FDG-PET/CT for the Preoperative Lymph Node Staging of Invasive Bladder Cancer

Background

Locoregional lymph node metastasis is an important prognostic factor in patients with bladder cancer. Multimodal treatment, depending on preoperative stage, may improve survival. The standard imaging modalities for staging (computed tomography [CT] or magnetic resonance imaging [MRI]) have an accuracy range of 70–90% for lymph node staging. A more accurate preoperative diagnostic test could improve survival rates even more.

Objective

To determine whether the use of 2-deoxy-2 [F] fluoro-D-glucose (FDG) positron emission tomography (PET) in combination with CT (FDG-PET/CT) can increase the reliability of preoperative lymph node staging in patients with nonmetastatic invasive bladder cancer (T2 or higher, M0) or recurrent high-risk superficial disease (T1G3 with or without Tis, M0).

Design, setting, and participants

Fifty-one patients underwent a preoperative FDG-PET/CT between April 2004 and December 2007. Independent of the result for lymph node status, all patients underwent a radical cystectomy and an extended lymphadenectomy. The FDG-PET/CT and CT results were compared with the definitive pathologic results.

Measurements

Among the 51 patients, 13 patients had metastatically involved locoregional lymph nodes, diagnosed on histopathology. In six patients, these nodes demonstrated increased FDG uptake on PET. In seven patients, PET/CT did not diagnose the positive lymph nodes. PET/CT was false positive in one patient.

Results and limitations

For the diagnosis of node-positive disease, the accuracy, the sensitivity, and the specificity of FDG-PET/CT were 84%, 46%, and 97%, respectively. When analysing the results of CT alone, there was accuracy of 80%, sensitivity of 46%, and specificity of 92%. The use of FDG-PET/CT is hampered by technical limitations.

Conclusions

We found no advantage for combined FDG-PET/CT over CT alone for lymph node staging of invasive bladder cancer or recurrent high-risk superficial disease.     

Cytologic evaluation of solitary thyroid nodules

Fine-needle aspiration is a low-cost diagnostic tool with principal value in determining which patients with thyroid nodules should undergo surgery. Team work and close cooperation among endocrinologists, surgeons, and pathologists are essential for success. Cytologic criteria for diagnosis of the most frequent conditions (benign cystic lesions), Hashimoto thyroiditis and malignancies found in thyroid aspirates have been provided. The unsolved problem of the so-called "follicular" or oxyphilic lesion or neoplasia will be investigated by immunocytochemistry.     

Diagnosis of vascular prosthesis infection with FDG-PET/CT

Fluorodeoxyglucose positron emission tomography (FDG-PET) is on the verge of becoming an established imaging tool in the fields of clinical oncology, cardiology, and neurology. Because of the high glucose uptake of inflammatory cells, FDG scanning is an appropriate tool for use in tracing suspected inflammation or to evaluate infection. PET, although highly sensitive, often lacks the ability to define the precise anatomic location of abnormal FDG accumulation. The new PET/computed tomography (CT) technology provides precise registration of metabolic and structural imaging data in a single session. We report positive FDG-PET/CT findings in an infected vascular prosthesis 6 months after grafting. Our experience and a few available case reports support the hypothesis that FDG-PET/CT may have a promising role in future noninvasive diagnosis of infected vascular grafts.     

Diagnosis of abdominal aortic prosthesis infection with FDG-PET/CT

A 79-year-old man was referred with recurrent periods of fever and chills. Six years earlier an aortic bifurcation graft had been implanted. Blood examination showed elevated infection parameters. A regular computed tomographic (CT) scan in the previous hospital showed no signs of graft infection. When blood cultures revealed multiple enteric bacteria, a 2-deoxy-2-[F18]fluoro- d-glucose-positron emission tomographic/CT (FDG- PET/CT) scan was performed that demonstrated ring-shaped pathological uptake at the proximal anastomosis. The patient was operated on and an infected graft was found, with a 1-cm defect in the distal part of the duodenum. Bacterial cultures of the explanted graft were positive. The patient recovered well from surgery and is on a regimen of prolonged antibiotic and antimycotic treatment.     

Preoperative FDG-PET imaging to assess the malignant potential of follicular neoplasms of the thyroid

OBJECTIVE: When a fine needle aspiration biopsy of a thyroid nodule suggests follicular neoplasm, surgery is required for diagnosis. Establishing the diagnosis preoperatively would allow the patient to undergo the appropriate initial thyroidectomy. Preoperative [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging may be able to determine malignancy in follicular neoplasms. STUDY DESIGN: Prospective cases series. SUBJECTS AND METHODS: Twenty-three patients with a diagnosis of follicular neoplasm underwent presurgical FDG-PET at 60, 90, and 120 minutes after injection of fluorodeoxyglucose (F18). Thyroidectomy was performed with comparison of the histopathologic results with the FDG-PET results. RESULTS: There were 5 malignant conditions and 18 benign conditions identified with the standard uptake valve (SUV) ranging from 0.9 to 44.8. The follicular thyroid cancers that exhibited only capsular invasion had an average SUV of 3.1, whereas those with vascular invasion had an average SUV of 39.9. The SUV increased in 80% of the malignant cases but in only 50% of the benign cases. CONCLUSION: Despite certain patterns being suggestive of malignancy, FDG-PET can not consistently predict the malignant potential of a follicular neoplasm.     

