Diagnostic accuracy of FDG-PET cancer screening in asymptomatic individuals: use of record linkage from the Osaka Cancer Registry

Applicability and performance of 18F-FDG PET-based modalities for whole-body cancer screening: a systematic review and meta-analysis

PURPOSE

Screening tests are the cornerstone for early detection and optimal management of cancers. Most of the present cancer-screening tests are intrusive, time-consuming, and specifically target a particular anatomical site or cancer type. Only a few studies have reported the objective measures of 18F-FDG PET-based cancer screening in asymptomatic individuals. This review and meta-analysis is an attempt to assess the applicability and performance of 18F-FDG PET-based modalities for whole-body cancer screening.

MATERIALS AND METHODS

The systematic review and meta-analysis were performed following PRISMA guidelines. Literature searches in PubMed, Scopus, and Embase were conducted using relevant MeSH terms and keywords, for articles published in the last 2 decades (2000-2022). Pooled estimates of diagnostic test accuracy-including sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and hierarchical summary ROC (HSROC) curve were generated using bivariate random-effects meta-analysis.

RESULTS

Seventeen studies were included in the systematic review and 13 studies were deemed eligible for meta-analysis. The mean estimates of pooled sensitivity, specificity, positive-likelihood ratio, negative-likelihood ratio, and Odds ratio using 18F-FDG PET with a 95% confidence interval were 0.47 (0.25-0.69), 0.97 (0.95-0.98), 18.8 (6.8-51.5), 0.45 (0.27-0.76), 41.0 (7.9-211.8) and for 18F-FDG PET/CT were 0.83 (0.75-0.88), 0.98 (0.97-0.99), 49.7 (29.2-84.5), 0.15 (0.8-0.28), 329.9 (125.0-870.8), respectively. Among screening modalities, 18F-FDG PET/CT had a higher accuracy i.e., the area under the HSROC curve (AUC): 0.91 (0.87-0.95) compared to 18F-FDG PET: 0.72 (0.61-0.82).

CONCLUSION

This study demonstrates that currently 18F-FDG PET-based screening has limited applicability for population-based cancer-screening programs. However, it has a promising role as a combined screening strategy for at-risk individuals and allows for comprehensive diagnostic and prognostic evaluation in high-resource settings.

Prospective Employer-Initiated Whole-Body Cancer Screening-Costs and Outcomes of a Cancer Screening Program in Japan

PURPOSES

To determine cancer detection and mortality and its costs associated with employee-initiated, prospective whole-body cancer screening program in an engineering company in Hamamatsu, Japan.

MATERIALS AND METHODS

The program includes whole-body fluorine-18-2-fluoro-2-deoxy-D-glucose PET/CT, brain and pelvis MR, and abdominal ultrasound, offered every 2 years five consecutive times. Employees are free to opt in or opt out anytime. The subjects were divided into the full (five consecutive screenings), partial (more than once and less than five), and no participation groups. The rate ratio of cancer detection rate and cancer-related mortality and cancer-related costs of care were measured. All employees also received other annual health screenings, including chest radiograph or upper gastrointestinal study.

RESULTS

Among 1,213 subjects, 543 employees were under full participation, 318 were under partial participation, and 352 were under no participation. In all, 26, 9, and 19 cancers were detected from the full participation, partial participation, and nonparticipation groups, respectively. No statistical significance was observed in the cancer detection rate ratio. The rate ratio of cancer-related deaths was 0.11 (0.01-0.90) for the full participation group compared with the nonparticipation group, and the difference was statistically significant. The cost of cancer-related care was highest among the nonparticipation group; however, the difference was not statistically significant (P = .108).

CONCLUSION

Whole-body cancer screening can successfully reduce cancer-related mortality and costs of cancer-related care. The cancer detection rate was not significantly improved because of broad implementation of additional annual health screenings offered to all employees at no cost, resulting in the high baseline cancer detection rate.

