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Nieri A, Manco L, Bauckneht M, Urso L, Caracciolo M, Donegani MI, Borgia F, Vega K, Colella A, Ippolito C, Cittanti C, Morbelli S, Sambuceti G, Turra A, Panareo S, Bartolomei M. [18F]FDG PET-TC radiomics and machine learning in the evaluation of prostate incidental uptake. Expert Rev Med Devices 2023; 20:1183-1191. [PMID: 37942630 DOI: 10.1080/17434440.2023.2280685] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/26/2023] [Indexed: 11/10/2023]
Abstract
AIM To evaluate the relevance of incidental prostate [18F]FDG uptake (IPU) and to explore the potential of radiomics and machine learning (ML) to predict prostate cancer (PCa). METHODS We retrieved [18F]FDG PET/CT scans with evidence of IPU performed in two institutions between 2015 and 2021. Patients were divided into PCa and non-PCa, according to the biopsy. Clinical and PET/CT-derived information (comprehensive of radiomic analysis) were acquired. Five ML models were developed and their performance in discriminating PCa vs non-PCa IPU was evaluated. Radiomic analysis was investigated to predict ISUP Grade. RESULTS Overall, 56 IPU were identified and 31 patients performed prostate biopsy. Eighteen of those were diagnosed as PCa. Only PSA and radiomic features (eight from CT and nine from PET images, respectively) showed statistically significant difference between PCa and non-PCa patients. Eight features were found to be robust between the two institutions. CT-based ML models showed good performance, especially in terms of negative predictive value (NPV 0.733-0.867). PET-derived ML models results were less accurate except the Random Forest model (NPV = 0.933). Radiomics could not accurately predict ISUP grade. CONCLUSIONS Paired with PSA, radiomic analysis seems to be promising to discriminate PCa/non-PCa IPU. ML could be a useful tool to identify non-PCa IPU, avoiding further investigations.
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Affiliation(s)
- Alberto Nieri
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | - Luigi Manco
- Medical Physics Unit, Azienda USL of Ferrara, Ferrara, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Luca Urso
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Nuclear Medicine, PET/CT Centre, S. Maria della Misericordia Hospital, Rovigo, Italy
| | - Matteo Caracciolo
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
| | | | - Francesca Borgia
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Kevin Vega
- Centro Nacional de Radioterapia, Physics Unit, San Salvador, El Salvador
| | - Alessandro Colella
- Urology Unit, Surgical Department, University Hospital of Ferrara, Ferrara, Italy
| | - Carmelo Ippolito
- Urology Unit, Surgical Department, University Hospital of Ferrara, Ferrara, Italy
| | - Corrado Cittanti
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
| | - Silvia Morbelli
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Alessandro Turra
- Medical Physics Unit, University Hospital of Ferrara, Cona, Italy
| | - Stefano Panareo
- Nuclear Medicine Unit, Oncology and Haematology Department, University Hospital of Modena, Modena, Italy
| | - Mirco Bartolomei
- Nuclear Medicine Unit, Oncological Medical and Specialists Department, University Hospital of Ferrara, Ferrara, Italy
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Gökden Y, Özülker F, Özülker T. Prevalence and Clinical Significance of Incidental Focal 18F-FDG Uptake in Colon on PET/CT Imaging. Mol Imaging Radionucl Ther 2022; 31:96-103. [PMID: 35770960 PMCID: PMC9246315 DOI: 10.4274/mirt.galenos.2022.38247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives: The present study aimed to identify the prevalence of focal uptake in the colon on 18fluorine-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) studies performed for the evaluation of malignancies other than colon, to detect the rate of malignancy in incidental focal 18F-FDG avid colonic lesions and to investigate if any possible role of maximum standardized uptake value (SUVmax) values in the discrimination of malignant lesions from premalignant and benign ones exist. Methods: We retrospectively reviewed the files of 8,017 patients with known or suspected malignancy, who underwent whole-body 18F-FDG PET/CT at our institution during the period November 2017 to November 2019. Patients showing a single site of focally increased colonic 18F-FDG uptake that was more intense compared to liver uptake on 18F-FDG PET studies and referred to colonoscopy were enrolled in the study. Results: Fifty two patients (83.8%) had at least 1 corresponding lesion on colonoscopy, whereas in 10 patients no lesion was detected. Subsequent histopathological examinations revealed no corresponding lesion in 13 (13.7%), a benign lesion in 18 (18.9%), hyperplastic polyp in 10 (10.5%), low-grade polyp in 16 (16.8%), high-grade polyp in 29 (30.5%) and malignant lesion in 9 (9.5%) of the focal 18F-FDG uptake sites. According to histopathology results, statistically no significant difference was found between the SUVmax measurements of malignant and benign cases (p>0.05) but the average SUVmax measurements of malignant cases were found to be significantly higher than lower + high-grade cases (p<0.05) and hyperplastic polyp cases (p<0.01). Conclusion: In conclusion, any unexpected focal 18F-FDG uptake in 18F-FDG PET/CT studies is suspicious for malignancy and should be clarified by colonoscopy. The intensity of 18F-FDG uptake does not preclude the application of colonoscopy and histopathological verification of the lesion if there is any.