Predicting Pathological Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer Using 18FDG-PET/CT

Background

Pathologic complete response (pCR) after neoadjuvant chemoradiation (CRT) has been observed in 15?C30% of patients with locally advanced rectal cancer (LARC). The objective of this study was to determine whether PET/CT can predict pCR and disease-free survival in patients receiving CRT with LARC.

Methods

This is a retrospective review of patients with EUS-staged T3?CT4, N?+?rectal tumors treated with CRT, who underwent pre/post-treatment PET/CT from 2002?C2009. All patients were treated with CRT and surgical resection. Standardized uptake value (SUV) of each tumor was recorded. Logistic regression was used to analyze the association of pre-CRT SUV, post-CRT SUV, %SUV change, and time between CRT and surgery, compared with pCR. Kaplan?CMeier estimation evaluated significant predictors of survival.

Results

Seventy patients (age 62?years; 42M:28F) with preoperative stage T3 (n?=?61) and T4 (n?=?9) underwent pre- and post-CRT PET/CT followed by surgery. The pCR rate was 26%. Median pre-CRT SUV was 10.8, whereas the median post-CRT SUV was 4 (P?=?0.001). Patients with pCR had a lower median post-CRT SUV compared with those without (2.7 vs. 4.5, P?=?0.01). Median SUV decrease was 63% (7.5?C95.5%) and predicted pCR (P?=?0.002). Patients with a pCR had a greater time interval between CRT and surgery (median, 58 vs. 50?days) than those without (P?=?0.02). Patients with post-CRT SUV?P?=?0.03). Patients with SUV decrease ??63% had improved overall survival at median follow-up of 40?months than those without (P?=?0.006).

Conclusions

PET/CT can predict response to CRT in patients with LARC. Posttreatment SUV, %SUV decrease, and greater time from CRT to surgery correlate with pCR. Post-CRT, SUV?相似文献   

Preoperative FDG-PET for axillary metastases in patients with breast cancer

HYPOTHESIS: Fludeoxyglucose F 18 (FDG) positron emission tomography (PET) can be used to predict axillary node metastases. DESIGN: Case series. SETTING: Comprehensive breast care center. PATIENTS: Fifty-one women with 54 biopsy-proven invasive breast cancers. INTERVENTION: Whole-body FDG-PET performed before axillary surgery and interpreted blindly. MAIN OUTCOME MEASURES: Axillary FDG activity, quantified by standardized uptake value (SUV); axillary metastases, quantified histologically; and tumor characteristics. RESULTS: There was PET activity in 32 axillae (59%). The SUVs ranged from 0.7 to 11.0. Twenty tumors had an SUV of 2.3 or greater, and 34 had an SUV of less than 2.3. There were no significant differences between these 2 groups except in axillary metastasis size (SUV /=2.3): mean age, 53 vs 58 years (P = .90); mean modified Bloom-Richardson score, 7.7 vs 7.6 (P = .20); lymphovascular invasion present, 25% vs 36% (P = .40); mean Ki-67 level, 25% vs 32% (P = .20); mean tumor size, 2.9 vs 3.2 cm (P = .05); and axillary metastasis size, 0.9 vs 1.7 (P = .001). By adopting an SUV threshold of 2.3, FDG-PET had a sensitivity of 60%, a specificity of 100%, and a positive predictive value of 100%. CONCLUSIONS: Patients with an SUV greater than 2.3 had axillary metastases. This finding obviates the need for sentinel lymph node biopsy or needle biopsy to diagnose axillary involvement. Surgeons can proceed to axillary node dissection to assess the number of nodes involved, eliminate axillary disease, or perhaps provide a survival benefit if preoperative FDG-PET has an SUV greater than 2.3.     

