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The Lancet. Oncology Nov 2001Lung cancer is the cause of 32% of all male cancer deaths and 25% of all female cancer deaths. Because the prognosis depends on early diagnosis and staging, continuous... (Review)
Review
Lung cancer is the cause of 32% of all male cancer deaths and 25% of all female cancer deaths. Because the prognosis depends on early diagnosis and staging, continuous evaluation of the diagnostic tools available is important. The aim of this study was to assess the diagnostic value of dedicated positron emission tomography (PET) and gamma-camera PET in the diagnostic investigation of non-small-cell lung cancer (NSCLC). A systematic literature search was carried out in the MEDLINE and EMBASE databases and the Cochrane Controlled Trials Register. We identified 55 original works on the diagnostic performance of PET with fluorodeoxyglucose in the investigation of NSCLC. For diagnosis of NSCLC, the mean sensitivities and specificities were, respectively, 0.96 (SE 0.01) and 0.78 (0.03) for dedicated PET, and 0.92 (0.04) and 0.86 (0.04) for gamma-camera PET. In the mediastinal staging of NSCLC, the results were 0.83 (0.02) and 0.96 (0.01) for dedicated PET and 0.81 (0.04) and 0.95 (0.02) for ganuna-camera PET. We conclude that dedicated PET could be a valuable tool in the diagnosis and staging of NSCLC. However, studies of populations with a lower prevalence of NSCLC are recommended.
Topics: Aged; Carcinoma, Non-Small-Cell Lung; Female; Humans; Lung Neoplasms; Male; Middle Aged; Neoplasm Staging; Sensitivity and Specificity; Tomography, Emission-Computed
PubMed: 11902536
DOI: 10.1016/S1470-2045(01)00555-1 -
European Urology Open Science Apr 2023Prostate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance...
A Systematic Review of the Variability in Performing and Reporting Intraprostatic Prostate-specific Membrane Antigen Positron Emission Tomography in Primary Staging Studies.
CONTEXT
Prostate cancer (PCa) remains one of the leading causes of cancer-related deaths in men worldwide. Men at risk are typically offered multiparametric magnetic resonance imaging and, if suspicious, a targeted biopsy. However, false-negative rates of magnetic resonance imaging are consistently 18%; therefore, there is growing interest in improving the diagnostic performance of imaging through novel technologies. Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for PCa staging and, more recently, for intraprostatic tumour localisation. However, significant variability has been observed in how PSMA PET is performed and reported.
OBJECTIVE
In this review, we aim to evaluate how pervasive this variability is in trials investigating the performance of PSMA PET in primary PCa workup.
EVIDENCE ACQUISITION
Following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, we performed an optimal search in five different databases. After removing duplicates, 65 studies were included in our review.
EVIDENCE SYNTHESIS
Studies dated back as early as 2016, with numerous different source countries. There was variation in the reference standard for PSMA PET, with some using biopsy specimens or surgical specimens, and in some cases, a combination of the two. Similar inconsistencies were noted when studies selected histological definitions of clinically significant PCa, while some omitted their definition altogether. The most significant variations in performing PSMA PET were the radiotracer type, dose, acquisition time after injection, and the PET camera being utilised. Substantial variation in the reporting of PSMA PET was noted, with no consistency in defining what constitutes a positive intraprostatic lesion. Across 65 studies, four different definitions were used.
CONCLUSIONS
This systematic review has highlighted considerable variation in obtaining and performing a PSMA PET study in the context of primary PCa diagnosis. Given the discrepancy in how PSMA PET was performed and reported, it questions the homogony of studies from centre to centre. Standardisation of PSMA PET is required for this to become a consistently useful and reproducible modality in the diagnosis of PCa.
PATIENT SUMMARY
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET) is being utilised for staging and localisation of prostate cancer (PCa); however, there is significant variability in performing and reporting PSMA PET. Standardisation of PSMA PET is required for results to be consistently useful and reproducible for the diagnosis of PCa.
PubMed: 37101769
DOI: 10.1016/j.euros.2023.01.010 -
Journal of Clinical Medicine May 2023Pulmonary carcinoids (PCs) are part of a spectrum of well-differentiated neuroendocrine neoplasms (NENs) and are classified as typical carcinoid (TC) and atypical... (Review)
Review
Pulmonary carcinoids (PCs) are part of a spectrum of well-differentiated neuroendocrine neoplasms (NENs) and are classified as typical carcinoid (TC) and atypical carcinoid (AC). TC differ from AC not only for its histopathological features but also for its "functional imaging pattern" and prognosis. ACs are more undifferentiated and characterized by higher aggressiveness. Positron emission tomography/computed tomography (PET/CT) with somatostatin analogs (SSA) labeled with Gallium-68 (Ga-DOTA-TOC, Ga-DOTA-NOC, Ga-DOTA-TATE) has widely replaced conventional imaging with gamma camera using In- or Tc-labelled compounds and represents now the gold standard for diagnosis and management of NENs. In this setting, as already described for gastro-entero-pancreatic NENs, F-Fluorodeoxiglucose ([F]FDG) in addition to Ga-SSA can play an important role in clinical practice, particularly for ACs that show a more aggressive behavior compared to TCs. The aim of this systematic review is to analyze all original studies collected from the PubMed and Scopus databases regarding PCs in which both Ga-SSA PET/CT and [F]FDG PET/CT were performed in order to evaluate the clinical impact of each imaging modality. The following keywords were used for the research: "F, Ga and (bronchial carcinoid or carcinoid lung)". A total of 57 papers were found, of which 17 were duplicates, 8 were reviews, 10 were case reports, and 1 was an editorial. Of the remaining 21 papers, 12 were ineligible because they did not focus on PC or did not compare Ga-SSA and [F]FDG. We finally retrieved and analyzed nine papers (245 patients with TCs and 110 patients with ACs), and the results highlight the importance of the combined use of Ga-SSA and [F]FDG PET/CT for the correct management of these neoplasms.
