Chronic Periaortitis – Review and Presentations

Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis andinflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case showsa classic picture ofIgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery

Establishment of a ¹⁸F-FDG-PET/MRI Imaging Protocol for Gastric Cancer PDX as a Preclinical Research Tool

PURPOSE: The utility of 18-fluordesoxyglucose positron emission tomography ([¹⁸F]-FDG-PET) combined with computer tomography or magnetic resonance imaging (MRI) in gastric cancer remains controversial and a rationale for patient selection is desired. This study aims to establish a preclinical patient-derived xenograft (PDX) based [¹⁸F]-FDG-PET/MRI protocol for gastric cancer and compare different PDX models regarding tumor growth and FDG uptake.MATERIALS AND METHODS: Female BALB/c nu/nu mice were implanted orthotopically and subcutaneously with gastric cancer PDX. [¹⁸F]-FDG-PET/MRI scanning protocol evaluation included different tumor sizes, FDG doses, scanning intervals, and organ-specific uptake. FDG avidity of similar PDX cases were compared between ortho- and heterotopic tumor implantation methods. Microscopic and immunohistochemical investigations were performed to confirm tumor growth and correlate the glycolysis markers glucose transporter 1 (GLUT1) and hexokinase 2 (HK2) with FDG uptake.RESULTS: Organ-specific uptake analysis showed specific FDG avidity of the tumor tissue. Standard scanning protocol was determined to include 150 μCi FDG injection dose and scanning after one hour. Comparison of heterotopic and orthotopic implanted mice revealed a long growth interval for orthotopic models with a high uptake in similar PDX tissues. The H-score of GLUT1 and HK2 expression in tumor cells correlated with the measured maximal standardized uptake value values (GLUT1: Pearson r=0.743, P=0.009; HK2: Pearson r=0.605, P=0.049).CONCLUSIONS: This preclinical gastric cancer PDX based [¹⁸F]-FDG-PET/MRI protocol reveals tumor specific FDG uptake and shows correlation to glucose metabolic proteins. Our findings provide a PET/MRI PDX model that can be applicable for translational gastric cancer research.

Uso do PET-SCAN como preditor de eficácia para controle locoregional e sobrevida em carcinoma de cabeça e pescoço / Use of PET-SCAN as a predictor of efficacy for locoregional control and survival in head and neck carcinoma

Introdução: A avaliação da resposta à quimioterapia de indução (QI) com regimes triplos, incluindo taxane, cisplatina e 5 fluorouracil (TPF) em carcinoma de células escamosas de cabeça e pescoço localmente avançado (CECCPLA) é geralmente realizada após 2 ciclos de quimioterapia usando critérios morfológicos. Preocupações em relação ao perfil de toxicidade do TPF sugerem um benefício potencial de uma abordagem de avaliação de resposta precoce. Objetivo: o objetivo deste estudo é avaliar a utilidade de se avaliar precocemente a resposta tumoral por método funcional e morfológico com uso do PET-SCAN em pacientes portadores de CECCPLA tratados com QI seguido de radioteapia após o primeiro ciclo de QI. Métodos: Pacientes com CECCPLA que se submeteram ao QI com TPF foram avaliados prospectivamente. Os procedimentos de estadiamento incluíram imagem locorregional e de tórax, exame endoscópico e PET-SCAN. Pacientes foram avaliados para resposta tumoral após o segundo ciclo da QI e ao término do tratamento, conforme conduta estabelecida para a prática clínica. No dia 14 do primeiro ciclo, um segundo PET- SCAN foi realizado e os médicos e pacientes foram cegados para os seus resultados. Todos os pacientes assinaram consentimento para participação do estudo. Resultados: Entre fevereiro de 2010 e julho de 2013, 49 pacientes portadores de CECCPLA estádio III / IVA-B CECCPLA foram recrutados. Após um seguimento mediano de 44,3 meses, pacientes cujos achados de PET-SCAN não registraram aumento no Stardard Uptake Value (SUV) máximo dos linfonodos regionais apresentaram melhor sobrevida livre de recidiva (HR = 0,18; IC95% 0,056-0,585; p = 0,004) e sobrevida global (HR = 0,14, IC 95% 0,040-0,498; p = 0,002) e foram considerados respondedores. Neste subgrupo, os pacientes que atingiram pelo menos 45% de redução no SUV máximo do tumor primário apresentaram melhor sobrevida livre de progressão tumoral (HR = 0,23, IC 95% 0,062-0,854; p = 0,028) e sobrevida global (HR = 0,11, IC 95% 0,013 -0,96; p = 0,046). Conclusão: Estes resultados sugerem um potencial papel da avaliação da resposta tumoral precoce com PET-SCAN em pacientes com CECCPLA submetidos a QI. Aumento no SUV máximo do linfonodo regional e diminuição insuficiente na captação do tumor primário predizem pior evolução clínica (AU)

