Value of Dual-Phase 2-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography in Cervical Cancer

2003 ◽  
Vol 21 (19) ◽  
pp. 3651-3658 ◽  
Author(s):  
Tzu-Chen Yen ◽  
Koon-Kwan Ng ◽  
Shih-Ya Ma ◽  
Hung-Hsueh Chou ◽  
Chien-Sheng Tsai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Characteristic Curve ◽  
Locally Advanced ◽  
Emission Tomography ◽  
Dual Phase ◽  
Recurrent Cervical Cancer ◽  
Metastatic Lesions ◽  
Positron Emission

Purpose: The role of positron emission tomography (PET) with fluorine-18–labeled fluoro-2-deoxy-d-glucose (FDG) in cervical cancer has not yet been well defined. We conducted a prospective study to investigate its efficacy in comparison with magnetic resonance imaging and/or computed tomography (MRI-CT). Materials and Methods: Patients with untreated locally advanced (35%) or recurrent (65%) cervical cancer were enrolled onto this study. In the first part of this study, 41 patients had a conventional FDG-PET (40 minutes after injection), and in the second part, 94 patients received dual-phase PET (at both 40 minutes and 3 hours after injection). The overall results of PET scans were compared with MRI-CT, and the two protocols of PET were also compared with each other. Lesion status was determined by pathology results or clinical follow-up. The receiver operating characteristic curve method with area under the curve (AUC) calculation was used to evaluate the discriminative power. Results: Overall (N = 135), FDG-PET was significantly superior to MRI-CT in identifying metastatic lesions (AUC, 0.971 v 0.879; P = .039), although the diagnostic accuracy was similar for local tumors. Dual-phase PET was also significantly better than the 40-minute PET (n = 94). The latter accurately recognized 70% of metastatic lesions and the former detected 90% (AUC, 0.943 v 0.951; P = .007). Dual-phase FDG-PET changed treatment of 29 patients (31%; upstaging 27% and downstaging 4%). Conclusion: This study shows that dual-phase FDG-PET is superior to conventional FDG-PET or MRI-CT in the evaluation of metastatic lesions in locally advanced or recurrent cervical cancer.

Low Value of [18F]-Fluoro-2-Deoxy-d-Glucose Positron Emission Tomography in Primary Staging of Early-Stage Cervical Cancer Before Radical Hysterectomy

2006 ◽  
Vol 24 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Hung-Hsueh Chou ◽  
Ting-Chang Chang ◽  
Tzu-Chen Yen ◽  
Koon-Kwan Ng ◽  
Swei Hsueh ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Radical Hysterectomy ◽  
Fdg Pet ◽  
Early Stage ◽  
Emission Tomography ◽  
Dual Phase ◽  
Primary Staging ◽  
Positron Emission ◽  
Early Stage Cervical Cancer

Purpose The role of positron emission tomography (PET) with [18F]-fluoro-2-deoxy-d-glucose (FDG) in early-stage cervical cancer is unclear. We aimed to investigate the clinical benefit of FDG-PET in primary staging before radical hysterectomy and pelvic lymphadenectomy (RH-PLND). Patients and Methods Patients with untreated stage IA2 to IIA adenocarcinoma (AD) or adenosquamous carcinoma (ASC) or nonbulky (≤ 4 cm) squamous cell carcinoma cervical cancer with magnetic resonance imaging (MRI) –defined negative nodal metastasis were enrolled onto a prospective study with a two-stage design. All patients had a preoperative dual-phase FDG-PET, technetium-99m–sulfur colloid lymphoscintigraphy, and intraoperative sentinel lymph node (LN) detection at RH-PLND. The gold standard of LN metastasis is histologic. A sample size of 120 patients was calculated to fit study aims (diagnostic efficacy of PET and sentinel LN sampling). An interim analysis was performed when 60 patients were accrued, which led to the current report. Results There were 36 SCCs, 20 ADs, and four ASCs. Of the 60 patients, 10 (16.7%) had pelvic LN metastases, and one (1.7%) had para-aortic LN (PALN) metastasis histologically. FDG-PET detected the single PALN metastasis (one of one patient) but detected only one (10%) of the 10 pelvic LN metastases. The PET false-negative pelvic LN micrometastases measured a median of 4.0 × 3.0 mm (range, 0.5 × 0.5 to 7 × 6 mm). The second stage of this trial will be continued without PET. Conclusion This study shows that dual-phase FDG-PET has little value in primary, nonbulky, stage IA2 to IIA and MRI-defined, LN-negative cervical cancer.

