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Bruckmann NM, Kirchner J, Morawitz J, Umutlu L, Herrmann K, Bittner AK, Hoffmann O, Mohrmann S, Ingenwerth M, Schaarschmidt BM, Li Y, Stang A, Antoch G, Sawicki LM, Buchbender C. Prospective comparison of CT and 18F-FDG PET/MRI in N and M staging of primary breast cancer patients: Initial results. PLoS One 2021; 16:e0260804. [PMID: 34855886 PMCID: PMC8638872 DOI: 10.1371/journal.pone.0260804] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/18/2021] [Indexed: 01/10/2023] Open
Abstract
Objectives To compare the diagnostic accuracy of contrast-enhanced thoraco-abdominal computed tomography and whole-body 18F-FDG PET/MRI in N and M staging in newly diagnosed, histopathological proven breast cancer. Material and methods A total of 80 consecutive women with newly diagnosed and histopathologically confirmed breast cancer were enrolled in this prospective study. Following inclusion criteria had to be fulfilled: (1) newly diagnosed, treatment-naive T2-tumor or higher T-stage or (2) newly diagnosed, treatment-naive triple-negative tumor of every size or (3) newly diagnosed, treatment-naive tumor with molecular high risk (T1c, Ki67 >14%, HER2neu over-expression, G3). All patients underwent a thoraco-abdominal ceCT and a whole-body 18F-FDG PET/MRI. All datasets were evaluated by two experienced radiologists in hybrid imaging regarding suspect lesion count, localization, categorization and diagnostic confidence. Images were interpreted in random order with a reading gap of at least 4 weeks to avoid recognition bias. Histopathological results as well as follow-up imaging served as reference standard. Differences in staging accuracy were assessed using Mc Nemars chi2 test. Results CT rated the N stage correctly in 64 of 80 (80%, 95% CI:70.0–87.3) patients with a sensitivity of 61.5% (CI:45.9–75.1), a specificity of 97.6% (CI:87.4–99.6), a PPV of 96% (CI:80.5–99.3), and a NPV of 72.7% (CI:59.8–82.7). Compared to this, 18F-FDG PET/MRI determined the N stage correctly in 71 of 80 (88.75%, CI:80.0–94.0) patients with a sensitivity of 82.1% (CI:67.3–91.0), a specificity of 95.1% (CI:83.9–98.7), a PPV of 94.1% (CI:80.9–98.4) and a NPV of 84.8% (CI:71.8–92.4). Differences in sensitivities were statistically significant (difference 20.6%, CI:-0.02–40.9; p = 0.008). Distant metastases were present in 7/80 patients (8.75%). 18 F-FDG PET/MRI detected all of the histopathological proven metastases without any false-positive findings, while 3 patients with bone metastases were missed in CT (sensitivity 57.1%, specificity 95.9%). Additionally, CT presented false-positive findings in 3 patients. Conclusion 18F-FDG PET/MRI has a high diagnostic potential and outperforms CT in assessing the N and M stage in patients with primary breast cancer.
