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European Radiology Oct 2020To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
To review the diagnostic performance of contemporary imaging modalities for determining local disease extent and nodal metastasis in patients with newly diagnosed cervical cancer.
METHODS
Pubmed and Embase databases were searched for studies published from 2000 to 2019 that used ultrasound (US), CT, MRI, and/or PET for evaluating various aspects of local extent and nodal metastasis in patients with newly diagnosed cervical cancer. Sensitivities and specificities from the studies were meta-analytically pooled using bivariate and hierarchical modeling.
RESULTS
Of 1311 studies identified in the search, 115 studies with 13,999 patients were included. MRI was the most extensively studied modality (MRI, CT, US, and PET were evaluated in 78, 12, 9, and 43 studies, respectively). Pooled sensitivities and specificities of MRI for assessing all aspects of local extent ranged between 0.71-0.88 and 0.86-0.95, respectively. In assessing parametrial invasion (PMI), US demonstrated pooled sensitivity and specificity of 0.67 and 0.94, respectively-performance levels comparable with those found for MRI. MRI, CT, and PET performed comparably for assessing nodal metastasis, with low sensitivity (0.29-0.69) but high specificity (0.88-0.98), even when stratified to anatomical location (pelvic or paraaortic) and level of analysis (per patient vs. per site).
CONCLUSIONS
MRI is the method of choice for assessing any aspect of local extent, but where not available, US could be of value, particularly for assessing PMI. CT, MRI, and PET all have high specificity but poor sensitivity for the detection of lymph node metastases.
KEY POINTS
• Magnetic resonance imaging is the method of choice for assessing local extent. • Ultrasound may be helpful in determining parametrial invasion, especially in lower-resourced countries. • Computed tomography, magnetic resonance imaging, and positron emission tomography perform similarly for assessing lymph node metastasis, with high specificity but low sensitivity.
Topics: Female; Fluorodeoxyglucose F18; Humans; Lymphatic Metastasis; Magnetic Resonance Imaging; Neoplasm Invasiveness; Positron-Emission Tomography; Sensitivity and Specificity; Tomography, X-Ray Computed; Ultrasonography; Uterine Cervical Neoplasms
PubMed: 32415584
DOI: 10.1007/s00330-020-06909-3 -
Current Radiopharmaceuticals 2020In patients suitable for radical chemoradiotherapy for lung cancer, 18F-FDGPET/ CT is a proposed management to improve the accuracy of high dose radiotherapy. However,...
INTRODUCTION
In patients suitable for radical chemoradiotherapy for lung cancer, 18F-FDGPET/ CT is a proposed management to improve the accuracy of high dose radiotherapy. However, there is a high rate of locoregional failure in patients with locally advanced non-small cell lung cancer (NSCLC), probably due to the fact that standard dosing may not be effective in all patients. The aim of the present review was to address some criticisms associated with the radiotherapy image-guided in NSCLC.
MATERIALS AND METHODS
A systematic literature search was conducted. Only published articles that met the following criteria were included: articles, only original papers, radiopharmaceutical ([18F]FDG and any tracer other than [18F]FDG), target, only specific for lung cancer radiotherapy planning, and experimental design (eventually "in vitro" studies were excluded). Peer-reviewed indexed journals, regardless of publication status (published, ahead of print, in press, etc.) were included. Reviews, case reports, abstracts, editorials, poster presentations, and publications in languages other than English were excluded. The decision to include or exclude an article was made by consensus and any disagreement was resolved through discussion.
RESULTS
Hundred eligible full-text articles were assessed. Diverse information is now available in the literature about the role of FDG and new alternative radiopharmaceuticals for the planning of radiotherapy in NSCLC. In particular, the role of alternative technologies for the segmentation of FDG uptake is essential, although indeterminate for RT planning. The pros and cons of the available techniques have been extensively reported.
CONCLUSION
PET/CT has a central place in the planning of radiotherapy for lung cancer and, in particular, for NSCLC assuming a substantial role in the delineation of tumor volume. The development of new radiopharmaceuticals can help overcome the problems related to the disadvantage of FDG to accumulate also in activated inflammatory cells, thus improving tumor characterization and providing new prognostic biomarkers.
Topics: Carcinoma, Non-Small-Cell Lung; Fluorodeoxyglucose F18; Humans; Lung Neoplasms; Molecular Imaging; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Radiotherapy Planning, Computer-Assisted
PubMed: 32186275
DOI: 10.2174/1874471013666200318144154 -
PloS One 2019A comprehensive systematic review of the literature was conducted on parameters from 18 F-FDG PET and a meta-analysis of the prognostic value of the maximal standard... (Meta-Analysis)
Meta-Analysis
Prognostic value of maximum standard uptake value, metabolic tumor volume, and total lesion glycolysis of positron emission tomography/computed tomography in patients with breast cancer: A systematic review and meta-analysis.