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Affiliation(s)
- Yasemin Gökden
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Internal Medicine, İstanbul, Turkey
| | - Filiz Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
| | - Tamer Özülker
- University of Health Sciences Turkey, Prof. Dr. Cemil Taşcıoğlu City Hospital, Clinic of Nuclear Medicine, İstanbul, Turkey
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Lee H, Hwang KH, Kwon KA. Assessment of incidental focal colorectal uptake by analysis of fluorine-18 fluorodeoxyglucose positron emission tomography parameters. World J Clin Cases 2022; 10:5634-5645. [PMID: 35979099 PMCID: PMC9258383 DOI: 10.12998/wjcc.v10.i17.5634] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/11/2022] [Accepted: 04/09/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Colon and rectal cancers are among the top five cancers worldwide in terms of their incidence and mortality rates. As the treatment options for cure include surgery even in specific advanced-stage cases, the early detection of lesions is important for applying active treatment methods. Fluorine-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) is an established imaging study for many types of cancers; however, physiologic uptake in the gastrointestinal tract is a frequent finding and may interfere with lesion identification. Nevertheless, as unexpectedly observed focal colorectal F-18 FDG uptake may harbor malignant lesions, further examination must not be avoided.
AIM To assess the clinical implications of unexpected focal colorectal F-18 FDG uptake by analyzing FDG PET parameters.
METHODS A total of 15143 F-18 FDG PET/CT scans performed at our hospital between January 2016 and September 2021 were retrospectively reviewed to identify incidentally observed focal colorectal FDG uptake. Finally, 83 regions showing focal colorectal FDG uptake with final histopathological reports from 80 patients (45 men and 35 women with mean ages of 66.9 ± 10.7 years and 63.7 ± 15.3 years, respectively) were eligible for inclusion in the present study. Each focal hypermetabolic colorectal region was classified as malignant, premalignant, or benign according to the histopathological report. PET parameters such as maximum and peak standardized uptake value (SUVmax and SUVpeak), metabolic tumor volume (MTV), mean SUV of the metabolic tumor volume (mSUVmtv), and total lesion glycolysis (TLG) were measured or calculated for the corresponding hypermetabolic regions. Parametric and non-parametric statistical comparisons of these parameters were performed among the three groups. Receiver operating characteristic curves were plotted to identify cut-off values.
RESULTS The detection rate of incidental focal colorectal uptake was 0.53% (80/15,143). Of the 83 regions with unexpected focal colorectal hypermetabolism, 28.9% (24/83) were malignant, 32.5% (27/83) were premalignant, and 38.6% (32/83) were benign. Overall, 61.4% of the regions had malignant or premalignant lesions. SUVmax, SUVpeak, and mSUVmtv differentiated malignant and/or premalignant lesions from benign lesions with statistical significance (P < 0.05). mSUVmtv3.5 differentiated malignant from benign lesions, with the largest area under the curve (AUC) of 0.792 and a cut-off of 4.9. SUVmax showed the largest AUC of 0.758 with a cut-off value of 7.5 for distinguishing between premalignant and benign lesions. Overall, SUVmax with a cut-off value of 7.6 (AUC: 0.770, 95% confidence interval (CI): 0.668-0.872; sensitivity, 0.686; specificity, 0.688) was a superior parameter for distinguishing between malignant/premalignant and benign lesions or physiologic uptake. No parameters differentiated malignant from premalignant lesions. Moderate or weak positive correlations were observed between the long diameter of the malignant lesions and PET parameters such as SUVpeak and some mSUVmtv.