Role of [18F]fluoro-2-deoxy-D-glucose positron emission tomography in re-recurrent cervical cancer

2006 ◽  
Vol 16 (6) ◽  
pp. 1994-2003 ◽  
Author(s):  
C.-T. Lin ◽  
T.-C. Yen ◽  
T.-C. Chang ◽  
K.-K. Ng ◽  
C.-S. Tsai ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Scoring System ◽  
Proportional Hazards Model ◽  
Cox Proportional Hazards ◽  
Cox Proportional Hazards Model ◽  
Emission Tomography ◽  
Recurrent Cervical Cancer ◽  
Positron Emission

Cervical cancer patients with histologically documented re-recurrence after curative salvage therapy or unexplained tumor marker elevation (negative computed tomography and/or magnetic resonance imaging [CT-MRI]) proven to be a re-recurrence when a further attempt for cure (or control of cancer) appeared feasible were enrolled. Lesion status was determined from pathology or clinical follow-up for at least 12 months. Management decisions were recorded with CT-MRI alone and incorporating [18F]fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), respectively. The benefits calculated were based on clinical impact because of the FDG-PET findings. Cox proportional hazards model was used to select independent prognostic covariates. Of the 26 patients who were eligible for analysis, 12 (46.2%) patients had positive impacts due to PET. Squamous cell carcinoma (SCC,P= 0.029), re-recurrence at distant metastasis only (P= 0.012), and level of SCC antigen ≤4 ng/mL (P= 0.005) were significantly associated with better survival. A scoring system using these covariates defined three distinct prognostic groups (P= 0.0001). Patients with score 0 had a 36-month cumulative survival rate of 80%. Using this prognostic scoring system, FDG-PET may facilitate selecting appropriate management for the individual patient with re-recurrent cervical cancer.

Monitoring Primary Systemic Therapy of Large and Locally Advanced Breast Cancer by Using Sequential Positron Emission Tomography Imaging With [18F]Fluorodeoxyglucose

2009 ◽  
Vol 27 (4) ◽  
pp. 535-541 ◽  
Author(s):  
Jörg Schwarz-Dose ◽  
Michael Untch ◽  
Reinhold Tiling ◽  
Stefanie Sassen ◽  
Sven Mahner ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Residual Disease ◽  
Locally Advanced Breast Cancer ◽  
Locally Advanced ◽  
Emission Tomography ◽  
Primary Systemic Therapy ◽  
Histopathologic Response ◽  
Positron Emission

Purpose To evaluate positron emission tomography (PET) using [18F]fluorodeoxyglucose (FDG) for prediction of histopathologic response early during primary systemic therapy of large or locally advanced breast cancer. Patients and Methods In a prospective multicenter trial, 272 FDG-PET scans were performed in 104 patients at baseline (n = 104) and after the first (n = 87) and second cycle (n = 81) of chemotherapy. The level and relative changes in standardized uptake value (SUV) of FDG uptake were assessed regarding their ability to predict histopathologic response. All patients underwent surgery after chemotherapy, and histopathologic response defined as minimal residual disease or gross residual disease served as the reference standard. Results Seventeen (16%) of 104 patients were histopathologic responders and 87 were (84%) nonresponders. All patients for whom baseline SUV was less than 3.0 (n = 24) did not achieve a histopathologic response. SUV decreased by 51% ± 18% after the first cycle of chemotherapy in histopathologic responders (n = 15), compared with 37% ± 21% in nonresponders (n = 54; P = .01). A threshold of 45% decrease in SUV correctly identified 11 of 15 responders, and histopathologic nonresponders were identified with a negative predictive value of 90%. Similar results were found after the second cycle when using a threshold of 55% relative decrease in SUV. Conclusion FDG-PET allows for prediction of treatment response by the level of FDG uptake in terms of SUV at baseline and after each cycle of chemotherapy. Moreover, relative changes in SUV after the first and second cycle are a strong predictor of response. Thus, FDG-PET may be helpful for individual treatment stratification in breast cancer patients.

Prospective Multicenter Study Evaluating the Survival of Patients With Locally Advanced Cervical Cancer Undergoing Laparoscopic Para-Aortic Lymphadenectomy Before Chemoradiotherapy in the Era of Positron Emission Tomography Imaging

2013 ◽  
Vol 31 (24) ◽  
pp. 3026-3033 ◽  
Author(s):  
Sebastien Gouy ◽  
Philippe Morice ◽  
Fabrice Narducci ◽  
Catherine Uzan ◽  
Alejandra Martinez ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Locally Advanced ◽  
Nodal Metastasis ◽  
Emission Tomography ◽  
Advanced Cervical Cancer ◽  
Nodal Involvement ◽  
Prospective Multicenter Study ◽  
Locally Advanced Cervical Cancer ◽  
Positron Emission