PubMed: 37297914
DOI: 10.3390/jcm12113719 -
Journal of Nuclear Cardiology :... Aug 2022With the appearance of cadmium-zinc-telluride (CZT) cameras, dynamic myocardial perfusion imaging (MPI) has been introduced, but comparable data to other MPI modalities,... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With the appearance of cadmium-zinc-telluride (CZT) cameras, dynamic myocardial perfusion imaging (MPI) has been introduced, but comparable data to other MPI modalities, such as quantitative coronary angiography (CAG) with fractional flow reserve (FFR) and positron emission tomography (PET), are lacking. This study aimed to evaluate the diagnostic accuracy of dynamic CZT single-photon emission tomography (SPECT) in coronary artery disease compared to quantitative CAG, FFR, and PET as reference.
MATERIALS AND METHODS
Different databases were screened for eligible citations performing dynamic CZT-SPECT against CAG, FFR, or PET. PubMed, OvidSP (Medline), Web of Science, the Cochrane Library, and EMBASE were searched on the 5th of July 2020. Studies had to meet the following pre-established inclusion criteria: randomized controlled trials, retrospective trails or observational studies relevant for the diagnosis of coronary artery disease, and performing CZT-SPECT and within half a year the methodological references. Studies which considered coronary stenosis between 50% and 70% as significant based only on CAG were excluded. Data extracted were sensitivity, specificity, likelihood ratios, and diagnostic odds ratios. Quality was assessed with QUADAS-2 and statistical analysis was performed using a bivariate model.
RESULTS
Based on our criteria, a total of 9 studies containing 421 patients were included. For the assessment of CZT-SPECT, the diagnostic value pooled analysis with a bivariate model was calculated and yielded a sensitivity of 0.79 (% CI 0.73 to 0.85) and a specificity of 0.85 (95% CI 0.74 to 0.92). Diagnostic odds ratio (DOR) was 17.82 (95% CI 8.80 to 36.08, P < 0.001). Positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 3.86 (95% CI 2.76 to 5.38, P < 0.001) and 0.21 (95% CI 0.13 to 0.33, P < 0.001), respectively.
CONCLUSION
Based on the results of the current systematic review and meta-analysis, dynamic CZT-SPECT MPI demonstrated a good sensitivity and specificity to diagnose CAD as compared to the gold standards. However, due to the heterogeneity of the methodologies between the CZT-SPECT MPI studies and the relatively small number of included studies, it warrants further well-defined study protocols.
Topics: Cadmium; Coronary Angiography; Coronary Artery Disease; Fractional Flow Reserve, Myocardial; Humans; Myocardial Perfusion Imaging; Retrospective Studies; Tellurium; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed; Zinc
PubMed: 34350553
DOI: 10.1007/s12350-021-02721-8 -
Molecular imaging for prostate cancer: Performance analysis of Ga-PSMA PET/CT versus choline PET/CT.Actas Urologicas Espanolas Jun 2017There is a need for a precise and reliable imaging to improve the management of prostate cancer. In recent years the PET/CT with choline has changed the handling of... (Comparative Study)
Comparative Study Review
INTRODUCTION
There is a need for a precise and reliable imaging to improve the management of prostate cancer. In recent years the PET/CT with choline has changed the handling of prostate cancer in Europe, and it is commonly used for initial stratification or for the diagnosis of a biochemical recurrence, although it does not lack limitations. Other markers are being tested, including the ligand of prostate-specific membrane antigen (PSMA), that seems to offer encouraging prospects. The goal of this piece of work was to critically review the role of choline and PSMA PET/CT in prostate cancer.
EVIDENCE ACQUISITION
A systematic literature review of databases PUBMED/MEDLINE and EMBASE was conducted searching for articles fully published in English on the PET marker in prostate cancer and its clinical application.
EVIDENCE SYNTHESIS AND DISCUSSION
It seems as 68Ga-PSMA PET/CT is better than PET/CT in prostate cancer to detect primary prostate lesions, initial metastases in the lymph nodes and recurrence. However, further research is required to obtain high-level tests. Also, other PET markers are studied. Moreover, the emergence of a new PET/MR camera could change the performance of PET imaging.