Introduction: Evaluation of induction chemotherapy (IC) response with triplet taxane, cisplatin and 5 fluorouracil containing regimen (TPF) in locally advanced head and neck squamous cell carcinoma (LASCCHN) is usually performed after 2 cycles of chemotherapy using morphological criteria. Concerns regarding the TPF toxicity profile suggest a potential benefit of an early tumor response assessment approach. Objective: The objective of this study is to evaluate the usefulness of early evaluation of tumor response by functional and morphological method using PET-SCAN patients with LASCCHN treated with IC followed by radiotherapy after the first IC cycle. Methods: Patients with LASCCHN who underwent IC with TPF were prospectively evaluated. Staging procedures included standard primary neck tumor and chest imaging, endoscopic examination and PET-SCAN. Patients were evaluated for tumor response after the second cycle of IC and at the end of treatment, according to established practice guidelines. On day 14 of the first cycle, a second PET-SCAN was performed and physicians and patients were blinded to their exam findings. Results: Between February 2010 and July 2013, 49 patients staged AJCC III / IVA-B LASCCHN were recruited. After a median follow-up of 44.3 months, patients with no increase in the regional maximum lymph node SUV had better relapse-free survival (HR = 0.18, 95% CI 0.056-0.585, p = 0.004) and overall survival (HR = 0.14, 95% CI 0.040-0.498, p = 0.002) and were considered responders. Among cases considered responders, patients who achieved at least 45% reduction of SUV in the primary tumor presented improvement in progression-free (HR = 0.23, 95% CI 0.062-0.854, p = 0.028) and overall survival (HR = 0.11, 95% CI 0.013 -0.96, p = 0.046). All patients provided informed consent for study participation. Conclusion: These results suggest an important role of the evaluation of the early response with PET-SCAN in patients with LASCCHN undergoing IC. Increase in the regional SUV maximum and insufficient decrease in primary tumor uptake predict worse clinical outcome (AU)

Importancia de la laparoscopia diagnóstica en la detección de implantes tumorales. Reporte de un caso / Importance of diagnostic laparoscopy in the detection of tumor implants. A case report

Resumen ANTECEDENTES: Los tumores malignos de células germinales de ovario constituyen un grupo heterogéneo de neoplasias de rápida evolución a la malignización, que suelen aparecer durante las dos primeras décadas de la vida. La prevalencia en México es de 3.4% de los tumores ováricos. El 10% de las pacientes afectadas padece dolor abdominal agudo por distención capsular, necrosis, hemorragia, rotura o torsión. CASO CLÍNICO: Paciente de 17 años, acudió al servicio de Urgencias por dolor pélvico de inicio súbito. En la laparotomía se encontró una torsión ovárica secundaria a una tumoración anexial derecha; por eso se le efectuó la salpingooferectomía. Se detectó elevada concentración de alfa-fetoproteína (10,702 ng/mL); el servicio de Oncología pediátrica indicó quimioterapia durante dos años; sin embargo, después de suspender el tratamiento persistió elevada su concentración. El ultrasonido y PET-SCAN no evidenciaron enfermedad activa. En la laparoscopia diagnóstica se observaron múltiples implantes tumorales. El reporte histopatológico fue de tumoración de senos endodérmicos. La paciente se envió, nuevamente, a Oncología pediátrica para continuar con quimioterapia y radioterapia. En la actualidad permanece estable, con descenso de la concentración de alfa-fetoproteína (última determinación: 1200 ng/mL). CONCLUSIÓN: La importancia de la laparoscopia toma relevancia en este tipo de casos, cuando existe discordancia entre los estudios bioquímicos y de imagen (ultrasonido y PET-SCAN); además, orienta hacia un diagnóstico más certero, mediante la visualización y obtención de biopsias directas, con la finalidad de establecer el tratamiento específico.