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Affiliation(s)
- Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
- * E-mail:
| | - Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Oliver Hoffmann
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Marc Ingenwerth
- Institute of Pathology, West German Cancer Center, University Hospital Essen, University Duisburg-Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Benedikt M. Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Yan Li
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Lino M. Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Dusseldorf, Germany
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Bruckmann NM, Kirchner J, Umutlu L, Fendler WP, Seifert R, Herrmann K, Bittner AK, Hoffmann O, Mohrmann S, Antke C, Schimmöller L, Ingenwerth M, Breuckmann K, Stang A, Buchbender C, Antoch G, Sawicki LM. Prospective comparison of the diagnostic accuracy of 18F-FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. Eur Radiol 2021; 31:8714-8724. [PMID: 33912991 PMCID: PMC8523471 DOI: 10.1007/s00330-021-07956-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/15/2021] [Accepted: 03/26/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To compare the diagnostic performance of [18F]FDG PET/MRI, MRI, CT, and bone scintigraphy for the detection of bone metastases in the initial staging of primary breast cancer patients. MATERIAL AND METHODS A cohort of 154 therapy-naive patients with newly diagnosed, histopathologically proven breast cancer was enrolled in this study prospectively. All patients underwent a whole-body [18F]FDG PET/MRI, computed tomography (CT) scan, and a bone scintigraphy prior to therapy. All datasets were evaluated regarding the presence of bone metastases. McNemar χ2 test was performed to compare sensitivity and specificity between the modalities. RESULTS Forty-one bone metastases were present in 7/154 patients (4.5%). Both [18F]FDG PET/MRI and MRI alone were able to detect all of the patients with histopathologically proven bone metastases (sensitivity 100%; specificity 100%) and did not miss any of the 41 malignant lesions (sensitivity 100%). CT detected 5/7 patients (sensitivity 71.4%; specificity 98.6%) and 23/41 lesions (sensitivity 56.1%). Bone scintigraphy detected only 2/7 patients (sensitivity 28.6%) and 15/41 lesions (sensitivity 36.6%). Furthermore, CT and scintigraphy led to false-positive findings of bone metastases in 2 patients and in 1 patient, respectively. The sensitivity of PET/MRI and MRI alone was significantly better compared with CT (p < 0.01, difference 43.9%) and bone scintigraphy (p < 0.01, difference 63.4%). CONCLUSION [18F]FDG PET/MRI and MRI are significantly better than CT or bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. Both CT and bone scintigraphy show a substantially limited sensitivity in detection of bone metastases. KEY POINTS • [18F]FDG PET/MRI and MRI alone are significantly superior to CT and bone scintigraphy for the detection of bone metastases in patients with newly diagnosed breast cancer. • Radiation-free whole-body MRI might serve as modality of choice in detection of bone metastases in breast cancer patients.
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Affiliation(s)
- Nils Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany.
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Wolfgang Peter Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Ann-Kathrin Bittner
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Oliver Hoffmann
- Department Gynecology and Obstetrics, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, Medical Faculty, University Dusseldorf, D-40225, Dusseldorf, Germany
| | - Christina Antke
- Department of Nuclear Medicine, Medical Faculty, University Dusseldorf, 40225, Dusseldorf, Germany
| | - Lars Schimmöller
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Marc Ingenwerth
- Institute of Pathology, University Duisburg-Essen and the German Cancer Consortium (DKTK), University Hospital Essen, West German Cancer Center, Essen, Germany
| | - Katharina Breuckmann
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg-Essen, D-45147, Essen, Germany
| | - Andreas Stang
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital of Essen, Essen, Germany
| | - Christian Buchbender
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany
| | - Lino M Sawicki
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University Dusseldorf, Moorenstrasse 5, D-40225, Dusseldorf, Germany
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Han S, Choi JY. Impact of 18F-FDG PET, PET/CT, and PET/MRI on Staging and Management as an Initial Staging Modality in Breast Cancer: A Systematic Review and Meta-analysis. Clin Nucl Med 2021; 46:271-282. [PMID: 33651022 PMCID: PMC7938917 DOI: 10.1097/rlu.0000000000003502] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/28/2020] [Accepted: 11/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We performed a systematic review and meta-analysis to evaluate the impact of 18F-FDG PET, PET/CT, and PET/MRI on staging and management during the initial staging of breast cancer. METHODS We searched the PubMed, Embase, Cochrane Library, and KoreaMed databases until March 2020 to identify studies that reported the proportion of breast cancer patients whose clinical stage or management were changed after PET scans. The proportion of changes was pooled using a random-effects model. Subgroup and metaregression analyses were performed to explore heterogeneity. RESULTS We included 29 studies (4276 patients). The pooled proportions of changes in stage and management were 25% (95% confidence interval [CI], 21%-30%) and 18% (95% CI, 14%-23%), respectively. When stage changes were stratified according to initial stage, the pooled proportions were 11% (95% CI, 3%-22%) in stage I, 20% (95% CI, 16%-24%) in stage II, and 34% (95% CI, 27%-42%) in stage III. The relative proportions of intermodality and intention-to-treat changes were 74% and 70%, respectively. Using metaregression analyses, the mean age and the proportion of initial stage III to IV and histologic grade II to III were significant factors affecting the heterogeneity in changes in stage or management. CONCLUSIONS Currently available literature suggests that the use of 18F-FDG PET, PET/CT, or PET/MRI leads to significant modification of staging and treatment in newly diagnosed breast cancer patients. Therefore, there may be a role for routine clinical use of PET imaging for the initial staging of breast cancer.