Efficacy of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans in diagnosis of pulmonary nodules

To evaluate the value of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, we performed FDG-PET scans in 23 patients with indeterminate pulmonary nodules less than 3 cm in size and analyzed these scans qualitatively and semiquantitatively. Histologie specimens were obtained by thoracoscopic excisional biopsy in 16 patients, CT-guided needle aspiration cytology in three, and bronchoscopic brushing cytology in four. Pathological diagnoses were lung cancer in 16 patients, benign inflammation in six, and malignant lymphoma in one. Sensitivity, specificity and accuracy of the FDG-PET scans were 88% (15/17), 67% (4/6) and 83% (19/23), respectively. There were two false-positive cases (organizing pneumonia and cryptococcosis) and two false-negative ones (slow-growing adenocarcinoma and malignant lymphoma). Although a few false-positive cases of granulomatous disease were yielded, the FDG-PET scans were highly sensitive in the detection of lung cancer. We conclude that the FDG-PET scanning in a useful diagnostic imaging modailty in the management of indeterminate pulmonary nodules.     

Utility of Preoperative 18F-FDG PET/CT and Brain MRI in Melanoma Patients with Palpable Lymph Node Metastases

Background  

The aims of this prospective study were to determine the diagnostic value of ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and brain MRI in melanoma patients with palpable lymph node metastases and to assess the impact of these imaging modalities on their management.     

自设评分标准用于甲状腺结节术中评估的研究

目的应用术中解剖甲状腺结节自设评分标准，分析甲状腺结节的良恶性可能，评估甲状腺结节术中自设评分的诊断价值。 方法选取2018年1月至12月在广东药科大学附属第一医院因甲状腺结节性质待查、恶性肿瘤、良性结节等行甲状腺手术治疗的患者共173例，以术后石蜡切片病理作为"金标准"，分析评估术中解剖甲状腺结节自设评分标准的诊断价值。 结果173例患者共238个结节均经术中冰冻病理及术后石蜡切片病理诊断。评分≤1分（39个）及>4分（67个）的结节与石蜡病理结果的符合率达到100.00%；评分为2、3及4分时，与术中冰冻病理结果符合率分别为87.50%、87.23%、94.34%，与术后石蜡切片病理结果的符合率则分别为81.25%、82.98%、92.45%。 结论我们设计的甲状腺结节术中评分标准是准确性高、相对客观、简单易学，能够有效筛选出阳性结节，降低漏诊率，帮助术中决策，是一个可靠的诊断方法。     

Efficacy of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans in diagnosis of pulmonary nodules]

To evaluate the value of F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) scans, we performed FDG-PET scans in 23 patients with indeterminate pulmonary nodules less than 3 cm in size and analyzed these scans qualitatively and semiquantitatively. Histologic specimens were obtained by thoracoscopic excisional biopsy in 16 patients, CT-guided needle aspiration cytology in three, and bronchoscopic brushing cytology in four. Pathological diagnoses were lung cancer in 16 patients, benign inflammation in six, and malignant lymphoma in one. Sensitivity, specificity and accuracy of the FDG-PET scans were 88% (15/17), 67% (4/6) and 83% (19/23), respectively. There were two false-positive cases (organizing pneumonia and cryptococcosis) and two false-negative ones (slow-growing adenocarcinoma and malignant lymphoma). Although a few false-positive cases of granulomatous disease were yielded, the FDG-PET scans were highly sensitive in the detection of lung cancer. We conclude that the FDG-PET scanning in a useful diagnostic imaging modailty in the management of indeterminate pulmonary nodules.     

The utility of FDG-PET/CT and other imaging techniques in the evaluation of IgG4-related disease

ObjectivesThis study aimed to evaluate the utility of imaging techniques, including 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT), in immunoglobulin (IgG)4-related disease (IgG4-RD).MethodsWe reviewed eight IgG4-RD patients who were referred to our hospital between August 2006 and April 2012. All cases underwent FDG-PET/CT and brain magnetic resonance imaging (MRI) and endobronchial ultrasonography (EBUS) were also performed in five cases and one case, respectively.ResultsAlthough nearly all patients with IgG4-RD in this study were negative for CRP (mean 0.22 mg/dL), various organ involvement sites were detected by FDG-PET/CT. In the active phase in two autoimmune pancreatitis (AIP) cases, FDG-PET/CT showed longitudinal and heterogeneous FDG accumulation in the pancreas with FDG uptake in the hilar or mediastinal lymph nodes. Follow-up FDG-PET/CT after therapy in one case revealed that the abnormal FDG uptake in all affected lesions had completely disappeared. In two cases, brain MRI revealed asymptomatic hypertrophic pachymeningitis. In one case, EBUS imaging of mediastinal lymph node swelling was consistent with tortuous vessels with high Doppler signals and hyperechoic strands between lymph nodes.ConclusionsWhen FDG-PET/CT shows FDG accumulation, characteristic of IgG4-RD in organs, without evidence of an associated inflammatory reaction, a diagnosis of IgG4-RD can be made. Treatment effects can be assessed by the disappearance of FDG uptake. A routine brain MRI is useful for detecting asymptomatic hypertrophic pachymeningitis. EBUS may also be useful for differentiating among the etiologies of lymphadenopathy with characteristic sonographic imaging findings.