DIAGNOSTIC ACCURACY IN RESECABLE ESOPHAGEAL CANCER

Abstract INTRODUCTION In localized oesophageal cancer (EC), a correct clinical tumor staging is essential in order to offer an optimal treatment, although often challenging. The aim of this work is to assess the accuracy of the diagnostic tests by comparing them with the pathological staging. MATERIAL AND METHODS Retrospective observational study of patients who underwent oesophagectomy for cancer in a referral hospital between January 2003 and September 2019. Those patients who received neoadjuvant treatment were excluded in order to avoid bias from dowstaging effects. The preoperative stage cT and cN as well as the combination of both (cTNM) were compared with the pathological stage of the surgical specimen (pT, pN, pTNM), considered the gold standard. Computed tomography (CT) and endoscopic ultrasound (EUS) were evaluated for cT and cN, while Positron emission tomography (PET/CT) only for cN. Furthermore, the pT stage was correlated with the tumor length described in the oesophagogram (EG). RESULTS Among the 63 patients included, the clinical staging was correct in 16 cases (global accuracy 25.4%), it was overstaged in 21 (33.2%) and understaged in 26 (41.3%). For cT staging, the accuracy of EUS was higher than that of CT (46.6% and 34.9% respectively), specially for early stages. EG tumor length correlated with pT stage (p < 0.05). For cN staging, PET/CT had the highest sensitivity (50.0%) and NPV (75.0%). CONCLUSIONS Despite the multiple diagnostic tools used, the global accuracy of clinical staging in localized EC is still a challenge, with the therapeutic and prognostic implications that this entails.

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Extraparotid Warthin Tumors Imitating Metastasis of Oral Cancers

International Archives of Otorhinolaryngology ◽

10.1055/s-0041-1724090 ◽

2021 ◽

Author(s):

Michał Gontarz ◽

Krzysztof Gąsiorowski ◽

Jakub Bargiel ◽

Tomasz Marecik ◽

Paweł Szczurowski ◽

...

Keyword(s):

Neck Dissection ◽

Case Series ◽

Warthin Tumor ◽

Tumor Node Metastasis ◽

Surgical Specimen ◽

Neck Metastasis ◽

Oral Cancers ◽

Node Metastasis ◽

Positron Emission ◽

Pet Ct

Abstract Introduction Extraparotid Warthin tumor (WT) is a very rare entity, especially when synchronous with oral cancer (OC). Objective The present study presents a case series of extraparotid WTs detected in the surgical specimen of patients treated for OC. Methods From 2007 to 2016, 336 patients were operated for OC in our institution. Neck dissection was performed in 306 patients. Results In the 306 patients operated for OC whose necks were dissected, unexpected WTs were observed in 4 surgical neck specimens. In 3 cases, extraparotid WTs were responsible for tumor, node, metastasis (TNM) overstaging before surgery. Conclusion Extraparotid WTs may be discovered during neck dissection in ∼ 1% of OC patients, and they may mimic neck metastasis, especially in positron-emission tomography/computed tomography (PET/CT) imaging.

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FDOPA-(18F): a PET radiopharmaceutical recently registered for diagnostic use in countries of the European Union

Brazilian Archives of Biology and Technology ◽

10.1590/s1516-89132007000600009 ◽

2007 ◽

Vol 50 (spe) ◽

pp. 77-90 ◽

Cited By ~ 4

Author(s):

Yanna-Marina Chevalme ◽

Françoise Montravers ◽

Jean-Philippe Vuillez ◽

Michel Zanca ◽

Charles Fallais ◽

...

