18F-Fluciclovine-Avid Pulmonary Hamartoma

ABSTRACT

A 73-year-old man with history of grade group 1/Gleason 3 + 3 = 6 prostate adenocarcinoma status post prostatectomy had subsequent biochemical recurrence with serum prostate-specific antigen level of 2.4 ng/mL. He underwent an 18F-fluciclovine PET/CT scan that demonstrated a left prostate bed recurrence and an incidental 18F-fluciclovine-avid smooth-edged solitary lung nodule with internal fat attenuation. Such uptake of 18F-fluciclovine in a lung hamartoma could be mistaken for prostate cancer metastasis. Given the increasing use of advanced imaging for prostate cancer, there is need for the imaging specialist to know about pitfalls and how to interpret them.

Optimal efficient imaging time for identification of sentinel lymph node with Tc-99m Tilmanocept in breast cancer patients

We determined the optimal imaging time for axillary lymph node (LN) visualization following Tc-99m Tilmanocept in breast cancer patients to establish imaging guidelines that can allow for a reliable and efficient yet high yield study prior to surgery. Retrospective analysis in 651 patients who underwent lymphoscintigraphy, comparing LN visualization on immediate, 15-minute, and 90-minute delayed imaging after injection of Tc-99m Tilmanocept. Statistical analysis was performed using McNemar's test, kappa coefficient, and Pearson Chi-square test. Five hundred and six patients had either immediate or immediate and 90-minute delayed imaging. Of these patients, 203 (40.1%) had both immediate and 90-minute delayed images. Of these 203 patients, 54 (26.6%) had ≥1 lymph node(s) identified immediately and 196 (96.6%) had ≥1 lymph node(s) identified at 90 minutes (P<0.0001). A kappa coefficient of .0256 was observed (95% CI: .0058-.0453). One hundred and forty-five additional patients had 15-minute delayed imaging. Of these patients, 117 (80.7%) had ≥1 lymph node(s) identified, which was significantly fewer compared to the number of patients with ≥1 lymph node(s) detected at 90 minutes (P<0.0001). Ninety-minute delayed imaging is optimal for identifying sentinel lymph node(s) following Tc-99m Tilmanocept injection in breast cancer patients.