Abstract BACKGROUND: Malignant germ cell tumors of the ovary constitute a heterogeneous group of highly malignant and rapidly progressive neoplasms that usually appear during the first two decades of life. Its frequency in Mexico is 3.4% on ovarian tumors. Approximately 10% of affected patients report acute abdominal pain due to capsular distension, necrosis, hemorrhage, rupture or torsion. CLINICAL CASE: A 17 years-old patient, who went to the Emergency Department for pelvic pain of sudden onset. It was decided to perform a laparotomy and ovarian torsion was found secondary to a right adnexal tumor, so salpingo-ophorectomy was performed. High alpha-fetoprotein concentration (10.702 ng/mL) was detected; the Pediatric Oncology Service indicated chemotherapy for two years; however, after stopping the treatment, its concentration persisted. The ultrasound and PET-SCAN did not show active disease, so it was sent to the gynecological endoscopy service, where they performed diagnostic laparoscopy, observing multiple tumor implants. The histopathological results was endodermal sinus tumor. The patient was sent, again, to Pediatric Oncology to continue with chemotherapy and radiotherapy. It is currently stable, with a decrease in values of alpha-fetoprotein (last determination: 1200 ng/mL). CONCLUSION: The importance of diagnostic laparoscopy is especially relevant in this type of cases when there is disagreement between biochemical and imaging studies (ultrasound and PET-SCAN), which through laparoscopy guides us towards a more accurate diagnosis through visualization and direct biopsy taking sample and give a directed management.

Performance of pre-treatment ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography for detecting metastasis in ovarian cancer: a systematic review and meta-analysis / 부인종양

OBJECTIVE: We describe a systematic review and meta-analysis of the performance of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) for detecting metastasis in ovarian cancer. METHODS: MEDLINE and Embase were searched for diagnostic accuracy studies that used 18F-FDG PET or PET/CT for pre-treatment staging, using surgical findings as the reference standard. Sensitivities and specificities were pooled and plotted in a hierarchic summary receiver operating characteristic plot. Potential causes of heterogeneity were explored through sensitivity analyses. RESULTS: Eight studies with 594 patients were included. The overall pooled sensitivity and specificity for metastasis were 0.72 (95% confidence interval [CI]=0.61–0.81) and 0.93 (95% CI=0.85–0.97), respectively. There was considerable heterogeneity in sensitivity (I2=97.57%) and specificity (I2=96.74%). In sensitivity analyses, studies that used laparotomy as the reference standard showed significantly higher sensitivity and specificity (0.77; 95% CI=0.67–0.87 and 0.96; 95% CI=0.92–0.99, respectively) than those including diagnostic laparoscopy (0.62; 95% CI=0.46–0.77 and 0.84; 95% CI=0.69–0.99, respectively). Higher specificity was shown in studies that confirmed surgical findings by pathologic evaluation (0.95; 95% CI=0.90–0.99) than in a study without pathologic confirmation (0.69; 95% CI=0.24–1.00). Studies with a lower prevalence of the FDG-avid subtype showed higher specificity (0.97; 95% CI=0.94–1.00) than those with a greater prevalence (0.89; 95% CI=0.80–0.97). CONCLUSION: Pre-treatment 18F-FDG PET/CT shows moderate sensitivity and high specificity for detecting metastasis in ovarian cancer. With its low false-positive rate, it can help select surgical approaches or alternative treatment options.

