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Abstract
PURPOSE This retrospective study aimed to investigate the clinical value of -deoxy-2-(F)-fluorodeoxyglucose positron emission tomography/computed tomography (F-FDG PET/CT) in detecting primary lesions of hepatic metastases. METHODS A total of 124 patients with hepatic metastatic carcinoma of unknown primary underwent whole body F-FDG PET/CT imaging. According to the final diagnoses for both primary sites and hepatic metastases that were confirmed either histopathologically or by clinical follow up, all patients were divided into 4 groups: a true positive group (TP, 95 cases), a false positive group (FP, 9), a true negative group (TN, 8) and a false negative group (FN, 12). RESULTS The TP rate of primary lesions, detected by F-FDG PET/CT, was 76.61%, the FP rate 7.26%, the TN rate 6.45% and the FN rate 9.68%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of F-FDG PET/CT in the detection of primary tumors were 88.78%, 52.94%, 91.35%, 40%, and 83.06%, respectively. Accurate diagnosis groups (TP, TN) showed a significantly higher SUVmax (standard uptake maximum value) level than that in error diagnosis groups (FP, FN). The SUVmax between hepatic metastases and primary lesions had a positive correlation. The primary tumor sites of hepatic metastases were mainly located in the gastrointestinal organs and the lungs. CONCLUSIONS Whole body F-FDG PET/CT imaging was sensitive for detecting primary sites/lesions with hepatic metastatases of unknown primary, especially when the SUVmax of hepatic metastases were greater than 4.7.
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Affiliation(s)
- Yuekai Li
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Fengcai Li
- Department of Hepatology, Qilu Hospital of Shandong University, Jinan, China
| | - Xin Li
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Lili Qu
- Department of Nuclear Medicine, Cheeloo College of Medicine
| | - Jiankui Han
- Department of Nuclear Medicine, Cheeloo College of Medicine
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Zytoon AA, Elsayed EE, Nassar AI, Murakami K. Pivotal role of PET/CT in characterization of occult metastasis with undetermined origin. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The purpose of this multicenter diagnostic accuracy test study was conducted to assess the role of positron emission tomography/computed tomography in the detection of primary tumor in cases of metastasis of undetermined primary site, to estimate its capability in detecting additional lesions as well as evaluating disease burden and staging. This multicentric diagnostic accuracy test study included 175 patients with pathologically proven, radiologically, and/or clinically suspected metastatic lesions of undetermined primary site. Clinical, surgical, and histopathologic findings and correlative imaging modalities were used to assess the results of PET/CT; the accuracy of PET/CT was expressed in terms of sensitivity and specificity, positive and negative predictive values.
Results
The study included 175 patients; PET-CT-positive lesions suggestive of primary malignant tumors were detected in 105 out of 175 patients. These lesions were pathologically proven to be malignant (true positive) in 100/175 patients (57.1%). Five out of 175 patients (2.9%) proved to be falsely positive after pathologic assessment; 70 out of 175 patients (40%) were negative for detection of primary malignancy all over the body by PET/CT (true negative) with no false negative results. PET/CT achieved a sensitivity of 100%, and specificity of 93.3% in detection of unknown primary tumor location.
Conclusion
PET/CT is an effective modality for early detection of the primary tumor site in patients with cancer of undetermined primary (CUP) which facilitates early selection of appropriate treatment protocols that will improve patients’ prognosis.
