S‐100B as an extra selection tool for FDG PET/CT scanning in follow‐up of AJCC stage III melanoma patients

Objective: We investigated the findings and pitfalls of FDG-PET/CT scanning after maxillectomy with reconstruction/rehabilitation procedures, in patients with head and neck malignancies treated during nine years at one tertiary medical centre. Methods: Fourteen patients (10 males), aged 22–84 years, underwent 17 reconstruction/rehabilitation maxillectomy surgeries and 35 PET/CT scans. Postoperative PET/CT findings were correlated with clinical and imaging follow-up. Results: Increased FDG uptake, mean SUVmax 2.4 ± 1.4 (range 0.3–4.3), was observed at the postoperative bed following 12 of 17 surgeries (71%; 10 obturators, two mesh reconstructions). Following the remaining 5/17 surgeries (three with a fat flap and two without any reconstructions), abnormal FDG uptake was not observed at the postoperative bed. CT features of postoperative sites included: non-homogeneous mixed iso/hyperdense structures (hollow or filled) with multiple surrounding and/or inside air bubbles (“sponge appearance”) and mucosal thickening along the postoperative bed wall (in all cases with obturator implants); rich fat density material in reconstructions with a fat flap and in closures without reconstruction, and radiopaque elongated structures in mesh reconstructions. No correlation was found of the mean SUVmax in initial scans, with the time from the surgery date (10 ± 6 months; r=0.04, P=0.90), or with the mean SUVmax in final scans (at 25± 17 months, P=0.17). Conclusions: : Increased FDG uptake, together with corresponding non-specific CT features, may persist for a prolonged period after surgery with obturators and mesh implantations, mimicking malignancy or infection. Awareness of variations in postoperative PET-CT appearance can help avoid false interpretations and redundant invasive procedures.

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Utility of FDG PET/CT and Brain MRI in Melanoma Patients with Increased Serum S-100B Level During Follow-up

Annals of Surgical Oncology ◽

10.1245/s10434-010-0963-x ◽

2010 ◽

Vol 17 (6) ◽

pp. 1657-1661 ◽

Cited By ~ 23

Author(s):

Tjeerd S. Aukema ◽

Renato A. Valdés Olmos ◽

Catharina M. Korse ◽

Bin B. R. Kroon ◽

Michel W. J. M. Wouters ◽

...

Keyword(s):

Fdg Pet ◽

Brain Mri ◽

Pet Ct ◽

Melanoma Patients ◽

Fdg Pet Ct

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The use of FDG‐PET/CT to detect early recurrence after resection of high‐risk stage III melanoma

Journal of Surgical Oncology ◽

10.1002/jso.26155 ◽

2020 ◽

Vol 122 (7) ◽

pp. 1328-1336

Author(s):

Emma H. A. Stahlie ◽

Bernies Hiel ◽

Marcel P. M. Stokkel ◽

Yvonne M. Schrage ◽

Winan J. Houdt ◽

...

Keyword(s):

High Risk ◽

Fdg Pet ◽

Early Recurrence ◽

Stage Iii ◽

Pet Ct ◽

Stage Iii Melanoma ◽

Fdg Pet Ct

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Assessment of early metabolic progression in melanoma patients under immunotherapy: an 18F-FDG PET/CT study

EJNMMI Research ◽

10.1186/s13550-021-00832-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Christos Sachpekidis ◽

Annette Kopp-Schneider ◽

Jessica C. Hassel ◽

Antonia Dimitrakopoulou-Strauss

Keyword(s):