Comparison of FDG-PET/CT for Cancer Detection in Populations With Different Risks of Underlying Malignancy

Background/Aim: Whole-body positron-emission tomography/computed tomography with the glucose analog 2-[ 18 F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) has been used to screen examinees for underlying malignancy in many countries. The aim of this study was to compare the potential value of FDG-PET/CT application in asymptomatic individuals with those with suspected malignancy. Patients and Methods: A total of 9,408 examinees underwent whole-body FDG-PET/CT at our hospital from July 2006 to August 2013. Three thousand and seven hundred asymptomatic individuals and 848 individuals with laboratory and clinical/radiologicaI suspicion of malignancy who had undergone FDG-PET/CT for cancer screening were recruited. The final confirmation of cancer and outcomes were based on a pathological report and continuous follow-up. Results: Forty-five out of 3,700 asymptomatic individuals (1.2%) had proven malignancy, and 42 of them (93.3%) were found by FDG-PET/CT. Two hundred and twelve out of 848 with suspected malignancy (25%) had proven malignancy, and 196 of them (92.5%) were detected by FDG-PET/CT. Most of these cancers in asymptomatic individuals were clinically at an early stage. The discovery rate in asymptomatic individuals and those with suspected malignancy was 1.1% and 23.1%, respectively. The overall survival of patients with cancer diagnosed with PET/CT was higher than those with suspected malignancy (78.6% vs. 48.5%, p<0.001). Patients with a resectable lesion, early-stage disease, and lower maximal standardized uptake value had significantly better survival than those without. Conclusion: FDG-PET/CT is useful in the early diagnosis of cancer and thus might improve the survival rates of these patients. Considering the costs and risk of radiation exposure, it would be better used as a priority in patients with laboratory and clinical/radiologic suspicion of malignancy.

Thirty Years Cancer Incidence Data for Lahore, Pakistan: Trends and Patterns 1984-2014

This research was conducted to generate trends and patterns of most common male and female cancers from 1984-2014 for the city population of Lahore Pakistan. Cancer incidence data gathered for different organs were processed through cleaning, integration, transformation, reduction and mining for ultimate representation. Risk of cancer appeared to be continuously increasing among both males and females. Overall, lymphomas and breast cancer are the most common neoplasm in males and females, respectively, in Lahore with almost the highest rates in the Asian Pacific region. The incidence of head and neck, brain, and lung cancers, as well as leukemia have rapidly increased among males, whereas, ovarian, cervix, head and neck and lymphomas have become more common among females. The present communication should be helpful for adequate strategic planning, identification of risk factors and taking appropriate prevention and control measures at the national level.

Application of whole-body FDG-PET for cancer screening in a cohort of hospital employees

Whole-body positron emission tomography/computed tomography with the glucose analog 2-[F]fluoro-2-deoxy-D-glucose (FDG-PET/CT) has been extensively used to screen for underlying malignancies in asymptomatic individuals. We were able to survey a cohort of hospital employees using FDG-PET/CT and to report the results herein.A total of 116 hospital employees older than 55 years old were offered whole-body FDG-PET in our hospital. Ninety-seven employees (83.6%) completed the assessment from February 2014 to August 2014 in our PET center. The final confirmation of cancer was based on pathologic examination and follow-up after more than 1 year.Among the 97 participants, 92 were asymptomatic and 5 presented with previously diagnosed cancers. Six of the 92 asymptomatic participants (6.6%) with significant nodular lesions were referred for histological or cytological evaluation of the possibility of malignancy, and 1 case was considered clinically important and required surgical resection. The cancer discovery rate was 3.3% (3/92) with positive predictive value of 50% (3/6). In the 5 participants with previously identified cancers, no recurrence or metastasis was detected.The offer of whole-body FDG-PET for cancer screening was welcomed with enthusiasm by most of the hospital employees. PET/CT combines the merits of PET and CT and can be administered to and provide benefits to a select group of hospital employees.

Trends and Analysis of Cancer Incidence for Common Male and Female Cancers in the Population of Punjab Province of Pakistan during 1984 to 2014

BACKGROUND

The Pakistan Atomic Energy Commission Cancer Registry (PAECCR) program has made availability of a common cancer incidence database possible in Pakistan. The cancer incidence data from nuclear medicine and oncology institutes were gathered and presented.

