scholarly journals Staging esophageal cancer: low EUS accuracy in t2n0 patients

2021 ◽  
Vol 09 (03) ◽  
pp. E313-E318
Author(s):  
Germana de Nucci ◽  
Maria Chiara Petrone ◽  
Nicola Imperatore ◽  
Emanuele Asti ◽  
Gemma Rossi ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Distant Metastases ◽  
High Volume ◽  
Lymph Node Status ◽  
Tumor Depth ◽  
Surgical Specimen ◽  
Positron Emission ◽  
Appropriate Therapy ◽  
Pet Scans

Abstract Background and study aims Esophageal cancer (EC) is one of the most lethal malignancies worldwide. Staging of EC is performed with computed tomography (CT), positron-emission tomography (PET), and endoscopic ultrasonography (EUS). Patient management mostly depends on lymph node status. Compared to histopathology, the accuracy of EUS for T and N parameters is about 85 % and 75 %, respectively. Errors in staging may change prognosis. The aim of this study was to assess the role of EUS in T2-N0 EC considering the experience of two high-volume digestive endoscopic centers. Methods Two prospectively collected databases were queried to identify all patients with EC, staged as cT2N0 by EUS, with no distant metastases at CT/PET scan and who underwent transthoracic esophagectomy. Preoperative EUS staging (cTNM) was compared to histopathology of the surgical specimen (pTNM) to evaluate accuracy. Results Of 729 consecutive patients with EC between January 2011 and September 2018, 72 (49 men) had cT2N0 disease. CT and PET scans confirmed the absence of distant metastasis. In 43 of 72 patients (60 %), the evaluation was correct, 23 of 72 (31,7 %) were understaged, and six of 72 patients (8,3 %) were overstaged. Among the understaged patients, eight were understaged by tumor depth (35 %), seven by nodal involvement (30 %), and eight by both (35 %). All six patients who were overstaged had T1b-N0 disease. EUS accuracy was 77 % in staging for tumor depth and 82 % in staging for nodal metastases. The positive predictive value (PPV) for cT2N0 EC was 60 % (43 pT2N0 /72 cT2N). Conclusions The accuracy of EUS staging of T2N0 EC is low, with only 60 % of patients undergoing appropriate therapy based on histopathology.

Role of Functional Imaging in the Management of Lymphoma

2011 ◽  
Vol 29 (14) ◽  
pp. 1844-1854 ◽  
Author(s):  
Bruce D. Cheson
Keyword(s):  
Fdg Pet ◽  
B Cell Lymphoma ◽  
Post Treatment ◽  
Metabolic Imaging ◽  
Interim Pet ◽  
Positron Emission ◽  
Pet Ct ◽  
Pretreatment Assessment ◽  
Pet Scans

18-F-fluorodeoxyglucose (FDG) –positron emission tomography (PET), and more recently PET/computed tomography (CT), is the most sensitive and specific imaging technique currently available for patients with lymphoma. Nevertheless, despite being increasingly used in pretreatment assessment, midtreatment evaluation of response, post-treatment restaging, and surveillance during follow-up of patients with lymphoma, its impact on clinical outcome in most clinical situations remains to be confirmed. PET/CT provides its greatest clinical benefit in the post-treatment evaluation of Hodgkin's lymphoma and diffuse large B-cell lymphoma; however, the role of metabolic imaging in other indications and in other histologies remains to be demonstrated. Ongoing risk-adapted studies will hopefully provide evidence for clinical improvement on the basis of altering treatment as a result of interim PET results. Efforts are ongoing to better standardize the conduct and interpretation of FDG-PET scans. FDG-PET has the potential to improve lymphoma patient management; however, its usefulness will likely vary by histology, stage, therapy, and clinical setting.

FDG-Positron Emission Tomography in T-Cell Lymphoma

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1614-1614
Author(s):  
Chiara Rusconi ◽  
Cristina Gabutti ◽  
Vittorio Ruggero Zilioli ◽  
Erika Meli ◽  
Maddalena Mazzucchelli ◽  
...  
Keyword(s):  
T Cell ◽  
Fdg Pet ◽  
Cell Lymphoma ◽  
Clinical Stage ◽  
T Cell Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Scans

