RESUMO
Current guidelines do not systematically recommend 18F-FDG PET/CT for breast cancer staging; and the recommendations and level of evidence supporting its use in different groups of patients vary among guidelines. This review summarizes the evidence about the role of 18F-FDG PET/CT in breast cancer staging and the therapeutic and prognostic impact accumulated in the last decade. Other related aspects, such as the association of metabolic information with biology and prognosis are considered and evidence-based recommendations for the use of 18F-FDG PET/CT in breast cancer staging are offered. We systematically searched MEDLINE for articles reporting studies with at least 30 patients related to clinical questions following the Problem/Population, Intervention, Comparison, and Outcome framework. We critically reviewed the selected articles and elaborated evidence tables structuring the summarized information into methodology, results, and limitations. The level of evidence and the grades of recommendation for the use of 18F-FDG PET/CT in different contexts are summarized. Level III evidence supports the use of 18F-FDG PET/CT for initial staging in patients with recently diagnosed breast cancer; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a weak recommendation in this population. In patients with locally advanced breast cancer, level II evidence supports the use of 18F-FDG PET/CT for initial staging; the diagnostic and therapeutic impact of the 18F-FDG PET/CT findings is sufficient for a strong recommendation in this population. In patients with recently diagnosed breast cancer, the metabolic information from baseline 18F-FDG PET/CT is associated with tumor biology and has prognostic implications, supported by level II evidence. In conclusion, 18F-FDG PET/CT is not recommended for staging all patients with early breast cancer, although evidence of improved regional and systemic staging supports its use in locally advanced breast cancer. Baseline tumor glycolytic activity is associated with tumor biology and prognosis.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Fluordesoxiglucose F18/uso terapêutico , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Prognóstico , Neoplasias da Mama/patologia , Feminino , Guias como Assunto , Humanos , Imagem Multimodal , Estadiamento de Neoplasias , Compostos RadiofarmacêuticosRESUMO
OBJECTIVES: A meta-analysis of the literature was performed in this article in order to evaluate the diagnostic accuracy of 18F-FDG PET in suspected recurrent head and neck cancer. MATERIAL AND METHODS: A systematic review of the literature was performed using 1987 to 2007 MEDLINE and CANCERLIT databases, applying selection criteria to the studies found. Sensitivity, specificity, positive and negative likelihood ratios, and odds ratio were calculated. The diagnostic accuracy was evaluated with ROC (receive-operating-characteristics) curves. RESULTS: Nineteen articles were included in the meta-analysis. Sensitivity of 18F-FDG PET was 94 %, specificity 80 %, and the summary ROC curve showed a good trade-off between sensitivity and specificity. CONCLUSIONS: 18F-FDG PET was useful in patients with suspected recurrence of head and neck cancer, showing a high sensitivity and intermediate-high specificity.
Assuntos
Fluordesoxiglucose F18 , Neoplasias de Cabeça e Pescoço/metabolismo , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Diagnóstico Diferencial , Humanos , Recidiva Local de Neoplasia , Sensibilidade e EspecificidadeRESUMO
Objetivos: En este trabajo se realizó un metaanálisis de la literatura para evaluar la exactitud diagnóstica de la PET 18F-FDG en la sospecha de recurrencia de cánceres de cabeza y cuello. Material y métodos: Inicialmente se realizó una búsqueda sistemática de la literatura en las fuentes MEDLINE y CANCERLITE hasta mayo de 2007, aplicando unos criterios de cribado a los estudios hallados. Se calcularon los valores de sensibilidad, especificidad, cocientes de probabilidad positivo y negativo y la odds ratio diagnóstica. El rendimiento diagnóstico se valoró mediante curvas ROC (receive-operating-characteristic). Resultados: Fueron incluidos 19 artículos en el metaanálisis. La sensibilidad de la PET 18F-FDG fue del 94 %, la especificidad del 80 % y la curva ROC mostró una buena relación entre sensibilidad y especificidad. Conclusiones: La PET 18F-FDG fue útil en pacientes con sospecha de recurrencia tumoral por cáncer de cabeza y cuello; mostró una sensibilidad alta y una especificidad intermedia-alta
