Prognostic role of early interim [18F] fluoro-deoxy-glucose positron emission tomography in patients with advanced seminoma undergoing standard treatment.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 5055-5055
Author(s):  
Daniele Raggi ◽  
Marco Bandini ◽  
Patrizia Giannatempo ◽  
Elena Farè ◽  
Laura Marandino ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Cox Regression ◽  
Clinical Stage ◽  
Risk Groups ◽  
Emission Tomography ◽  
Maximum Diameter ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Pet Ct

5055 Background: In patients (pts) with advanced seminoma, efforts are underway to tailor a risk-adapted treatment strategy to the individual pt. Our main objective was to prospectively determine the prognostic value of [18F]fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT2) after two cycles of bleomycin, etoposide and cisplatin (BEP) or EP chemotherapy under standardized treatment and PET evaluation criteria. Methods: Pts with advanced-stage seminoma were treated with BEP or EP according to guidelines. PET/CT examinations were performed at baseline, after two cycles in all pts and after chemotherapy at physician’s choice. PET/CT response was qualitatively evaluated by two independent nuclear medicine physicians. Contrast-enhanced CT scans were also performed according to the guidelines (at baseline, after treatment, during follow-up). The primary endpoint was the relapse-free survival (RFS). Results: From 01/2009 to 01/2017, 75 consecutive pts were enrolled, of whom 70 were evaluable. The clinical stage was IIA-B and IIC-III in 40% and 60% of the pts, respectively. Eight pts (11.4%) received consolidation radiotherapy. By local assessment, 46 PET/CT2 scans (65.7%) were reported as negative, and 46% of these pts presented with stage IIC-III. The median follow-up was 79 months. Five-year RFS of PET/CT2-positive pts was 75% (95%CI: 60-95%) compared with 97.8% (95%CI: 93.7-100%) of PET/CT2-negative pts (p = .002). This significant improvement in RFS was maintained when analyzing only pts with clinical stage IIC-III (p = 0.04) and by excluding those who received consolidation RT (p = 0.02). An increasing linear association was found between the maximum diameter of retroperitoneal lymph nodes and the rate of PET/CT2+. In univariable Cox regression analyses, PET/CT2+ (HR: 12.9, 95%CI: 1.5-106.9, p = 0.02) and elevated HCG levels (HR: 6.3, 95%CI: 1.2-32.3, p = 0.03) were significantly associated with RFS, whereas IGCCCG risk group was not (p = 0.1). PET/CT2 result was also associated with the tumor shrinkage post-BEP (p = 0.009), whereas complete response at CT did not predict the RFS (p = 0.3). Conclusions: No residual FDG-uptake after 2 cycles of conventional chemotherapy is prognostic in advanced seminoma, may outperform the utility of standard prognostic risk groups and may be more accurate to predict the RFS compared to standard response criteria. Benchmark RFS estimates for the design of the next clinical trials of chemotherapy de-escalation are offered.

scholarly journals Prospective Study on the Performance of 18F-DOPA Positron Emission Tomography/Computed Tomography in Patients with Medullary Thyroid Carcinoma

2022 ◽  
Author(s):  
Inés Califano ◽  
Fabian Pitoia ◽  
Roxana Chirico ◽  
Alejandra de Salazar ◽  
Maria Bastianello
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Distant Metastases ◽  
Emission Tomography ◽  
Medullary Thyroid ◽  
Contrast Enhanced Ct ◽  
Positron Emission ◽  
Contrast Enhanced ◽  
Pet Ct ◽  
Enhanced Ct

