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18F-FDG PET/TC para la estadificación y la delineación del volumen de radioterapia en el cáncer de cabeza y cuello
摘要： Purpose: The aim is to investigate the use of 18F-FDG (fluorine-18 fluorodeoxyglucose) PET/CT in head and neck cancer (HNC) staging and its effect on the therapeutic strategy and radiotherapy (RT) planning. Methods and materials: One hundred patients with HNC were included. Primary tumor sites: 18% oral cavity, 20% oropharynx, 12% hypopharynx, 11% nasopharynx, 37% larynx, 2% paranasal sinuses. Patients were staged according to the American Joint Committee of Cancer 7th edition. Stage: 5% stage I, 7% stage II, 14% stage III, 61% stage IVA, 7% stage IVB and 6% stage IVC. A contrast-enhanced CT and a 18F-FDG PET/CT acquired under RT position were performed. Both exams were compared to analyze patients' staging reclassification. Changes in therapeutic strategy were analyzed. Results: 18F-FDG PET/CT detected 6 distant metastases and treatment intention changed to palliative. Eight synchronous tumors were detected; one received palliative treatment. 18F-FDG PET/CT reclassified cTNM staging in 27 patients. Tumor extension changed in 28 (14% up-staged; 14% down-staged), implying a change in GTV (Gross Tumor Volume) delineation. Nodal detection was reclassified in 47 patients: 8 patients down-staged (N2C to N2A/N2B/N1) and 2 were false positive. Nineteen patients were false negatives and 5 staged as N+ (N1/N2A/N2B) turned out into N2C. These staging modifications imply adapting the nodal volume to be irradiated. Conclusions: 18F-FDG PET/CT reclassification was higher than 10% in almost all categories studied (cTNM, tumor extension and nodal disease) and detects more metastases and synchronous tumors than conventional studies, which has an impact on the therapeutic patient management and RT planning.
关键词： Head and neck cancer,18F-FDG PET/CT,Radiotherapy planning,Staging
更新于2025-09-23 15:22:29
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Low-Dose PET/CT and Full-Dose Contrast-Enhanced CT at the Initial Staging of Localized Diffuse Large B-Cell Lymphomas
摘要： Computed tomography (CT) has been used as the reference imaging technique for the initial staging of diffuse large B-cell lymphoma until recent days, when the introduction of positron emission tomography (PET)/CT imaging as a hybrid technique has become of routine use. However, the performance of both examinations is still common. The aim of this work was to compare the findings between low-dose 2-deoxy-2-(18F)fluoro-d-glucose (18F-FDG) PET/CT and full-dose contrast-enhanced CT (ceCT) in 28 patients with localized diffuse large B-cell lymphoma according to PET/CT findings, in order to avoid the performance of ceCT. For each technique, a comparison in the number of nodal and extranodal involved regions was performed. PET/CT showed more lesions than ceCT in both nodal (41 vs. 36) and extranodal localizations (16 vs. 15). Disease staging according to both techniques was concordant in 22 patients (79%) and discordant in 6 patients (21%), changing treatment management in 3 patients (11%). PET/CT determined a better staging and therapeutic approach, making the performance of an additional ceCT unnecessary.
