ABSTRACT
Sentinel node status is the most powerful prognostic factor in patients with early-stage melanoma. This review discusses several issues of clinical interest and technical points for an optimized sentinel node biopsy (SNB) procedure. The role of fluorodeoxyglucose positron emission tomography/computed tomography is clearly established in patients with suspicion of locoregional or distant recurrence of melanoma before any surgical decision. However, its role at initial staging or follow-up of patients with localized disease or with positive SNB is less clear. Further research and efforts should focus on identifying which groups of patients are at specific high risk of early distant recurrence.
Subject(s)
Candidiasis/diagnostic imaging , Fluorodeoxyglucose F18 , Liver Diseases/diagnostic imaging , Splenic Diseases/diagnostic imaging , Antifungal Agents/therapeutic use , Candidiasis/complications , Candidiasis/drug therapy , Fluconazole/therapeutic use , Humans , Leukemia, Myeloid, Acute/complications , Leukemia, Myeloid, Acute/drug therapy , Liver Diseases/microbiology , Male , Positron-Emission Tomography , Radiopharmaceuticals , Splenic Diseases/microbiology , Tomography, X-Ray Computed , Young AdultSubject(s)
Cytogenetic Analysis , Dermatofibrosarcoma/genetics , Skin Neoplasms/genetics , Adult , Antineoplastic Agents/therapeutic use , Benzamides , Combined Modality Therapy , Dermatofibrosarcoma/pathology , Dermatofibrosarcoma/therapy , Female , Humans , Imatinib Mesylate , In Situ Hybridization, Fluorescence , Piperazines/therapeutic use , Positron-Emission Tomography , Pyrimidines/therapeutic use , Skin Neoplasms/pathology , Skin Neoplasms/therapyABSTRACT
PURPOSE: To investigate the potential effect of using (18)F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) in the initial assessment of patients with clinical Stage II or III breast cancer. METHODS AND MATERIALS: During 14 consecutive months, 39 patients (40 tumors) who presented with Stage II or III breast cancer on the basis of a routine extension assessment were prospectively included in this study. PET/CT was performed in addition to the initial assessment. RESULTS: In 3 cases, PET/CT showed extra-axillary lymph node involvement that had not been demonstrated with conventional techniques. Two of these patients had hypermetabolic lymph nodes in the subpectoral and infraclavicular regions, and the third had a hypermetabolic internal mammary node. PET/CT showed distant uptake in 4 women. Of these 4 women, 1 had pleural involvement and 3 had bone metastasis. Overall, of the 39 women, the PET/CT results modified the initial stage in 7 (18%). The modified staging altered the treatment plan for 5 patients (13%). It led to radiotherapy in 4 patients (bone metastasis, pleural lesion, subpectoral lymph nodes, and internal mammary nodes) and excision of, and radiotherapy to, the infraclavicular lymph nodes in 1 patient. CONCLUSIONS: PET/CT can provide information on extra-axillary lymph node involvement and can uncover occult distant metastases in a significant percentage of patients. Therefore, initial PET/CT could enable better treatment planning for patients with Stage II and III breast cancer.
Subject(s)
Breast Neoplasms/diagnosis , Fluorodeoxyglucose F18 , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Adult , Aged , Aged, 80 and over , Female , Humans , Lymphatic Metastasis , Middle Aged , Neoplasm Staging , Radiopharmaceuticals , Reproducibility of Results , Sensitivity and SpecificitySubject(s)
Abdominal Neoplasms/drug therapy , Antineoplastic Agents/adverse effects , Coma/chemically induced , Fibroma/drug therapy , Fibrosarcoma/drug therapy , Indoles/adverse effects , Protein Kinase Inhibitors/adverse effects , Protein-Tyrosine Kinases/antagonists & inhibitors , Pyrroles/adverse effects , Abdominal Neoplasms/pathology , Abdominal Neoplasms/surgery , Antineoplastic Agents/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fatal Outcome , Female , Fibroma/surgery , Fibrosarcoma/secondary , Fibrosarcoma/surgery , Humans , Indoles/administration & dosage , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Middle Aged , Protein Kinase Inhibitors/administration & dosage , Pyrroles/administration & dosage , Sunitinib , Treatment FailureABSTRACT
OBJECTIVE: The aim of this study was to assess the performance of FDG PET/CT for the detection of colonic lesions, especially advanced neoplasms (villous or >10-mm adenomas, carcinomas). Because of 18F FDG accumulation in adenomatous polyps, PET using FDG can detect early premalignant colorectal lesions. MATERIALS AND METHODS: FDG PET/CT studies performed for a 1-year period in 1,716 consecutive patients with various malignant diseases, except colorectal cancer, were retrospectively reviewed. PET images obtained 1 hr after FDG injection and non-contrast CT images used for attenuation correction were fused for analysis. Of 45 patients showing intense focal colonic FDG uptake, 20 patients (with 21 foci) underwent a colonoscopic investigation, and, when necessary, polyp resection. The intensity of FDG uptake was quantified using the standardized uptake value (SUV(max)). RESULTS: The FDG colonic foci were associated with 18 colonoscopic abnormalities in 15 patients, with no colonic abnormality detected in five patients (false-positive [FP] results). Histopathologic findings revealed advanced neoplasms in 13 patients (13 villous adenomas and three carcinomas) and two cases of hyperplastic polyps. A difference in the mean SUV(max) was found between FP and true-positive colonic FDG foci but was not statistically significant (p = 0.14). CONCLUSION: Presence of a focal colonic FDG uptake incidental finding on a PET/CT scan justifies a colonoscopy to detect (pre-)malignant lesions. The fusion of PET and CT images allows an accurate localization of the lesions. PET/CT is a useful tool to differentiate pathologic from physiologic FDG uptake.