CONCLUSION Approximately two-thirds (61.4%) of incidental focal hypermetabolic colorectal regions were malignant/premalignant lesions, for which SUVmax was an independent diagnostic parameter. Unexpected suspicious focal colorectal FDG uptake should not be avoided and consideration for further evaluation is strongly recommended not to miss the two-thirds.
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Affiliation(s)
- Haejun Lee
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kyung-Hoon Hwang
- Department of Nuclear Medicine, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
| | - Kwang An Kwon
- Department of Gastroenterology, Gachon University College of Medicine, Gil Medical Center, Incheon 21565, South Korea
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Albertsen LN, Jaensch C, Tornbjerg SM, Teil J, Madsen AH. Correlation between incidental focal colorectal FDG uptake on PET/CT and colonoscopic and histopathological results. Scand J Gastroenterol 2022; 57:246-252. [PMID: 34735311 DOI: 10.1080/00365521.2021.1998602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE AND AIMS The primary aim of this study was to evaluate the correlation between incidental focal colorectal foci on fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) with colonoscopic and histopathological results. The secondary aim was to determine to what extent these findings led to a change in patient management. MATERIALS AND METHODS A retrospective study was performed among 5850 patients who had an FDG-PT/CT scan from July 2015 to July 2018. Among these patients, we identified patients with a PET/CT description of incidental colorectal FDG uptake, and a colonoscopy within 90 days from the PET/CT scan. PET/CT findings were compared with colonoscopy-detected lesions and eventually histopathology on a per-lesion analysis and a per-person analysis. RESULTS A total of 145 patients were included in the study. A total of 180 foci of colorectal FDG uptake were detected on FDG-PET/CT. Of these, 86 foci corresponded to advanced colorectal neoplasia (ACRN), positive predictive value (PPV) 47.8%; 95% CI: 40.5-55.1%). On a per-patient analysis 81 patients had a least one ACRN at colonoscopy (PPV 55.9%; 95% CI: 47.6-63.8), this group included 20 patients (13.8%) diagnosed with cancer. There was a small positive correlation between focal FDG-uptake and the finding of ACRN at the same colonic segment at colonoscopy, which was statistically significant, rho = 0.2565, p = .002. The findings changed patient management in 67 (46.2%) cases. CONCLUSIONS Incidental focal colorectal FDG uptake on PET/CT is associated with a high risk of ACRN and is affecting subsequent patient management. Further evaluation with colonoscopy is recommended when the patient is considered suitable for further treatment.
