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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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Cuzzocrea M, Paone G, Treglia G. Two Birds with One Stone: Hepatocellular Carcinoma and Small Cell Lung Cancer Imaged with [ 18F]Fluorocholine Positron Emission Tomography/Computed Tomography. Diagnostics (Basel) 2023; 13:2639. [PMID: 37627897 PMCID: PMC10453700 DOI: 10.3390/diagnostics13162639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/06/2023] [Accepted: 08/08/2023] [Indexed: 08/27/2023] Open
Abstract
We describe the case of a 67-year-old male patient with a moderately differentiated hepatocellular carcinoma (HCC) of the right liver lobe who underwent [18F]fluorocholine positron emission tomography/computed tomography (PET/CT) for staging due to a suspicious lung lesion at previous CT scan. [18F]fluorocholine PET/CT showed increased radiopharmaceutical uptake in a liver lesion corresponding to the known HCC. Furthermore, a right pulmonary hilar lesion suspicious for metastatic spread of HCC showed increased radiopharmaceutical uptake. Surprisingly, the histological assessment of the thoracic lesion demonstrated the presence of small cell lung cancer (SCLC). The patient underwent treatment with radiation therapy and chemotherapy for the SCLC and selective internal radiation therapy (SIRT) for the HCC. The patient died after one year due to progressive SCLC. This case demonstrates that coexisting tumors showing increased cell membrane turnover, including SCLC, can be detected by [18F]fluorocholine PET/CT. In our case, [18F]fluorocholine PET/CT findings influenced the patient management in terms of histological verification and different treatment of the detected lesions.
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Affiliation(s)
- Marco Cuzzocrea
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.C.); (G.P.)
| | - Gaetano Paone
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.C.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, 6500 Bellinzona, Switzerland; (M.C.); (G.P.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), 6900 Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne (UNIL), 1011 Lausanne, Switzerland
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3
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Parihar AS, Hofman MS, Iravani A. 177Lu-Prostate-specific Membrane Antigen Radioligand Therapy in Patients with Metastatic Castration-resistant Prostate Cancer. Radiology 2023; 306:e220859. [PMID: 36125377 DOI: 10.1148/radiol.220859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A 76-year-old man with metastatic castration-resistant prostate carcinoma progressing with antiandrogen and taxane therapy was treated with lutetium 177 prostate-specific membrane antigen (PSMA)-617 and showed marked biochemical and imaging response, with improvement in clinical status and osseous pain. A summary of nuclear medicine theranostics with emphasis on PSMA targeting agents is presented.
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Affiliation(s)
- Ashwin Singh Parihar
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
| | - Michael S Hofman
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
| | - Amir Iravani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 4525 Scott Ave, Suite 3433, MIR East Building, St Louis, MO 63110 (A.S.P., A.I.); and Department of Molecular Imaging and Therapeutic Nuclear Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia (M.S.H.)
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Broos WA, Knol RJ, Zant FMVD, Schaper NC, Wondergem M. Incidental Findings on 18F-Fluorocholine PET/CT for Parathyroid Imaging. World J Nucl Med 2022; 21:192-199. [PMID: 36060082 PMCID: PMC9436517 DOI: 10.1055/s-0042-1751031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction
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F-choline positron emission tomography/computed tomography (PET/CT) is an upcoming imaging technique for the localization of hyperfunctioning parathyroid glands. However,
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F-choline is a nonspecific tracer that also accumulates in malignancies, inflammatory lesions, and several other benign abnormalities. The aim of this study was to determine the occurrence and relevance of incidental findings on
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F-choline PET/CT for parathyroid localization.
Materials and Methods
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F-choline PET/CTs performed in our center for parathyroid localization from 2015 to 2019 were reviewed. Abnormal uptake of
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F-choline, with or without anatomical substrate on the co-registered low-dose CT and also incidental findings on CT without increased
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F-choline uptake were recorded. Each finding was correlated with follow-up data from the electronic medical records.
Results
A total of 388
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F-choline PET/CTs were reviewed, with 247 incidental findings detected in 226 patients (58%): 82
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F-choline positive findings with corresponding pathology on CT, 16 without CT substrate, and 149
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F-choline negative abnormalities on CT. Malignant lesions were detected in 10/388 patients (2.6%). Of all 98 detected
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F-choline positive lesions, 15 were malignant (15.3%), concerning 4 metastases and 11 primary malignancies: breast carcinoma (
n
= 7), lung carcinoma (
n
= 2), thyroid carcinoma (
n
= 1), and skin melanoma (
n
= 1).