PURPOSE
A comprehensive systematic review of the literature was conducted on parameters from 18 F-FDG PET and a meta-analysis of the prognostic value of the maximal standard uptake value (SUVmax), metabolic tumor volume (MTV) and total lesional glycolysis (TLG) in patients with breast cancer (BC).
PATIENTS AND METHODS
Relevant English articles from PubMed, EMBASE, and the Cochrane Library were retrieved. Pooled hazard ratios (HRs) were used to assess the prognostic value of SUVmax, MTV, and TLG.
RESULTS
A total of 20 primary studies with 3115 patients with BC were included. The combined HRs (95% confidence interval [CI] of higher SUVmax and higher TLG for event-free survival (EFS) were 1.53 (95% CI, 1.25-1.89, P = 0.0006) and 5.94 (95% CI, 2.57-13.71, P = 0.97), respectively. Regarding the overall survival (OS), the combined HRs were 1.22 (95%CI, 1.02-1.45, P = 0.0006) with higher SUVmax, and 2.91(95% CI, 1.75-4.85, P = 0.44) with higher MTV. Higher MTV showed no correlation with EFS [1.31(95% CI, 0.65-2.65, P = 0.18)] and similarly higher TLG showed no correlation with OS [1.20(95% CI, 0.65-2.23, P = 0.45)]. Subgroup analysis showed that SUVmax, with a median value of 5.55 was considered as a significant risk factor for both EFS and OS in BC patients.
CONCLUSION
Despite clinically heterogeneous BC patients and adoption of various methods between studies, the present meta-analysis results confirmed that patients with high SUVmax are at high risk of adverse events or death in BC patients, high MTV predicted a high risk of death and high TLG predicted a high risk of adverse events.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Energy Metabolism; Female; Fluorodeoxyglucose F18; Glycolysis; Humans; Middle Aged; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Prognosis; Tumor Burden
PubMed: 31826010
DOI: 10.1371/journal.pone.0225959 -
Annals of Hematology Jan 2020This study aimed to systematically review the value of end-of-treatment F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in improving overall survival...
This study aimed to systematically review the value of end-of-treatment F-fluoro-2-deoxy-D-glucose (FDG) positron emission tomography (PET) in improving overall survival (OS) of lymphoma patients. Medline was systematically searched for (1) randomized trials comparing the OS of patients who underwent end-of-treatment FDG-PET to those without and FDG-PET-based end-of-treatment evaluation and for (2) non-randomized studies comparing the OS of patients who underwent end-of-treatment FDG-PET to a (historical) cohort of patients without an FDG-PET-based end-of-treatment evaluation. The Medline search revealed 6284 articles. However, none of these reported data on the value of end-of-treatment FDG-PET in improving OS of lymphoma patients. In conclusion, the present systematic review reveals that there is currently no study at all that evaluates the value of end-of-treatment FDG-PET in improving OS of lymphoma patients. As a result, it remains unknown whether end-of-treatment FDG-PET increases OS and in which lymphoma subtype these examinations are of particular value. Future studies are required to demonstrate its value in this setting before it can be recommended as an evidence-based diagnostic tool by guidelines on the use of imaging in lymphoma.
Topics: Cohort Studies; Disease-Free Survival; Female; Fluorodeoxyglucose F18; Humans; Lymphoma; Male; Positron-Emission Tomography; Survival Rate
PubMed: 31811361
DOI: 10.1007/s00277-019-03881-x -
PET Clinics Jan 2020This systematic review summarizes the current applications of F-FDG PET imaging in the diagnosis, staging, radiation treatment response assessment, and outcome...
This systematic review summarizes the current applications of F-FDG PET imaging in the diagnosis, staging, radiation treatment response assessment, and outcome prognostication of head and neck cancers. For head and neck cancers of unknown primary origin, F-FDG PET/CT increases the likelihood of identifying the primary tumor and establishing the diagnosis. F-FDG PET/CT is important in the accurate staging of locoregionally advanced cases of HNSCC, which can greatly affect recommendations for treatment. Following definitive chemoradiation, F-FDG PET/CT is validated as a means of treatment response assessment. Emerging PET tracers of hypoxia and their potential applications are reviewed.