Topics: Choline; Edetic Acid; Gallium Isotopes; Gallium Radioisotopes; Humans; Male; Molecular Imaging; Oligopeptides; Positron Emission Tomography Computed Tomography; Prostatic Neoplasms
PubMed: 27912910
DOI: 10.1016/j.acuro.2016.09.015 -
Health Technology Assessment... 1999Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in... (Review)
Review
BACKGROUND
Positron emission tomography (PET) is an expensive diagnostic imaging technology. Despite the long history of PET development, the costs and effectiveness of its use in routine clinical practice remain unknown. Against this background of uncertainty regarding the clinical role of PET, the UK Standing Group on Health Technology requested a review of its current and potential role which would enable research priorities in this area to be established.
OBJECTIVES
This 3-month project had two explicit objectives: (1) to review the state of knowledge regarding the clinical applications of PET; (2) to determine the key health technology assessment (HTA) research questions relating to the use of PET in the UK.
METHODS
A literature review to ascertain the state of knowledge regarding the clinical applications of PET and a three-round Delphi study to inform the key HTA research questions relating to the use of PET in the UK were undertaken. The results of an earlier systematic review, published by the Veteran's Health Administration (VHA) in the USA in 1996, were used as the starting point for the literature review. The VHA review was updated and extended by means of MEDLINE and Cochrane Library database searches. Participants in the Delphi study were selected by discussion with five individuals in the UK with an interest in, and awareness of, developments in PET. As a result of their suggestions, 43 individuals were initially invited to participate, of whom two did not feel appropriately qualified. Questionnaires were sent by facsimile to all invited participants, who were asked to return the completed forms by facsimile within a week. The content and structure of the Delphi study was informed by the results of the literature review. The responses and comments of the participants were a major source of information for this report.
RESULTS
Clinical applications for PET have been advocated in three broad disease groups: oncology, cardiology and neuropsychiatric disorders. There are currently four PET modalities that need to be considered when assessing its potential clinical role in the UK: full ring PET scanners operating in two or three dimensions (available at five sites); partial ring rotating PET scanners (one currently operating in the UK); coincidence imaging with modified gamma camera technology; and high-energy collimator imaging of 511 keV photons with modified gamma camera technology. There is a paucity of available evidence relating to the cost-effectiveness of the various PET modalities in all of the clinical indications for which the technology is currently being advocated. In addition, many existing reports on the diagnostic accuracy of PET are limited because they are liable to bias and often relate only to very small patient numbers. The results of the Delphi study indicated that the four most important research priorities for the NHS, in descending order of their importance, are: (1) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to determine staging prior to operative intervention for lung cancer; (2) partial ring PET compared with full ring PET in oncology (3) the relative cost-effectiveness of (a) full ring PET, (b) gamma camera PET using coincidence imaging and (c) existing diagnostic strategies to stage and monitor treatment response in breast cancer; (4) the relative cost-effectiveness of (a) gamma camera PET using coincidence imaging and (b) 511 keV collimated positron imaging for assessing myocardial viability when selecting patients for revascularisation surgery. Vignettes describing each of the research priorities are provided in the main report.
CONCLUSIONS
The findings of this project, which was undertaken rapidly in order to inform HTA research prioritization in the UK, provide a contemporary overview of the potential clinical role for PET in the NHS. Evidence is needed that using PET as a diagnostic
Topics: Clinical Competence; Cost-Benefit Analysis; Female; Health Care Costs; Health Priorities; Humans; Male; Sensitivity and Specificity; Technology Assessment, Biomedical; Tomography, Emission-Computed; United Kingdom; Unnecessary Procedures
PubMed: 10632626
DOI: No ID Found -
International Journal of Technology... Jul 2009Nuclear medicine has changed rapidly as a result of technological developments. Very little is reported on the effects these developments may have on technologist... (Review)
Review
OBJECTIVES
Nuclear medicine has changed rapidly as a result of technological developments. Very little is reported on the effects these developments may have on technologist productivity. This study aims to determine whether advances have created a workplace where more patient studies can be performed with fewer technologists. The level of change in automation or time taken to perform a routine task by the nuclear medicine technologist as a result of technological development over the past decade is reported.
METHODS
A systematic review was conducted using Embase.com, Medline, INSPEC, and Cinahl. Two authors reviewed each article for eligibility. Technological developments in routine areas over the past decade were reviewed. The resultant automation or time effects on data acquisition, data processing, and image processing were summarized.
RESULTS
Sixteen articles were included in the areas of myocardial perfusion, information technology, and positron emission tomography (PET). Gamma camera design has halved the acquisition time for myocardial perfusion studies, automated analysis requires little manual intervention and information technologies and filmless departments are more efficient. Developments in PET have reduced acquisition to almost one-fifth of the time.
CONCLUSIONS
Substantial efficiencies have occurred over the decade thereby increasing productivity, but whether staffing levels are appropriate for safe, high quality practice is unclear. Future staffing adequacy is of concern given the anticipated increasing service needs.
Topics: Biomedical Technology; Efficiency; Gamma Cameras; Nuclear Medicine; Positron-Emission Tomography
PubMed: 19619358
DOI: 10.1017/S0266462309990195