Conclusion
Clinically relevant incidental findings were observed in a substantial number of patients. In 15.3% of the incidental
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F-choline positive findings, the lesions were malignant. These data contribute to better knowledge of
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F-choline distribution, enhance interpretation of
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F-choline PET/CT, and guide follow-up of incidental findings. Attention should especially be paid to breast lesions in this particular patient group with hyperparathyroidism in which women are typically over-represented.
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Affiliation(s)
- Wouter A.M. Broos
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
| | - Remco J.J. Knol
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
| | | | - Nicolaas C. Schaper
- CAPHRI School for Care and Public Health Research, Maastricht University, Maastricht, the Netherlands
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Maurits Wondergem
- Department of Nuclear Medicine, Northwest Clinics, Alkmaar, the Netherlands
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Roland A, Drouet C, Boulahdour H, Cochet A, De Bari B. Unusual uptakes on 18F-fluorocholine positron emission tomography/computed tomography (PET/CT): a retrospective study of 368 prostate cancer patients referred for a biochemical recurrence or an initial staging. Quant Imaging Med Surg 2021; 11:172-182. [PMID: 33392020 DOI: 10.21037/qims-19-981] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background 18F-fluorocholine positron emission tomography/computed tomography (F-choline PET/CT) is considered a cornerstone in the staging and restaging of patients with prostate cancer (PCa). The aim of this study was to retrospectively assess unusual uptakes in patients who underwent a F-choline PET/CT for the initial staging or for the restaging of a relapsing PCa. Methods Three hundred and sixty-eight PCa patients were staged or restaged using F-choline PET/CT. Unusual uptakes were defined as uptakes occurring outside the usual paths of diffusion of PCa or as uptake in bone with a clear morphological evidence of nonmetastatic lesion. Results We found unusual uptakes in 47/368 patients (12.8%). Among them, 41/47 presented with benign F-choline uptake, usually within lymph nodes, due to inflammatory processes (22/47). Other benign processes were found in: thyroid (3/47), adrenal gland (3/47), brain (2/47), liver (1/47), bowel (3/47), frontal sinus (1/47), lungs (4/47), parotid gland (1/47) and bone (1/47). The six remaining patients presented with a second cancer, including lymphoma (1/47), non-small cell lung cancer (4/47) and neuroendocrine tumor (1/47). Conclusions unusual uptakes on F-choline PET/CT are quite frequent and should be explored since they may correspond to non-PCa.
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Affiliation(s)
- Antoine Roland
- Nuclear Medicine Department, University Hospital of Besançon, Besançon, France
| | - Clément Drouet
- Department of Nuclear Medicine, Georges-François Leclerc Cancer Center, Dijon, France
| | - Hatem Boulahdour
- Nuclear Medicine Department, University Hospital of Besançon, Besançon, France
| | - Alexandre Cochet
- Department of Nuclear Medicine, Georges-François Leclerc Cancer Center, Dijon, France.,ImViA EA 7535, University of Burgundy, Dijon, France
| | - Berardino De Bari
- Radiation Oncology Department, University Hospital of Besançon, Besançon, France
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Incidental Metastatic Melanoma Identified on 18F-FDOPA PET/CT With Confirmation by Histology. Clin Nucl Med 2020; 45:817-818. [PMID: 32796240 DOI: 10.1097/rlu.0000000000003233] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 47-year-old woman with a history of surgically treated abdominal paraganglioma and left thigh melanoma underwent an F-FDOPA PET/CT for suspected locoregional recurrence of paraganglioma. F-FDOPA PET/CT disconfirmed this recurrence but revealed 2 FDOPA-avid left inguinal lymph nodes, confirmed on a subsequent F-FDG PET/CT. Excision and pathology characterized these lymph nodes as melanoma metastases. F-FDOPA PET/CT is a widely used and valuable tool in the assessment of paraganglioma, both for staging and recurrence detection. Uptake of FDOPA has only rarely been documented in metastatic melanoma that could be a pitfall for detecting neuroendocrine tumors.