Fusion Imaging - The Broadened Horizon In Maxilloacial Imaginga Review

Fusion imaging is the amalgamation of various advanced imaging modalities used in oral and maxillofacial imaging today, which takes a lion share in improvising diagnostic and formulation of effective treatment outcomes. In today’s scenario, this has been widely accepted in various disciplines of dentistry in a broadened horizon for capturing the head and neck pathologies. This review paper therefore aims to highlight various aspects of fusion imaging with its bird’s view in various dental specialties

Parotid Incidentaloma Identified by Positron Emission/Computed Tomography: When to Consider Diagnoses Other than Warthin Tumor

Introduction Parotid gland incidentalomas (PGIs) are unexpected hypermetabolic foci in the parotid region that can be found when scanning with whole-body positron emission/computed tomography (PET/CT). These deposits are most commonly due to benign lesions such as Warthin tumor. Objective The aim of this study was to determine the prevalence of PGIs identified in PET/CT scans and to assess the role of smoking in their etiology. Methods We retrospectively reviewed all PET/CT scans performed at our center in search of PGIs and identified smoking status and standardized uptake value (SUVmax) in each case. We also analyzed the database of parotidectomies performed in our department in the previous 10 years and focused on the pathologic diagnosis and the presence or absence of smoking in each case. Results Sixteen cases of PGIs were found in 4,250 PET/CT scans, accounting for 0.4% . The average SUVmax was 6.5 (range 2.8 to 16). Cytology was performed in five patients; it was benign in four cases and inconclusive in one case. Thirteen patients had a history of smoking. Of the parotidectomies performed in our center with a diagnosis of Warthin tumor, we identified a history of smoking in 93.8% of those patients. Conclusions The prevalence of PGIs on PET/CT was similar to that reported by other authors. Warthin tumor is frequently diagnosed among PGIs on PET/CT, and it has a strong relationship with smoking. We suggest that a diagnosis other than Warthin tumor should be considered for PGIs in nonsmokers. .

MicroPET: tomografía por emisión de positrones para animales de laboratorio / MicroPET: Positron emission tomography for laboratory animals

Resumen: El tomógrafo por emisión de positrones (PET, por sus siglas en inglés [positron emission tomography]) es una poderosa herramienta no invasiva para el diagnóstico clínico e investigación in vivo por medio de imágenes empleada en humanos y animales de laboratorio. Se han desarrollado equipos exclusivos para los diversos modelos animales con los beneficios de esta técnica para el estudio de diferentes enfermedades.

Abstract: The positron emission tomography , PET scan (Positron Emission Tomography) is a powerful noninvasive tool for clinical diagnosis and research in vivo by means of images used in humans and laboratory animals. We have developed exclusive equipment for the various animal models with the benefits of this technique for the study of different diseases.

Impact of immunosuppressant therapy on early recurrence of hepatocellular carcinoma after liver transplantation

BACKGROUND/AIMS: The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated. METHODS: Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 +/- 1.3 ng/mL (mean +/- SD). RESULTS: The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05). CONCLUSIONS: Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients.

Utility of PET in unknown primary with cervical metastasis: A retrospective study.

Background: FDG-PET is recommended as an investigation in unknown primary tumors, but its definitive role and cost effectiveness are yet to be established. Aims: dditional value of FDG-PET over conventional imaging in unknown primary tumors with cervical metastasis. Setting and Design: Retrospective study in a tertiary level oncology centre. Materials and Methods: A total of 112 patients were divided into three groups; 53 with conventional modalities (either computed tomography or magnetic resonance imaging) (group I), 59 with FDG-PET (group II), and group III (subgroup of group II) with both (40 patients). Statistical Analysis: Sensitivity and specificity of both conventional modality and PET were calculated. Association between neck nodes and distant metastasis was analysed using multivariate logistic regression analysis. Results: Sensitivity and specificity for conventional modalities was 92.3% and 50% and sensitivity and specificity of FDG-PET was 92.8% and 71.4%, respectively. FDG-PET detected metastasis in 52.54% of patients. Multivariate logistic regression analysis showed statistically significant association between distant metastasis and multiplicity of nodes (N2b, N2c) (P = 0.007). Among all patients with low neck nodes in group II, FDG-PET detected primaries in 12 patients, 9 of which were infraclavicular (75%). FDG-PET added information to conventional imaging in 32.5% of patients and influenced an overall change in management in 38.9% of patients. Conclusions: FDG-PET is a valuable tool influencing change of management in unknown primary with cervical metastasis. It is recommended especially in the presence of low or multiple neck nodes in view of high incidence of infraclavicular primary and distant metastasis, respectively.

