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Costanzo R, Scalia G, Strigari L, Ippolito M, Paolini F, Brunasso L, Sciortino A, Iacopino DG, Maugeri R, Ferini G, Viola A, Zagardo V, Cosentino S, Umana GE. Nuclear medicine imaging modalities to detect incidentalomas and their impact on patient management: a systematic review. J Cancer Res Clin Oncol 2024; 150:368. [PMID: 39052066 PMCID: PMC11272692 DOI: 10.1007/s00432-024-05891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024]
Abstract
PURPOSE This systematic review aims to investigate the role of nuclear imaging techniques in detecting incidentalomas and their impact on patient management. METHODS Following PRISMA guidelines, a comprehensive literature search was conducted from February to May 2022. Studies in English involving patients undergoing nuclear medicine studies with incidental tumor findings were included. Data on imaging modalities, incidentaloma characteristics, management changes, and follow-up were extracted and analyzed. RESULTS Ninety-two studies involving 64.884 patients were included. Incidentalomas were detected in 611 cases (0.9%), with thyroid being the most common site. PET/CT with FDG and choline tracers showed the highest incidentaloma detection rates. Detection of incidentalomas led to a change in therapeutic strategy in 59% of cases. Various radiotracers demonstrated high sensitivity for incidentaloma detection, particularly in neuroendocrine tumors and prostate cancer. CONCLUSION Nuclear imaging techniques play a crucial role in detecting incidentalomas, leading to significant changes in patient management. The high sensitivity of these modalities highlights their potential in routine oncology follow-up protocols. Future directions may include enhancing spatial resolution and promoting theranostic approaches for improved patient care.
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Affiliation(s)
- Roberta Costanzo
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy.
| | - Lidia Strigari
- Department of Medical Physics, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Massimiliano Ippolito
- Department of Advanced Technologies, Nuclear Medicine and PET, Cannizzaro Hospital, Catania, Italy
| | - Federica Paolini
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Lara Brunasso
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Andrea Sciortino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Domenico Gerardo Iacopino
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Rosario Maugeri
- Department of Biomedicine Neurosciences and Advanced Diagnostics, Neurosurgical Clinic, AOUP "Paolo Giaccone", School of Medicine, University of Palermo, Palermo, Italy
| | - Gianluca Ferini
- Radiation Oncology Unit, REM Radioterapia Srl, Viagrande, Italy
| | - Anna Viola
- Radiation Oncology Unit, REM Radioterapia Srl, Viagrande, Italy
| | | | - Sebastiano Cosentino
- Department of Advanced Technologies, Nuclear Medicine and PET, Cannizzaro Hospital, Catania, Italy
| | - Giuseppe E Umana
- Department of Neurosurgery, Trauma and Gamma-Knife Center, Cannizzaro Hospital, Catania, Italy
- Department of Medicine and Surgery, Kore University of Enna, Enna, Italy
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Abstract
PURPOSE OF REVIEW Testicular cancer is rare, but its incidence is expected to rise. [18F] fluorodeoxyglucose ([18F]FDG) PET/computed tomography (CT) added role in testicular cancer management has been defined in a set of specific clinical settings. The current review focuses on recent advances in the employment of PET/CT in testicular cancer patients. RECENT FINDINGS [18F]FDG PET/CT is not recommended for initial staging or for suspected testicular tumours. PET/CT role in testicular cancer management is mainly for the assessment of seminoma residual masses after therapy (>3 cm). Although [18F]FDG PET/CT has a very high negative predictive value, its positive predictive value varies across studies: appropriate PET/CT scheduling after therapy and a careful history are mandatory for accurate interpretation. Interim PET/CT could prove valuable to spare subsequent chemotherapy cycles in patients already in remission, reducing related toxicity. The role of [18F]FDG in nonseminoma tumours is hampered by the low sensitivity in teratoma. SUMMARY [18F]FDG PET/CT is currently used for the assessment of seminoma residual masses (>3 cm) after therapy. A negative PET could also spare unnecessary further chemotherapy cycles in responding patients, reducing toxicity. Although rare, testicular secondary lesions can be detected with non[18F]FDG tracers when PET/CT is performed for other primary tumours.
