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de Fonseka D, Arnold DT, Smartt HJM, Culliford L, Stadon L, Tucker E, Morley A, Zahan-Evans N, Bibby AC, Lynch G, Mishra E, Khan S, Haris M, Steer H, Lewis L, Ionescu A, Harvey J, Blyth K, Rahman NM, Edey AE, Rogers CA, Maskell NA. PET-CT-guided versus CT-guided biopsy in suspected malignant pleural thickening: a randomised trial. Eur Respir J 2024; 63:2301295. [PMID: 38097208 PMCID: PMC10831139 DOI: 10.1183/13993003.01295-2023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND Pleural biopsy is the gold standard for diagnosis of pleural malignancy but a significant proportion will have an inconclusive biopsy despite ongoing clinical suspicion of malignancy. We investigated whether positron emission tomography-computed tomography (PET-CT) targeted pleural biopsy is superior to standard CT-guided pleural biopsy following an initial non-diagnostic biopsy. METHODS The TARGET trial was a multicentre, parallel group randomised trial. Patients with a previous inconclusive pleural biopsy but an ongoing suspicion of pleural malignancy were randomised (1:1) to receive either CT-guided biopsy (standard care) or PET-CT followed by a targeted CT biopsy (intervention). The primary outcome was pleural malignancy correctly identified from the trial biopsy. RESULTS Between September 2015 and September 2018, 59 participants were randomised from eight UK hospital sites: 29 to CT-only followed by targeted biopsy and 30 to PET-CT followed by targeted biopsy. The proportion of pleural malignancy correctly identified was similar between the groups (risk ratio 1.03 (95% CI 0.83-1.29); p=0.77). The sensitivity of the trial biopsy to identify pleural malignancy was 79% (95% CI 54-94%) in the CT-only group versus 81% (95% CI 54-96%) in the PET-CT group. CONCLUSIONS The results do not support the practice of PET-CT to guide pleural biopsies in patients with a previous non-diagnostic biopsy. The diagnostic sensitivity in the CT-only group was higher than anticipated and supports the practice of repeating a CT-guided biopsy following an inconclusive result if clinical suspicion of malignancy persists.
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Affiliation(s)
- Duneesha de Fonseka
- Academic Directorate of Respiratory Medicine, University of Sheffield, Sheffield, UK
| | - David T Arnold
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Helena J M Smartt
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Lucy Culliford
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Louise Stadon
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Emma Tucker
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Anna Morley
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Anna C Bibby
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Geraldine Lynch
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | - Eleanor Mishra
- University of East Anglia, Norwich, UK
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Henry Steer
- Gloucestershire Hospitals NHS Trust, Gloucester, UK
| | - Leon Lewis
- Academic Directorate of Respiratory Medicine, University of Sheffield, Sheffield, UK
| | - Alina Ionescu
- Aneurin Bevan University Hospital Trust, Newport, UK
| | - John Harvey
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
| | | | - Najib M Rahman
- Oxford NIHR Biomedical Research Centre, Oxford, UK
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Chinese Academy of Medical Sciences Oxford Institute, Oxford, UK
| | | | - Chris A Rogers
- Bristol Trials Centre, Medical School, University of Bristol, Bristol, UK
| | - Nick A Maskell
- Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, UK
- North Bristol NHS Trust, Bristol, UK
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Ahmad H, Vallance K, Sharma I, Berry S, Orr K, Ray A. Multimodal Management With Immunotherapy, Radiation, and Surgery of Histiocytic Sarcoma Following Acute Lymphoblastic Leukemia: An Unusual Presentation of a Rare Disease. J Pediatr Hematol Oncol 2023; 45:463-466. [PMID: 37691159 DOI: 10.1097/mph.0000000000002751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 07/19/2023] [Indexed: 09/12/2023]
Abstract
Histiocytic sarcoma (HS) is a rare neoplasm with no known cause. This sarcoma is characterized by morphology similar to that demonstrated by mature tissue histiocytes and mostly afflicts adults. HSs typically have a poor prognosis due to a rapidly progressive clinical course. Our patient's case was unique due to its presentation four years after completion of treatment for B-cell acute lymphoblastic leukemia. The patient experienced progression with initial therapy for HS. With dual immunotherapy and radiation, however, the patient has remained clinically stable without detectable disease. Immunotherapy may be a successful and tolerable therapeutic option for histiocytic disease.