Topics: Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Incidental Findings; Neoplasm Recurrence, Local; Neoplasm Staging; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Squamous Cell Carcinoma of Head and Neck; Thoracic Neoplasms; Treatment Outcome
PubMed: 31735303
DOI: 10.1016/j.cpet.2019.08.010 -
The Journal of Spinal Cord Medicine Jul 2021: The importance of physiologic distribution of F-FDG in the spinal cord.: The recognition of the physiologic distribution of F-FDG in the spinal cord is pivotal for...
: The importance of physiologic distribution of F-FDG in the spinal cord.: The recognition of the physiologic distribution of F-FDG in the spinal cord is pivotal for accurate PET/CT imaging interpretation, especially in oncologic patients. Therefore, we performed a systematic review to investigate the normal distribution of F-FDG throughout the spinal cord.: Data sources: We carried out a comprehensive search of the literature on the physiologic patterns of F-FDG distribution in the spinal cord. PubMed and Scopus databases were searched using the following keywords: "spinal cord" AND "FDG". Data extraction: Findings of the selected articles were described.: Thirteen studies comprising 24,125 patients entered the systematic review. These investigations showed discrepancies in location, size, number, and intensity of F-FDG uptake throughout the spinal cord. However, cumulative results showed that F-FDG uptake was higher in the lower thoracic portion of spinal cord (T11-T12). Moreover, a decreasing trend in F-FDG uptake was observed from cervical to lumbar levels. Low maximal standardized uptake values, female sex, and higher body weight seem to be related to the physiological spinal cord F-FDG uptake.: On F-FDG PET/CT imaging, focal hypermetabolism of the spinal cord at the level of lower thoracic and lower cervical vertebrae should be considered physiological until proven otherwise.
Topics: Female; Fluorodeoxyglucose F18; Humans; Positron Emission Tomography Computed Tomography; Radiopharmaceuticals; Spinal Cord; Spinal Cord Injuries
PubMed: 31682787
DOI: 10.1080/10790268.2019.1672954 -
Journal of the Formosan Medical... May 2020Nuclear imaging, including gallium scintigraphy and fluorodeoxyglucose (FDG) positron emission tomography (PET), has been widely used to identify focus of infection in... (Meta-Analysis)
Meta-Analysis
BACKGROUND/PURPOSE
Nuclear imaging, including gallium scintigraphy and fluorodeoxyglucose (FDG) positron emission tomography (PET), has been widely used to identify focus of infection in fever of unknown origin. However, little is known about its role in critically ill patients, who are usually with multiple inflammatory foci and unable to tolerate long image acquisition time. This systematic review aimed to evaluate the diagnostic performance of FDG PET for suspected infection in critically ill patients.
METHODS
PubMed and Embase were searched up to July 24th, 2019 to identify studies evaluating the diagnostic performance of FDG PET for finding infection focus in critically ill patients following the PRISMA guidelines. The bivariate mixed-effects model was used to pool the measure for diagnostic performance. Publication bias was evaluated by Deeks' method.
RESULTS
A total of 4 studies with 87 patients were included. All the four studies evaluated FDG PET. Majority of the patients were either mechanically ventilated (76%) or shocked requiring vasopressors (61%). Test and transportation related adverse events were rare (2%). The summary sensitivity and specificity were 0.94 (95% CI, 0.79-0.99) and 0.66 (95% CI, 0.45-0.83), respectively. The AUC for summary ROC curve was 0.83.
CONCLUSION
FDG PET was a very sensitive tool with acceptable specificity for detecting the origin of infection in critically ill patients. However, current available studies have limitation in evaluating safety issue. Further research should investigate both benefit and risk of doing this test for this group of vulnerable patients.
Topics: Critical Illness; Fluorodeoxyglucose F18; Humans; Infections; Positron Emission Tomography Computed Tomography; Positron-Emission Tomography; Radiopharmaceuticals; Sensitivity and Specificity
PubMed: 31604648
DOI: 10.1016/j.jfma.2019.09.010 -
International Journal of Molecular... Oct 2019Despite its name, prostate-specific membrane antigen (PSMA) has been shown using immunohistochemistry (IHC) to also be over-expressed in the tumor neovasculature of a... (Review)
Review
Despite its name, prostate-specific membrane antigen (PSMA) has been shown using immunohistochemistry (IHC) to also be over-expressed in the tumor neovasculature of a wide variety of solid tumors other than prostate carcinoma. Accordingly, positron-emitting radiolabeled small molecules targeting PSMA, initially developed for positron emission tomography in prostate carcinomas, are currently being explored for their staging and restaging potential as an alternative imaging modality in other solid tumor types where 18-F-fluorodeoxyglucose (FDG)-PET imaging has low diagnostic accuracy. In this paper, the currently available literature in this field is reviewed. Preliminary, mainly retrospective studies are encouraging, with evidence of improved diagnostic sensitivity and specificity in clear cell renal carcinoma, glioma, and hepatocellular carcinoma, leading to a change in patient management in several patients. However, the results published thus far warrant confirmation by larger prospective studies additionally assessing the longitudinal impact on patient outcomes.