Abstract Abstract 1614 Background: Few data are available on the role of fluoro-deoxy-glucose positron emission tomography (FDG-PET) in T-cell non Hodgkin Lymphoma (NHL). We compared standard contrast-enhanced computerized tomography (CECT) and FDG-PET for initial staging and restaging after treatment in T-cell NHL. Methods: We reviewed 58 FDG-PET scans performed in 29 patients (pts) affected by T-cell NHL and we focused on the 42 cases for which a simultaneous standard CECT was available for comparison. The specific T-cell histology was Peripheral T-Cell Lymphoma Not Otherwise Specified in 12 pts, Angioimmunoblastic T-Cell Lymphoma in 4 pts, Anaplastic Large Cell Lymphoma in 10 pts, other T-NHL hystologies in 3 pts. Twelve pts were males and median age at diagnosis was 57 years (range: 25–77). Baseline FDG-PET scans were 20, while FDG-PET performed for disease reassessment were 22. Results: FDG-PET performed at baseline was positive in all cases. In 6 cases (30%) FDG-PET identified fewer disease sites than CECT, while in 14 cases (70%) FDG-PET identified additional disease sites. New sites identified by FDG-PET were: other nodal sites (11 pts), spleen (2 pts), nasopharynx (1 pt) and testicles (1 pt). Different disease extent evaluation according to FDG-PET modified clinical stage in 10 pts (50%): one pt was downstaged and 9 pts were upstaged. FDG-PET-based stage was not considered for therapeutic decision. FDG-PET scans performed at restaging were negative in 16 cases (72%) and positive in the remaining 6 cases (28%). In 13/16 (81%) negative cases CECT was concordant and showed a complete remission, while in the remaining 3 cases CECT showed a residual nodal disease. In the 6 FDG-PET positive cases, CECT was as follows: abnormal in the same site of FDG-PET in 1 case, abnormal in fewer sites than FDG-PET in 3 cases and abnormal in more sites than FDG-PET in 2 cases. With a median follow-up of 32 months, the median overall survival (OS) of the 6 positive FDG-PET cases at restaging was 26 months. With a median follow-up of 23 months, the median OS of the 16 negative FDG-PET cases at restaging was not reached. Conclusion: FDG-PET can be useful in the initial staging of T-cell NHL, since it can allow a more accurate disease extension evaluation: in our experience it could identify additional sites, both nodal and extra-nodal, in 70% of pts. A change in clinical stage according to FDG-PET was observed in 50% of cases, with an upstaging in the majority of pts. We could confirm the high sensitivity of baseline FDG-PET in T-cell NHL. A high level of concordance was observed between PET and CECT at restaging. However, independently on CECT result, the worse OS of FDG-PET positive cases confirms the role of FDG-PET as prognostic factor for survival. Larger prospective trials are needed to confirm the utility of FDG-PET in baseline staging, reassessment after chemotherapy and treatment planning. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Positron Emission Tomography (PET) and Neuroimaging in the Personalized Approach to Neurodegenerative Causes of Dementia

2020 ◽  
Vol 21 (20) ◽  
pp. 7481 ◽  
Author(s):  
Maria Ricci ◽  
Andrea Cimini ◽  
Agostino Chiaravalloti ◽  
Luca Filippi ◽  
Orazio Schillaci
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Positron Emission Tomography ◽  
Differential Diagnosis ◽  
Emission Tomography ◽  
Treatment Management ◽  
Positron Emission ◽  
Appropriate Therapy ◽  
Personalized Approach

Generally, dementia should be considered an acquired syndrome, with multiple possible causes, rather than a specific disease in itself. The leading causes of dementia are neurodegenerative and non-neurodegenerative alterations. Nevertheless, the neurodegenerative group of diseases that lead to cognitive impairment and dementia includes multiple possibilities or mixed pathologies with personalized treatment management for each cause, even if Alzheimer’s disease is the most common pathology. Therefore, an accurate differential diagnosis is mandatory in order to select the most appropriate therapy approach. The role of personalized assessment in the treatment of dementia is rapidly growing. Neuroimaging is an essential tool for differential diagnosis of multiple causes of dementia and allows a personalized diagnostic and therapeutic protocol based on risk factors that may improve treatment management, especially in early diagnosis during the prodromal stage. The utility of structural and functional imaging could be increased by standardization of acquisition and analysis methods and by the development of algorithms for automated assessment. The aim of this review is to focus on the most commonly used tracers for differential diagnosis in the dementia field. Particularly, we aim to explore 18F Fluorodeoxyglucose (FDG) and amyloid positron emission tomography (PET) imaging in Alzheimer’s disease and in other neurodegenerative causes of dementia.

scholarly journals Deep Convolutional Neural Network-Based Positron Emission Tomography Analysis Predicts Esophageal Cancer Outcome

2019 ◽  
Vol 8 (6) ◽  
pp. 844 ◽  
Author(s):  
Cheng-Kun Yang ◽  
Joe Chao-Yuan Yeh ◽  
Wei-Hsiang Yu ◽  
Ling-I. Chien ◽  
Ko-Han Lin ◽  
...  
Keyword(s):  
Neural Network ◽  
Lung Cancer ◽  
Positron Emission Tomography ◽  
Esophageal Cancer ◽  
Emission Tomography ◽  
Positron Emission ◽  
Cancer Outcome ◽  
One Year ◽  
3D Cnn ◽  
Pet Scans

