MPR images has shown promising accuracy in the evaluation of local extent and nodal involvement of colorectal cancer. Combined PET/CT images have significant advantages over either alone because it provides both functional and anatomical data. Therefore, it is natural to expect that PET/CT would improve the accuracy of preoperative staging of colorectal cancer. The most significant additional information provided by PET/CT relates to the accurate detection of distant metastases. For the evaluation of patients with colorectal cancer, CT has relative advantages over PET/CT in regard to the depth of tumor invasion through the wall, extramural extension, and regional lymph node metastases. PET/CT should be performed on selected patients with suggestive but inconclusive metastatic lesions with CT. In addition, PET/CT with dedicated CT protocols, such as contrast-enhanced PET/CT and PET/CT colonography, may replace the diagnostic CT for the preoperative staging of colorectal cancer.
Collapse
Affiliation(s)
- Sang Soo Shin
- Department of Diagnostic Radiology, Chonnam National University Medical School, #8 Hack-dong, Dong-gu, Gwangju, 501-757, South Korea
| | | | | | | | | | | |
Collapse
|
24
|
Akduman EI, Momtahen AJ, Balci NC, Mahajann N, Havlioglu N, Wolverson MK. Comparison between malignant and benign abdominal lymph nodes on diffusion-weighted imaging. Acad Radiol 2008; 15:641-6. [PMID: 18423322 DOI: 10.1016/j.acra.2007.12.023] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2007] [Revised: 12/27/2007] [Accepted: 12/29/2007] [Indexed: 12/14/2022]
Abstract
RATIONALE AND OBJECTIVES The purpose of this study is to review the apparent diffusion coefficient (ADC) values of benign and metastatic abdominal lymph nodes on diffusion-weighted imaging (DWI). MATERIALS AND METHODS Twenty-eight patients with a total of 40 benign (20 patients) and 16 malignant (8 patients) lymph nodes who underwent DWI MRI of the abdomen (b = 0.600) were enrolled in the study. ADC values of the lymph nodes were measured and comparison was made between benign and malignant groups. RESULTS Mean ADC value of lymph nodes was 2.38 +/- 0.29 and 1.84 +/- 0.37 x 10(-3) mm(2)/sec in the benign and malignant groups, respectively. There was a significant statistical difference between the ADC values of benign and malignant lymph nodes (P < .0005). CONCLUSION A wide range of ADC values exist in patients with metastatic abdominal lymph nodes, with a tendency of higher ADC values in benign lymph nodes.
Collapse
Affiliation(s)
- E Isin Akduman
- Department of Radiology, Saint Louis University Hospital, 3635 Vista Avenue, St. Louis, MO 63110, USA
| | | | | | | | | | | |
Collapse
|
25
|
Kinner S, Antoch G, Bockisch A, Veit-Haibach P. Whole-body PET/CT-colonography: a possible new concept for colorectal cancer staging. ACTA ACUST UNITED AC 2008; 32:606-12. [PMID: 17387540 DOI: 10.1007/s00261-007-9202-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is a leading cause of death, and necessitates a conjointly performed staging. Until now, a multi-step-examination including optical colonoscopy, cross-sectional and functional imaging is recommended. However, a single examination for whole-body staging with a dedicated CRC staging protocol is desirable. Thus, we developed and evaluated a combined whole-body PET/CT-colonography protocol for dedicated CRC staging in routine clinical use. METHODS We integrated CT-colonography into a whole-body PET/CT protocol to achieve a specific "all-in-one" examination for patients suspected of having CRC. After oral and rectal bowel distension, PET/CT-colonography has been performed in 55 patients. All patients had optical colonoscopy one day before PET/CT. PET/CT data sets were evaluated concerning detection and evaluation of colorectal tumour sites, lymph nodes and distant metastases; these results were compared to the results of CT-colonography alone. Surgical resection and/or biopsy served as standards of reference in all patients. RESULTS All examinations were fully diagnostic and well tolerated by the patients. PET/CT-colonography showed highly accurate results for overall TNM-evaluation and was significantly more accurate than CT-colonography alone. CONCLUSIONS Staging patients with whole-body PET/CT-colonography is technically feasible and accurate. Patients with incomplete colonoscopy or potential synchronous bowel lesions might benefit from this approach.