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Affiliation(s)
- Hufsa Ahmad
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | | | - Ishna Sharma
- University of North Texas Health Science Center, Texas College of Osteopathic Medicine
| | | | - Kaci Orr
- Texas A&M Health Science Center School of Medicine, Bryan, TX
| | - Anish Ray
- Cook Children's Medical Center, Fort Worth
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3
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FDG-PET findings associated with various medical procedures and treatments. Jpn J Radiol 2022; 41:459-476. [PMID: 36575286 PMCID: PMC9794480 DOI: 10.1007/s11604-022-01376-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 12/29/2022]
Abstract
[18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) is a well-established modality with high sensitivity for the diagnosis and staging of oncologic patients. FDG is taken up by the glucose transporter of the cell membrane and becomes trapped within the cell. In addition to malignant neoplasms, active inflammatory lesions and some kinds of benign tumors also accumulate FDG. Moreover, the degree of uptake into normal organs and tissues depends on various physiological conditions, which is affected by various medical procedures, treatments, and drugs. To avoid misleading interpretations, it is important to recognize possible situations of unexpected abnormal accumulation that mimic tumor lesions. In this review, we present various FDG findings associated with surgical or medical procedures and treatments. Some findings reflect the expected physiological reaction to treatment, and some show inflammation due to prior procedures. Occasionally, FDG-PET visualizes other disorders that are unrelated to the malignancy, which may be associated with the adverse effects of certain drugs that the patient is taking. Careful review of medical records and detailed interviews of patients are thus necessary.
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4
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Szyszko TA, Dunn JT, Phillips MM, Bomalaski J, Sheaff MT, Ellis S, Pike L, Goh V, Cook GJ, Szlosarek PW. Role of 3'-Deoxy-3'-[ 18F] Fluorothymidine Positron Emission Tomography-Computed Tomography as a Predictive Biomarker in Argininosuccinate Synthetase 1-Deficient Thoracic Cancers Treated With Pegargiminase. JTO Clin Res Rep 2022; 3:100382. [PMID: 36082278 PMCID: PMC9445378 DOI: 10.1016/j.jtocrr.2022.100382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/22/2022] [Accepted: 07/14/2022] [Indexed: 10/26/2022] Open
Abstract
Introduction Pegargiminase (ADI-PEG 20I) degrades arginine in patients with argininosuccinate synthetase 1-deficient malignant pleural mesothelioma (MPM) and NSCLC. Imaging with proliferation biomarker 3'-deoxy-3'-[18F] fluorothymidine (18F-FLT) positron emission tomography (PET)-computed tomography (CT) was performed in a phase 1 study of pegargiminase with pemetrexed and cisplatin (ADIPemCis). The aim was to determine whether FLT PET-CT predicts treatment response earlier than CT. Methods A total of 18 patients with thoracic malignancies (10 MPM; eight NSCLC) underwent imaging. FLT PET-CT was performed at baseline (PET1), 24 hours post-pegargiminase monotherapy (PET2), post one cycle of ADIPemCis (PET3), and at end of treatment (EOT, PET4). CT was performed at baseline (CT1) and EOT (CT4). CT4 (modified) Response Evaluation Criteria in Solid Tumors (RECIST) response was compared with treatment response on PET (changes in maximum standardized uptake value [SUVmax] on European Organisation for Research and Treatment of Cancer-based criteria). Categorical responses (progression, partial response, and stable disease) for PET2, PET3, and PET4 were compared against CT using Cohen's kappa. Results ADIPemCis treatment response resulted in 22% mean decrease in size between CT1 and CT4 and 37% mean decrease in SUVmax between PET1 and PET4. PET2 agreed with CT4 response in 62% (8 of 13) of patients (p = 0.043), although decrease in proliferation (SUVmax) did not precede decrease in size (RECIST). Partial responses on FLT PET-CT were detected in 20% (3 of 15) of participants at PET2 and 69% (9 of 13) at PET4 with good agreement between modalities in MPM at EOT. Conclusions Early FLT imaging (PET2) agrees with EOT CT results in nearly two-thirds of patients. Both early and late FLT PET-CT provide evidence of response to ADIPemCis therapy in MPM and NSCLC. We provide first-in-human FLT PET-CT data in MPM, indicating it is comparable with modified RECIST.