Topics: Animals; Antigens, Surface; Diagnosis, Differential; Fluorodeoxyglucose F18; Glutamate Carboxypeptidase II; Humans; Neoplasms; Positron-Emission Tomography; Radiopharmaceuticals
PubMed: 31581638
DOI: 10.3390/ijms20194886 -
Medicine Oct 2019FDG-PET might be able to reflect histopathology features of tumors. Ki 67 in head and neck carcinomas (HNSCC). The present study sought to elucidate the association... (Meta-Analysis)
Meta-Analysis
BACKGROUND
FDG-PET might be able to reflect histopathology features of tumors. Ki 67 in head and neck carcinomas (HNSCC). The present study sought to elucidate the association between Ki 67 index and SUVmax based upon a large patient sample.
METHODS
PubMed database was screened for studies analyzed the relationship between Ki 67 and SUV in HNSCC. Nine studies comprising 211 patients were suitable for analysis.
RESULTS
SUVmax increased with tumor grade and was statistically significant different between G1, G2, and G3 tumors. The ROC analysis for discrimination between G1/G2 and G3 tumors revealed an area under curve of 0.71. In the overall patient sample, SUVmax correlated statistically significant with Ki 67 index (r = 0.154, P = .032).
CONCLUSION
The present study identified a weak correlation between SUV values and proliferation index Ki 67 index in HNSCC in a large patient sample. Therefore, SUVmax cannot be used as surrogate parameter for proliferation activity in HNSCC.
Topics: Fluorodeoxyglucose F18; Head and Neck Neoplasms; Humans; Ki-67 Antigen; Positron-Emission Tomography; Squamous Cell Carcinoma of Head and Neck
PubMed: 31577779
DOI: 10.1097/MD.0000000000017472 -
Current Oncology (Toronto, Ont.) Aug 2019Paraneoplastic neurologic syndrome (pns) is a rare condition indirectly caused by an underlying malignancy. In many cases, the malignancy is occult at the time of the... (Meta-Analysis)
Meta-Analysis
F-Fluorodeoxyglucose positron-emission tomography for the investigation of malignancy in patients with suspected paraneoplastic neurologic syndromes and negative or indeterminate conventional imaging: a retrospective analysis of the Ontario PET Access Program, with systematic review and...
OBJECTIVE
Paraneoplastic neurologic syndrome (pns) is a rare condition indirectly caused by an underlying malignancy. In many cases, the malignancy is occult at the time of the pns diagnosis, and the optimal diagnostic modality to detect the underlying tumour is unclear. In the present study, we aimed to assess the utility of F-fluorodeoxyglucose positron-emission tomography (fdg-pet) or pet integrated with computed tomography (pet/ct) in the investigation of these patients.
METHODS
We retrospectively analyzed data from the PET Access Program (pap) database in the province of Ontario to identify patients who underwent fdg-pet/ct imaging as part of a workup for pns. In all patients, prior conventional imaging was negative or indeterminate. To determine the diagnostic accuracy of fdg-pet/ct, data about demographics, presenting symptoms, and biochemical and radiologic workup, including fdg-pet/ct imaging results, were compared with data collected by the Ontario Cancer Registry (ocr). A systematic review of the literature and meta-analysis using our study inclusion criteria were performed for studies of fdg-pet accuracy.
RESULTS
Of 29 patients identified in the pap database, 9 had fdg-pet/ct results suspicious for malignancy. When correlated with data from the ocr, 5 fdg-pet/ct results were informative, resulting in a detection rate of 17%. Local sensitivity and specificity were 0.83 and 0.83 respectively. Two studies meeting our criteria were identified in the literature. The pooled sensitivity and specificity from the literature and local data were 0.88 and 0.90 respectively.
CONCLUSIONS
When investigating for underlying malignancy in patients with suspected pns and negative conventional imaging, pet has high sensitivity and specificity.
Topics: Adult; Aged; Aged, 80 and over; Female; Fluorodeoxyglucose F18; Humans; Male; Middle Aged; Ontario; Paraneoplastic Syndromes, Nervous System; Retrospective Studies; Sensitivity and Specificity; Young Adult
PubMed: 31548813
DOI: 10.3747/co.26.4583