Positron emission tomography changes management and prognostic stratification in patients with oesophageal cancer: results of a multicentre prospective study

OBJECTIVES

The aims of this study were (1) to determine the incremental information provided by (18)F-FDG positron emission tomography (PET) in staging patients with oesophageal cancer, and (2) to determine the impact of PET staging on post-PET clinical management of oesophageal cancer, and on prognosis.

METHODS

In a multicentre, single-arm open study, patients with proved oesophageal cancer without definite distant metastases and regarded as suitable for potentially curative treatment were examined by PET. Clinicians were requested to supply a management plan before and another plan after being supplied with the PET scan results. Patients were followed for at least 1 year for outcome analysis.

RESULTS

A total of 129 patients (104 men, mean age 67 y) were recruited. PET detected additional sites of disease in 53 patients (41%). Significant changes in management (high or medium impact) were observed in 38% of patients, primarily as a result of identifying additional sites of disease and/or confirming previously equivocal regional and distant metastases. Progression-free survival was significantly shorter in patients found to have additional lesions on PET (p < 0.05), but was not related to SUV(max).

CONCLUSION

These findings demonstrate the significant impact of PET on the clinical management of patients with newly diagnosed oesophageal carcinoma, and on prognostic stratification of these patients.

Multi-centre prospective assessment of accuracy and impact on management of positron emission tomography (PET) in esophageal and gastroesophageal junction cancers (EC). Australian PET Data Collection Project

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Background: In localized EC, radical surgery may be curative. This study evaluated PET and conventional imaging techniques (CI) for staging, and the potential impact of PET on management and prognosis of EC. Methods: Subjects had confirmed EC (SCC or adenocarcinoma), were fit for investigation and surgery and/or chemoradiotherapy and had no unequivocal distant metastatic disease clinically or by CT and endoscopy at presentation. Sensitivity, including N and M staging of pre-operative CT, PET and endoscopic ultrasound (EUS) and clinical impact of confirmation or detection of metastases on intent (curative or palliative) were recorded. Management changes, including radiotherapy field determined by new information from PET, were recorded. Variables, including standardized uptake value (SUV) were compared with progression-free survival (PFS.) Results: 129 patients (104 male), mean age 66 (range 36- 87) were evaluated. 127 of 129 primary lesions were detected. In 41% of patients, PET detected a total of 148 additional lesions, 75 regional lymph nodes, 72 distant metastases and 1 second EC primary. 22% of patients were upstaged from M0 to M1. CT detected regional and distant metastases in 57% and 0% (entry criterion), PET in 70% and 44%. Of 20 patients who had EUS, it detected regional metastases in 67%, PET in 33%.The number of patients intended to be treated palliatively increased from 10 pre- to 32 post-PET. Of patients with curative management intent based on PET 34% progressed in 12 months, with palliative intent 59%. Significant changes in management (high or medium impact) occurred in 38%. The PFS of 54 patients below and 54 above the median SUV(8) was no different (p=0.79) Conclusions: PET influenced management in 38% of patients with EC already studied by CI.

No significant financial relationships to disclose.

A comparison of fluorine-18 fluoro-deoxyglucose PET and technetium-99m sestamibi in assessing patients with multiple myeloma

OBJECTIVE

The extent of disease in patients with multiple myeloma or related conditions may be difficult to assess. In previous small studies, both FDG-PET (PET) and Tc-99m sestamibi scans (MIBI) have identified sites of occult disease in myeloma.

METHODS

We reviewed the results for patients at our institution who have undergone PET and/or MIBI scans to assess myeloma. Concordance between the scans, ability to identify otherwise occult disease and impact on patient management was assessed.

RESULTS

Thirty-six patients had > or =1 PET scan, 56 had > or =1 MIBI scan and 23 had concurrent PET and MIBI scans. MIBI detected additional sites to skeletal survey in 38 of 56 (68%) cases. PET detected additional sites to skeletal survey in 18 of 36 (50%) cases. MIBI generally detected more disease sites than PET. PET and MIBI were concordant in eight of 23 (35%) cases. The percentage plasma cell infiltrate within the marrow correlated with the number of sites detected by MIBI, but not by PET. In 23 of 69 cases (33%), scan results impacted on management, particularly by upstaging disease at diagnosis and by recognising subsequent disease progression. The results were also helpful for evaluating the presence of ongoing disease activity in previously irradiated sites remaining abnormal on skeletal survey following treatment.

CONCLUSIONS

MIBI and PET are useful additional diagnostic tools for detecting otherwise occult sites of myeloma. The use of MIBI PET should particularly be considered in the evaluation of a patient with an early-stage plasma cell dyscrasia to exclude the presence of more extensive disease.

Imaging of carbon granulomas of the breast following carbon track localization

Three cases of carbon granuloma are described following the instillation of carbon solution at the time of stereotactic fine needle aspiration for pre-operative localization of impalpable mammographic abnormalities. If the carbon track is not excised following carbon instillation the retained carbon may result in a granuloma. This may present as a new mass on subsequent clinical or mammographic follow-up.