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Affiliation(s)
| | - Claudia Jaensch
- Surgical Research Department, Regional Hospital West, Herning, Denmark
| | | | - Jørn Teil
- Department of Nuclear Medicine, Regional Hospital West, Herning, Denmark
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Dutta AK, Mitchell-Hay R, Baio G, Phull PS. Clinically significant findings in patients with focal incidental colorectal abnormalities on positron emission tomography-CT scans. J Med Imaging Radiat Oncol 2021; 66:749-754. [PMID: 34609070 DOI: 10.1111/1754-9485.13338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/25/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The aim of this study was to determine the clinical significance of focal incidentally detected colorectal abnormalities on 18 F- Fluoro-2-Deoxy-D-Glucose (FDG) PET-CT scans. METHODS Retrospective audit of PET-CT scans performed at our institution between 2009 and 2014. Demographic and clinical details were retrieved from electronic patient records. An advanced adenoma was defined as: ≥1 cm in size, tubullo-villous histology, or displaying high grade dysplasia. A high-risk lesion (HRL) was defined as an advanced adenoma or colorectal cancer (CRC). RESULTS Of the 1911 PET-CT eligible scans, focal incidental colorectal FDG uptake was detected in 99 (5.2%) patients. Colonoscopy was undertaken in 43 (43.4%) patients and 45 FDG-avid sites were evaluated. The commonest site of abnormal FDG uptake was the rectosigmoid region, with 34 (75.6%) of the 45 foci being located in this area. Overall, 23 (53.5%) of these patients had clinically significant pathology. Of the 45 focal PET-CT abnormalities evaluated, 17 (37.8%) were adenomas, of which 11 (24.4%) were advanced adenomas, and six (13.3%) were cancers, with a total of 17 (37.8%) HRLs. Five of the six patients with CRC underwent surgical resection, whilst one had endoscopic resection. The overall survival for the entire cohort was 18 months (range 1-72 months) with those that underwent colonoscopy having higher overall survival compared to those that did not (38 vs. 13.5 months). CONCLUSION Incidental colorectal abnormalities on PET-CT scans are often clinically significant. However, careful selection for colonoscopy is important due to the poor survival in these patients related to the underlying primary malignancy.
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Affiliation(s)
- Amit K Dutta
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK.,Department of Gastroenterology, Christian Medical College, Vellore, India
| | | | - Gabriella Baio
- Aberdeen Biomedical Imaging Centre, University of Aberdeen, Aberdeen, UK
| | - Perminder S Phull
- Department of Digestive Disorders, Aberdeen Royal Infirmary, Aberdeen, UK
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Abstract
OBJECTIVE Parotid incidentalomas on fluorodeoxyglucose positron emission tomography/computed tomography imaging are rare. A systematic review was performed to assess their aetiology and association with scanning indication, and to develop an evidence-based algorithm for their management. METHODS A literature search was performed on 25 August 2020 using the keywords 'incidentaloma', 'incidental finding', 'parotid', 'parotid gland', 'salivary gland' and 'head and neck'. Articles were reviewed by two authors before their inclusion. RESULTS Forty articles were included, totalling 558 incidentalomas. The mean incidence was 0.74 per cent. Lung cancer was the most common imaging indication. The most common aetiologies were cystadenolymphoma, pleomorphic salivary adenoma and metastases. Only cystadenolymphoma (p = 0.015) and pleomorphic salivary adenoma (p = 0.011) were significantly associated with a primary malignancy (lung). The most common further investigations were aspiration cytology, ultrasound imaging and core biopsy, usually prior to parotidectomy. CONCLUSION If appropriate, parotid incidentalomas should be followed up with flexible endoscopy, skin examinations, and head and neck examinations. Ultrasound-guided core biopsy provides higher accuracy, avoiding repeat sampling and excision biopsy.
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Basendowah M, Alshaynawi S, Madani TA, Alabdulqader MH, Hakami M. Positron Emission Tomography With Fluorodeoxyglucose Incidental Detection of Colon Cancer in a Patient's Follow-Up for Nasopharyngeal Carcinoma During the COVID-19 Pandemic: A Case Report. Cureus 2020; 12:e9939. [PMID: 32968599 PMCID: PMC7505672 DOI: 10.7759/cureus.9939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Colorectal cancer (CRC) is a type of widespread, deadly malignancy that took thousands of lives around the globe. In the last two decades, CRC represented the most common cancer among men and ranked third among women in Saudi Arabia. Positron emission tomography with fluorodeoxyglucose (FDG-PET), can incidentally detect malignancy, as in our case, FDG-PET disclosed high abnormal FDG far away from the first primary malignancy. The current case is of a 65-year-old female who was following up on her nasopharyngeal carcinoma (first primary). During her last management, FDG-PET was requested to find any FDG uptake in the nasopharyngeal region; stunning FDG uptake was incidentally found at the ascending colon diagnosed as early-stage (pT2N0) colon cancer. Colonoscopy was done and India Ink was injected to facilitate localizing the mass during the laparoscopic removal of the tumor, which was delayed due to the pandemic of COVID-19. This took place in March 2020 at King Abdul-Aziz University Hospital in Jeddah.
