Clinicopathological and prognostic relevance of uptake level using 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer

Objective: Using integrated ¹⁸F-fluorodeoxyglucose positron emission tomography/computedtomography fusion imaging (¹⁸F-FDG PET/CT), the clinical significanceof ¹⁸F-FDG uptake was evaluated in patients with primary breastcancer. Methods: Clinicopathological correlation with the level of maximum standardizeduptake values (SUV) 60 min obtained from preoperative ¹⁸F-FDGPET/CT were examined in 152 patients with primary breast cancer.The prognostic impact of the level of SUV was explored usingsimulated prognosis derived from computed program Adjuvant!in 136 (89%) patients with invasive ductal carcinoma (IDC). Results: High SUV level was significantly correlated with tumor invasivesize (2 cm) (P <0.0001), higher score of nuclear grade (P<0.0001), nuclear atypia (P <0.0001) and mitosis counts(P <0.0001), negative hormone receptor status (P = 0.001),high score of c-erbB-2 expression (P = 0.006), lymph node metastasis(P = 0.002), and IDC in comparison with invasive lobular carcinoma(P = 0.004). Multivariate analyses showed tumor invasive size,nuclear grade and estrogen receptor negativity were significantlycorrelated with SUV in primary breast cancer (P <0.0001,<0.0001,and <0.012, respectively), and nuclear grade was significantlycorrelated with SUV in tumors of invasive size 2 cm or less(P <0.0001). Tumors with high SUV (cutoff value 4.0) showedhigher relapse and mortality rate compared to those with lowSUV (P <0.0001). Conclusions: High uptake of ¹⁸F-FDG would be predictive of poor prognosisin patients with primary breast cancer, and aggressive featuresof cancer cells in patients with early breast cancer. ¹⁸F-FDGPET/CT could be a useful tool to pretherapeutically predictbiological characteristics and baseline risk of breast cancer.     

18F‐fluoro‐2‐deoxy‐D‐glucose positron emission tomography and positron emission tomography/computed tomography imaging of malignant pleural mesothelioma*

Malignant pleural mesothelioma (MPM) is the most common primary pleural tumor and its incidence is rising. Its diagnosis, staging and response assessment are challenging for imaging. Integrated positron emission tomography (PET)/CT increases the accuracy of overall staging in patients with mesothelioma and improves the selection of patients for curative surgical resection. It is particularly useful in identifying occult distant metastases. It may be used to predict prognosis and to assess the metabolic response to therapy.     

Role of 18F‐FDG‐PET/CT in the management of marginal zone B cell lymphoma

The use of PET in patients with marginal zone B cell lymphoma (MZL) is controversial because of variability of fluorodeoxyglucose (FDG) avidity. We analyzed 40 PET/CT in 25 consecutive patients to compare its performance with CT at staging and as a first‐line response assessment. Sensitivity of PET/CT and CT was 96 and 76%. Mean standard uptake value was 6.1, 6.9 and 3.4 (p = 0.3) in nodal, extranodal and splenic subtypes, respectively. Of 17 patients (extranodal: n = 9; nodal: n = 6; splenic subtype: n = 2) with both imaging tests available at diagnosis, 8 (47%) had more involved areas with PET/CT than with CT, 75% of which were extranodal lesions. PET/CT resulted in upstaging of five patients although treatment of only two of them was changed. Responses of 15 patients with post‐treatment PET/CT were the following: 9 negative and 6 positive of which 3 were isolated residual lesions. Progression was documented in two of these three patients. Response was also assessed by CT in 11 patients. Discrepancies were found in three: Two were in complete remission by CT while PET/CT detected localized residual disease; another patient was in partial remission by CT, whereas PET/CT showed only one positive lesion. Two of these three patients relapsed. Patients with negative post‐treatment PET/CT did not relapse. With a median follow‐up of 50 months (10–152 months), 3‐year overall survival was 100 and 80% for patients with negative and positive post‐treatment PET/CT (p = 0.2). Three‐year disease‐free survival was 86%; the negative predictive value (NPV) was 100%, and the positive predictive value (PPV) was 83.3%. Although a larger number of patients will be required to further confirm these data, we can conclude that PET/CT is a useful imaging tool for both staging and response assessment in patients with nodal and extranodal MZL as a result of its high sensitivity, NPV and PPV. Copyright © 2014 John Wiley & Sons, Ltd.     