Keyword(s):

Case Reports ◽

The Body ◽

Clinical Usefulness ◽

Diagnostic Tools ◽

The European Union ◽

Commercial Preparation ◽

Non Invasive ◽

Positron Emission ◽

Pet Ct ◽

Pet Radiopharmaceutical

Positron emission tomography (PET) and its recent update PET/CT are very effective diagnostic tools for non-invasive imaging of metabolic or functional disorders in target tissues. The clinical usefulness of fluorodeoxyglucose-(18F) (FDG) has been now widely accepted. Recently, the clinical usefulness of fluoroDOPA-(18F) or FDOPA, an aminoacid labelled with the same positron emitter fluorine-18, has been evaluated and recognised in France and subsequently in several EU countries. FDOPA is diagnostic PET agent, which has been used for decades in imaging the loss of dopaminergic neurons in Parkinson's disease, and more recently to detect, stage and restage neuroendocrine tumours and to search for recurrence of viable glioma tissue. The present article summarises the body of evidence that led the French Medicines Agency (AFSSAPS) to grant a marketing authorisation to IASOdopa, a commercial preparation of FDOPA. Brief case reports and figures illustrate the diagnostic performance of FDOPA PET or PET/CT in the different settings that are currently approved in oncology.

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Deferral of rectal surgery following a continued response to preoperative chemoradiotherapy (Watch and Wait) study: A phase II multicenter study in the United Kingdom.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.489 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 489-489 ◽

Cited By ~ 11

Author(s):

S. K. Yu ◽

G. Brown ◽

R. J. Heald ◽

S. Chua ◽

G. Cook ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Resection ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Complete Response ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Clinical Staging ◽

Pet Ct

489 Background: Neoadjuvant chemoradiotherapy (CRT) and surgical resection are standard components of therapy for patients locally advanced rectal cancer (T3,T4 or N+) in UK. In 15%-30% of patients treated pre-operatively with CRT will develop pathological complete response (CR). The time from completion of CRT to maximal tumour response is as yet unknown. This study is the first prospective study to attempt to identify the percentage of patients who can safely omit surgery and the safety of deferred surgery in patients who achieve clinical complete response post CRT. Of the 59 patients required for the study, this provides an update on 19 patients entered. Methods: Patients with locally advanced rectal cancer requiring neoadjuvant treatment are identified in the multidisciplinary meet (MDT). Patients undergo CRT using a minimum of 50.4Gy in 28 # daily conformal CT planned CRT with concomitant Capecitabine at 825mg/m2 BD. MRI pelvis and body CT are repeated 4 weeks post CRT and rediscussed at MDT. If there is a good partial response or CR, patients are considered for Deferral of Surgery Study. Based on the pre treatment clinical staging, patients are considered for adjuvant chemotherapy as per NICE guidance. At any point of the study, if there is histology proven tumour regrowth or progression, patient undergo surgery. Results: 10 (53%) patients remain in CR. 6 (32%) patients underwent surgical resection with clear margin after detection of tumour regrowth at from 2-23 months post CRT. 5 out of 6 of the patients with tumour regrowth underwent PET CT as per protocol, and all tumour regrowth in those 5 patients were detected by PET CT, i.e. FDG avid disease. The pathological stages on these 6 patients were ypT2N0 CRM negative in 5 and ypT3N0 CRM negative in 1. 3 (15%) patients with tumour regrowth refused surgery. Conclusions: In the 19 recruited patients, all the patients with tumour regrowth underwent surgical resection with clear margins. PET CT appears a useful tool for detecting tumour regrowth. The median time for tumour regrowth is 17.5 months post CRT. The trial will be successful if at least 11/59 patients are able to safely omit surgery. Accrual of patients continues. No significant financial relationships to disclose.

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18F FDG-PET/CT evaluation of histological response after neoadjuvant treatment in patients with cancer of the esophagus or gastroesophageal junction

Acta Radiologica ◽

10.1177/0284185118791204 ◽

2018 ◽

Vol 60 (5) ◽

pp. 578-585

Author(s):

Stefan Gabrielson ◽

Alejandro Sanchez-Crespo ◽

Fredrik Klevebro ◽

Rimma Axelsson ◽

Jon Albert Tsai ◽

...

