Cervical Lymph Nodes Detected by F-18 FDG PET/CT in Oncology Patients: Added Value of Subsequent Ultrasonography for Determining Nodal Metastasis

Background and Objectives: To investigate the diagnostic performance of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) and subsequent ultrasonography (US) for determining cervical nodal metastasis in oncology patients. Materials and Methods: Fifty-nine cervical lymph nodes (LNs) initially detected by PET/CT with subsequent neck US were included in this retrospective study. All LNs were subjected to US-guided fine-needle aspiration or core needle biopsy. The maximum standardized uptake value (SUVmax) and sonographic features were assessed. Results: Forty-three of 59 cervical LNs detected by PET/CT were malignant. PET/CT alone showed a highest diagnostic value for metastatic LNs with 81.4% sensitivity, 68.8% specificity, and 78% accuracy when SUVmax ≥5.8 was applied as an optimal cut-off value. Combined PET/CT and subsequent US diagnoses for determining nodal metastasis showed the following diagnostic performance: 81.4% sensitivity, 87.5% specificity, and 83.1% accuracy. There was a significant difference in the diagnostic performance between the two diagnostic imaging approaches (p = 0.006). Conclusions: Combined diagnosis using subsequent US showed a significantly higher diagnostic performance for determining nodal metastasis in the neck. Therefore, we believe that our proposed diagnostic strategy using subsequent US can be helpful in evaluating cervical LNs on PET/CT. Moreover, our results clarify the need for US-guided tissue sampling in oncology patients.

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Application of Deep Learning as a Noninvasive Tool to Determine Pathological Diagnosis of Enlarged Cervical Lymph Nodes with PET/CT

10.21203/rs.3.rs-75481/v1 ◽

2020 ◽

Author(s):

Yuhan Yang ◽

Bo Zheng ◽

Yixi Wang ◽

Xuelei Ma

Keyword(s):

Deep Learning ◽

Lymph Nodes ◽

Diagnostic Performance ◽

Imaging Modality ◽

Ct Images ◽

Pathological Diagnosis ◽

Therapeutic Interventions ◽

Cross Sectional ◽

Cervical Lymph Nodes ◽

Pet Ct

Abstract Objective: To construct a deep-learning convolution neural network (DL-CNN) system for pathological diagnosis of cervical lymph nodes by using computed tomography (CT), fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET), and fused PET/CT images.Materials and methods: A total of 1020 cross-sectional images for each imaging modality was obtained from 211 patients (153 patients with lymphomas and 116 patients with metastases) with enlarged cervical lymph nodes from January 2014 to June 2018. All eligible images were distributed randomly into the training, validation, and testing cohorts with ratios of 70%, 15%, and 15%. We applied eight DL-CNN algorithms with pretrained bases from ImageNet dataset on CT, PET, and fused PET/CT imaging datasets to differentiate lymphomatous nodes from metastatic nodes, respectively. Attention heatmaps of PET and fused PET/CT images generated by class activation mapping (CAM) were used in visualization of class specific regions recognized by the prediction model with best performance. Results: The accuracy of eight deep learning algorithms with pretrained base ranged from 0.650 to 0.981 on PET testing cohort, and from 0.738 to 0.981 on fused PET/CT testing cohort. The VGG16 model on PET images and DenseNet121 model on fused PET/CT images had the best diagnostic performance among all eight algorithms with sensitivity and specificity of 1.000 and 0.963. Class-specific discriminative subregions were highlighted by attention maps for clinical review.Conclusion: A DL-CNN system was developed for classifying metastatic and lymphomatous involvement with favorable diagnostic performance on PET and PET/CT images in patients with enlarged cervical lymph nodes. The further clinical practice of this system may improve quality of the following therapeutic interventions and optimize patients’ outcomes.