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Sánchez Pérez M, Jiménez Marrero P, Kim Lee D, Neumann MP, Jorge Pérez N, Hernández Hernández C, Hernández Escobar S, Marrero Domínguez R. Incidental Leydig Cell Tumor in Patient with Hormone Resistant Prostate Cancer. Urol Case Rep 2017; 13:48-50. [PMID: 28443242 PMCID: PMC5397599 DOI: 10.1016/j.eucr.2017.03.027] [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: 02/13/2017] [Revised: 03/21/2017] [Accepted: 03/23/2017] [Indexed: 11/15/2022] Open
Abstract
We hereby present the case of a 55 years old patient with clinical diagnosis of high-risk prostate cancer T2bN1Mo Gleason 9 (4 + 5) treated with androgen deprivation therapy and external beam radiotherapy. Despite treatment, castration levels were not achieved and clinical progression was evidenced by the appearance of bone metastases and progression of PSA. After several hormonal treatments without any PSA or testosterone response, surgical castration was performed by bilateral orchiectomy. The pathology results showed an incidental Leydig cell tumor in the right testicle.
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Affiliation(s)
- M Sánchez Pérez
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - P Jiménez Marrero
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - D Kim Lee
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - M P Neumann
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - N Jorge Pérez
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - C Hernández Hernández
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - S Hernández Escobar
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
| | - R Marrero Domínguez
- Servicio de Urología HUGCDN Barranco de la Ballena s/n Las Palmas de Gran Canaria, Spain
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Welle CL, Cullen EL, Peller PJ, Lowe VJ, Murphy RC, Johnson GB, Binkovitz LA. ¹¹C-Choline PET/CT in Recurrent Prostate Cancer and Nonprostatic Neoplastic Processes. Radiographics 2016; 36:279-92. [PMID: 26761541 DOI: 10.1148/rg.2016150135] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Choline positron emission tomography (PET)/computed tomography (CT), with both carbon 11 ((11)C) choline and fluorine 18 ((18)F) choline, is an increasingly used tool in the evaluation of patients with biochemically recurrent prostate cancer. It has allowed detection and localization of locally recurrent and metastatic lesions that were difficult or impossible to identify using more conventional modalities. Many of the patients followed for their prostate cancer are elderly and have a higher rate of nonprostate cancer lesions or malignancies. As our experience with choline PET/CT has grown, it has become apparent that many of these nonprostate cancer processes, both benign and malignant, can be detected. Invasive thymoma, renal cell carcinoma, papillary thyroid carcinoma, and parathyroid adenoma are a few of the processes that have been incidentally detected with (11)C-choline PET/CT at our institution and have significantly altered subsequent clinical management of the patient. Although most of the secondary lesions are detected due to their increased (11)C-choline avidity, several have been detected due to their decreased or lack of avidity in the background of a highly avid organ. For instance, large liver masses that are relatively non-choline-avid create large activity defects in the otherwise highly active liver. Familiarity with normal (11)C-choline physiologic activity, the most common prostate metastatic patterns, and imaging characteristics of secondary lesions is essential for the detection and correct diagnosis of such lesions so that proper follow-up and management can be recommended.
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Affiliation(s)
- Christopher L Welle
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Ethany L Cullen
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Patrick J Peller
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Val J Lowe
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Robert C Murphy
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Geoffrey B Johnson
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
| | - Larry A Binkovitz
- From the Department of Radiology, Mayo Clinic, 200 First St SW, Rochester, MN 55905-0002 (C.L.W., E.L.C., V.J.L., R.C.M., G.B.J., L.A.B.); and Eka Medical Center-Jakarta, BSD City, Tangerang, Indonesia (P.J.P.)
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Abstract
We report a case of squamous cell carcinoma of the tonsil incidentally detected by F-choline PET/CT. A 55-year-old male patient with a history of prostate cancer underwent F-choline PET/CT for restaging. PET/CT revealed a focal area of increased F-choline uptake corresponding to the left tonsil. No other areas of abnormal F-choline uptake were detected in the rest of the body. Based on these PET/CT findings, the patient underwent clinical examination and biopsy of the left tonsil. Histology demonstrated the presence of a squamous cell carcinoma of the tonsil.
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Abstract
We report a case of metastatic colorectal carcinoma detected by F-choline PET/CT. A 72-year-old man with history of prostate cancer (previously treated with prostatectomy) underwent F-choline PET/CT for restaging. PET/CT revealed a focal area of increased F-choline uptake corresponding to a rectal nodule. Furthermore, 2 areas of increased radiopharmaceutical uptake were evident in the right clavicle and in the body of the 10th dorsal vertebra, corresponding to the osteolytic lesions. Based on these PET/CT findings, the patient underwent biopsy of the rectal nodule and left clavicular lesion. Histologic examination demonstrated the presence of a colorectal carcinoma metastatic to the bone.
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