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Affiliation(s)
- Teresa A. Szyszko
- King’s College London and Guy’s and St Thomas’ PET Centre, St Thomas’ Hospital, London, United Kingdom
- Department of Nuclear Medicine, Royal Free Hospital NHS Trust, London, United Kingdom
- Department of Oncology, University College London, London, United Kingdom
| | - Joel T. Dunn
- King’s College London and Guy’s and St Thomas’ PET Centre, St Thomas’ Hospital, London, United Kingdom
| | - Melissa M. Phillips
- Department of Medical Oncology, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
| | | | - Michael T. Sheaff
- Department of Histopathology, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Steve Ellis
- Department of Diagnostic Imaging, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Lucy Pike
- King’s College London and Guy’s and St Thomas’ PET Centre, St Thomas’ Hospital, London, United Kingdom
| | - Vicky Goh
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Gary J.R. Cook
- King’s College London and Guy’s and St Thomas’ PET Centre, St Thomas’ Hospital, London, United Kingdom
- Cancer Imaging, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, United Kingdom
| | - Peter W. Szlosarek
- Department of Medical Oncology, St. Bartholomew’s Hospital, Barts Health NHS Trust, London, United Kingdom
- Centre for Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
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Lang JA, Bhalla S, Ganeshan D, Felder GJ, Itani M. Side Effects of Oncologic Treatment in the Chest: Manifestations at FDG PET/CT. Radiographics 2021; 41:2071-2089. [PMID: 34723703 DOI: 10.1148/rg.2021210130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Fluorodeoxyglucose (FDG) PET/CT is a vital imaging technique used for staging, assessing treatment response, and restaging following completion of therapy in patients who are undergoing or have completed oncologic treatment. A variety of adverse effects from chemotherapy, targeted therapy, immunotherapy, and radiation therapy are commonly encountered in oncologic patients. It is important to be aware of the manifestations of these adverse effects seen on FDG PET/CT images to avoid misinterpreting these findings as disease progression. Furthermore, early identification of these complications is important, as it may significantly affect patient management and even lead to a change in treatment strategy. The authors focus on the FDG PET/CT manifestations of a broad spectrum of oncologic therapy-related adverse effects in the thorax, as well as some treatment-related changes that may potentially mimic malignancy. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Jordan A Lang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Dhakshinamoorthy Ganeshan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Gabriel J Felder
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
| | - Malak Itani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box #8131, St Louis, MO 63110 (J.A.L., S.B., M.I.); Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, Tex (D.G.); and Department of Radiology, NYU Winthrop Hospital, Mineola, NY (G.J.F.)