Purpose The aim of this prospective study conducted in three French comprehensive cancer centers was to evaluate the therapeutic impact on survival of laparoscopic para-aortic (PA) staging surgery in locally advanced cervical cancer (LACC) before chemoradiotherapy. Patients and Methods We conducted a prospective multicenter study of 237 patients treated from 2004 to 2011 for LACC with negative positron emission tomography (PET) imaging of the PA area and undergoing laparoscopic PA lymphadenectomy. Radiation fields were extended to the PA area when PA nodes were involved. Chemoradiotherapy modalities were homogeneous across institutions. Patients with a poor prognosis histologic subtype or peritoneal carcinosis were excluded. Results Patients had clinical International Federation of Gynecology and Obstetrics stages IB2 (n = 79), IIA (n = 10), IIB (n = 121), III (n = 22), or IVA (n = 5). One hundred ninety-nine patients had squamous carcinoma, and 38 had adenocarcinoma/adenosquamous lesions. Twenty-nine patients (12%) had nodal involvement (false-negative PET–computed tomography [CT] results)—16 with a PA nodal metastasis measuring more than 5 mm and 13 with a nodal metastasis measuring ≤ 5 mm. Event-free survival rates at 3 years in patients without PA involvement or with PA metastasis measuring ≤ or more than 5 mm were 74% (SE, 4%), 69% (SE, 21%), and 17% (SE, 14%; P < .001). Conclusion To our knowledge, this is the largest series of patients reported undergoing such a strategy. We obtained the same survival rate for patients with PA nodal metastasis ≤ 5 mm and patients without PA lymph node involvement, suggesting that this strategy is highly efficient in such patients. Conversely, the survival of patients with PA nodal involvement greater than 5 mm remained poor, despite the absence of extrapelvic disease on PET-CT imaging in this subgroup.

Scaled Subprofile Modeling and Convolutional Neural Networks for the Identification of Parkinson’s Disease in 3D Nuclear Imaging Data

2019 ◽  
Vol 29 (09) ◽  
pp. 1950010 ◽  
Author(s):  
Octavio Martinez Manzanera ◽  
Sanne K. Meles ◽  
Klaus L. Leenders ◽  
Remco J. Renken ◽  
Marco Pagani ◽  
...  
Keyword(s):  
Neural Networks ◽  
Parkinson’S Disease ◽  
Positron Emission Tomography ◽  
Parkinson's Disease ◽  
Convolutional Neural Networks ◽  
Fdg Pet ◽  
Characteristic Curve ◽  
Emission Tomography ◽  
Imaging Data ◽  
Positron Emission

Over the last years convolutional neural networks (CNNs) have shown remarkable results in different image classification tasks, including medical imaging. One area that has been less explored with CNNs is Positron Emission Tomography (PET). Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is a PET technique employed to obtain a representation of brain metabolic function. In this study we employed 3D CNNs in FDG-PET brain images with the purpose of discriminating patients diagnosed with Parkinson’s disease (PD) from controls. We employed Scaled Subprofile Modeling using Principal Component Analysis as a preprocessing step to focus on specific brain regions and limit the number of voxels that are used as input for the CNNs, thereby increasing the signal-to-noise ratio in our data. We performed hyperparameter optimization on three CNN architectures to estimate the classification accuracy of the networks on new data. The best performance that we obtained was [Formula: see text] and area under the receiver operating characteristic curve [Formula: see text] on the test set. We believe that, with larger datasets, PD patients could be reliably distinguished from controls by FDG-PET scans alone and that this technique could be applied to more clinically challenging tasks, like the differential diagnosis of neurological disorders with similar symptoms, such as PD, Progressive Supranuclear Palsy (PSP) and Multiple System Atrophy (MSA).

Surveillance Procedures for Patients for Cervical Carcinoma: A Review of the Literature

2009 ◽  
Vol 19 (3) ◽  
pp. 306-313 ◽  
Author(s):  
Vanna Zanagnolo ◽  
Lucas Alfonso Minig ◽  
Angelo Gadducci ◽  
Tiziano Maggino ◽  
E. Sartori ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Cervical Cancer ◽  
Positron Emission Tomography ◽  
Clinical Outcome ◽  
Cervical Carcinoma ◽  
Disease Free Survival ◽  
Emission Tomography ◽  
Recurrent Cervical Cancer ◽  
Positron Emission

Cervical cancer is still one of the most common malignancies in women. Treatment for cervical cancer is very successful, especially in early stage. However, some patients will experience recurrence. Primary purpose of follow-up programs is early detection of recurrence disease that should be more likely to be amenable to treatment, thereby improving the clinical outcome. Although, in the literature, most studies have shown that the surveillance programs did not improve the clinical outcome of patients with diagnosis of recurrence, this clinical practice is regarded as traditional management. The use of Papanicolaou tests to detect recurrent cervical cancer is not sufficiently justified. The assessment of tumor markers such as squamous cell carcinoma antigen could be useful. Imaging techniques are important for the detection and assessment of recurrent disease. The role of chest radiographs to detect asymptomatic recurrence in patients treated for cervical carcinoma remains controversial. Detection of a new abnormal mass or the changes in the size of a known lesion caused by cancer growth and the determination of the extent of recurrence with computed tomography and magnetic resonance imaging may provide clinical assistance in selection of optimal therapy. The fluoro-2-deoxy-glucose-positron emission tomography for surveillance only shows 80% of specificity and accuracy with negative predictive value of 100%. Integrated fluoro-2-deoxy-glucose-positron emission tomography/computed tomography provides precise anatomic localization of suspicious areas and therefore a better diagnostic interpretation with a possible impact on disease-free survival as well. In conclusion, our review confirms the need of prospective studies to compare the effectiveness of different follow-up regimens measuring as outcome overall survival and quality of life parameters.

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