GLUT1 expression in malignant tumors and its use as an immunodiagnostic marker

OBJECTIVE: To analyze glucose transporter 1 expression patterns in malignant tumors of various cell types and evaluate their diagnostic value by immunohistochemistry. INTRODUCTION: Glucose is the major source of energy for cells, and glucose transporter 1 is the most common glucose transporter in humans. Glucose transporter 1 is aberrantly expressed in several tumor types. Studies have implicated glucose transporter 1 expression as a prognostic and diagnostic marker in tumors, primarily in conjunction with positron emission tomography scan data. METHODS: Immunohistochemistry for glucose transporter 1 was performed in tissue microarray slides, comprising 1955 samples of malignant neoplasm from different cell types. RESULTS: Sarcomas, lymphomas, melanomas and hepatoblastomas did not express glucose transporter 1. Fortyseven per cent of prostate adenocarcinomas were positive, as were 29 percent of thyroid, 10 percent of gastric and 5 percent of breast adenocarcinomas. Thirty-six per cent of squamous cell carcinomas of the head and neck were positive, as were 42 percent of uterine cervix squamous cell carcinomas. Glioblastomas and retinoblastomas showed membranous glucose transporter 1 staining in 18.6 percent and 9.4 percent of all cases, respectively. Squamous cell carcinomas displayed membranous expression, whereas adenocarcinomas showed cytoplasmic glucose transporter 1 expression. CONCLUSION: Glucose transporter 1 showed variable expression in various tumor types. Its absence in sarcomas, melanomas, hepatoblastomas and lymphomas suggests that other glucose transporters mediate the glycolytic pathway in these tumors. The data suggest that glucose transporter 1 is a valuable immunohistochemical marker that can be used to identify patients for evaluation by positron emission tomography scan. The function of cytoplasmic glucose transporter 1 in adenocarcinomas must be further examined.

Abnormal Cerebral Glucose Metabolism in Patients with Narcolepsy

BACKGROUND: The purpose of this study was to investigate the differences of cerebral glucose metabolism between narcoleptic patients and normal controls. METHODS: We enrolled 24 patients with narcolepsy who underwent night polysomnography and multiple sleep latency tests to confirm the narcolepsy. 18F-fluorodeoxy glucose positron emission tomography scan was performed in all narcoleptic patients and 24 normal age-sex matched controls. To compare the cerebral glucose metabolism between the two groups, statistical parametric mapping (SPM99) was used. RESULTS: Patients with narcolepsy showed significant decreases of cerebral glucose metabolism in the bilateral rectal and subcallosal gyri, right superior frontal gyrus, right medial frontal gyrus, bilateral precuneus, right inferior parietal lobule, and left supramarginal gyrus of the parietal lobe at the uncorrected P<0.001. The bilateral posterior hypothalami and mediodorsal thalamic nuclei showed glucose hypometabolism at the level of corrected P<0.05 with small volume correction. CONCLUSIONS: This study showed cerebral glucose hypometabolism of hypothalamus-thalamus-orbitofrontal pathways in narcoleptic brains. The distribution of abnormal glucose metabolism is concordant to the cerebral pathways of the hypocretin system.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

Detection of Recurrence with FDG-PET Scan in Patients with Endometrial Cancer / 대한산부인과학회잡지

OBJECTIVE: The aim of this study was to evaluate the feasibility of 2-[18F]-fluoro-2-deoxy-D-glucose-Positron emission tomography (FDG-PET) scan for detecting early recurrence in patients with endometrial cancer who showed no evidence of the disease after primary treatment. METHODS: A total of 14 patients, diagnosed and treated for endometrial cancer with surgery and/or subsequent radiotherapy, were included. Whole-body FDG-PET scanning was performed on 14 patients. PET images were interpreted was suspicious for malignancy in areas of localized FDG uptake compared to the surrounding tissues. computed tomography (CT) or magnetic resonance imaging (MRI) and/or fine needle biopsy were performed to evaluate positive FDG uptakes, and all patients were closely followed up at least for 6 months. RESULTS: Of the 14 patients, 2 recurrences were detected by FDG-PET scan. One of these two patients had increased FDG uptake in abdomen, which was negative on CT, and was confirmed to be recurrent 3 month later on follow-up CT. The other patient had a single focus of hypermetabolic activity in right upper quadrant of abdomen, which was correspondent to 5 cm sized hypodense mass along the right anterior segment of the liver on CT scan, and was confirmed to have adenocarcinoma cell on a needle biopsy. CONCLUSION: These preliminary data demonstrate the feasibility of FDG-PET imaging in detection of early recurrence in patients with endometrial cancer. Further prospective evaluation of FDG-PET in larger numbers of patients with endometrial cancer is warranted to more precisely define its accuracy.