关键词： 18F-FDG,staging,positron emission tomography/computed tomography,diffuse large B-cell lymphoma
更新于2025-09-23 15:22:29
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Staging laparoscopy with ultrasound and near-infrared fluorescence imaging to detect occult metastases of pancreatic and periampullary cancer
摘要： Introduction Up to 38% of pancreatic and periampullary cancer patients undergoing curative intended surgery turn out to have incurable disease. Therefore, staging laparoscopy (SL) prior to laparotomy is advised to spare patients the morbidity, inconvenience and expense of futile major surgery. The aim of this study was to assess the added value of SL with laparoscopic ultrasonography (LUS) and laparoscopic near-infrared fluorescence imaging (LFI). Methods All patients undergoing curative intended surgery of pancreatic or periampullary cancer were included prospectively in this single arm study. Patients received an intravenous infusion of 10 mg indocyanine green (ICG) one or two days prior to surgery to allow LFI. Suspect lesions were analyzed via biopsy or resection. Follow-up visits after surgery occurred every three months. Results A total of 25 patients were included. Suspect lesions were identified in 7 patients: liver metastases (n = 2; identified by inspection, LUS, and LFI), peritoneal metastases (n = 1; identified by inspection only), and benign lesions (n = 4; identified by inspection or LUS). Quality of LFI was good in 67% (10/15) of patients dosed one day and 89% (8/9) dosed two days prior to surgery. A futile laparotomy was averted in 3 patients (12%). Following SL the primary tumor was resected in 20 patients. Two patients (10%) developed metastases within 3 months after resection. Conclusions Despite current preoperative imaging modalities metastases are still identified during surgery. This study shows limited added value of LUS during SL in patients with pancreatic or periampullary cancer. LFI was of added value due to its high negative predictive value in case of suspect hepatic lesions identified by inspection.
关键词： near-infrared fluorescence imaging,staging laparoscopy,laparoscopic ultrasonography,pancreatic cancer,periampullary cancer,indocyanine green
更新于2025-09-23 15:21:01
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Comparing the Staging/Restaging Performance of 68Ga-Labeled Prostate-Specific Membrane Antigen and 18F-Choline PET/CT in Prostate Cancer
摘要： PET/CT using prostate-specific membrane antigen (PSMA) and choline radiotracers is widely used for diagnosis of prostate cancer. However, the roles of and differences in diagnostic performance between these 2 radiotracers for prostate cancer are unclear. The aim of this study was to compare the staging and restaging performance of 68Ga-labeled PSMA and 18F-choline PET/CT imaging in prostate cancer. Methods: A comprehensive search was performed in PubMed for studies reporting the staging performance of 68Ga-PSMA and 18F-choline PET/CT in prostate cancer from the inception of the database to October 1, 2018, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. Thirty-five studies were included in this systematic review and meta-analysis. Pooled estimates of patient- and lesion-based sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and diagnostic odds ratio (DOR) for 68Ga-PSMA and 18F-choline PET/CT were calculated alongside 95% confidence intervals. Summary receiver operating characteristic curves were plotted, and the area under the summary receiver operating characteristic curve (AUC) was determined alongside the Q* index. Results: The patient-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (13 studies) were 0.92, 0.94, 7.91, 0.14, 79.04, and 0.96, respectively, whereas those of 18F-choline PET/CT (16 studies) were 0.93, 0.83, 4.98, 0.10, 68.27, and 0.95. The lesion-based overall pooled sensitivity, specificity, PLR, NLR, DOR, and AUC of 68Ga-PSMA PET/CT for staging in prostate cancer (9 studies) were 0.83, 0.95, 23.30, 0.17, 153.58, and 0.94, respectively, and those of 18F-choline PET/CT (4 studies) were 0.81, 0.92, 8.59, 0.20, 44.82, and 0.98. In both patient- and lesion-based imaging, there was no statistically significant difference in the abilities of detecting or excluding prostate cancer between 68Ga-PSMA PET/CT and 18F-choline PET/CT. Conclusions: For staging and restaging performance in patients with prostate cancer, there was no significant difference between 68Ga-PSMA PET/CT and 18F-choline PET/CT. 68Ga-PSMA PET/CT and 18F-choline PET/CT have demonstrated high diagnostic performance for accurate staging and restaging in patients with prostate cancer, and thus both should be considered for staging in this disease.