Abstract Purpose 18F-DOPA Positron Emission Tomography/Computed Tomography (18F-DOPA PET/CT) is a sensitive functional imaging method (65-75%) for detecting disease localization in medullary thyroid cancer (MTC). We aimed: i) to assess the clinical usefulness of 18F-DOPA PET/CT in patients with MTC and elevated calcitonin (Ctn) and CEA levels and, ii) to evaluate changes in disease management secondary to the findings encountered with this methodology. Methods thirty-six patients with MTC and Ctn levels ≥150 pg/ml were prospectively included. Neck ultrasound, chest contrast-enhanced CT, liver magnetic resonance imaging/ abdominal 3-phase contrast-enhanced CT and bone scintigraphy were carried out up to 6 months before the 18F DOPA PET/CT. Results 77.7% were female and 27% had hereditary MTC. Median Ctn level was 1450 pg/ml [150-56620], median CEA level 413 ng/ml [2.9-7436]. Median Ctn DT was 37.5 months [5.7-240]; median CEA DT was 31.8 [4.9-180]. 18F-DOPA PET/CT was positive in 33 patients (91.6%); in 18 (56%) uptake was observed in lymph nodes in the neck or mediastinum, in 7 cases (22%) distant metastases were diagnosed, and in 8 additional patients (24%) both locoregional and distant sites of disease were found. Ctn and CEA levels were higher in patients with ≥ 3 foci of distant metastases. In 14 patients (38.8%), findings on 18F-DOPA PET/CT led to changes in management; surgery for locoregional lymph nodes was the most frequent procedure in 8 patients (22%). Conclusion 18F-DOPA PET/CT was useful for the detection of recurrent disease in MTC and provided helpful information for patient management.

scholarly journals IMAGING IN ENDOCRINOLOGY: 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography in differentiated thyroid carcinoma: clinical indications and controversies in diagnosis and follow-up

2015 ◽  
Vol 173 (3) ◽  
pp. R115-R130 ◽  
Author(s):  
Massimo Salvatori ◽  
Bernadette Biondi ◽  
Vittoria Rufini
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Emission Tomography ◽  
Whole Body ◽  
Clinical Indications ◽  
Positron Emission ◽  
Pet Ct ◽  
Fdg Pet Ct

In recent years, 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (FDG-PET/CT) has emerged as an important tool for the postoperative management of patients with differentiated thyroid cancer (DTC) and it is widely used in selected clinical situations. The most valuable role that FDG-PET/CT plays in clinical practice is that it can be used to obtain prognostic information in patients with increasing thyroglobulin (Tg) levels and negative 131I whole-body scan post-thyroidectomy and radioiodine (RAI) ablation. FDG-PET/CT may also have a potential role in the initial staging and follow-up of high-risk patients with aggressive histological subtypes, in the identification of patients who are at the highest risk of disease-specific mortality, in the management of patients with RAI-refractory disease, in clinical trials of novel targeted therapies in patients with advanced metastatic disease, and in the evaluation of thyroid nodules with indeterminate fine-needle aspiration for cytology. However, several controversies remain to be resolved, namely: the cutoff value of Tg in the selection of DTC patients for FDG-PET/CT, whether FDG-PET/CT scanning should be performed under thyrotropin stimulation or suppression, and the clinical significance of thyroid FDG-PET/CT incidentalomas. The aim of the present article is to provide an overview of the data about the molecular basis for, clinical indications of, and controversies related to the use of FDG-PET/CT in patients with DTC.

Traditional Versus Up-Front [18F] Fluorodeoxyglucose–Positron Emission Tomography Staging of Non–Small-Cell Lung Cancer: A Dutch Cooperative Randomized Study

2006 ◽  
Vol 24 (12) ◽  
pp. 1800-1806 ◽  
Author(s):  
Gerarda J.M. Herder ◽  
Henk Kramer ◽  
Otto S. Hoekstra ◽  
Egbert F. Smit ◽  
Jan Pruim ◽  
...  
Keyword(s):  
Lung Cancer ◽  
Positron Emission Tomography ◽  
Final Stage ◽  
Clinical Stage ◽  
Randomized Study ◽  
Tnm Staging ◽  
Emission Tomography ◽  
Positron Emission