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Role of 18F-PET-CT to predict pathological response after neoadjuvant treatment of rectal cancer

Discover Oncology ◽

10.1007/s12672-021-00405-w ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Riccardo Caruso ◽

Emilio Vicente ◽

Yolanda Quijano ◽

Hipolito Duran ◽

Isabel Fabra ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Standardized Uptake Value ◽

Tumour Regression Grade ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives Neoadjuvant chemoradiation (nCRT) is universally considered to be a valid treatment to achieve downstaging, to improve local disease control and to obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in the tumour 18F-FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of the pathologic response (pR) achieved in patients with LARC. Data description We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients underwent a baseline 18F-FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-CT SUV2) within 6 weeks of the completion of nCRT. We evaluated the prognostic value of 18F-FDG PET-CT in terms of disease-free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumour regression grade): 107 (80%) as the responders group (TRG0-TRG1) and 26 (25%) as the no-responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups; responders versus no-responders (p < 0.012). The results of this analysis show that 18F-FDG PET-CT may be an indicator to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumour may offer important information in order for an early identification of those patients more likely to obtain a pCR to nCRT and to predict those who are unlikely to significantly regress.

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Sarcoidosis and Sarcoid Reactions in Endometrial Cancer Cases Masquerading Advanced Stage Malignancy

Current Women s Health Reviews ◽

10.2174/1573404817666210208163237 ◽

2021 ◽

Vol 17 ◽

Author(s):

Serkan Akis ◽

Canan Kabaca ◽

Esra Keles ◽

Handan Cetiner ◽

Hatice Akay

Keyword(s):

Endometrial Cancer ◽

Lymph Nodes ◽

Inflammatory Diseases ◽

Uterine Cavity ◽

Standardized Uptake Value ◽

Granulomatous Inflammation ◽

Pathological Examination ◽

Pet Ct ◽

Granulomatous Lesions ◽

Granulomatous Lymphadenitis

Background: Sarcoidosis is usually diagnosed by ruling out other granulomatous inflammatory diseases. Rarely, it may be suspected with a pathological examination after surgical intervention for another disease. The sarcoid reaction is noninfectious granulomatous lymphadenitis which can occur at nodes draining a neoplasm. We demonstrated granulomatous lesions masquerading metastasis by Positron Emission Tomography/Computed Tomography (PET/CT) in endometrial cancer. We presented two cases of endometrial cancer with sarcoidosis and sarcoid-like reactions because of their challenging clinical and radiological findings. Cases: In case 1, there was diffuse granulomatous inflammation (no metastasis) in lymph nodes (n=92) and giant cells containing calcifications (Schaumann bodies). In case 2, PET/CT revealed hypermetabolism with malignancy suspicion in the pelvic lymph nodes (maximum standardized uptake value= 13) and pathological evaluation reported a 4.5 cm tumor within the uterine cavity without any nodal metastasis. Results: PET/CT has no role in the evaluation of differential diagnosis between granulomatous lymphadenitis and metastatic disease. Conclusions: Granulomatous lesions might mimic the metastasis of coexisting malignant diseases.

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Clinical and Biological Prognostic Factors in Follicular Lymphoma Patients During Treatment

10.21203/rs.3.rs-275643/v1 ◽

2021 ◽

Author(s):

Ádám Jóna ◽

Anna Kenyeres ◽

Sándor Barna ◽

Árpád Illés ◽

Zsófia Simon

Keyword(s):