A Case of Thyroid Cancer Detected with Pet Scan

Although the utility of FDG-PET scan is usually limited to the follow up of a recurrence follow the resection of primary malignant tumors. Its usefulness may be widen to the diagnosis in some malignant neoplasms; that use mostly glucose their energy sources. Thyroid cancers use glucose for their metabolic activities and incidental focal thyroid uptake shown on FDG-PET scans may be representative of a primary tumor. Therefore, increased focal thyroid uptake shown on whole body FDG-PET scans should not be overlooked even when it is not marked, and prompt further investigation should be done to rule out a possible cancer. We present a case of thyroid cancer, incidentally detected with a PET scan in a 60-year-old-man. We also present a review of the literatures regarding the usefulness of PET scan in thyroid cancer.

Feasibility of FDG-PET Scan before Second Look Operation in Patients with Ovarian Cancer / 대한산부인과학회잡지

OBJECTIVE: This study is to investigate whether Positron Emission Tomography (PET) is useful for determining pathologic complete response in patients with ovarian carcinoma who had a clinical complete response after primary treatment. METHODS: FDG-PET scans were performed in 10 patients with advanced ovarian cancer (4 patients with stage IIC, 6 patients with IIIC), who showed complete response with cytoreductive surgery and 6 cycles of post-operative adjuvant Cisplatin-based combination chemotherapy. FDG-PET scan was obtained with GE Advance Scanner, beginning at 50 minutes after injection of 370-555 MBq (10-15 mCi) of 18F FDG. Uptakes exceeding 3.5 SUV (Standardized Uptake Value) or larger than surrounding tissue were determined as a positive findings. Second-look laparotomy was undertaken within median 4 days after FDG-PET scanning. RESULTS: The mean age of the patients was 45 years and serous cystadenocarcinoma was most common histologic type. None showed active lesion in pelvis or abdomen with FDG-PET scan (SUV: >3.5 kg/ml), however, 5 patients (50%) showed residual tumors on multiple biopsy during second look operation. One patient showed positive lesion in lung on FDG-PET scan, which was confirmed to have metastatic lesion. CONCLUSION: FDG-PET scan is not useful for detection of small ovarian cancer lesions in pelvis and abdomen and cannot substitute for second-look operation to determine pathologic complete response.

FDG-PET Scan in Patients with Cervical Cancer: Experience in Patients with Clinically No Evidence of Disease / 대한산부인과학회잡지

OBJECTIVE: The purpose of this study was to investigate the clinical feasibility of FDG-PET (Positron Emission Tomography) scan in patients with clinically no evidence of disease after treatment of cervical cancer. METHODS: One hundred and one patients with clinically NED(no evidence of disease) state after treatment of cervical cancer underwent PET scan. FDG-PET scan was obtained with a GE Advance Scanner, beginning at 50 minutes after injection of 370-555 MBq(10-15 mCi) of 18F FDG. Regional scan was also obtained with emission image. Uptake exceeding 3.0 SUV was determined as a positive finding. Recurrence was confirmed by CT, MRI, and needle biopsy if possible. RESULTS: Among 101 patients showing no evidence of disease, 17 patients(16.8%) showed abnormal PET scan findings. Clinically, 8 patients(7.9%) were confirmed to have recurrent lesion by CT, MRI or by needle biopsy. PET scan could detect recurrent lesions in the mediastinum or lung(10/17), pelvis(7/17), and supraclavicular lymph node(2/17). The sensitivity and specificity of PET scan in patients with cervical cancer showing no evidence of disease were 100% and 90.3%, respectively. The positive predictive value, negative predictive value and false positive rate were 47.1%, 100% and 52.9%. CONCLUSION: PET scan could detect 7.9% of early recurrence in patients with cervical cancer with NED status. FDG-PET scan may be a useful method in detecting metastases or recurrence of a cervical cancer showing no evidence of disease by routine conventional imaging studies.