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Nishimori M, Yoshimatsu R, Iwasa H, Miyatake K, Nitta N, Anayama T, Yamagami T. Evaluation of pleural lesions after pleurodesis with OK-432 by fluorodeoxyglucose-positron emission tomography/CT. Ann Nucl Med 2020; 34:793-798. [PMID: 32809160 DOI: 10.1007/s12149-020-01508-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 07/26/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study aimed to determine changes in FDG-PET/CT after pleurodesis with OK-432 and to investigate differences in the changes between non-malignant and malignant lesions. METHODS Study participants were 17 patients with a history of malignant chest disease who underwent FDG-PET/CT after pleurodesis using OK-432 and in whom pleural lesions were determined to be non-malignant (n = 8) or malignant (n = 9). FDG uptake (SUVmax) was counted on all pleural lesions. CT findings (CT attenuation, shape) of pleural lesions with increased FDG uptake were evaluated. RESULTS The number of patients with increased FDG uptake in the pleura differed significantly between the non-malignant group (3/8) and malignant group (9/9) (p < 0.01) The mean SUVmax of non-malignant lesions with increased FDG uptake was 2.3 ± 0.7 vs. 6.2 ± 2.2 in malignant lesions, for a significant difference (p < 0.01). The mean CT attenuation of lesions was 36 ± 11 HU in the non-malignant group and 34 ± 14 HU in the malignant group, a difference that was not significant (p = 0.91). There was a significant difference in nodular and linear shapes between non-malignant and malignant lesions (p < 0.01). All non-malignant lesions were linear. CONCLUSIONS Positive FDG uptake was shown in non-malignant pleural lesions as well as in malignant pleural lesions after pleurodesis using OK-432. Combined analysis of FDG accumulation and CT morphology is helpful to distinguish between benign and malignant lesions.
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Affiliation(s)
- Miki Nishimori
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Rika Yoshimatsu
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Hitomi Iwasa
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kana Miyatake
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Noriko Nitta
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Takashi Anayama
- Division of Thoracic Surgery, Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Kitajima K, Nakamichi T, Hasegawa S, Kuribayashi K, Yamakado K. Fluorodeoxyglucose versus Choline Positron Emission Tomography/Computed Tomography Response Evaluation in Two Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Neoadjuvant Chemotherapy. Cureus 2018; 10:e3654. [PMID: 30723653 PMCID: PMC6351117 DOI: 10.7759/cureus.3654] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Talc pleurodesis has been reported to increase fluorodeoxyglucose (FDG) uptake in the high attenuation areas of pleural thickening, making it difficult to distinguish between benign granulomatous inflammatory processes and malignancies, which may therefore interfere with the post-chemotherapy disease evaluation on FDG-positron emission tomography/computed tomography (PET/CT). We present two cases of malignant pleural mesothelioma treated with talc pleurodesis and neoadjuvant chemotherapy (NAC) before pleurectomy/decortication in which post-NAC FDG-PET/CT showed intense FDG uptakes in the high attenuation areas of pleural thickening with false positive result, whereas post-NAC 11C-choline PET/CT showed mild choline uptake of pleural talc deposit, which did not interfere with the post-chemotherapy disease evaluation. Thus we suggest choline-PET/CT may show little choline uptake to granulomatous inflammation and evaluate treatment response in malignant pleural mesothelioma patients treated with talc pleurodesis and NAC.
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Affiliation(s)
| | - Toru Nakamichi
- Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, JPN
| | - Seiki Hasegawa
- Thoracic Surgery, Hyogo College of Medicine, Nishinomiya, JPN
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False-positive lung positron emission tomography-computed tomography result in a patient with a history of cancer. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2017; 14:206-208. [PMID: 29181051 PMCID: PMC5701599 DOI: 10.5114/kitp.2017.70537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 05/25/2017] [Indexed: 11/17/2022]
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9
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Bonomi M, De Filippis C, Lopci E, Gianoncelli L, Rizzardi G, Cerchiaro E, Bortolotti L, Zanello A, Ceresoli GL. Clinical staging of malignant pleural mesothelioma: current perspectives. LUNG CANCER-TARGETS AND THERAPY 2017; 8:127-139. [PMID: 28860886 PMCID: PMC5571821 DOI: 10.2147/lctt.s102113] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Malignant pleural mesothelioma (MPM) is a disease with limited therapeutic options, the management of which is still controversial. Diagnosis is usually made by thoracoscopy, which allows multiple biopsies with histological subtyping and is indicated for staging purposes in surgical candidates. The recommended and recently updated classification for clinical use is the TNM staging system established by the International Mesothelioma Interest Group and the International Association for the Study of Lung Cancer, which is based mainly on surgical and pathological variables, as well as on cross-sectional imaging. Contrast-enhanced computed tomography is the primary imaging procedure. Currently, the most used measurement system for MPM is the modified Response Evaluation Criteria in Solid Tumors (RECIST) method, which is based on unidimensional measurements of tumor thickness perpendicular to the chest wall or mediastinum. Magnetic resonance imaging and functional imaging with 18F-fluoro-2-deoxy-D-glucose positron-emission tomography can provide additional staging information in selected cases, although the usefulness of this method is limited in patients undergoing pleurodesis. Molecular reclassification of MPM and gene expression or miRNA prognostic models have the potential to improve prognostication and patient selection for a proper treatment algorithm; however, they await prospective validation to be introduced in clinical practice.