In esophageal cancer, few prediction tools can be confidently used in current clinical practice. We developed a deep convolutional neural network (CNN) with 798 positron emission tomography (PET) scans of esophageal squamous cell carcinoma and 309 PET scans of stage I lung cancer. In the first stage, we pretrained a 3D-CNN with all PET scans for a task to classify the scans into esophageal cancer or lung cancer. Overall, 548 of 798 PET scans of esophageal cancer patients were included in the second stage with an aim to classify patients who expired within or survived more than one year after diagnosis. The area under the receiver operating characteristic curve (AUC) was used to evaluate model performance. In the pretrain model, the deep CNN attained an AUC of 0.738 in identifying patients who expired within one year after diagnosis. In the survival analysis, patients who were predicted to be expired but were alive at one year after diagnosis had a 5-year survival rate of 32.6%, which was significantly worse than the 5-year survival rate of the patients who were predicted to survive and were alive at one year after diagnosis (50.5%, p < 0.001). These results suggest that the prediction model could identify tumors with more aggressive behavior. In the multivariable analysis, the prediction result remained an independent prognostic factor (hazard ratio: 2.830; 95% confidence interval: 2.252–3.555, p < 0.001). We conclude that a 3D-CNN can be trained with PET image datasets to predict esophageal cancer outcome with acceptable accuracy.

The role of FDG-PET scans in patients with lymphoma

Blood ◽  
2007 ◽  
Vol 110 (10) ◽  
pp. 3507-3516 ◽  
Author(s):  
Pamela Seam ◽  
Malik E. Juweid ◽  
Bruce D. Cheson
Keyword(s):  
Fdg Pet ◽  
Imaging Modality ◽  
False Negative ◽  
Surrogate Marker ◽  
3 Dimensional ◽  
Positron Emission ◽  
Development Data ◽  
Pretreatment Staging ◽  
Pet Scans

Abstract18-Fluoro-deoxyglucose positron emission tomography (FDG-PET) is a noninvasive, 3-dimensional imaging modality that has become widely used in the management of patients with malignant lymphomas. This technology has been demonstrated to be more sensitive and specific than either 67gallium scintigraphy or computerized tomography, providing a more accurate distinction between scar or fibrosis and active tumor. PET scans have been evaluated in pretreatment staging, restaging, monitoring during therapy, posttherapy surveillance, assessment of transformation, and, more recently, as a surrogate marker in new drug development. Data to support these various roles require prospective validation. Moreover, caution must be exercised in the interpretation of PET scans because of technical limitations, variability of FDG avidity among the different lymphoma histologic subtypes, and in the large number of etiologies of false-negative and false-positive results. Recent attempts to standardize PET in clinical trials and incorporation of this technology into uniformly adopted response criteria will hopefully lead to improved outcome for patients with lymphoma.

scholarly journals Protocol for 18F-PSMA PET imaging in staging and management of prostate cancer - a retrospective cohort study

2021 ◽  
Author(s):  
Matthew H V Byrne ◽  
Nithesh Ranasinha ◽  
Richard J Bryant ◽  
Freddie C Hamdy ◽  
Tom Leslie ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Electronic Patient Records ◽  
Prostate Cancer Cells ◽  
Diagnosis And Management ◽  
Positron Emission ◽  
Psma Pet ◽  
Gallium 68 ◽  
Pet Scans ◽  
Specific Membrane

Background: MRI, bone scan, and CT staging is recommended in the staging of prostate cancer. However, prostate-specific membrane antigen positron emission tomography (PSMA PET) could be superior in detection of local and distant prostate cancer cells. Most PSMA PET scans for prostate cancer are performed with a Gallium-68 ligand, with the Fluorine-18 (18F) ligand being introduced more recently. Methods: We will conduct a retrospective review of electronic patient records for all consecutive patients who underwent preoperative 18F-PSMA PET scan for prostate cancer from its introduction at our centre in 2019. We will compare PET scans with other imaging modalities and evaluate its use in diagnosis and management decisions for prostate cancer. Conclusions: Understanding the role of 18F-PSMA PET in diagnosis and management could influence the diagnostic pathway of primary and secondary prostate cancer.