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Affiliation(s)
| | | | - Turki A Madani
- Surgery, King Abdulaziz University Hospital, Jeddah, SAU
| | - Mutaz H Alabdulqader
- Family Medicine, King Abdulaziz Medical City, National Guard Hospital - Health Affairs, Jeddah, SAU
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Mannas MP, Lee T, Pourghiasian M, Wilson DC, Black PC. Incidentalomas of the prostate detected by 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography. Can Urol Assoc J 2020; 14:E180-E184. [PMID: 31793859 PMCID: PMC7197962 DOI: 10.5489/cuaj.5976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Prostate incidentalomas are prostatic lesions suspicious for cancer discovered by imaging patients without a known history of prostatic cancer (PCa) for other reasons. 18-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (FDG PET) is used to diagnose, stage, and assess response to treatment for numerous cancers, but it is not routinely used for PCa. We aimed to determine the rate of detection of prostate incidentalomas in patients undergoing FDG PET and to evaluate the natural history of these lesions. METHODS A retrospective review was conducted of all FDG PET scans performed between 2005 and 2017 at a single institution. Patients were selected who had prostatic uptake without a history of PCa. Clinical data were collected from electronic medical records to determine how the prostate incidentalomas were further evaluated and to define the rate of malignancy. RESULTS A prostate incidentaloma was identified in 309 (1.0%) of 31 019 FDG PET scans performed on men. A prostate-specific antigen (PSA) test was obtained in 40.1% of patients within six months of prostate incidentaloma detection. Six patients underwent a multiparametric magnetic resonance imaging (mpMRI) of the prostate, which identified PCa in one case. Overall, PCa was diagnosed in 33 cases, representing 10.7% of the prostate incidentalomas and 0.1% of the scanned patients. PCa was intermediate- or high-risk in 27 (8.7%) of the prostate incidentalomas. CONCLUSIONS Incidental lesions detected in the prostate by FDG PET may represent clinically significant PCa. Referral to a urologist for further evaluation should be considered if the patient is otherwise in reasonable health.
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Affiliation(s)
- Miles P Mannas
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Taeweon Lee
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Maral Pourghiasian
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Don C Wilson
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver BC, Canada; Vancouver Prostate Centre, Vancouver BC, Canada
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Howard MD. Melanoma Radiological Surveillance: A Review of Current Evidence and Clinical Challenges. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2020; 93:207-213. [PMID: 32226349 PMCID: PMC7087071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Melanoma is a common cancer in both young and older populations in many western countries. Rates of melanoma diagnosis worldwide are increasing. With the introduction of both targeted and immunotherapies there have been dramatic improvements in the care of patients with metastatic melanoma. With these new therapies being increasingly offered to patients with stage III metastatic melanoma and stage IV disease, radiological surveillance of melanoma has become a widely used method of monitoring melanoma patients for early locoregional and distant metastasis. However, concerns have been raised about risk of false positive results, which patients to consider radiological surveillance for, and at what intervals to do so. To date, there are no published review articles on the topic of radiological surveillance in melanoma patients identified in the MEDLINE database. A comprehensive literature review was performed by searching the MEDLINE database to review all published works on this topic. This article aims to present an extensive review of literature surrounding radiological surveillance in melanoma patients, a discussion of controversies, and recommendations for surveillance modalities.