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Affiliation(s)
- Maria Bonomi
- Department of Oncology, Thoracic and GU Oncology Unit
| | | | - Egesta Lopci
- Nuclear Medicine Unit, Humanitas Clinical and Research Hospital, Milan
| | | | - Giovanna Rizzardi
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
| | | | - Luigi Bortolotti
- Department of Thoracic Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy
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10
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Garg G, Benchekroun MT, Abraham T. FDG-PET/CT in the Postoperative Period: Utility, Expected Findings, Complications, and Pitfalls. Semin Nucl Med 2017; 47:579-594. [PMID: 28969758 DOI: 10.1053/j.semnuclmed.2017.07.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
FDG-PET/CT as a modality is increasingly used for detection of recurrence and for restaging in patients with clinical suspicion of malignancy, as well as in patients with elevated tumor markers. However, there are many pitfalls in the interpretation of these scans when the studies are performed after some treatment. Some of these are attributed to normal physiological distribution and are compounded when there are inflammatory changes occurring after surgery. The body's inherent response to the surgical insult results in this inflammation. In addition, there are also complications that can happen following surgery, causing increased FDG uptake. Despite various fallacies, FDG-PET/CT provides valuable information in evaluation of residual and recurrent malignant disease. In this article, we aim to describe some of these postsurgical changes secondary to inflammation, common surgical complications, and finally, the utility of FDG-PET/CT in these patients to detect recurrent disease, even in the background of postsurgical changes.
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Affiliation(s)
- Gunjan Garg
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Mohammed Taoudi Benchekroun
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY
| | - Tony Abraham
- Division of Nuclear Medicine, Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY.
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11
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Intense pleural FDG uptake 12 years after talc pleurodesis: PET/CT findings. Arch Bronconeumol 2017; 53:638. [PMID: 28554586 DOI: 10.1016/j.arbres.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/09/2017] [Accepted: 04/17/2017] [Indexed: 11/20/2022]
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12
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Meirelles GDSP, Capobianco J, de Oliveira MAC. Pitfalls and artifacts in the interpretation of oncologic PET/CT of the chest. Radiol Bras 2017; 50:55-59. [PMID: 28298733 PMCID: PMC5347504 DOI: 10.1590/0100-3984.2015.0194] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
PET/CT is widely used for the evaluation of patients with thoracic malignancies.
Although the levels of 18F-fluorodeoxyglucose (FDG) uptake are
usually high in neoplastic diseases, they can also be physiological, due to
artifacts. In addition, FDG uptake can occur in benign conditions such as
infectious, inflammatory, and iatrogenic lesions. Furthermore, some malignant
tumors, such as adenocarcinoma in situ (formerly known as bronchoalveolar
carcinoma) and carcinoid tumors, may not show FDG uptake. Here, we illustrate
the main pitfalls and artifacts in the interpretation of the results of
oncologic PET/CT of the chest, outlining strategies for avoiding
misinterpretation.