Collapse
Affiliation(s)
- Sonja Kinner
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstrasse 55, 45122, Essen, Germany.
| | | | | | | |
Collapse
|
26
|
|
27
|
Veit-Haibach P. Potential New Staging Perspectives in Colorectal Cancer. Cancer Imaging 2008. [DOI: 10.1016/b978-012374212-4.50107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
28
|
Crippa F, Gerali A, Alessi A, Agresti R, Bombardieri E. The Role of FDG-PET for Axillary Lymph Node Staging in Primary Breast Cancer. Breast Cancer 2007. [DOI: 10.1007/978-3-540-36781-9_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
29
|
Rothschild S, Studer G, Seifert B, Huguenin P, Glanzmann C, Davis JB, Lütolf UM, Hany TF, Ciernik IF. PET/CT staging followed by Intensity-Modulated Radiotherapy (IMRT) improves treatment outcome of locally advanced pharyngeal carcinoma: a matched-pair comparison. Radiat Oncol 2007; 2:22. [PMID: 17559684 PMCID: PMC1924526 DOI: 10.1186/1748-717x-2-22] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 06/09/2007] [Indexed: 12/25/2022] Open
Abstract
Background Impact of non-pharmacological innovations on cancer cure rates is difficult to assess. It remains unclear, whether outcome improves with 2- [18-F]-fluoro-2-deoxyglucose-positron emission tomography and integrated computer tomography (PET/CT) and intensity-modulated radiotherapy (IMRT) for curative treatment of advanced pharyngeal carcinoma. Patients and methods Forty five patients with stage IVA oro- or hypopharyngeal carcinoma were staged with an integrated PET/CT and treated with definitive chemoradiation with IMRT from 2002 until 2005. To estimate the impact of PET/CT with IMRT on outcome, a case-control analysis on all patients with PET/CT and IMRT was done after matching with eighty six patients treated between 1991 and 2001 without PET/CT and 3D-conformal radiotherapy with respect to gender, age, stage, grade, and tumor location with a ratio of 1:2. Median follow-up was eighteen months (range, 6–49 months) for the PET/CT-IMRT group and twenty eight months (range, 1–168 months) for the controls. Results PET/CT and treatment with IMRT improved cure rates compared to patients without PET/CT and IMRT. Overall survival of patients with PET/CT and IMRT was 97% and 91% at 1 and 2 years respectively, compared to 74% and 54% for patients without PET/CT or IMRT (p = 0.002). The event-free survival rate of PET/CT-IMRT group was 90% and 80% at 1 and 2 years respectively, compared to 72% and 56% in the control group (p = 0.005). Conclusion PET/CT in combination with IMRT and chemotherapy for pharyngeal carcinoma improve oncological therapy of pharyngeal carcinomas. Long-term follow-up is needed to confirm these findings.
Collapse
Affiliation(s)
- Sacha Rothschild
- Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
- Medical Oncology, Kantonsspital Aarau, Tellstrasse, 5001, Aarau, Switzerland
| | - Gabriela Studer
- Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Burkhardt Seifert
- Institute for Social- and Preventive Medicine, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Pia Huguenin
- Radiation Oncology, Kantonsspital Graubünden, Loëstrasse 107, 7000 Chur, Switzerland
| | - Christoph Glanzmann
- Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
| | - J Bernard Davis
- Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Urs M Lütolf
- Radiation Oncology, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Thomas F Hany
- Nuclear Medicine, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
| | - I Frank Ciernik
- Center for Clinical Research, Zurich University Hospital, Rämistrasse 100, 8091, Zurich, Switzerland
- Oncology Institute of Southern Switzerland, Ospedale San Giovanni e Valli, 6500 Bellinzona, Switzerland
| |
Collapse
|
30
|
Braam PM, Raaijmakers CPJ, Terhaard CHJ. Cranial location of level II lymph nodes in laryngeal cancer: Implications for elective nodal target volume delineation. Int J Radiat Oncol Biol Phys 2007; 67:462-8. [PMID: 17236968 DOI: 10.1016/j.ijrobp.2006.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/04/2006] [Accepted: 10/04/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To analyze the cranial distribution of level II lymph nodes in patients with laryngeal cancer to optimize the elective radiation nodal target volume delineation. METHODS AND MATERIALS The most cranially located metastatic lymph node was delineated in 67 diagnostic CT data sets. The minimum distance from the base of the skull (BOS) to the lymph node was determined. RESULTS A total of 98 lymph nodes were delineated including 62 ipsilateral and 36 contralateral lymph nodes. The mean ipsilateral and contralateral distance from the top of the most cranial metastatic lymph node to the BOS was 36 mm (range, -9-120; standard deviation [SD], 17.9) and 35 mm (range, 14-78; SD 15.0), respectively. Only 5% and 12% of the ipsilateral and 3% and 9% of the contralateral metastatic lymph nodes were located within 15 mm and 20 mm below the BOS, respectively. No significant differences were found between patients with only ipsilateral metastatic lymph nodes and patients with bilateral metastatic lymph nodes. Between tumors that do cross the midline and those that do not, no significant difference was found in the distance of the most cranial lymph node to the BOS and the occurrence ipsilateral or contralateral. CONCLUSIONS Setting the cranial border of the nodal target volume 1.5 cm below the base of the skull covers 95% of the lymph nodes and should be considered in elective nodal irradiation for laryngeal cancer. Bilateral neck irradiation is mandatory, including patients with unilateral laryngeal cancer, when elective irradiation is advised.
Collapse
Affiliation(s)
- Pètra M Braam
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
| | | | | |
Collapse
|