Keyword(s):

Primary Tumor ◽

Fdg Pet ◽

Gastroesophageal Junction ◽

Neoadjuvant Treatment ◽

Histological Response ◽

Surgical Specimen ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Background In most parts of the world, curatively intended treatment for esophageal cancer includes neoadjuvant therapy, either with chemoradiotherapy or chemotherapy alone, followed by esophagectomy. Currently 18F-FDG positron emission tomography/computed tomography (PET/CT) is used for preoperative disease staging, but is not well established in the evaluation of neoadjuvant treatment. Purpose To evaluate changes in PET parameters in relation to the histological primary tumor response in the surgical specimen in patients randomized to neoadjuvant chemoradiotherapy or chemotherapy. Material and Methods Patients were randomized between either neoadjuvant chemotherapy or chemoradiotherapy followed by esophagectomy.18F-FDG PET/CT exams were conducted at baseline and following neoadjuvant treatment. Standardized uptake ratio (SUR) values were measured in the primary tumor and compared as regards histological responders and non-responders as well as different treatment arms. Results Seventy-nine patients were enrolled and 51 were available for analysis. A significant rate of SUR reduction was observed ( P = 0.02) in the primary tumor in histological responders compared to non-responders. Changes in SUR were significantly greater in responders following chemoradiotherapy ( P = 0.02), but not following chemotherapy alone ( P = 0.49). There was no statistically significant difference in SUR in patients with a complete histological response compared to those with a subtotal response. Conclusion Our results are similar to those of previous studies and show that changes in the rate of SUR can be used reliably to differentiate histological responders from non-responders after neoadjuvant treatment with either chemoradiotherapy or chemotherapy. Limitations of current PET technology are likely to restrict the possibility of accurately ruling out limited residual disease.

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Malignant Melanoma

ISRN Dermatology ◽

10.5402/2012/308279 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 7

Author(s):

Aída Ortega Candil ◽

Cristina Rodríguez Rey ◽

José Luis Carreras Delgado

Keyword(s):

Essential Role ◽

Distant Metastases ◽

Lymph Node Biopsy ◽

Diagnostic Methods ◽

Emission Tomography ◽

Diagnostic Tools ◽

Choice Procedure ◽

Node Biopsy ◽

Positron Emission ◽

Pet Ct

Nuclear medicine plays an essential role in the correct staging of patients suffering from melanoma. Both sentinel lymph node biopsy (SLNB) and positron emission tomography (PET) represent its main diagnostic tools. SLNB is the choice procedure for lymphatic regional staging of these patients, including the result of this technique in the 2002 American Joint Cancer Committee melanoma staging. SLNB sensitivity is superior than PET/CT for the detection of lymphatic micrometastases in early stages of the disease. PET/CT is mainly used in confirming clinical metastases suspected, detection of recurrences, and recurrence restaging. PET/CT has also shown superiority against conventional diagnostic methods in the detection of distant metastases, being able to detect illness even six months earlier than those methods.

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The Role of Fluorine-18-fluorodeoxyglucose Positron Emission Tomography in Assessing the Response to Neoadjuvant Treatment in Patients with Osteosarcoma

International Journal of Molecular Imaging ◽

10.1155/2012/870301 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Carmelo Caldarella ◽

Marco Salsano ◽

Maria Antonietta Isgrò ◽

Giorgio Treglia

Keyword(s):

Positron Emission Tomography ◽

Fdg Pet ◽

Neoadjuvant Treatment ◽

Emission Tomography ◽

Whole Body ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct ◽

Fluorine 18 Fluorodeoxyglucose

Aim. The objective of this study is to systematically review the role of positron emission tomography (PET) and PET/computed tomography (PET/CT) with fluorine-18-fluorodeoxyglucose (FDG) in assessing the response to neoadjuvant treatment in patients with osteosarcoma (OS). Methods. A comprehensive literature search of published studies through March 2012 in PubMed/MEDLINE, Embase, and Scopus databases regarding whole-body FDG-PET and FDG-PET/CT in patients with OS was performed. Results. Twenty-two studies have investigated the role of FDG-PET and FDG-PET/CT in the evaluation of response to neoadjuvant treatment with either chemotherapy or radiation therapy in patients with OS. The main findings of these studies are presented. Conclusion. FDG-PET or PET/CT seems to be sensitive and reliable diagnostic tools in the assessment of metabolic response to treatment in patients with OS, after baseline PET evaluation has been performed in advance. However, false positive findings due to inflammation in sites of tumoral response should be considered.