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Gamal GH. Validity of FDG PET/CT in patients presenting with primary colonic symptoms. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0001-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Cancer of unknown primary origin: Can FDG PET/CT have a role in detecting the site of primary? THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Burglin SA, Hess S, Høilund-Carlsen PF, Gerke O. 18F-FDG PET/CT for detection of the primary tumor in adults with extracervical metastases from cancer of unknown primary: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6713. [PMID: 28422888 PMCID: PMC5406105 DOI: 10.1097/md.0000000000006713] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Cancer of unknown primary (CUP) is a heterogeneous group of cancers, so called when a biopsy from a patient reveals malignancy without giving a clue to where in the body the primary tumor is located. Whole-body 18-fluorine-fluorodeoxyglucose positron-emission-tomography/computed tomography (18F-FDG PET/CT) is widely used for diagnosis and staging of most cancers. We hypothesized that 18F-FDG PET/CT-especially if used early-is suitable for the detection of the primary tumor in patients with CUP. OBJECTIVE To assess the ability of 18F-FDG PET/CT to detect the primary tumor in adult CUP patients. DATA SOURCES PubMed/Medline, Embase, and Web of Science. STUDY ELIGIBILITY CRITERIA Studies on CUP from extracervical metastases in which every patient had received an 18F-FDG PET/CT scan and at least one 18F-FDG PET/CT-positive finding was confirmed by biopsy or clinical follow-up. STUDY APPRAISAL PRISMA and QUADAS-2 were applied. SYNTHESIS METHODS The pooled detection rate (DR) of 18F-FDG PET/CT was assessed with a fixed-effects model. Heterogeneity among studies was assessed with the I-squared statistic. RESULTS A total of 2953 articles were identified from which N = 82 were assessed by full text and N = 20, comprising 1942 adult patients, were included in the study. Median (range) number of patients and DR was N = 72 (21-316) and 36.3% (9.8%-75.3%), respectively. Two-thirds of included studies were retrospective, and the pooled DR was 40.93% (95% confidence interval: 38.99%-42.87%). There was large heterogeneity between studies (I-squared = 95.9%), randomization was not applied, CUP diagnosis was not standardized, and workup (if described) was characterized by multiple testing procedures resulting in a highly selected, challenging patient group. CONCLUSIONS Despite great heterogeneity in diagnostic workup and in studies in general, an overall DR of 40.93% suggests that upfront application of 18F-FDG PET/CT may have a role in CUP by obviating a great many futile diagnostic procedures. To what degree 18F-FDG PET/CT used early in the course of disease may improve the detection rate could not be deducted from selected articles. A large, prospective, preferably randomized, study on the potential benefit of using 18F-FDG PET/CT up front in CUP patients is warranted to judge if and when 18F-FDG PET/CT should be applied in these patients.
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Affiliation(s)
- Synne Alexandra Burglin
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
| | - Søren Hess
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
- Department of Radiology and Nuclear Medicine, Hospital South West Jutland, Esbjerg
| | - Poul Flemming Høilund-Carlsen
- Department of Nuclear Medicine, Odense University Hospital
- Department of Clinical Research, University of Southern Denmark, Odense C
| | - Oke Gerke
- Department of Nuclear Medicine, Odense University Hospital
- Centre of Health Economics Research, University of Southern Denmark, Odense M, Denmark
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Subramaniam RM, Shields AF, Sachedina A, Hanna L, Duan F, Siegel BA, Hillner BE. Impact on Patient Management of [18F]-Fluorodeoxyglucose-Positron Emission Tomography (PET) Used for Cancer Diagnosis: Analysis of Data From the National Oncologic PET Registry. Oncologist 2016; 21:1079-84. [PMID: 27401896 DOI: 10.1634/theoncologist.2015-0364] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Accepted: 05/12/2016] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We assessed the impact of [(18)F]-fluorodeoxyglucose (FDG)-positron emission tomography (PET) on intended management of patients in the National Oncologic PET Registry (NOPR) for three different diagnostic indications: (a) determining whether a suspicious lesion is cancer (Dx), (b) detecting an unknown primary tumor site when there is confirmed or strongly suspected metastatic disease (cancer of unknown primary origin [CUP]), and (c) detecting a primary tumor site when there is a presumed paraneoplastic syndrome (PNS). METHODS We reviewed a sample of randomly selected reports of NOPR subjects who underwent PET for Dx and CUP and all reports for PNS to find subjects for analysis. For these studies, we evaluated the impact of PET on referring physicians' intended management, based on their management plans reported before and after PET. RESULTS Intended management was changed more frequently in the CUP group (43.1%) than in the Dx (23.9%) and PNS (25.4%) groups (CUP vs. Dx, p < .0001; PNS vs. Dx, p < .0001; CUP vs. PNS, p < .0002). Referring physicians reported that, in light of PET results, they were able to avoid further testing in approximately three-fourths of patients (71.8%-74.6%). At the time when the post-PET forms were completed, biopsies of suspicious sites had been performed in 21.2%, 32.4%, and 23.2%, respectively, of Dx, CUP, and PNS cases. CONCLUSION Our analysis of NOPR data shows that PET appears to have a substantial impact on intended management when used for three common diagnostic indications. IMPLICATIONS FOR PRACTICE [(18)F]-fluorodeoxyglucose-positron emission tomography appears to have a substantial impact on intended management when used for three targeted diagnostic indications: (a) determining whether a suspicious lesion is cancer, (b) detecting an unknown primary tumor site in a patient with confirmed or strongly suspected metastatic disease, and (c) detecting a primary tumor site in a patient with a presumed paraneoplastic syndrome.