Objectives: A meta-analysis of the literature was performed in this article in order to evaluate the diagnostic accuracy of 18F-FDG PET in suspected recurrent head and neck cancer. Material and methods: A systematic review of the literature was performed using 1987 to 2007 MEDLINE and CANCERLIT databases, applying selection criteria to the studies found. Sensitivity, specificity, positive and negative likelihood ratios, and odds ratio were calculated. The diagnostic accuracy was evaluated with ROC (receive-operating-characteristics) curves. Results: Nineteen articles were included in the meta-analysis. Sensitivity of 18F-FDG PET was 94 %, specificity 80 %, and the summary ROC curve showed a good trade-off between sensitivity and specificity. Conclusions: 18F-FDG PET was useful in patients with suspected recurrence of head and neck cancer, showing a high sensitivity and intermediate-high specificity
Assuntos
Humanos , Masculino , Feminino , Neoplasias de Cabeça e Pescoço/metabolismo , Tomografia Computadorizada de Emissão , Recidiva Local de Neoplasia/complicações , Fluordesoxiglucose F18 , Compostos Radiofarmacêuticos , Sensibilidade e Especificidade , Diagnóstico DiferencialRESUMO
Objetivo: Valorar las modificaciones en el tratamiento inducidas por la tomografía por emisión de positrones con 18F-desoxiglucosa (PET-FDG) en pacientes con sospecha de enfermedad residual o recurrente de cáncer diferenciado de tiroides (CDT) con tiroglobulina (Tg) elevada y rastreo corporal total (RCT) con 131I negativo. Pacientes y método: Se analizó de forma retrospectiva a un grupo de 50 pacientes (35 mujeres y 15 varones) tratados de CDT, a los que se hizo estudio PET-FDG (51 exploraciones) por elevación de Tg con RCT con 131I negativo. La comprobación de resultados se hizo según la anatomía patológica, respuesta al tratamiento o seguimiento clínico. Valoraron el impacto los médicos, que indicaron cómo influyó esta técnica en las decisiones terapéuticas, y se clasificó como alto, moderado, bajo o sin impacto, según los criterios de Hicks modificados. Resultados: La PET-FDG tuvo alto impacto en 18 (35,3%) pacientes, en los que se modificó la estrategia terapéutica; en 2 (3,9%) el impacto fue moderado, ya que no se aplicó tratamiento pero el resultado negativo de la PET-FDG evitó la realización de otros métodos diagnósticos; en 18 (35,3%), el impacto fue bajo, ya que no modificó el tratamiento; en 13 (25,5%) no tuvo impacto, pues no se tuvo en cuenta a la hora de decidir el tratamiento. Conclusiones: La PET-FDG resulta una técnica diagnóstica útil para la toma de decisiones terapéuticas en pacientes con sospecha de enfermedad residual o recurrente de CDT que presentan Tg elevada y RCT con 131I negativo (AU)
Objective: To assess FDG-PET-induced treatment modifications in patients with suspected recurrent or residual differentiated thyroid cancer (DTC) with elevated thyroglobulin (Tg) and negative 131I whole body scan (WBS). Patients and method: Fifty-one FDG-PET studies due to elevated Tg with negative WBS were retrospectively analyzed in 50 patients treated for DTC (35 women and 15 men). The results were verified by pathological analysis, treatment response or clinical follow-up. The impact of FDG-PET was assessed by asking the physicians to indicate how this technique had affected their therapeutic decisions and the influence was classified as high, moderate, low or nil according to Hicks' modified criteria. Results: The impact of FDG-PET was high in 18 patients (35.3%), in whom the therapeutic strategy was modified. A moderate impact was found in 2 patients (3.9%) since no treatment was applied; however, in these patients, negative FDG-PET results obviated the need for other diagnostic methods. Impact was low in 18 patients (35.3%) as treatment was not modified, and was null in 13 (25.5%) since this technique was not considered when therapeutic decisions were made. Conclusions: FDG-PET is a useful diagnostic technique for therapeutic decision-making in patients with suspected residual or recurrent DTC, elevated Tg and negative 131I-WBS (AU)