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Affiliation(s)
| | - Julia Capobianco
- MD, Specialist in PET/CT, Radiologist for the Grupo Fleury, São Paulo, SP, Brazil
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13
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Shroff GS, Carter BW, Viswanathan C, Benveniste MF, Wu CC, Marom EM, Mawlawi OR, Truong MT. Challenges in Interpretation of Staging PET/CT in Thoracic Malignancies. Curr Probl Diagn Radiol 2016; 46:330-341. [PMID: 28159371 DOI: 10.1067/j.cpradiol.2016.11.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 01/15/2023]
Abstract
18F-fluorodeoxryglucose (18F-FDG) PET/CT imaging is routinely performed in the evaluation of patients with known or suspected thoracic malignancy. Indications for its use include staging of malignancy, assessment of response to therapy, evaluation of suspected disease recurrence, and evaluation of a solitary pulmonary nodule. In this article, we will discuss specific technical artifacts and also review potential pitfalls in the interpretation of PET/CT in thoracic malignancies including normal variations in physiologic uptake of FDG, benign conditions (such as infection, inflammation, posttreatment changes, and iatrogenic factors) that can result in increased FDG uptake, and malignancies that demonstrate scarce to no FDG uptake.
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Affiliation(s)
- Girish S Shroff
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chitra Viswanathan
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Carol C Wu
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Edith M Marom
- Department of Diagnostic Imaging, The Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Osama R Mawlawi
- Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mylene T Truong
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Amorim E, Saad Junior R, Salgado Filho N, Melo GCFD, Silva GEB, Santos RAP, Marchi DDD, Carli RCD, Malafaia O, Ribas-Filho J. The effects of aqueous extract of babassu (Orbignya phalerata) on the pleura and lung parenchyma in rats. Acta Cir Bras 2016; 31:243-9. [PMID: 27168536 DOI: 10.1590/s0102-865020160040000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 03/22/2016] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To evaluate macro and microscopically, changes following the use of the aqueous extract of babassu (Orbignya phalerata) in the lung parenchyma and pleura of rats. METHODS Sixty adult male rats with average weight of 350 g, were randomized into two groups of 30 animals (experimental and control) further divided into sub-groups of 10 to be sacrificed at 48 h, 72 h and 21 days. The substance was injected into the right pleura of the animals. RESULTS There was intense pleuropulmonary macroscopic reaction with statistically significant differences between groups respectively (p<0.05, p<0.02, p<0.03). Microscopically, no statistically significant difference was evident (p>0.05). CONCLUSION The aqueous extract of babassu (Orbignya phalerata) was found to be highly irritating to the pleura and lung of rats, evidenced macroscopically by numerous adhesions and inflammation while no major changes were evident microscopically.
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Affiliation(s)
- Elias Amorim
- Department of Surgery, Universidade Federal do Maranhão, Sao Luis, MA, Brazil
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Abstract
Talc pleurodesis (TP) is a technique, widely employed in the management of patients with persistent pleural effusions or pneumothoraces not amenable to other treatment options. It is well documented that talc deposits produce areas of highly increased F-FDG uptake, because of talc-induced inflammation. We present a case of a patient with history of TP who was evaluated with both F-FDG and Ga-DOTA-TATE. The hypermetabolic area seen on F-FDG-PET-CT in the region of talc placement showed no uptake by Ga-DOTA-TATE, suggesting the potential role of Ga-DOTA-TATE-PET-CT in elucidating F-FDG-postitive lesions in patients with history of both neuroendocrine malignancy and TP.