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Affiliation(s)
- Rathan M Subramaniam
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Anthony F Shields
- Karmanos Cancer Institute, Wayne State University, Detroit, Michigan, USA
| | - Archana Sachedina
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Lucy Hanna
- Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Fenghai Duan
- Center for Statistical Sciences, Brown University, Providence, Rhode Island, USA
| | - Barry A Siegel
- Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA Siteman Cancer Center, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bruce E Hillner
- Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia, USA
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Tamam C, Tamam M, Mulazimoglu M. The Accuracy of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Evaluation of Bone Lesions of Undetermined Origin. World J Nucl Med 2016; 15:124-9. [PMID: 27134563 PMCID: PMC4809153 DOI: 10.4103/1450-1147.176885] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.
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Affiliation(s)
- Cuneyt Tamam
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
| | - Muge Tamam
- Department of Nuclear Medicine, Okmeydani Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Mulazimoglu
- Department of Orthopedics and Traumatology, Kasimpasa Military Hospital, Istanbul, Turkey
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YAYLALI O, KIRAÇ FS, YÜKSEL D. The role of 18F-FDG PET-CT in the detection of unknown primary malignancy: a retrospective study. Turk J Med Sci 2016; 46:474-82. [DOI: 10.3906/sag-1502-99] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/01/2015] [Indexed: 11/03/2022] Open
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Deonarine P, Han S, Poon FW, de Wet C. The role of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography in the management of patients with carcinoma of unknown primary. Scott Med J 2013; 58:154-62. [PMID: 23960054 DOI: 10.1177/0036933013496958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Carcinoma of unknown primary is one of the ten most frequent cancers worldwide. Its median survival time is less than 10 months. Detecting primary tumour locations and/or occult metastatic lesions may inform definitive treatment and improve patients’ prognosis. We aimed to determine: (1) the sensitivity, specificity and accuracy of 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography; (2) its detection rate of primary tumour locations and occult metastases and (3) factors associated with improved survival times. Methods We retrospectively reviewed all cases in the West of Scotland for the period 1 December 2007 to 31 May 2011 that met all our selection criteria: (1) diagnosis of carcinoma of unknown primary; (2) a thorough but negative ‘work-up’ and (3) 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography report. Statistical methods included frequencies, Kaplan-Meier graphs and log-rank tests to compare survival times. Results 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected primary tumour sites in 19/51 (37.3%) and occult metastases in 28/51 (54.9%) of eligible patients. Its sensitivity, specificity and accuracy were 79.2%, 70.4% and 74.5%, respectively; 20/51 (39.2%) patients died during the study period with a median survival of 8.4 months (range 21.4, SD ± 6.2). The number of metastatic locations was strongly associated with survival ( p = 0.002), but detection of a primary tumour site ( p = 0.174) or histopathology ( p = 0.301) was not. Conclusion 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography detected occult metastatic sites in the majority and a primary cancer location in a substantial minority of patients. Our results were comparable with international literature and may indicate that 18F-fluoro-2-deoxyglucose positron emission tomography/computed tomography have an early role to improve the accuracy of cancer staging and to optimise carcinoma of unknown primary management.