Fdg Pet ◽

Checkpoint Inhibitors ◽

Evaluation Criteria ◽

Prognostic Information ◽

European Organization ◽

Positron Emission ◽

Pet Ct ◽

Melanoma Patients ◽

Fdg Pet Ct

Abstract Background The usage of immune checkpoint inhibitors (ICIs) is the standard practice for the treatment of metastatic melanoma. However, a significant amount of patients show no response to immunotherapy, while issues on its reliable response interpretation exist. Aim of this study was to investigate the phenomenon of early disease progression in 2-deoxy-2-(18F)fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) in melanoma patients treated with ICIs. Methods Thirty-one patients under ICIs serially monitored with 18F-FDG PET/CT were enrolled. All patients exhibited progressive metabolic disease (PMD) after two ICIs’ cycles according to the European Organization for Research and Treatment of Cancer (EORTC) criteria, and were characterized as unconfirmed PMD (uPMD). They were further followed with at least one PET/CT for either confirmation of PMD (cPMD) or demonstration of pseudoprogression remission. Patients were also evaluated with the PET Response Evaluation Criteria for Immunotherapy (PERCIMT). Moreover, in an attempt to investigate immune activation, the spleen to liver ratios (SLRmean, SLRmax) of 18F-FDG uptake were measured. Results Median follow up was 69.7 months [64.6–NA]. According to EORTC, 26/31 patients with uPMD eventually showed cPMD (83.9%) and 5/31 patients showed pseudoprogression (16.1%). Patients with cPMD (n = 26) had a median OS of 10.9 months [8.5–NA], while those with pseudoprogression (n = 5) did not reach a median OS [40.9–NA]. Respectively, after application of PERCIMT, 2/5 patients of the pseudoprogression group were correctly classified as non-PMD, reducing the uPMD cohort to 29 patients; eventually, 26/29 patients demonstrated cPMD (89.7%) and 3/29 pseudoprogression (10.3%). One further patient with pseudoprogression exhibited transient, sarcoid-like, mediastinal/hilar lymphadenopathy, a known immune-related adverse event (irAE). Finally, patients eventually showing cPMD exhibited a significantly higher SLRmean than those showing pseudoprogression after two ICIs’ cycles (p = 0.038). Conclusion PET/CT, performed already after administration of two ICIs’ cycles, can identify the majority of non-responders in melanoma immunotherapy. In order to tackle however, the non-negligible phenomenon of pseudoprogression, another follow-up PET/CT, the usage of novel response criteria and vigilance over emergence of radiological irAEs are recommended. Moreover, the investigation of spleen glucose metabolism may offer further prognostic information in melanoma patients under ICIs.

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The use of PET/CT to detect early recurrence after resection of high-risk stage III melanoma, prior to the start of adjuvant therapy and during follow-up.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e22039 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e22039-e22039

Author(s):

Bernies Van Der Hiel ◽

Emma H.A. Stahlie ◽

Marcel P Stokkel ◽

Michel W.J.M. Wouters ◽

Yvonne Schrage ◽

...

Keyword(s):

High Risk ◽

Adjuvant Therapy ◽

Complete Resection ◽

Stage Iiib ◽

Stage Iii ◽

Asymptomatic Patients ◽

Pet Ct ◽

Melanoma Patients ◽

Stage Iii Melanoma

e22039 Background: To date, international consensus concerning the use of PET/CT as a surveillance tool in the follow-up of high-risk melanoma patients after complete resection of disease is lacking. Moreover, with the rise of adjuvant therapy it seems appropriate to investigate the role of this imaging modality to exclude newly developed metastases after resection and prior to starting treatment. The aim of this study was to investigate the use of PET/CT as surveillance tool in the follow-up and prior to adjuvant therapy in asymptomatic patients with complete resection of stage IIIB and IIIC melanoma. Methods: Prospectively two cohorts were set up with stage III melanoma patients with complete resection of disease. In the first cohort (stage IIIB/C AJCC 7th) surveillance PET/CT was performed 6-monthly for two years if patients stayed asymptomatic with normal serum S100B, with a final scan at three years. In the second cohort (stage IIIB/C/D AJCC 8th) patients underwent one screening PET/CT after resection and prior to starting adjuvant treatment. Results: Eighty patients entered follow-up in cohort 1. Of these, the majority did not undergo surveillance scans, because they required treatment for newly detected clinical metastases. Thirty-five patients remained asymptomatic and were included in surveillance cohort one (105 scans) with a median follow-up of 33 months. Twelve patients (34%) developed a recurrence, seven (20%) of which were detected on the first scan at six months. Seven recurrences involved stage IIIC patients, five stage IIIB patients. Sensitivity and specificity were 92% and 100% respectively. Forty-two patients were included in cohort 2. Recurrence was suspected on nine scans, four (10%) of which were true positive. One patient proceeded to undergo a node dissection and then started adjuvant therapy. The other three patients had progressed to stage IV and therefore started radiotherapy and/or systemic immunotherapy. Five (12%) scans were false positive, the suspected lesions were not related to the preceded surgery. The number of scans needed to find one asymptomatic recurrence were 8.8 and 10.5 in cohort one and two, respectively. Conclusions: This study shows that PET/CT is a useful surveillance tool for detecting recurrence in asymptomatic high-risk resected stage III melanoma patients, especially within the first six months after surgery and therefore should be considered when monitoring these patients during follow-up as well as prior to starting adjuvant therapy.

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FDG-PET/CT response and outcome of neoadjuvant immunotherapy for clinical stage III melanoma.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e21569 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e21569-e21569

Author(s):

Milton Jose De Barros E. Silva ◽

Caio Dabbous Liz ◽

Marcos Rezende Teixeira ◽

José Augusto Rinck ◽

Monique Celeste Tavares ◽

...