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Lack of Increased FDG Uptake in the Lacrimal and Salivary Glands in Patients With Sarcoidosis and Potential Underlying Mechanism. Clin Nucl Med 2016; 41:274-7. [DOI: 10.1097/rlu.0000000000001127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Amarante MPF, Younes RN, Rigo L, de Sousa Cruz MR. Interpretation of PET/CT findings in patients with advanced lung cancer who have undergone pleurodesis. Ecancermedicalscience 2014; 8:452. [PMID: 25183997 PMCID: PMC4144710 DOI: 10.3332/ecancer.2014.452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Indexed: 12/19/2022] Open
Abstract
A consensus has not yet been reached for the ideal moment to carry out pleurodesis in patients with malignant pleural effusion among the majority of centres, especially those which don’t specialise in oncologic treatment. The PET (positron emission tomography)/CT (computed tomography) used in the staging of patients with non-small-cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) has caused controversy when used in the evaluation of therapeutical response and in detection of recurrence in patients with pleurodesis. For not distinguishing between inflammatory and neoplasic processes while using PET or CT, suspicion of pleural involvement can result in the indication for invasive diagnostic procedures or inadequate exchange of therapy. In such cases, the hypothesis of the inflammatory process must be included in the differential diagnoses for positive findings with the PET/CT in patients with NSCLC who have undergone pleurodesis, independently of time since the procedure. The reports of two patients with NSCLC have been presented in order to illustrate situations in which pleurodesis has been performed at the moment of diagnosis, outside of a cancer centre.
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Affiliation(s)
| | - Riad Naim Younes
- Clinical Oncology Department, Antônio Ermírio de Moraes Cancer Centre, Beneficência Portuguesa, São Paulo 01321-001, Brazil
| | - Letícia Rigo
- Medimagem, Beneficência Portuguesa, São Paulo 01321-001, Brazil
| | - Marcelo Rocha de Sousa Cruz
- Clinical Oncology Department, Antônio Ermírio de Moraes Cancer Centre, Beneficência Portuguesa, São Paulo 01321-001, Brazil
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Ulaner GA, Lyall A. Identifying and Distinguishing Treatment Effects and Complications from Malignancy at FDG PET/CT. Radiographics 2013; 33:1817-34. [DOI: 10.1148/rg.336125105] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Persistent Inflammation in Pulmonary Granuloma 48 Years after Talcage Pleurodesis, Detected by FDG-PET/CT. Case Rep Med 2012; 2012:686153. [PMID: 23251181 PMCID: PMC3509450 DOI: 10.1155/2012/686153] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022] Open
Abstract
In patients with suspicion of lung malignancy, FDG PET/CT is frequently used as a diagnostic and staging imaging modality. However, false positive findings are not uncommon. We demonstrate a case with FDG-avid pulmonary nodules, mimicking lung cancer. After histopathological examination they appeared to be the result of persistent inflamed tissue, due to talcage pleurodesis, which occurred 48 years ago. We concluded that, nearly five decades after talcage pleurodesis, there can still be an ongoing inflammation reaction in the pleurae, which can be detected by FDG PET/CT.
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Genestreti G, Moretti A, Piciucchi S, Giovannini N, Galassi R, Scarpi E, Burgio MA, Amadori D, Sanna S, Poletti V, Matteucci F, Gavelli G. FDG PET/CT Response Evaluation in Malignant Pleural Mesothelioma Patients Treated with Talc Pleurodesis and Chemotherapy. J Cancer 2012; 3:241-5. [PMID: 22670158 PMCID: PMC3366479 DOI: 10.7150/jca.2586] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 04/10/2012] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Talc pleurodesis (TP) is employed worldwide for the management of persistent pneumothorax or pleural effusion, particularly of malignant origin. However, there are very little available data on (18)F-fluorodeoxyglucose positron-emission tomography/computed tomography ((18)F FDG PET/CT) response evaluation in malignant pleural mesothelioma (MPM) patients treated with TP and chemotherapy. METHODS Patients with histologically confirmed MPM underwent TP and FDG PET/CT staging and restaging after 3-4 courses of chemotherapy. All patients fasted and received a dose of 5.18 MBq (18)F-FDG per kilogram of body weight. Whole-body emission scans were acquired with and without Ordered Subset Expectation Maximization (OSEM) iterative reconstruction algorithm. RESULTS From January 2004 to March 2010, 8 patients with biopsy confirmed MPM (7 epithelial, 1 biphasic), with a median age of 65 years (range: 54-77), were evaluated. Median follow-up was 31 months (range: 4-44). After TP treatment, there was a mean interval of 14 days (range: 9-22) and 125 days (range: 76-162) between FDG PET/CT staging and restaging. According to modified RECIST and EORTC criteria, there was a concordance between the radiologic and metabolic SUVmean and SUVmax responses in 6 (75%) and 3 (37.5%) patients, respectively. CONCLUSION TP produces an increased FDG PET uptake which may interfere with the post-chemotherapy disease evaluation. In our case series, the metabolic response measured by SUVmean seems to be in better agreement with the radiologic response compared to the SUVmax.