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Affiliation(s)
- Sangwon Han
- From the Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine
| | - Joon Young Choi
- Department of Nuclear Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Basendowah M, Alshaynawi S, Madani TA, Alabdulqader MH, Hakami M. Positron Emission Tomography With Fluorodeoxyglucose Incidental Detection of Colon Cancer in a Patient's Follow-Up for Nasopharyngeal Carcinoma During the COVID-19 Pandemic: A Case Report. Cureus 2020; 12:e9939. [PMID: 32968599 PMCID: PMC7505672 DOI: 10.7759/cureus.9939] [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: 11/05/2022] Open
Abstract
Colorectal cancer (CRC) is a type of widespread, deadly malignancy that took thousands of lives around the globe. In the last two decades, CRC represented the most common cancer among men and ranked third among women in Saudi Arabia. Positron emission tomography with fluorodeoxyglucose (FDG-PET), can incidentally detect malignancy, as in our case, FDG-PET disclosed high abnormal FDG far away from the first primary malignancy. The current case is of a 65-year-old female who was following up on her nasopharyngeal carcinoma (first primary). During her last management, FDG-PET was requested to find any FDG uptake in the nasopharyngeal region; stunning FDG uptake was incidentally found at the ascending colon diagnosed as early-stage (pT2N0) colon cancer. Colonoscopy was done and India Ink was injected to facilitate localizing the mass during the laparoscopic removal of the tumor, which was delayed due to the pandemic of COVID-19. This took place in March 2020 at King Abdul-Aziz University Hospital in Jeddah.
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Affiliation(s)
| | | | - Turki A Madani
- Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mutaz H Alabdulqader
- Family Medicine, King Abdulaziz Medical City, National Guard Hospital - Health Affairs, Jeddah, SAU
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Tibana TK, Santos RFT, Arão Filho A, Bacelar B, Martins LDA, de Souza RO, Marchiori E, Nunes TF. Detection of additional primary malignancies: the role of CT and PET/CT combined with multiple percutaneous biopsy. Radiol Bras 2019; 52:166-171. [PMID: 31210689 PMCID: PMC6561365 DOI: 10.1590/0100-3984.2018.0024] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Objective To evaluate the imaging findings of 18F-fluorodeoxyglucose
positron emission tomography/computed tomography (18F-FDG PET/CT)
and computed tomography (CT) in patients with additional primary tumors,
correlating the results with those of the method used in order to elucidate
the diagnosis and of the pathology reports. Materials and Methods We retrospectively analyzed the medical records, pathology reports and images
of 11 patients who underwent CT, 18F-FDG PET/CT, or both. We
included patients with at least two tumors, with confirmed distinct
histopathological profiles, at different sites. Patients in whom there was
no diagnostic confirmation were excluded, as were those in whom the
additional lesion was suspected of being a metastasis of the first. Results New primary malignancies were identified in 11 patients, one new tumor being
found in 10 and two new tumors being found in 1. The confirmed sites of the
additional malignancies were the lung, kidney, prostate, jejunum, and
breast. Single or multiple percutaneous biopsies were performed in 10
patients, and 1 patient underwent a surgical procedure for diagnostic and
therapeutic purposes. The tumors were metachronous in 6 cases and
synchronous in 5. Conclusion CT and 18F-FDG PET-CT combined with multiple percutaneous biopsy
could facilitate the diagnosis of additional lesions, thus optimizing the
treatment and follow-up of the affected patients.