Role of fluorine‐18‐fluorodeoxyglucose positron emission tomography/computed tomography in evaluating breast mucosa‐associated lymphoid tissue lymphoma: A case series

Mucosa‐associated lymphatic tissue (MALT) lymphoma of the breast is an extremely rare disease; its pathogenesis is not clear because of the rarity of disease, and the best diagnostic method has yet to be established. The metabolic behavior of this lymphoma is not still clear because only a few case reports are present in literature describing the possible role of fluorine‐18‐fluorodeoxyglucose positron emission tomography/computed tomography (18F‐FDG PET/CT) in this field. This report presents 4 cases of women with histologically proven breast MALT lymphoma who underwent 7 18F‐FDG PET/CT throughout the course of disease. All patients underwent staging PET/CT showing in all cases an FDG avid lesion corresponding to breast lymphoma; 3 patients underwent 18F‐FDG PET/CT also after chemotherapy. Our results suggest that breast MALT lymphomas are 18F‐FDG‐avid lymphomas. Positron emission tomography/computed tomography showed heterogeneous but high FDG uptake (mean maximum standardized uptake value 7.9), suggesting that it could be part of diagnostic workup and restaging process.     

Diagnostic value of fluorine 18 fluorodeoxyglucose positron emission tomography/computed tomography for the detection of metastases in non–small‐cell lung cancer patients

In the recent years, fluorine 18 fluorodeoxyglucose (¹⁸F‐FDG) positron emission tomography (PET)/computed tomography (CT) has emerged as a new modality for staging non–small‐cell lung cancer (NSCLC) patients. The aim of this meta‐analysis was to assess the diagnostic value of ¹⁸F‐FDG PET/CT in detecting metastatic lesions in NSCLC patients. Meta‐analysis methods were used to pool sensitivity, specificity, positive and negative likehood ratios, diagnostic odd ratios and to construct a summary receiver‐operating characteristic curve. Data from included studies were pooled to compare the diagnostic accuracy between PET/CT and PET or CT alone in nodal staging. Totally, 56 studies involving 8,699 patients met the inclusion criteria. The pooled sensitivities and specificities of ¹⁸F‐FDG PET/CT were 0.72 [95% confidence interval (CI): 0.65–0.78] and 0.91 (95% CI: 0.86–0.94) in determining mediastinal nodal staging; 0.71 (95% CI: 0.60–0.80) and 0.83 (95% CI: 0.77–0.88) in intrathoracic staging; 0.78 (95% CI: 0.64–0.87) and 0.90 (95% CI: 0.84–0.94) in intrathoracic staging on a per‐node basis. For detecting extrathoracic metastases, the pooled sensitivities and specificities of ¹⁸F‐FDG PET/CT were 0.77 (95% CI: 0.47–0.93) and 0.95 (95% CI: 0.92–0.97) for all extrathoracic metastases; 0.91 (95% CI: 0.80–0.97) and 0.98 (95% CI: 0.94–0.99) for bone metastases. ¹⁸F‐FDG PET/CT is beneficial in detecting lymph node metastases and extrathoracic metastases although PET/CT showed low sensitivity in detecting brain metastases. ¹⁸F‐FDG PET/CT confers significantly higher sensitivity and specificity than contrast‐enhanced CT (both p < 0.01) and higher sensitivity than ¹⁸F‐FDG PET in staging NSCLC (p < 0.05).     