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Affiliation(s)
- Giovenzio Genestreti
- 1. Department of Medical Oncology, IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST), Meldola, Italy
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Intense Focal F-18 FDG Uptake in Vocal Cord Associated with Injection of Calcium Hydroxylapatite Microspheres. Clin Nucl Med 2011; 36:e175-7. [DOI: 10.1097/rlu.0b013e31821a2ad5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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22
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Daddi N, Vannucci J, Maggio C, Giontella A, Bravi I, Marziani F, Capozzi R, Ragusa M, Bufalari A, Puma F. Efficacy of tigecycline pleurodesis: a comparative experimental study. J Surg Res 2010; 169:e109-18. [PMID: 20934718 DOI: 10.1016/j.jss.2010.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 06/08/2010] [Accepted: 07/01/2010] [Indexed: 11/19/2022]
Abstract
BACKGROUND We investigated whether tigecycline (TIGE) is more effective than talc in inducing pleurodesis in rabbits. METHODS Fifty-six New Zealand rabbits were utilized in a two-phase study: Effects at 14 d (phase I) and at 28 d (phase II) were assessed. Saline solution (SAL n = 3), talc slurry (TALC 200 mg/kg, n = 5), and TIGE at different concentrations (mg/kg): TIGE0.5 (n = 5); TIGE1 (n = 5); TIGE3 (n = 5); TIGE25 (n = 5); TIGE50 (n = 5) were randomly injected, for each phase, through a right chest drainage. TIGE0.5 and TIGE1 were ineffective during phase I and were thus excluded from further investigation. At post mortem examination, pleurodesis was graded grossly and microscopically by three observers blinded to treatment groups. RESULTS Phase I: pleurodesis was more effective in TIGE25 and TIGE50 (P < 0.001); TALC was better than TIGE0.5 (P < 0.001), and TIGE1 (P = 0.49), macroscopically. Pleural thickness was significantly higher in TIGE25 compared with SAL, TALC, TIGE0.5, TIGE1, and TIGE3 (P < 0.01). No significant differences were evident between TALC and TIGE3, both macroscopically (P = 0.90) and microscopically (inflammation P = 0.99, fibrosis P = 0.96, pleural thickness P = 0.99). Phase II: better effectiveness of TIGE50 compared with all other groups (P < 0.001) except TIGE 25 (P = 0.29); results similar to phase I for TALC and TIGE3 (P = 0.99), macroscopically. Microscopically greater inflammation in TALC compared with TIGE3 (P < 0.05) and in TIGE50 to TIGE3 (P = 0.05). Significant complications occurred in all TIGE50 group. One of TIGE25 and one of TIGE50 died of respiratory distress and of right hemothorax+ascites, respectively. CONCLUSIONS Intrapleural TIGE3 mg/kg is as effective as talc in inducing pleurodesis in rabbits. The intrapleural TIGE toxicity threshold was reached at TIGE25 mg/kg concentration.
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Affiliation(s)
- Niccolò Daddi
- Thoracic Surgery Unit in Perugia and Terni, University of Perugia, Italy.
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