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Affiliation(s)
- Tiago Kojun Tibana
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | - Rômulo Florêncio Tristão Santos
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
| | | | - Bernardo Bacelar
- Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | | | - Edson Marchiori
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Thiago Franchi Nunes
- Hospital Universitário Maria Aparecida Pedrossian da Universidade Federal de Mato Grosso do Sul (HUMAP-UFMS), Campo Grande, MS, Brazil
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Reddy Akepati NK, Abubakar ZA, Bikkina P. Role of 18F-Fluorodeoxyglucose Positron-Emission Tomography/Computed Tomography Scan in Primary Staging of Breast Cancer Compared to Conventional Staging. INDIAN JOURNAL OF NUCLEAR MEDICINE : IJNM : THE OFFICIAL JOURNAL OF THE SOCIETY OF NUCLEAR MEDICINE, INDIA 2018; 33:190-193. [PMID: 29962713 PMCID: PMC6011560 DOI: 10.4103/ijnm.ijnm_52_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Aim: In newly diagnosed carcinoma breast cancer patients, comparing conventional staging and 18F-fluorodeoxyglucose positron-emission tomography–computed tomography (18F-FDG PET/CT) staging. Materials and Methods: This was a retrospective observational study. A total of 171 new diagnosed carcinoma breast patients who underwent staging 18F-FDG PET/CT scan and routine conventional imaging including mammosonography of breast and axilla, chest X-ray, ultrasound sonography abdomen, and bone scan were included in the study. Staging was done according to the American Joint Committee on Cancer staging (tumor-node-metastasis). Changes in staging and management with 18F-FDG PET/CT scan were assessed. Results: Overall PET/CT upstaged in 22.2% of cases and changed management in 15.78% of cases. PET/CT upstaged in three of eight cases in Stage IA patients but changed management in only one case. In Stage IIA, of 31 patients PET/CT upstaged in two patients (6.45%). In Stage IIB, of 45 patients PET/CT upstaged in six patients (13.3%). In Stage IIIA, of 22 patients PET/CT upstaged in six patients (27.2) and in five patients there is a change in management. In Stage IIIB, of 43 patients PET/CT upstaged in 21 patients (48.8%) with change in management in 13 patients (25.5%). Conclusion: 18F-FDG PET/CT scan can be helpful in a significant number of patients with Stage IIB and above in upstaging and changing management.
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Affiliation(s)
- Naveen Kumar Reddy Akepati
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Zakir Ali Abubakar
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
| | - Prathyusha Bikkina
- Department of Nuclear Medicine, Basavatarakam Indo-American Cancer Hospital and Research Institute, Hyderabad, Telangana, India
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do Vale RHB, Ferraro DA, Duarte PS, Carvalho G, Lima MS, Coura Filho GB, Sapienza MT, Buchpiguel CA. Bone marrow uptake of 18F-fluorodeoxyglucose in Hodgkin lymphoma without bone involvement: comparison between patients with and without B symptoms. Radiol Bras 2018; 51:76-80. [PMID: 29743733 PMCID: PMC5935399 DOI: 10.1590/0100-3984.2016.0201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Objective To compare the degree of benign bone marrow uptake of
18F-fluorodeoxyglucose (18F-FDG) between Hodgkin
lymphoma patients with and without B symptoms. Materials and Methods We analyzed the medical charts of 74 Hodgkin lymphoma patients who underwent
18F-FDG positron emission tomography/computed tomography
(PET/CT) prior to the initiation of therapy between October 2010 and
September 2013. In all of the patients, the bone marrow biopsy was negative
and the 18F-FDG PET/CT images did not suggest bone marrow
involvement. Of the 74 patients evaluated, 54 presented inflammatory (B)
symptoms and 20 did not. Regions of interest (ROIs) were drawn on the
sternum, the proximal thirds of the humeri, the proximal thirds of the
femora, and both iliac wings (totaling seven ROIs per patient). To compare
the patients with and without B symptoms, in terms of standardized uptake
values (SUVs) for the seven ROIs, we used the Mann-Whitney U test. Results For six of the ROIs, the SUVs were higher in the patients with B symptoms
than in those without, and the difference was statistically significant
(p < 0.05). There was also a tendency toward a
statistically significant difference between the two groups in terms of the
SUV for the right iliac wing ROI (p = 0.06). Conclusion In our sample, the presence of B symptoms was associated with increased
18F-FDG uptake in bone marrow.
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Affiliation(s)
| | - Daniela Andrade Ferraro
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Paulo Schiavom Duarte
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Giovana Carvalho
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Marcos Santos Lima
- MD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - George Barbério Coura Filho
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Marcelo Tatit Sapienza
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
| | - Carlos Alberto Buchpiguel
- MD, PhD, Division of Nuclear Medicine, Instituto do Câncer do Estado de São Paulo (Icesp), São Paulo, SP, Brazil
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