Purpose We investigated whether application of positron emission tomography (PET) immediately after first presentation might simplify staging while maintaining accuracy, as compared with traditional strategy in routine clinical setting. Methods At first presentation, patients with a provisional diagnosis of lung cancer without overt dissemination were randomly assigned to traditional work-up (TWU) according to international guidelines or early PET followed by histologic/cytologic verification of lesions, or imaging and follow-up. Patients with [18F] fluorodeoxyglucose (18FDG) –avid, noncentral tumors without suspicion of mediastinal or distant metastases on PET proceeded directly to thoracotomy. Follow-up in presumed benign lesions was at least 12 months. In patients treated with surgery or neoadjuvant therapy, the quality of staging was measured by comparing the clinical stage to the final stage (combination of peroperative staging and 6 months of follow-up). To investigate test substitution, we analyzed the number of (non)invasive tests to achieve clinical TNM staging, and its associated costs. Results Between 1999 and 2001, 465 patients (233 TWU, 232 PET) were enrolled at 22 hospitals. The mean (standard deviation) number of procedures to finalize staging was equal in the TWU arm and the PET arm: 7.9 (2.0) v 7.9 (1.9), P = .90, respectively. Mediastinoscopies occurred significantly less often in the PET arm. Agreement between clinical and final stage was good in both arms (κ = .85 v .78; P = .07). Costs did not differ significantly. Conclusion Up-front 18FDG-PET in patients with (suspected) lung cancer does not reduce the overall number of diagnostic test, but it maintains quality of TNM staging with the use of less invasive surgery.

scholarly journals Reliability of Contrast CT and Positron Emission Tomography in Post-Surgical Colorectal Cancer and Its Association with Obesity

2019 ◽  
Vol 7 (14) ◽  
pp. 2256-2262
Author(s):  
Safenaz Y. El Sherity ◽  
Shymaa A. A Shalaby ◽  
Nayera E. Hassan ◽  
Sahar A. El-Masry ◽  
Rokia A. El-Banna
Keyword(s):  
Colorectal Cancer ◽  
Positron Emission Tomography ◽  
Risk Factor ◽  
Therapeutic Response ◽  
Abdominal Fat ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Contrast Ct

BACKGROUND: Post-surgical recurrence of cancer colon occurs in one-third of patients within the first two years, so early detection is important. The assessment of the therapeutic response is important to change protocol strategy. Positron emission tomography/computed tomography PET/CT, a valuable tool gives both metabolic and anatomic information for whole-body regions. Obesity is an important risk factor for colorectal cancer. AIM: To evaluate post-surgical and therapeutic colorectal cancer by PET/CT and study obesity association to its prognosis. METHODS: This was a prospective study involved 93 patients with, post-surgical colorectal cancer examined by PET/CT, then follow up after 4-6 months. RESULTS: There was a statistically significant difference between PET/CT and contrast CT. The sensitivity& the specificity were (96.4%-100% & 92.3%-98.2%) for PET/CT and (84.2%-90.2% & 76.5%-85.4%) for contrast CT respectively. Post-therapeutic follow up showed; progressive course (24.5%), stationary course (26.4%), partial regression (28.3%) and complete regression course (20.8%). Obesity is a risk factor for progression with highly statistically significant to treatment response. Obese patients had a progressive or stationary course of the disease. Also, there was a highly statistically significant association between total abdominal fat & visceral abdominal fat areas with good response of treatment. CONCLUSION: PET/CT is the most appropriate imaging technique to detect any recurrence or metastases in post-surgical colorectal cancer with high sensitivity and specificity comparing to CT. Obesity is a predictor risk factor for prognosis of the disease, as generally and abdominally (total & visceral fat) had an association with therapeutic response.

scholarly journals Prognostic Value of Volume-Based Positron Emission Tomography/Computed Tomography in Nasopharyngeal Carcinoma Patients after Comprehensive Therapy

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Yueli Tian ◽  
Khamis Hassan Bakari ◽  
Shanshan Liao ◽  
Xiaotian Xia ◽  
Xun Sun ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Overall Survival ◽  
Nasopharyngeal Carcinoma ◽  
Prognostic Value ◽  
Emission Tomography ◽  
Whole Body ◽  
Positron Emission ◽  
Pet Ct