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Affiliation(s)
- P Deonarine
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
| | - S Han
- Consultant Physician, Glasgow Royal Infirmary, UK
- Consultant Physician, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - FW Poon
- Radiology Consultant, Radiology Department, Glasgow Royal Infirmary, UK
- Radiology Consultant, West of Scotland PET Centre, Gartnavel General Hospital, UK
| | - C de Wet
- Associate Adviser in Postgraduate GP Education, NHS Education for Scotland, UK
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Møller AKH, Loft A, Berthelsen AK, Pedersen KD, Graff J, Christensen CB, Costa JC, Skovgaard LT, Perell K, Petersen BL, Daugaard G. A prospective comparison of 18F-FDG PET/CT and CT as diagnostic tools to identify the primary tumor site in patients with extracervical carcinoma of unknown primary site. Oncologist 2012; 17:1146-54. [PMID: 22711751 DOI: 10.1634/theoncologist.2011-0449] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate prospectively the diagnostic value of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) and conventional CT regarding the ability to detect the primary tumor site in patients with extracervical metastases from carcinoma of unknown primary (CUP) site. PATIENTS AND METHODS From January 2006 to December 2010, 136 newly diagnosed CUP patients with extracervical metastases underwent (18)F-FDG PET/CT. A standard of reference (SR) was established by a multidisciplinary team to ensure that the same set of criteria were used for classification of patients, that is, either as CUP patients or patients with a suggested primary tumor site. The independently obtained suggestions of primary tumor sites using PET/CT and CT were correlated with the SR to reach a consensus regarding true-positive (TP), true-negative, false-negative, and false-positive results. RESULTS SR identified a primary tumor site in 66 CUP patients (48.9%). PET/CT identified 38 TP primary tumor sites and CT identified 43 TP primary tumor sites. No statistically significant differences were observed between (18)F-FDG PET/CT and CT alone in regard to sensitivity, specificity, and accuracy. CONCLUSION In the general CUP population with multiple extracervical metastases (18)F-FDG PET/CT does not represent a clear diagnostic advantage over CT alone regarding the ability to detect the primary tumor site.
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Affiliation(s)
- Anne Kirstine H Møller
- Department of Oncology 5073, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, Copenhagen Ø, Denmark.
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Chen YK, Yeh CL, Chen YL, Wang SC, Cheng RH, Kao PF. The frequency and spectrum of thymus 2-[fluorine-18] fluoro-2-deoxy-D-glucose uptake patterns in hyperthyroidism patients. Acad Radiol 2011; 18:1292-7. [PMID: 21893295 DOI: 10.1016/j.acra.2011.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/27/2011] [Accepted: 05/02/2011] [Indexed: 01/15/2023]
Abstract
RATIONALE AND OBJECTIVES Thymic hyperplasia is associated with hyperthyroidism. Increased thymus 2-[fluorine-18]fluoro-2-deoxy-D-glucose (FDG) uptake in hyperthyroidism patients has been reported. The aim of this study was to analyze the FDG positron emission tomography (PET) thymus uptake spectrum in patients with active hyperthyroidism with correlation with serum hormones. MATERIALS AND METHODS The prospective study included FDG PET scans from 65 hyperthyroidism patients and 30 subjects with euthyroid status as control group. The intensity of FDG uptake in thyroid and thymus regions was graded subjectively on a five-point scale and semi-quantitatively by measuring standard uptake value (SUV). Correlation coefficient between thymus SUV and serum thyroxine, triiodothyronine, thyrotropin, thyroid peroxidase antibodies (TPO Ab), thyrotropin receptor autoantibody (TR Ab), and thymulin were analyzed. RESULTS Among 65 hyperthyroidism patients, 30 (46.2%) and 39 (60%) patients showed thyroid and thymus FDG uptake, respectively. The frequency of thymus uptake FDG was high in patients younger than age 40 (28/31, 90.3%). The patterns of the thymic FDG uptake include inverted V or triangular, separated triangular, united nontriangular, unilateral right or left extension, and focal midline. Focal midline FDG uptake was the most common pattern (15/39, 38.5%). None of the control group showed thymus FDG uptake. The correlation coefficient between the FDG uptake SUV levels in thymus and serum hormones, thyrotropin, TPO Ab, TR Ab, and thymulin levels were all low (P > .05). CONCLUSIONS In FDG PET scan, thymus activity was common in hyperthyroidism patients; this should not be misdiagnosed as a malignancy in patients exhibiting weight loss.