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Case Report: Nasal Cavity Epithelial-Myoepithelial Carcinoma With High Fluoro-D-Glucose Uptake on Positron Emission Tomography/Computed Tomography

Frontiers in Medicine ◽

10.3389/fmed.2021.664520 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jacques Dzuko Kamga ◽

Jean-Christophe Leclere ◽

Arnaud Uguen ◽

Karim Amrane ◽

Ronan Abgral

Keyword(s):

Nasal Cavity ◽

Fdg Pet ◽

Tumor Staging ◽

Malignant Neoplasm ◽

Myoepithelial Carcinoma ◽

First Case ◽

Positron Emission ◽

Pet Ct ◽

Epithelial Myoepithelial Carcinoma ◽

Fdg Pet Ct

Epithelial-myoepithelial carcinoma (EMC) is a rare malignant neoplasm arising most frequently in the salivary glands and exceptionally in the nasal cavity. EMC accounts for ~1–2% of salivary gland tumors. Even if the nodal and distant metastasis rates are low, tumor staging remains indicated. Here, the authors present the 2-deoxy-2-[18F]fluoro-D-glucose PET-CT (18F-FDG-PET/CT) study of a very rare case of biopsy-proven EMC of the left nasal cavity. This 18F-FDG-PET/CT was performed to stage this tumor and guide the therapeutic strategy due to an atypical high-grade presentation in immunohistochemistry. To our knowledge, this is the first case reporting such high 18F-FDG avidity of EMC of the nasal cavity in PET/CT.

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Radiologic Assessment of Osteosarcoma Lung Metastases: State of the Art and Recent Advances

Cells ◽

10.3390/cells10030553 ◽

2021 ◽

Vol 10 (3) ◽

pp. 553

Author(s):

Anna Maria Chiesa ◽

Paolo Spinnato ◽

Marco Miceli ◽

Giancarlo Facchini

Keyword(s):

Low Dose ◽

Lung Metastases ◽

Diagnostic Tools ◽

Volume Doubling Time ◽

Positron Emission ◽

Pet Ct ◽

Frequent Site ◽

Volume Doubling ◽

Aided Diagnosis

The lung is the most frequent site of osteosarcoma (OS) metastases, which are a critical point in defining a patient’s prognosis. Chest computed tomography (CT) represents the gold standard for the detection of lung metastases even if its sensitivity widely ranges in the literature since lung localizations are often atypical. ESMO guidelines represent one of the major references for the follow-up program of OS patients. The development of new reconstruction techniques, such as the iterative method and the deep learning-based image reconstruction (DLIR), has led to a significant reduction of the radiation dose with the low-dose CT. The improvement of these techniques has great importance considering the young-onset of the disease and the strict chest surveillance during follow-up programs. The use of 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT is still controversial, while volume doubling time (VDT) and computer-aided diagnosis (CAD) systems are recent diagnostic tools that could support radiologists for lung nodules evaluation. Their use, well-established for other malignancies, needs to be further evaluated, focusing on OS patients.

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Diagnostic Performance of Whole Body Dual Modality 18F-FDG PET/CT Imaging for N- and M-Staging of Malignant Melanoma: Experience With 250 Consecutive Patients

Journal of Clinical Oncology ◽

10.1200/jco.2005.03.5634 ◽

2006 ◽

Vol 24 (7) ◽

pp. 1178-1187 ◽

Cited By ~ 190

Author(s):

Michael J. Reinhardt ◽

Alexius Y. Joe ◽

Ursula Jaeger ◽

Andrea Huber ◽

Alexander Matthies ◽

...