Objective. We assessed the prognostic value of standardized uptake value (SUV) and volume-based methods including whole-body metabolic tumor volume (WBMTV) and whole-body total lesion glycolysis (WBTLG) using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) of patients with nasopharyngeal carcinoma (NPC) after therapy. Methods. A total of 221 posttherapy NPC cases were enrolled, all of whom had undergone PET/CT scanning and follow-up in this retrospective study. The diagnostic results of PET/CT were analyzed and compared with histopathological diagnosis or clinical follow-up. Receiver operator characteristic curves, the Kaplan-Meier method, and the log-rank test were used to assess the optimal cutoff values for WBMTV and WBTLG to identify independent predictors of survival. Results. The detection rates of the threshold SUV were 2.5, 20%, and 40%, and SUV background methods were 65.6% (378/576), 80.2% (462/576), 71.5% (412/576), and 90.4% (521/576), respectively (P<0.005). Patients with a WBMTV < 8.10 and/or a WBTLG < 35.58 had significantly better 5-year overall survival than those above the cutoffs (90.7% versus 51.2%, P<0.001; 91.7% versus 50.4%, P<0.001), respectively. Multivariate Cox regression modeling showed both WBTLG (RR, 1.002; P=0.004) and age (RR, 1.046; P=0.006) could be used to predict overall survival. WBTLG (RR, 1.003; P<0.001) may have predictive relevance in estimating disease-free survival. Conclusions. SUV volume-based threshold background methodology had a significantly higher detection rate for metastatic lesions. WBTLG could be used as an independent prognostic indicator for posttherapy NPC.

scholarly journals Radiomics-Based Texture Analysis of 68Ga-DOTATATE Positron Emission Tomography and Computed Tomography Images as a Prognostic Biomarker in Adults With Neuroendocrine Cancers Treated With 177Lu-DOTATATE

2021 ◽  
Vol 11 ◽  
Author(s):  
Charlotte Atkinson ◽  
Balaji Ganeshan ◽  
Raymond Endozo ◽  
Simon Wan ◽  
Matthew D. Aldridge ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Texture Analysis ◽  
Cox Regression ◽  
Emission Tomography ◽  
Unknown Primary ◽  
Cox Regression Analysis ◽  
Computed Tomography Images ◽  
Positron Emission ◽  
Pet Ct

PurposeNeuroendocrine tumors (NET) are rare cancers with variable behavior. A better understanding of prognosis would aid individualized management. The aim of this hypothesis-generating pilot study was to investigate the prognostic potential of tumor heterogeneity and tracer avidity in NET using texture analysis (TA) of 68Ga-DOTATATE positron emission tomography (PET) and non-enhanced computed tomography (CT) performed at baseline in patients treated with 177Lu-DOTATATE. It aims to justify a larger-scale study to evaluate its clinical value.MethodsThe pretherapy 68Ga-DOTATATE PET-CT scans of 44 patients with metastatic NET (carcinoid, pancreatic, thyroid, head and neck, catecholamine-secreting, and unknown primary NET) treated with 177Lu-DOTATATE were analyzed retrospectively using commercially available texture analysis research software. Image filtration extracted and enhanced objects of different sizes (fine, medium, coarse), then quantified heterogeneity by statistical and histogram-based parameters (mean intensity, standard deviation, entropy, mean of positive pixels, skewness, and kurtosis). Regions of interest were manually drawn around up to five of the most 68Ga-DOTATATE avid lesions for each patient. 68Gallium uptake on PET was quantified as SUVmax and SUVmean. Associations between imaging and clinical markers with progression-free (PFS) and overall survival (OS) were assessed using univariate Kaplan-Meier analysis. Independence of the significant univariate markers of survival was tested using multivariate Cox regression analysis.ResultsMeasures of heterogeneity (higher kurtosis, higher entropy, and lower skewness) on coarse-texture scale CT and unfiltered PET images predicted shorter PFS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness: p=0.03) and shorter OS (CT coarse kurtosis: p=0.05, PET entropy: p=0.01, PET skewness p=0.02). Conventional PET parameters such as SUVmax and SUVmean showed trends towards predicting outcome but were not statistically significant. Multivariate analysis identified that CT-TA (coarse kurtosis: HR=2.57, 95% CI=1.22–5.38, p=0.013) independently predicted PFS, and PET-TA (unfiltered skewness: HR=9.05, 95% CI=1.19–68.91, p=0.033) independently predicted OS.ConclusionThese preliminary data generate a hypothesis that radiomic analysis of neuroendocrine cancer on 68Ga-DOTATATE PET-CT may be of prognostic value and a valuable addition to the assessment of patients.