Utility of positron emission tomography (PET) scans on the management of cancers of unknown primary.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 6066-6066
Author(s):  
Hao Chen ◽  
Winson Y. Cheung
Keyword(s):  
Overall Survival ◽  
Diagnostic Value ◽  
Primary Site ◽  
Nodal Status ◽  
Ct Scans ◽  
Unknown Primary ◽  
Lymph Node Status ◽  
Small Subset ◽  
Positron Emission ◽  
Pet Scans

6066 Background: PET scans can be potentially useful in the diagnostic and staging workup of certain cancers. Although frequently ordered, its precise role in the investigation and management of cancers of unknown primary (CUP) remains poorly defined. Our main study aims were to 1) compare the utility of PET vs. CT scans in determining the primary site, lymph node status, and metastases for patients with CUP, and 2) describe the overall survival of patients for whom the primary site was determined by PET vs. those who were not. Methods: Patients diagnosed with CUP in British Columbia, Canada from 2006 to 2009, evaluated at 1 of 5 regional cancer centers in the province, and underwent a PET scan were reviewed. We measured concordance rates between PET and CT scans and constructed regression models to characterize the effect of PET scans on treatment and survival. Results: A total of 175 patients were included: median age was 60 years and 76% were men. PET scans were most commonly performed for the following indications: locating primary (45%); staging (42%); and others (13%). Among those in whom CT did not detect the primary site, PET revealed the location of the primary in 9% of cases. CTs and PETs were concordant in demonstrating nodal status and metastases in 91% and 95% of patients, respectively. PET scans were able to show additional nodal involvement and uncover metastatic disease in 9% and 5%, respectively, when compared to CT scans. Identification of the site of primary cancer by PET did not substantially modify subsequent therapy (p=0.37) and it also failed to significantly improve the median overall survival (10.1 vs. 7.3 months, p=0.57) when compared to those in whom the location of the primary was unconfirmed. Conclusions: In this retrospective cohort of CUP patients, CT and PET scans appear to provide a similar level of diagnostic and staging information. For a small proportion of CUP patients, PETs were superior in clarifying the primary site, nodal status, and metastases, but these did not alter therapy or increase overall survival. Based on these findings and considering the cost implications of intensive imaging studies, the diagnostic value of PET scans over CT scans appears limited to a small subset of patients with CUP.

RA07.07: THE ROLE OF 18F-FLUORODEOXYGLUCOSE POSITRON-EMISSION TOMOGRAPHY ON SURVIVAL OF PATIENTS FOLLOWING NEOADJUVANT CHEMOTHERAPY AND SURGERY FOR ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 35-36
Author(s):  
Junya Aoyama ◽  
Hirofumi Kawakubo ◽  
Shuhei Mayanagi ◽  
Kazumasa Fukuda ◽  
Koichi Suda ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Esophageal Cancer ◽  
Prognostic Factors ◽  
Neoadjuvant Chemotherapy ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Fluorodeoxyglucose Positron Emission Tomography ◽  
Positron Emission ◽  
Fluorodeoxyglucose Positron Emission

Abstract Background The occurrence of lymph node metastases (LNMs) is a critical factor for postoperative survival in patients with esophageal cancer. Generally F-fluorodeoxyglucose positron-emission tomography (FDG-PET) has a low sensitivity and a relatively high rate of false-negative for detecting LNMs. However, the role of FDG-PET in predicting the outcome is still unclear. The aim of this study is to assess the role of FDG-PET in predicting survival in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) treated with neoadjuvant chemotherapy (NAC). Methods Seventy-three patients with TESCC received NAC followed by surgery, and underwent FDG-PET before NAC in our hospital between January 2012 and November 2016. The number of PET-positive lymph nodes (LNs) and the maximum standardized uptake value (SUVmax) of the LNs were prospectively evaluated. The results of FDG-PET were compared with the pathological results and the prognosis. Results 15 patients had no PET-positive LNs, 23 had one, 15 had two and 20 patients had three or more positive LNs. A significantly high proportion of the PET-positive LNs ≧3 group had ≧3 pathological LNMs than the PET-positive LNs ≦2 group (70.0 vs. 22.6%, P < 0.001). The PET-positive LNs ≧3 group also had a significantly lower 3-year overall survival rate (47.9 vs. 71.9%, P = 0.018). Univariate Cox's proportional hazard regression analyses revealed the PET-positive LNs ≧3 status (Hazard ratio = 2.68 [1.14–6.28], P = 0.024) and the SUVmax of the LNs ≧8 status (Hazard ratio = 2.45 [1.06–5.65], P = 0.036) were significant prognostic factors. On the other hand, the SUVmax of the primary tumor was not a significant prognostic factor. Conclusion We identified the PET-positive LNs ≧3 status and the SUVmax of the LNs ≧8 status in patients with resectable TESCC before NAC as potential adverse prognostic factors for survival. Disclosure All authors have declared no conflicts of interest.

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