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Pizzuto DA, Annunziata S, Ieria FP, Caldarella C, Isgrò MA, Lanni V, Bencivenga G, Rufini V, Giordano A. Lung uptake of fluorine-18 fluoroethyl-choline PET-CT in patients with prostate cancer. THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2019; 63:387-393. [PMID: 29345442 DOI: 10.23736/s1824-4785.18.02985-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Metastatic spreading to the lungs is a negative prognostic factor in patients with prostate cancer (PC). Aim of our study was to assess the prevalence of lung PC metastases in patients with fluorine-18 fluoroethyl-choline (F-18-FECh) PET-CT positive lung lesions and the role of Gleason Score (GS) and common biochemical markers in predicting metastatic spreading to the lungs. METHODS We retrospectively evaluated the scans of 1283 patients ongoing (F-18-FECh) PET-CT for PC between May 2010 and July 2014. Patients with lung lesion with F-18-FECh uptake were included. Data concerning GS at diagnosis, "trigger" prostate-specific antigen (PSAtr), PSA doubling time (PSAdt), PSA velocity (PSAvel) and ongoing androgen deprivation therapy were collected. PET-CT findings were confirmed by histology or follow-up (FU) and classified as follows: inflammation, primary lung cancer or metastases from tumor other than PC, and lung metastases from PC. RESULTS Twenty-two patients with F-18-FECh positive lung lesion and available histology or FU were identified. PSAdt was significantly (P=0.029) shorter in patients with lung metastases from PC (median PSAdt 1.7 months, interquartile range [IQR] 1.5-4.1 months) than in patients without lung PC relapse (median PSAdt 6.7 months, IQR 3.9-7.8); PSAvel was significantly (P=0.019) higher in patients with lung metastases from PC (median PSAvel 3.2 ng/mL/month, IQR 0.65-6.65 ng/mL/month) than in patients without lung PC relapse (median PSAvel 0.3 ng/mL/month, IQR 0.2-0.5 ng/mL/month). Patients with lung metastases from PC had significantly (P=0.006) higher GS at diagnosis (median GS 8) than the other ones (median GS 7). CONCLUSIONS Our analysis shows that the prevalence of F-18-FECh positive lung metastases in patients with PC, especially with higher GS at diagnosis, is higher in presence of a steady increase in PSA values, confirmed by higher PSAvel and shorter PSAdt.
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Affiliation(s)
- Daniele A Pizzuto
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy -
| | - Salvatore Annunziata
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Francesco P Ieria
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carmelo Caldarella
- Unit of Nuclear Medicine, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Maria A Isgrò
- Chemical-Clinical and Hematologic Analysis Laboratory, Circolo e Fondazione Macchi Hospital, Varese, Italy
| | - Valerio Lanni
- Unit of Nuclear Medicine, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Gaia Bencivenga
- PET-CT Center, Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Vittoria Rufini
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Giordano
- Unità Operativa Complessa di Medicina Nucleare, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Istituto di Medicina Nucleare, Università Cattolica del Sacro Cuore, Rome, Italy
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18F-Choline and 18F-FDG PET/CT in a Patient With Diffuse Large B-Cell Lymphoma and Recurrent Prostate Cancer. Clin Nucl Med 2018; 43:e471-e472. [DOI: 10.1097/rlu.0000000000002296] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Incidental Detection of a Melanoma by 18F-Fluorocholine PET/CT Performed for Evaluation of Primary Hyperparathyroidism. Clin Nucl Med 2018; 43:265-266. [DOI: 10.1097/rlu.0000000000001972] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Bongiovanni A, Recine F, Celli M, Marcantognini G, Foca F, Liverani C, Fausti V, De Vita A, Miserocchi G, Mercatali L, Amadori D, Ibrahim T. Osteoblastic bone metastases from neuroendocrine tumor (NET) of unknown origin detected by 18fluorocholine PET/CT and its comparison with 68gallium-DOTATOC PET/CT: Case report and review of the literature. Medicine (Baltimore) 2017; 96:e8567. [PMID: 29145267 PMCID: PMC5704812 DOI: 10.1097/md.0000000000008567] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 10/08/2017] [Accepted: 10/18/2017] [Indexed: 01/06/2023] Open
Abstract
RATIONALE Choline (CH) positron emission tomography (PET)/computed tomography (CT) with fluorine 18 (F) CH is increasingly used not only to evaluate patients with biochemically recurrent prostate cancer but also to assess metastatic lesions that are difficult or impossible to identify using more conventional modalities. Our experience with CH PET/CT has shown that it can also be used for many other malignancies. PRESENTING CONCERNS A 71-year-old male with a neuroendocrine tumor (NET) of unknown origin showed osteoblastic bone metastases positive to F-CH PET. INTERVENTIONS Diffuse bone and liver metastases were gallium-DOTATOC PET-positive with only mild uptake on FDG PET/CT. An increased prostate specific antigen (8 μg/L) gave rise to a suspicion of concurrent prostate cancer and the patient underwent F-CH PET/CT which showed diffuse uptake in the bone. A CT-guided bone biopsy confirmed osteoblastic bone metastases from NET. OUTCOMES Given the aggressiveness of the tumor, the patient underwent treatment with temozolomide from July 2015 to December 2015, maintaining stable disease. However, progression was documented in January 2016 and the patient was enrolled onto a phase II peptide receptor radionuclide therapy retreatment trial, which is currently ongoing. MAIN LESSON Our study highlights that NETs should be taken into consideration in the differential diagnosis of osteoblastic bone metastases showing F-CH uptake. A prognostic role for this imaging technique can also be hypothesized.
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Affiliation(s)
| | | | | | | | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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