Usefulness of Positron Emission Tomography Using 18F-FDG Performed At Diagnosis and During Initial Chemotherapy for Imaging Primary Central Nervous System Lymphoma: A 24 Immunocompetent patient's Study.

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 1597-1597 ◽  
Author(s):  
Herve Ghesquieres ◽  
Céline Ferlay ◽  
Bertrand Richioud ◽  
Vanina Isnardi ◽  
Emmanuelle Nicolas-Virlizier ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Fdg Pet ◽  
Central Nervous System Lymphoma ◽  
Emission Tomography ◽  
Positron Emission ◽  
Systemic Spread ◽  
Pet Ct ◽  
The Mean ◽  
Fdg Pet Ct

Abstract Abstract 1597 Background: Primary central nervous system lymphoma (PCNSL) is a rare brain tumor potentially curable by chemotherapy alone or a combination of chemotherapy and radiation therapy. At staging, gadolinium-enhanced magnetic resonance imaging (MRI) is the standard method to evaluate CNS lesions and computed tomography (CT) is perform at diagnosis to detect the presence of a systemic disease. The initial tumor response to therapy is usually assessed by MRI. At present, there are no established imaging markers of prognosis in patients with PCNSL. Positron emission tomography (PET) using 18F-Fluorodeoxyglucose (FDG) is routinely used for the initial staging and the evaluation of treatment response in systemic Diffuse Large B-cell Lymphoma (DLBCL). In PCNSL, the clinical relevance of positron emission tomography FDG PET/CT is not well known. The aim of our study was to determine the added value of FDG PET/CT in the management of PCNSL performed at diagnosis and during initial treatment to assess whether it could predict the outcome of PCNSL patients. Patients and methods: From august 2008 to may 2011, we enrolled 24 consecutive PCNSL immunocompetent patients with histological proven DLBCL who underwent FDG PET/CT before specific treatment. The mean age of patients was 63.7 years (range, 51.7–78.8). Follow-up FDG PET/CT examinations were performed in 14 of them (58%) after 2 cycles of chemotherapy and in patients who relapsed. All PET images were acquired 1 hour after FDG injection and interpreted qualitatively and semi quantitatively by 2 nuclear medicine physician. The maximum standard uptake value (maxSUV) corrected to body weight and injected FDG activity was measured for each patient into the most hypermetabolic CNS lesion (TmaxSUV). The results were compared to the clinical and conventional imaging data. The correlation between TmaxSUV and respectively the Progression Free Survival (PFS) and Overall Survival (OS) was statistically analysed. We also evaluated for 15 patients, the correlation between the Ki67 index on tumors and TmaxSUV. Results: All the patients presented with brain lesions. The spinal cord was also involved in 1 of them. The sensitivity of FDG PET/CT for the detection of CNS lesions was 91.7 %. Two out of 24 patients were considered as false negative. The mean TmaxSUV was 13.9 +/− 9.3 (range, 4.9–38). FDG PET/CT found systemic spread of lymphoma in 2 patients (8.3%). Follow-up ranged from 3.2 to 33.8 months (mean, 20.6 months). After 2 cycles of chemotherapy, FDG PET/CT was considered as negative in 14/14 patients whereas gadolinium-enhanced MRI showed lesions with residual contrast-enhancement in 7 of them. Four patients who were PET- and MRI + after 2 cycles of chemotherapy relapsed exclusively into the CNS (n=2) and/or outside (n=2). FDG PET/CT showed all the sites of relapse. At last follow-up, 18 patients were alive and six died of progressive disease. No correlation between TmaxSUV at diagnosis and PFS (P =.15), OS (P =.14) and Ki67 index was respectively observed. Conclusions: Although the physiologic glucose metabolism in normal brain tissue is high, FDG PET/CT has a good sensitivity to detect PCNSL. FDG PET/CT could be useful to detect any systemic spread of PCNSL at staging and is able to diagnose disease relapse. Pretreatment Tmax SUV is not correlated with PFS and OS in our study. Moreover, FDG PET/CT seems not to be reliable for the prediction of relapse when it is performed after 2 cycles of chemotherapy. Others type of TEP tracers need to be study in PCNSL for response assessment and the prediction of patient's outcome. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Comparison between The Diagnostic Performance of Positron Emission Tomography and Diffusion-Weighted MRI in Detecting Recurrence of Head and Neck Squamous Cell Carcinoma during Post Treatment Follow-up