Prognostic Factors ◽

High Risk ◽

Follicular Lymphoma ◽

Risk Group ◽

Standardized Uptake Value ◽

Progression Free Survival ◽

High Risk Group ◽

Pet Ct ◽

Significant Difference ◽

Biological Prognostic Factors

Abstract Introduction: Follicular lymphoma (FL) is an indolent yet heterogeneous B-cell lymphoproliferative disorder. Most people respond to treatment well. However, a particular group of patients has a poor prognosis, and these patients are difficult to define.Patients and methods: We retrospectively analyzed FL patients treated at the University of Debrecen in the past 20 years. We investigated prognostic factors that may influence the survival of FL patients.Results: We found a standardized uptake value (SUV)max cut-off value of 9.85 at the staging PET/CT to significantly separate FL patients’ progression-free survival (PFS) (p=0.0003, HR: 0.2560, 95%CI: 0.1232-0.5318). Lymphocyte/ monocyte (Ly/Mo) ratio of 3.45 drawn at diagnosis also significantly predicted PFS (p=0.0324, HR: 1.806, 95% CI: 1.051-3.104). Combining patients’ with staging SUVmax >9.85 and Ly/Mo < 3.45 a high-risk group of FL patients can be identified (p<0.0001, HR: 0.1033, 95%CI: 0.03719-0.2868). Similarly, a significant difference was shown with a SUVmax cut-off of 3.15 at the interim PET/CT (p<0.0001, HR: 0.1535, 95%CI: 0.06329-0.3720). Combining patients with staging SUVmax >9.85 and interim SUVmax >3.15, a high-risk group of FL patients can be identified (p<0.0001, HR: 0.1037, 95%CI: 0.03811-0.2824). The PFS difference is translated into overall survival advantage (p=0.0506, HR: 0.1187, 95%CI: 0.01401-1.005).Discussion: Biological prognostic factors, such as the Ly/ Mo ratio, may improve the prognostic assessment of staging PET/CT. Nevertheless, PFS difference is translated into OS when using a combination of staging and interim SUVmax. We consider investigating additional biological prognostic factors while currently highlighting PET/CT's role in FL.

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Role of 18F-PET-CT to Predict Pathological Response After Neoadjuvant Treatment of Rectal Cancer

10.21203/rs.3.rs-143636/v1 ◽

2021 ◽

Author(s):

Riccardo Caruso ◽

Emilio Vicente ◽

Yolanda Quijano ◽

Hipolito Duran ◽

Isabel Fabra ◽

...

Keyword(s):

Rectal Cancer ◽

Fdg Pet ◽

Locally Advanced ◽

Neoadjuvant Treatment ◽

Standardized Uptake Value ◽

Disease Free Survival ◽

Pet Ct ◽

Significant Difference ◽

18F Fdg ◽

Fdg Pet Ct

Abstract Objectives: Neoadjuvant radiochemotherapy (nCRT) is universally considered to be a valid treatment to achieve downstaging, improve local disease control and obtain better resectability in locally advanced rectal cancer (LARC). The aim of this study is to correlate the change in tumor 18F -FDG PET-CT standardized uptake value (SUV) before and after nCRT, in order to obtain an early prediction of pathologic response (pR) achieved in patients with LARC.Data description: We performed a retrospective analysis of patients with LARC diagnosis who underwent curative resection. All patients received nCRT and surgical treatment was carried after 8/12th. All patients underwent a baseline 18F -FDG PET-CT scan within the week prior to the initiation of the treatment (PET-CT SUV1) and a second scan (PET-C T SUV2) within six weeks of the completion of nCRT. Furthermore, we evaluated the prognostic value of 18F -FDG PET-CT in terms of disease free survival (DFS) and overall survival (OS) in patients with LARC.A total of 133 patients with LARC were included in the study. Patients were divided in two groups according to the TRG (tumor regression grade): 107 (80%) as Responders group (TRG0-TRG1) and 26 (25%) as the No-Responders group (TRG2-TRG3). We obtained a significant difference in Δ%SUV between the two different groups responders vs no responders (p<0.012).The results of this analysis have shown that 18F-FDG PET-CT may be an indicator in order to evaluate the pR to nCRT in patients with LARC. The decrease in 18F-FDG PET-CT uptake in the primary tumor may offer primary information in order to early identify those patients more likely to obtain a pCR to nCRT and predict those unlikely to regress significantly.

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Serendipitous Detection of Cervical Nodal Metastasis in Glomus Jugulare

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1639383 ◽

2018 ◽

Vol 07 (03) ◽

pp. 256-259

Author(s):

Shruti Venkitachalam ◽

Rayappa Chinnusamy ◽

Narendranath Ashok ◽

Swatee Halbe

Keyword(s):

Radiation Therapy ◽

Lymph Nodes ◽

Neck Dissection ◽

Similar Pattern ◽

Adjuvant Radiotherapy ◽

Nodal Metastasis ◽

Cervical Lymph Nodes ◽

Glomus Jugulare ◽

History Of

AbstractWe present the case of a 50-year-old man who presented to us with a history of having received radiation therapy for a glomus jugulare tumor. He had been on regular follow-up with serial imaging scans. The MRI done after 4 years of treatment revealed an interval increase in size. Carotid angiogram revealed, in addition to the glomus, multiple lymph nodes of similar pattern of vascularity, well lateral to the carotid sheath, in the ipsilateral neck. He underwent resection of the tumor and a neck dissection. Histopathology confirmed metastatic glomus jugulare in the cervical lymph nodes. He received adjuvant radiotherapy and is doing well.

