Actionable locoregional failures (LRFs) after therapy of localized esophageal carcinoma (LEC): Surveillance strategies and their benefits.

21 Background: The goal of surveillance after local therapy (trimodality or bimodality) is to salvage patients with actionable LRF, however, the benefits of current surveillance strategies are not well documented. We report on a large cohort of LEC patients with actionable LRF. Methods: Between 2000 and 2013, 127 patients with actionable LRF were assessed. Histologic/cytologic confirmation of LRF was the gold standard. All surveillance tools (imaging and endoscopy) were assessed. Results: The majority of the patients were men (89%), had adenocarcinoma (79%), had their LRF identified through surveillance (85%) and most had no new symptoms (72%). For the 41 LRFs after trimodality, the sensitivity of PET/CT alone was 93% but the specificity was 67%. In trimodality patients with a positive PET/CT for LRF, only 44% had LRF confirmed by endoscopy and 56% LRFs confirm by additional testing (e.g., FNA, etc). Alternatively, in bimodality patients, endoscopy confirmed LRF in 81% (n=85; 1 patient not evaluable). Trimodality patients were at higher risk of subsequent (e.g., distant) relapse after LRF was documented than were bimodality patients (p=0.03); 78% of the relapses were distant. In bimodality patients, 99% of relapses (LRF and/or distant) occurred within 36 months of therapy while in trimodality patients, 90% of relapses occurred within 36 months of surgery. Conclusions: Our data suggest that PET/CT is more likely to detect LRFs than endoscopy in trimodality patients. However, in bimodality patients, endoscopy is more valuable than PET/CT for documenting LRFs. At least 3 years of surveillance are needed for all LEC patients. However, even after the salvage, distant relapses are common. From U. T. M. D. Anderson Cancer Center (UTMDACC), Houston, Texas, USA. (Supported in part by UTMDACC, and CA 138671 and CA172741 from the NCI).

Download Full-text

Exceptions to the rule: Novel retrospective analysis of a single-center institution of the PSMA PET/CT modality.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e14625 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e14625-e14625

Author(s):

Vipal P. Durkal ◽

Matthew Rettig

Keyword(s):

Gold Standard ◽

Case Reports ◽

False Negative ◽

Cancer Center ◽

Negative Results ◽

False Negative Results ◽

Psma Pet ◽

Pet Ct ◽

Adenocarcinoma Of The Prostate ◽

Average Size

e14625 Exceptions to the Rule: Using Pathology as a Gold Standard to Evaluate the Sensitivity of PSMA PET/CT Modality. Background: The experience with the novel Ga-68 PSMA PET/CT imaging and its limitations are described anecdotally in the literature. Cases of false-positive PSMA PET/CT of various benign and malignant etiologies are described in case reports. False-negative PSMA PET/CT results are significantly less well characterized. Our analysis is based on the UCLA Cancer Center experience with patients who underwent PSMA PET/CT and subsequent biopsy of target lesions. Methods: Of 44 evaluable patients, we found four patients with false negative results based on the 'Gold Standard' of pathologic biopsy. In this context, false negative is defined as PSMA PET/CT negative but proven to be PSMA-expressing adenocarcinoma of the prostate using biopsy of target lesions. Results: In our analysis, we found several stark patterns of these false-negative lesions. The vast majority were pulmonary in origin (75%). Their average size was subcentimeter (0.96 cm). The average Gleason Score at diagnosis was relatively high (8.25), while the initial PSA at diagnosis was relatively modest (4.3). A majority (75%) of these patients received radiation to the prostate. In terms of treatment: a majority were on Androgen-Deprivation Therapy (75%); Abiraterone (50%); had received prostatectomy (100%). The average age at diagnosis was 65. Conclusions: False-negative adenocarcinoma of the prostate that has been-biopsy proven to express PSMA has not been described in the literature. This is the first such instance that we can encountered. The implications of this finding are potentially far-reaching, since the lung remains the second most common site of metastasis in prostate cancer after the bone. The average sub-centimeter size of the target lesions that were biopsied suggests that the density of PSMA receptors may have a role in the detection on Ga-68 PSMA PET/CT and correlate with sensitivity.