~(18)F-FDG PET/CT结直肠代谢活跃灶分型对于良恶性判断的价值

背景与目的:结直肠迁延迂曲且位置不固定,肠管自身蠕动造成肠壁厚度变化。结直肠自身葡萄糖代谢不稳定,平滑肌蠕动、腺体分泌活动、痉挛、炎症等均可造成代谢异常。这些解剖和生理代谢方面的因素均会给18F-FDGPET/CT的正确诊断带来一定困难。本研究探讨18F-FDGPET/CT结直肠代谢活跃灶的影像特点及对于临床诊断的价值。方法:将74例患者共118个18F-FDGPET/CT发现的结直肠代谢活跃灶依据代谢及形态特点分为6型,局灶/CT+型、局灶/CT-型、节段/CT+型、节段/CT-型、弥漫/CT+型、弥漫/CT-型。将各分型情况与定性资料进行对比分析,采用R×C列联表χ2检验进行统计学分析。结果:118个结直肠代谢活跃灶定性为恶性共50个、非恶性68个,其中局灶/CT+型共30个(恶性23个、非恶性7个)、局灶/CT-型35个(恶性22个、非恶性13个)、节段/CT+型4个(恶性4个、非恶性0个)、节段/CT-型35个(恶性1个、非恶性34个)、弥漫/CT+型0个、弥漫/CT-型14个(恶性0个、非恶性14个)。节段/CT-型、弥漫/CT-型的非恶性病变发生率(97.1%、100%)和节段/CT+型的恶性病变...     

The clinical application of 18F‐fluorodeoxyglucose positron emission tomography to predict survival in patients with operable esophageal cancer

BACKGROUND:

Metabolic tumor activity using ¹⁸F‐fluorodeoxyglucose positron emission tomography (FDG‐PET) was believed to have a predictive value for patient outcome in malignancies. The objective of the current study was to assess the prognostic effectiveness of the highest standardized uptake value (SUV) in the primary or regional area (peak SUV) and the number of PET‐positive lymph nodes in esophageal cancer.

METHODS:

The authors retrospectively reviewed their experience with 184 consecutive esophageal cancer patients imaged preoperatively using FDG‐PET scanning.

RESULTS:

The median peak SUV was 4.5 (range, 1.4‐21.9). The survival curve was analyzed using the median peak SUV as the cutoff value. Comparison of each group and clinicopathologic characteristics revealed significant associations between peak SUV and each of the following factors: tumor status (P < .001), lymph node status (P < .001), metastatic status (P < .05), stage of disease (P < .001), number of PET‐positive lymph nodes (P < .001), and the number of histologically positive lymph nodes (P < .001). The 5‐year overall survival (OS) rate for patients having FDG uptake with a peak SUV ≥4.5 was 47% and that for patients with a peak SUV <4.5 was 76% (P < .0001). On multivariate survival analysis using the Cox proportional hazards model, peak SUV and the number of PET‐positive lymph nodes were found to be independent predictive factors for OS. The number of PET‐positive lymph nodes was a single prognostic factor predicting both disease‐free survival and OS.

CONCLUSIONS:

Pretreatment PET cannot only potentially diagnose the extent of disease, but also may be predictive of patient survival after esophageal cancer resection. Cancer 2009. © 2009 American Cancer Society.     

FDG‐PET/CT Compared with Conventional Imaging in the Detection of Distant Metastases of Primary Breast Cancer

Purpose.

Evidence from studies with small numbers of patients indicates that ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) accurately detects distant metastases in the staging of primary breast cancer. We compared the sensitivity and specificity of PET/CT and conventional imaging (CT, ultrasonography, radiography, and skeletal scintigraphy) for the detection of distant metastases in patients with primary breast cancer.

Patients and Methods.