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Talaat ◽  
E K Hakim ◽  
M S Taha ◽  
T M Rabie ◽  
A M Askoura ◽  
...  
Keyword(s):  
Positron Emission Tomography ◽  
Squamous Cell Carcinoma ◽  
Meta Analysis ◽  
Emission Tomography ◽  
Diffusion Weighted Mri ◽  
Positron Emission ◽  
Pet Ct ◽  
Significant Difference ◽  
Pet Ct Scan

Abstract Background Head and neck squamous cell carcinoma (HNSCC) is the sixth most common malignancy worldwide. (16) Despite aggressive combined-modality treatment regimens, there remains a high percentage (15-50%) of locoregional recurrences.(7) This problem make the clinician to rely on the functional imaging modalities such as Diffusion weighted MRI and Positron Emission Tomography to detect recurrence. Objective To perform a meta-analytical study on the comparison between the diagnostic role of DW/MRI and PET/CT scan in detecting recurrence of HNSCC during post-treatment follow-up. Methods This meta-analysis was conducted from 1/1/ 1998 to 31/3/2018 . Literature search on PubMed and Google scholar was done to identify randomised controlled trials and comparative studies either prospective or retrospective. MedCalc ver. 18.2 (MedCalc, Ostend, Belgium) was used for data analysis. Results Of the eight articles included, The meta-analysis was based on a total of 199 patients. All of them used DW/MRI and 186 of them used PET/CT. Comparative study between the two groups regarding sensitivity, specificity and accuracy revealed; highly significant difference in sensitivity in favor of PET/CT (p &lt; 0.009), significant increase in specificity in favor of DW/MRI (p = 0.048) and no significant difference in accuracy between the two group. Conclusion PET/CT scan was found to be more sensitive than DW/MRI while DW/MRI was found to be more specific than PET/CT. Yet both have the same degree of accuracy.

Clinical impact of positron emission tomography or positron emission tomography/computed tomography in the posttherapy surveillance of endometrial carcinoma: evaluation of 88 patients

2008 ◽  
Vol 18 (6) ◽  
pp. 1332-1338 ◽  
Author(s):  
J.-Y. Park ◽  
E. N. Kim ◽  
D.-Y. Kim ◽  
J.-H. Kim ◽  
Y.-M. Kim ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Positron Emission Tomography ◽  
Endometrial Carcinoma ◽  
Predictive Value ◽  
Clinical Impact ◽  
Emission Tomography ◽  
Positron Emission ◽  
Pet Ct ◽  
Sensitivity Specificity

The objective of this study was to evaluate the validity and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) using 18-fluoro-2-deoxy-D-glucose in the posttherapy surveillance of patients with endometrial carcinoma. Eighty-eight patients previously treated for histopathologically diagnosed endometrial adenocarcinoma underwent 99 PET or PET/CT scans at follow-up visits at Asan Medical Center, Seoul, Korea, between 2001 and 2007. The standard of reference for tumor recurrence consisted of histopathologic confirmation or follow-up information at least 6 months after PET or PET/CT. Of the 88 patients, 24 underwent PET (n= 11) and/or PET/CT (n= 14) scans due to suspected disease recurrence. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of PET and/or PET/CT in detecting recurrence in these patients were 100%, 83.3%, 96%, 95%, and 100%, respectively. Especially, PET/CT revealed true-positive findings in three patients with elevated tumor markers but negative CT findings. The remaining 64 patients underwent PET (n= 8) and/or PET/CT (n= 66) as part of routine posttherapy surveillance; these patients were asymptomatic, with no evidence of disease. The sensitivity, specificity, accuracy, PPV, and NPV of PET and/or PET/CT in detecting recurrence in these patients were all 100%. Clinical decisions on treatment were changed in 14 (21.9%) patients by introducing PET or PET/CT into their conventional posttherapy surveillance program. PET and/or PET/CT were highly effective in discriminating true recurrence in patients with suspected recurrence, highly sensitive in detecting recurrence in asymptomatic patients, and had impacts on clinical decisions in a considerable portion of patients.

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