Keyword(s):

Cutaneous Melanoma ◽

Fdg Pet ◽

Diagnostic Performance ◽

Tumor Staging ◽

Distant Metastases ◽

Ct Imaging ◽

Whole Body ◽

Positron Emission ◽

Pet Ct ◽

Fdg Pet Ct

Purpose To assess the diagnostic performance of positron emission tomography/computed tomography (PET/CT) using 18F-fluorodeoxyglucose (FDG) for N- and M-staging of cutaneous melanoma. Patients and Methods This is a retrospective and blinded study of 250 consecutive patients (105 women, 145 men; age 58 ± 16 years) who underwent FDG-PET/CT for staging of cutaneous melanoma at different time points in the course of disease. Whole-body FDG-PET/CT was performed 101 ± 21 minutes postinjection of 371 ± 41 MBq FDG. Diagnostic accuracy for N- and M-staging was determined for CT alone, PET alone, and PET/CT. Results PET/CT detected significantly more visceral and nonvisceral metastases than PET alone and CT alone (98.7%, 88.8%, and 69.7%, respectively). PET/CT imaging thus provided significantly more accurate interpretations regarding overall N- and M-staging than PET alone and CT alone. Overall N- and M-stage was correctly determined by PET/CT in 243 of 250 patients (97.2%; 95% CI, 95.2% to 99.4%) compared with 232 patients (92.8%; 95% CI, 89.6% to 96.0%) by PET, and 197 patients (78.8%; 95% CI, 73.7% to 83.9%) by CT. All differences were significant. Accuracy of PET/CT was significantly higher than that of PET and CT for M-staging (0.98 v 0.93 and 0.84) and significantly higher than that of CT for N-Staging (0.98 v 0.86). Change of treatment according to PET/CT findings occurred in 121 patients (48.4%). Conclusion The diagnostic performance of FDG-PET/CT for N- and M-staging of melanoma patients suggests its use for whole-body tumor staging, especially for detection or exclusion of distant metastases.

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Accuracy of Whole-Body Dual-Modality Fluorine-18–2-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography and Computed Tomography (FDG-PET/CT) for Tumor Staging in Solid Tumors: Comparison With CT and PET

Journal of Clinical Oncology ◽

10.1200/jco.2004.08.120 ◽

2004 ◽

Vol 22 (21) ◽

pp. 4357-4368 ◽

Cited By ~ 335

Author(s):

Gerald Antoch ◽

Nina Saoudi ◽

Hilmar Kuehl ◽

Gerlinde Dahmen ◽

Stefan P. Mueller ◽

...

Keyword(s):

Computed Tomography ◽

Positron Emission Tomography ◽

Tumor Staging ◽

Treatment Plan ◽

Ct Images ◽

Emission Tomography ◽

Tumor Node Metastasis ◽

Node Metastasis ◽

Positron Emission ◽

Pet Ct

Purpose To assess the accuracy of positron emission tomography/computed tomography (PET/CT) when staging different malignant diseases. Patients and Methods This was a retrospective, blinded, investigator-initiated study of 260 patients with various oncological diseases who underwent fluorine-18–2-fluoro-2-deoxy-d-glucose PET/CT for tumor staging. CT images alone, PET images alone, PET + CT data viewed side by side, and fused PET/CT images were evaluated separately according to the tumor-node-metastasis system. One hundred forty patients with tumors not staged according to the tumor-node-metastasis system or a lack of reference standard were excluded from data analysis; 260 patients were included. Diagnostic accuracies were determined for each of the four image sets. Histopathology and a clinical follow-up of 311 (± 125) days served as standards of reference. Results PET/CT proved significantly more accurate in assessing tumor-node-metastasis system stage compared with CT alone, PET alone, and side-by-side PET + CT (P < .0001). Of 260 patients, 218 (84%; 95% CI, 79% to 88%) were correctly staged with PET/CT, 197 (76%; 95% CI, 70% to 81%) with side-by-side PET + CT, 163 (63%; 95% CI, 57% to 69%) with CT alone, and 166 (64%; 95% CI, 58% to 70%) with PET alone. Combined PET/CT had an impact on the treatment plan in 16, 39, and 43 patients when compared with PET + CT, CT alone, and PET alone, respectively. Conclusion Tumor staging with PET/CT is significantly more accurate than CT alone, PET alone, and side-by-side PET + CT. This diagnostic advantage translates into treatment plan changes in a substantial number of patients.

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