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Affiliation(s)
- Matthew David Howard
- Victorian Melanoma Service, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Dermatology, Monash Health, Clayton, Victoria, Australia
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Moletta L, Bissoli S, Fantin A, Passuello N, Valmasoni M, Sperti C. PET/CT incidental detection of second tumor in patients investigated for pancreatic neoplasms. BMC Cancer 2018; 18:531. [PMID: 29728085 PMCID: PMC5936016 DOI: 10.1186/s12885-018-4469-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/30/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Positron Emission Tomography/computed tomography (PET/CT) is an imaging technique which has a role in the detection and staging malignancies (both in first diagnosis and follow-up). The finding of an unexpected region of FDG (Fluorodeoxyglucose) uptake can occur when performing whole-body FDG-PET, raising the possibility of a second primary tumor. The aim of this study was to evaluate our experience of second primary cancer incidentally discovered during PET/CT examination performed for pancreatic diseases, during the initial work-up or follow-up after surgical resection. METHODS In this study, a retrospective evaluation of a prospectively collected data base was performed. Three hundred ninety- nine patients with pancreatic pathology were evaluated by whole body PET/CT imaging from January 2004 to December 2014. Among them, 348 patients were scanned before surgical resection and 51 during the course of their follow-up (pancreatic cancer). Median follow-up time was 29 months (range 14-124). RESULTS Fifty-six patients (14%) had incidental uptake of FDG in their organs: 31 patients had focal uptake and 25 showed diffuse with or without focal uptake. All patients with focal uptake were investigated, and invasive malignancy was diagnosed in 22 patients: 14 colon, 4 lung, 1 larynx, 1 urothelial, 1 breast cancer, and 1 colon metastasis from pancreatic cancer. Twenty patients underwent resection, and 6 endoscopic removal of colonic polyps. Three patients were not operated for advanced disease, and two patients did not show any pathology (PET/CT false positive). Of the 10 patients investigated for diffuse uptake, no malignancy was found; none of these patients developed a second cancer during the follow-up. CONCLUSIONS As in other malignancies, unexpected FDG uptake can occur in patients having PET/CT investigation for pancreatic diseases. Focal uptake is likely to be a malignancy and deserves further investigations, although the stage and the poor prognosis of primary pancreatic cancer should be kept in mind. Some selected patients may benefit from the aggressive treatment of incidental lesions and show survival benefit.
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Affiliation(s)
- Lucia Moletta
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - Sergio Bissoli
- Department of Nuclear Medicine, Castelfranco Veneto General Hospital, Castelfranco Veneto, Treviso, Italy
| | - Alberto Fantin
- Gastroenterology Unit, University of Padua, Padua, Italy
| | - Nicola Passuello
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - Michele Valmasoni
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy
| | - Cosimo Sperti
- Department of Surgery, Oncology and Gastroenterology, 3rd Surgical Clinic, University of Padua, Padua, Italy.
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Pencharz D, Nathan M, Wagner TL. Evidence-based management of incidental focal uptake of fluorodeoxyglucose on PET-CT. Br J Radiol 2018; 91:20170774. [PMID: 29243502 DOI: 10.1259/bjr.20170774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Focal incidental uptake, with or without CT abnormalities, is a common finding on fluorodeoxyglucose PET/CT and evidence-based management for this type of uptake is lacking. This article reviews the evidence on focal incidental uptake including the incidence of malignancy, differential diagnosis and imaging criteria which can be used to further characterize it. The article focusses on PET rather than CT criteria. The strength of the evidence base is highly variable ranging from systematic reviews and meta-analyses to a virtual absence of evidence. Caution needs to be used when using standardized uptake values (SUVs) reported in other studies due to interpatient and institution observed variation in SUVs. There is sufficient evidence to permit specific suggestions on how to interpret the foci and recommend further management in the: pituitary (investigate when SUVmax >4.1), thyroid (investigate all), breast (investigate all), lung parenchyma (if focus of fluorodeoxyglucose without a CT nodule, no further investigations), colon (investigate all foci with SUVmax >5.9, urgently if SUVmax >11.4), adrenals (criteria depend on if patient has cancer) and prostate gland (investigate in males aged >50 years or >40 years if peripheral uptake or patient has other risk factors). There is some evidence to guide further management for the parotid gland, naso-orophaynx, oesophagus, pancreas, uterus and ovaries. There is insufficient evidence to guide management for the liver, spleen, kidneys, gallbladder, testis and bone, for these organs patient characteristics and other guidelines will likely be of more use in determining further management.
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Affiliation(s)
- Deborah Pencharz
- 1 Department of Nuclear Medicine, Brighton and Sussex University Hospitals NHS Trust , Brighton, East Sussex , UK
| | - Malavika Nathan
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
| | - Thomas L Wagner
- 2 Department of Nuclear Medicine, Royal Free Hospital NHS Foundation Trust , London , UK
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