MATERIALS AND METHODS

The cancer incidence data for the last 30 years (1984-2014) are included to describe a data set of male and female patients. The data analysis concerning occurrence, trends of common cancers in male and female patients, stage-wise distribution, and mortality/follow-up cases is also incorporated for the last 10 years (2004-2014).

RESULTS

The total population of provincial capital Lahore is 9,800,000. The total number of cancer cases was 80,390 (males 32,156, females 48,134). The crude incidence rates in PAECCR areas were 580.8/105 during 2010 to 885.4/105 in 2014 (males 354.1/105, females 530.1/105). The cancer incidence rates for head and neck (15.70%), brain tumors (10.5%), and non-Hodgkin lymphoma (NHL, 9.53%) were found to be the highest in male patients, whereas breast cancer (46.7%), ovary tumors (6.80%), and cervix (6.31%) cancer incidence rates were observed to be the most common in female patients. The age range distribution of diagnosed and treated patients in conjunction with the percentage contribution of cancer patients from 15 different cities of Punjab province treated at the Institute of Nuclear Medicine and Oncology, Lahore are also included. Leukemia was found to be the most common cancer for the age group of 1-12 years. It has been identified that the maximum number of diagnosed cases were found in the age range of 51-60 years for males and 41-50 years for female cancer patients.

CONCLUSIONS

Overall cancer incidence of the thirty years demonstrated that head and neck and breast cancers in males and in females respectively are the most common cancers in Punjab province in Pakistan, at rates almost the highest in Asia, requiring especial attention. The incidence of brain, NHL, and prostate cancers among males and ovarian and cervix cancers among females have increased rapidly. These data from a major population of Punjab province should be helpful for implementation of appropriate planning, prevention and cancer control measures and for determination of risk factors within the country.

A Phase I/II Study for Analytic Validation of 89Zr-J591 ImmunoPET as a Molecular Imaging Agent for Metastatic Prostate Cancer

PURPOSE

Standard imaging for assessing osseous metastases in advanced prostate cancer remains focused on altered bone metabolism and is inadequate for diagnostic, prognostic, or predictive purposes. We performed a first-in-human phase I/II study of (89)Zr-DFO-huJ591 ((89)Zr-J591) PET/CT immunoscintigraphy to assess performance characteristics for detecting metastases compared with conventional imaging modalities (CIM) and pathology.

EXPERIMENTAL DESIGN

Fifty patients with progressive metastatic castration-resistant prostate cancers were injected with 5 mCi of (89)Zr-J591. Whole-body PET/CT scans were obtained, and images were analyzed for tumor visualization. Comparison was made to contemporaneously obtained bone scintigraphy and cross-sectional imaging on a lesion-by-lesion basis and with biopsies of metastatic sites.

RESULTS

Median standardized uptake value for (89)Zr-J591-positive bone lesions (n = 491) was 8.9 and for soft-tissue lesions (n = 90), it was 4.8 (P < 0.00003). (89)Zr-J591 detected 491 osseous sites compared with 339 by MDP and 90 soft-tissue lesions compared with 124 by computed tomography (CT). Compared with all CIMs combined, (89)Zr-J591 detected an additional 99 osseous sites. Forty-six lesions (21 bone and 25 soft tissue) were biopsied in 34 patients; 18 of 19 (89)Zr-J591-positive osseous sites and 14 of 16 (89)Zr-J591-positive soft tissue sites were positive for prostate cancer. The overall accuracy of (89)Zr-J591 was 95.2% (20 of 21) for osseous lesions and 60% (15 of 25) for soft-tissue lesions.

CONCLUSIONS

(89)Zr-J591 imaging demonstrated superior targeting of bone lesions relative to CIMs. Targeting soft-tissue lesions was less optimal, although (89)Zr-J591 had similar accuracy as individual CIMs. This study will provide benchmark data for comparing performance of proposed prostate-specific membrane antigen (PSMA) targeting agents for prostate cancer.