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Moller AKH, Loft A, Berthelsen AK, Damgaard Pedersen K, Graff J, Christensen CB, Perell K, Petersen BL, Daugaard G. 18F-FDG PET/CT as a diagnostic tool in patients with extracervical carcinoma of unknown primary site: a literature review. Oncologist 2011; 16:445-51. [PMID: 21427201 DOI: 10.1634/theoncologist.2010-0189] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Carcinoma of unknown primary (CUP) represents a heterogeneous group of metastatic malignancies for which no primary tumor site can be identified after extensive diagnostic workup. Failure to identify the primary site may negatively influence patient management. The aim of this review was to evaluate (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) as a diagnostic tool in patients with extracervical CUP. MATERIALS AND METHODS A comprehensive literature search was performed and four publications were identified (involving 152 patients) evaluating (18)F-FDG PET/CT in CUP patients with extracervical metastases. All studies were retrospective and heterogeneous in inclusion criteria, study design, and diagnostic workup prior to (18)F-FDG PET/CT. RESULTS (18)F-FDG PET/CT detected the primary tumor in 39.5% of patients with extracervical CUP. The lung was the most commonly detected primary tumor site (∼50%). The pooled estimates of sensitivity, specificity, and accuracy of (18)F-FDG PET/CT in the detection of the primary tumor site were 87%, 88%, and 87.5%, respectively. CONCLUSIONS The present review of currently available data indicates that (18)F-FDG PET/CT might contribute to the identification of the primary tumor site in extracervical CUP. However, prospective studies with more uniform inclusion criteria are required to evaluate the exact value of this diagnostic tool.
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Affiliation(s)
- Anne Kirstine Hundahl Moller
- Department of Oncology 5073, Copenhagen University Hospital Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark.
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Abstract
The increased use of sensitive imaging modalities has led to increased identification of the incidental liver mass (ILM). A combination of careful consideration of patient factors and imaging characteristics of the ILM enables clinicians to recommend a safe and efficient course of action. Using an algorithmic approach, this article includes pertinent clinical factors and the specific radiologic criteria of ILMs and discusses the indications for potential procedures. It is the aim of this article to assist with the development of an individualized strategy for each patient with an ILM.
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Affiliation(s)
- Cherif Boutros
- Department of Hepatobiliary and Surgical Oncology, Roger Williams Medical Center, 825 Chalkstone Avenue, Prior 4, Providence, RI 02908, USA
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Luboldt W, Volker T, Wiedemann B, Zöphel K, Wehrmann U, Koch A, Toussaint T, Abolmaali N, Middendorp M, Aust D, Kotzerke J, Grünwald F, Vogl TJ, Luboldt HJ. Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off. Eur Radiol 2010; 20:2274-85. [PMID: 20503051 PMCID: PMC2914265 DOI: 10.1007/s00330-010-1772-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 02/16/2010] [Accepted: 02/19/2010] [Indexed: 12/21/2022]
Abstract
Objective: To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas ≥10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off. Methods: 84 patients, who underwent PET/CT and colonoscopy (n = 79)/sigmoidoscopy (n = 5) for \documentclass[12pt]{minimal}
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\begin{document}$${\left( {{\hbox{79}} \times {\hbox{6}} + {\hbox{5}} \times {\hbox{2}}} \right)} = {\hbox{484}}$$\end{document} colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs. Results: Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n = 23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n = 10) the SUVmax was ≥5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUVmax. Conclusion: FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUVmax ≥ 5 improves the accuracy.
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