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Combined Evaluation of FDG-PET/CT and CT Imaging Characteristics of Cervical Lymph Nodes to Increase the Interpretation Accuracy for Nodal Metastatic Involvement in Head and Neck Cancer

otolaryngology ◽

10.4172/2161-119x.1000213 ◽

2015 ◽

Vol 05 (06) ◽

Author(s):

Richard A Marshall ◽

Peter M Som ◽

Livnat Uliel

Keyword(s):

Head And Neck Cancer ◽

Lymph Nodes ◽

Head And Neck ◽

Neck Cancer ◽

Fdg Pet ◽

Cervical Lymph Nodes ◽

Imaging Characteristics ◽

Pet Ct ◽

Metastatic Involvement ◽

Fdg Pet Ct

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Positron emission tomography/computed tomography (PET/CT) as a biomarker of pathologic response to neoadjuvant chemotherapy in breast carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e21147 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e21147-e21147

Author(s):

Catherine M. Kelly ◽

Clare Smith ◽

Susan Conlon ◽

Reem Salman ◽

John McCaffrey ◽

...

Keyword(s):

Breast Cancer ◽

Breast Carcinoma ◽

Neoadjuvant Chemotherapy ◽

Lymph Nodes ◽

Breast Cancer Subtype ◽

Standardized Uptake Value ◽

Predictive Biomarkers ◽

Axillary Lymph Nodes ◽

Axillary Lymph ◽

Pet Ct

e21147 Background: Pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in breast carcinoma is prognostic. Predictive biomarkers for pCR include early response to NAC, estrogen receptor (ER) negativity, HER2 positivity, and high Ki67. We assessed whether absence of fluoro-deoxy glucose (FDG) uptake measured by standardized uptake value (SUV) after NAC would predict pCR. Methods: We identified 23 patients (pts) who had PET/CT scanning pre and post NAC. We examined breast cancer subtype, chemotherapy (CT) regimen, number of cycles of CT given, clinical and pathological staging data and changes in SUV in the breasts and lymph nodes pre and post NAC. pCR was defined as no residual cancer in the breast or axillary lymph nodes. Results: Median age at diagnosis was 46 years (IQR; 37 to 56). Median tumor size at diagnosis was 30mm (IQR; 25 to 43) and 19 pts (83%) had node positive breast cancer. Most tumors were ductal (n=22) with 1 lobular cancer. Preoperatively 95% received all CT. All HER2+ pts received Trastuzumab. Anthracycline/taxane based regimens were most frequently given in 22 cases, 1 received lapatinib/trastuzumab. Five tumors (21.7%) were ER+/HER2+; 14 (60.9%) ER+/HER2-; 2 (8.7%) ER-/HER2+ and 2 (8.7%) were ER-/HER2-. All tumors were high (n=9, 39.1%) or intermediate grade (n=14, 61%). SUV was significantly lower post NAC (p=0.035). We observed no SUV uptake in breast or lymph nodes in 15 cases (65.2%) post NAC, these corresponded to; ER+HER2+ 4/5 (80%); ER+HER2- 7/15 (46.7%); ER-HER2- 2/2(100%), ER-HER2+ 2/2(100%). Absent SUV uptake post NAC was associated with a pCR (breast and lymph nodes) in 5/15 (33%) of pts (ER+HER2+ n=1, ER+HER2- n=1, ER-HER2- n=2, ER-HER2+ n=1). Ten of 15 tumors (67%) had no SUV uptake in the breast post NAC and 7 (47%) were associated with a pCR. There was a trend toward increased odds of pCR with no SUV uptake post NAC (OR 2.76; 95% CI 0.85 to 8.94: P= 0.09). Overall rate of pCR was 21.7% (n=5). Conclusions: A non-statistically significant trend toward increased odds of pCR with no SUV uptake post NAC was observed. Larger subtype-specific breast cancer cohorts will be required to determine the value of PET/CT as a predictive biomarker for pCR.

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