We performed a retrospective review that identified 225 patients with primary breast cancer seen from January 2000 to September 2009 for whom PET/CT data were available for review. Imaging findings were compared with findings on biopsy, subsequent imaging, or clinical follow-up. Sensitivity and specificity in the detection of distant metastases were calculated for PET/CT and conventional imaging. Fisher''s exact tests were used to test the differences in sensitivity and specificity between PET/CT and conventional imaging.

Results.

The mean patient age at diagnosis was 53.4 years (range, 23–84 years). The sensitivity and specificity in the detection of distant metastases were 97.4% and 91.2%, respectively, for PET/CT and 85.9% and 67.3%, respectively, for conventional imaging. The sensitivity and specificity of PET/CT were significantly higher than those of conventional imaging (p = .009 and p < .001, respectively). Eleven cases of distant metastases detected by PET/CT were clinically occult and not evident on conventional imaging.

Conclusion.

PET/CT has higher sensitivity and specificity than conventional imaging in the detection of distant metastases of breast cancer. A prospective study is needed to determine whether PET/CT could replace conventional imaging to detect distant metastases in patients with primary breast cancer.     

The role of 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) in the management of patients with colorectal cancer.

AIM: In patients with colorectal cancer an accurate diagnostic work-up is mandatory in order to perform the most specific treatment. At this moment 18F-fluoro-deoxy-glucose positron emission tomography (FDG-PET) is considered an accurate imaging technique in staging/restaging several malignancies. The aim of this paper is to review the scientific literature available about the role of FDG-PET in the management of patients with colorectal cancer. METHODS: An overview on Medline of scientific literature concerning FDG-PET and colorectal cancer was performed. The most relevant studies are reported. Advantages, limitations and new chances in using FDG-PET in these subsets of patients are summarized. RESULTS: FDG-PET is a useful tool in the evaluation of colorectal cancer. In comparison to conventional imaging technique, FDG-PET has an additional diagnostic value because it allows to metabolically characterize undetermined lesions suspected for recurrence of disease, to perform a complete pre-surgical staging and to identify occult metastatic disease. In clinical practice its use leads to a change in therapeutic choices in a high percentage of cases. CONCLUSIONS: FDG-PET should be considered an essential diagnostic tool in the management of patients with colorectal cancer, especially in recurrent disease evaluation.     

Determination of indication for sentinel lymph node biopsy in clinical node-negative breast cancer using preoperative 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging

Objective: Sentinel node biopsy (SNB) is indicated for axillary lymph nodemetastasis-negative cases (N0), but clarification of the indicationmay increase treatment efficiency. Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucosepositron emission tomography (FDG-PET) may have a high positivepredictive value in diagnosis of axillary lymph node metastasis. Methods: Ninety-two breasts/axillae were analyzed retrospectively in90 patients (median age 54.6-year old, median primary tumor1.7 cm). FDG-PET/computed tomography was used to indicate SNBin N0 cases. Axillary lymph node dissection (ALND) was performedin cases that were axillary lymph node metastasis-positive (PETN+) on FDG-PET/CT. Results: Seventy-four (80.4%) and 18 (19.6%) of the 92 axillae were diagnosedas metastasis-negative (PET N0) and PET N+, respectively, byFDG-PET/CT. SNB was performed in 51 of the 74 PET N0 axillae.ALND was performed in 23 PET N0 axillae (at the patients’request) and in all 18 PET N+ axillae. Of the 74 PET N0 axillae,14 were metastasis-positive (pN+) and 60 were pN0 pathologically,and of the 18 PET N+ axillae, 13 were pN+ and five were pN0.The sensitivity and specificity of FDG-PET/CT for diagnosisof axillary metastasis were 48.1 and 92.3%, respectively, andthe positive and negative predictive values were 72.2 and 81.1%,respectively. Conclusion: The positive detection rate on FDG-PET/CT was insufficient fordetermining an indication of SNB. However, use of an appropriatecut-off for SUV_max (the positive rate was 90.9% with a cut-offof 2.0) and exclusion of surgically biopsied cases may achievea clinically applicable positive detection rate.