Keyword(s):

Fdg Pet ◽

Clinical Stage ◽

Complete Response ◽

The Other ◽

Stage Iii ◽

Mixed Response ◽

Neoadjuvant Immunotherapy ◽

Pet Ct ◽

Stage Iii Melanoma ◽

Fdg Pet Ct

e21569 Background: Neoadjuvant immunotherapy with nivolumab 3mg/kg and ipilimumab 1mg/kg for two cycles(N3+I1) or anti-PD1 for 3-8 weeks for clinical stage III melanoma have shown rates of pCR/near-pCR about 60% or 30%, respectively. The prognosis of this group seems to be excellent so far. On the other hand, patients classified as pathological non-response have a worse outcome and early identification of this group may allow us to tailor treatment before surgery. Methods: We conducted a retrospective analysis of patients with clinical stage III melanoma treated with neoadjuvant immune checkpoint blockade who did baseline and pre-operative FDG-PET/CT. The total number of FGD avid lesions and the percentual difference between the maximum SUV per lesion was calculated. The pathological results were correlated to FGD-PET/CT findings. Results: Between January 2019 and January 2021, nine patients with clinical stage III melanoma were identified. Six patients received Nivolumab 3m/kg and Ipilimumab 1mg/kg for two cycles and 3 received anti-PD1 for 60 days. Baseline FDG-PET/CT showed just one avid lesion in 7 patients, 2 avid lesions in one patient and 3 avid lesions in one patient. All known lesions identified by CT scan were also captured by FGD-PET/CT. After the neoadjuvant treatment, 4 patients achieved pCR/near-pCR. All of them were treated with N3+I1. Two of them had metabolic complete response (including the one with 3 PET- avid lesions) and 2 had reduction on FDG concentration (-31% and – 76%). Three patients had absence of response: 100% of viable tumor cells (VTC), all of them with increase in FDG concentration (+12% to + 307%) and appearance of a new lesion in one case. Two out of them were treated with anti-PD1. One patient had partial response (40% of VTC). Interestingly, this patient developed sarcoidosis-like reaction with increase of SUV in the index lesion (+68%) and appearance of mediastinal lymph-nodes. One patient, who had two lesions, presented a mixed response: complete response in one and 90% of VTC in the other. FDG-PET/CT was able to detect both responses (metabolic complete response and increase of FGD concentration of 17%, respectively). Conclusions: Reduction in FGD-PET/CT concentration with no appearance of new lesion(s) is associated with significant pathological response. An increase of SUV or appearance of new lesion(s) should be carefully interpreted.

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Prediction of lymph node metastase in NSCLC

Onkologische Welt ◽

10.1055/s-0038-1632899 ◽

2010 ◽

Vol 01 (05) ◽

pp. 219-226 ◽

Cited By ~ 1

Author(s):

F. Beyer ◽

B. Buerke ◽

J. Gerss ◽

K. Scheffe ◽

M. Puesken ◽

...

Keyword(s):

Lymph Nodes ◽

Fdg Pet ◽

Automatic Segmentation ◽

Correlation Coefficients ◽

Mediastinal Lymph Nodes ◽

Intra Class Correlation ◽

Axial Diameter ◽

Pet Ct ◽

Fdg Pet Ct

SummaryPurpose: To distinguish between benign and malignant mediastinal lymph nodes in patients with NSCLC by comparing 2D and semiautomated 3D measurements in FDG-PET-CT.Patients, material, methods: FDG-PET-CT was performed in 46 patients prior to therapy. 299 mediastinal lymph-nodes were evaluated independently by two radiologists, both manually and by semi-automatic segmentation software. Longest-axial-diameter (LAD), shortest-axial-diameter (SAD), maximal-3D-diameter, elongation and volume were obtained. FDG-PET-CT and clinical/FDG-PET-CT follow up examinations and/or histology served as the reference standard. Statistical analysis encompassed intra-class-correlation-coefficients and receiver-operator-characteristics-curves (ROC). Results: The standard of reference revealed involvement in 87 (29%) of 299 lymph nodes. Manually and semi-automatically measured 2D parameters (LAD and SAD) showed a good correlation with mean

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The Role of 18F-FDG PET/CT in Follow up After Treatment in Childhood Langerhans Cell Histiocytosis.

The Egyptian Journal Nuclear Medicine ◽

10.21608/egyjnm.2019.106661 ◽

2019 ◽

Vol 19 (2) ◽

pp. 50-63

Author(s):

Ismail, A ◽

Abdel Gaid, S.

Keyword(s):

Fdg Pet ◽

Langerhans Cell Histiocytosis ◽

Langerhans Cell ◽

Pet Ct ◽

18F Fdg ◽

Fdg Pet Ct

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