Download Full-text

Total FDG lesion number on PET/CT predicts survival of esophageal carcinoma patients with recurrence following curative surgery

The Quarterly Journal of Nuclear Medicine and Molecular Imaging ◽

10.23736/s1824-4785.18.03041-8 ◽

2020 ◽

Vol 64 (2) ◽

Author(s):

Soo J. Kim ◽

Seung H. Hyun ◽

Seung H. Moon ◽

Young S. Cho ◽

Hyun K. Yi ◽

...

Keyword(s):

Esophageal Carcinoma ◽

Curative Surgery ◽

Pet Ct ◽

Lesion Number

Download Full-text

BIOM-02. LEPTOMENINGEAL DISEASE SECONDARY TO MELANOMA: UPDATES ON THE VALIDITY OF THE VERIDEX CELLSEARCH SYSTEM

Neuro-Oncology ◽

10.1093/neuonc/noab196.034 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi10-vi10

Author(s):

yolanda Pina ◽

Sepideh Mokhtari ◽

Youngchul Kim ◽

Brittany Evernden ◽

Nam Tran ◽

...

Keyword(s):

Median Survival ◽

Gold Standard ◽

Retrospective Chart Review ◽

Standard Test ◽

Diagnostic Tools ◽

Cancer Center ◽

Leptomeningeal Disease ◽

Csf Cytology ◽

Cellsearch System ◽

Additional Tool

Abstract BACKGROUND Leptomeningeal disease (LMD) is devastating with a median survival of 8-10 weeks without treatment. LMD affects approximately 5% to 25% of melanoma patients. Its pathophysiology remains unknown and effective treatments are virtually non-existent. The primary aim of this study was to evaluate the validity of Veridex CellSearch® System (VCS) compared to Gold Standard test (i.e., CSF cytology). MATERIALS AND METHODS A retrospective chart review was performed of subjects with suspected LMD from melanoma enrolled in the MCC 19332/19648 at Moffitt Cancer Center. Patients underwent standard of care with different treatments as deemed appropriate by treating physician. CSF samples were obtained from lumbar punctures, surgeries, and Ommaya reservoir. CSF was evaluated for quantification of CSF circulating tumor cells (CTCs) with the Veridex CellSearch® System (VCS). RESULTS Forty-eight patients were identified with melanoma as primary tumor, ages 29-80. Twenty-seven had LMD (median age 62) with median KPS 70. N=19 (70%) were diagnosed radiographically and n=5 (19%) with CSF cytology; n=14 (54%) had positive cytology on first LP. From 24 patients with LMD who underwent VCS, n=22 (92% patients had positive CSF CTCs. Number of CTCs/mL CSF was significantly higher in patients with LMD versus in patients without LMD (mean SD 227.6 vs. 0.07, p < 0.001). VCS sensitivity and specificity was analyzed. AUC was 0.515, with TPR 0.250 and FPR 0.286. CSF analysis and treatments were described. The median survival of those with LMD was 2.7 months. CONCLUSION These results indicate the potential value of the VCS as an additional tool to the gold standard in the diagnosis of LMD in patients with high suspicion of the disease. Future directions involve doing prospective studies to further validate this method, and to better understand this patient population to enhance diagnostic tools and management of LMD.

Download Full-text

PV Modeling of Medical Imaging Systems

Benford's Law ◽

10.23943/princeton/9780691147611.003.0018 ◽

2015 ◽

Author(s):

John Chiverton ◽

Kevin Wells

Keyword(s):

Medical Imaging ◽

Gold Standard ◽

Ground Truth ◽

Imaging Data ◽

Nuclear Medicine Imaging ◽

Phantom Imaging ◽

Positron Emission ◽

Pet Ct ◽

Many Sources

This chapter applies a Bayesian formulation of the Partial Volume (PV) effect, based on the Benford distribution, to the statistical classification of nuclear medicine imaging data: specifically Positron Emission Tomography (PET) acquired as part of a PET-CT phantom imaging procedure. The Benford distribution is a discrete probability distribution of great interest for medical imaging, because it describes the probabilities of occurrence of single digits in many sources of data. The chapter thus describes the PET-CT imaging and post-processing process to derive a gold standard. Moreover, this chapter uses it as a ground truth for the assessment of a Benford classifier formulation. The use of this gold standard shows that the classification of both the simulated and real phantom imaging data is well described by the Benford distribution.

Download Full-text