关键词： 18F-fluorocholine (18F-choline),PET,staging,prostate cancer,68Ga-PSMA CT
更新于2025-09-11 14:15:04
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Utility of PET/CT in diagnosis, staging, assessment of resectability and metabolic response of pancreatic cancer
摘要： Pancreatic cancer is one of the most common gastrointestinal tumors, with its incidence staying at a high level in both the United States and China. However, the overall 5-year survival rate of pancreatic cancer is still extremely low. Surgery remains the only potential chance for long-term survival. Early diagnosis and precise staging are crucial to make proper clinical decision for surgery candidates. Despite advances in diagnostic technology such as computed tomography (CT) and endoscopic ultrasound, diagnosis, staging and monitoring of the metabolic response remain a challenge for this devastating disease. Positron emission tomography/CT (PET/CT), a relatively novel modality, combines metabolic detection with anatomic information. It has been widely used in oncology and achieves good results in breast cancer, lung cancer and lymphoma. Its utilization in pancreatic cancer has also been widely accepted. However, the value of PET/CT in pancreatic disease is still controversial. Will PET/CT change the treatment strategy for potential surgery candidates? What kind of patients benefits most from this exam? In this review, we focus on the utility of PET/CT in diagnosis, staging, and assessment of resectability of pancreatic cancer. In addition, its ability to monitor metabolic response and recurrence after treatment will be emphasis of discussion. We hope to provide answers to the questions above, which clinicians care most about.
关键词： Staging,Pancreatic cancer,Metabolic response,Position emission tomography/computed tomography,Diagnosis
更新于2025-09-10 09:29:36
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Imaging as a Personalized Biomarker for Prostate Cancer Risk Stratification
摘要： Biomarkers provide objective data to guide clinicians in disease management. Prostate-specific antigen serves as a biomarker for screening of prostate cancer but has come under scrutiny for detection of clinically indolent disease. Multiple imaging techniques demonstrate promising results for diagnosing, staging, and determining definitive management of prostate cancer. One such modality, multiparametric magnetic resonance imaging (mpMRI), detects more clinically significant disease while missing lower volume and clinically insignificant disease. It also provides valuable information regarding tumor characteristics such as location and extraprostatic extension to guide surgical planning. Information from mpMRI may also help patients avoid unnecessary biopsies in the future. It can also be incorporated into targeted biopsies as well as following patients on active surveillance. Other novel techniques have also been developed to detect metastatic disease with advantages over traditional computer tomography and magnetic resonance imaging, which primarily rely on defined size criteria. These new techniques take advantage of underlying biological changes in prostate cancer tissue to identify metastatic disease. The purpose of this review is to present literature on imaging as a personalized biomarker for prostate cancer risk stratification.
关键词： magnetic resonance imaging (MRI),cancer staging,active surveillance,radical prostatectomy,Gleason score,radiation therapy
更新于2025-09-09 09:28:46
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Towards More Structure: Comparing TNM Staging Completeness and Processing Time of Text-Based Reports versus Fully Segmented and Annotated PET/CT Data of Non-Small-Cell Lung Cancer
摘要： Results of PET/CT examinations are communicated as text-based reports which are frequently not fully structured. Incomplete or missing staging information can be a significant source of staging and treatment errors. We compared standard text-based reports to a manual full 3D-segmentation-based approach with respect to TNM completeness and processing time. TNM information was extracted retrospectively from 395 reports. Moreover, the RIS time stamps of these reports were analyzed. 2995 lesions using a set of 41 classification labels (TNM features + location) were manually segmented on the corresponding image data. Information content and processing time of reports and segmentations were compared using descriptive statistics and modelling. The TNM/UICC stage was mentioned explicitly in only 6% (n=22) of the text-based reports. In 22% (n=86), information was incomplete, most frequently affecting T stage (19%, n=74), followed by N stage (6%, n=22) and M stage (2%, n=9). Full NSCLC-lesion segmentation required a median time of 13.3 min, while the median of the shortest estimator of the text-based reporting time (R1) was 18.1 min (p<0.001), lesion size (p<0.001) correlated significantly with the segmentation time, but not with the estimators of text-based reporting time. Numerous text-based reports are lacking staging information. A segmentation-based reporting approach tailored to the staging task improves report quality with manageable processing time and helps to avoid erroneous therapy decisions based on incomplete reports. Furthermore, segmented data may be used for multimedia enhancement and automatization.
关键词： segmentation,TNM staging,structured reporting,NSCLC,PET/CT
更新于2025-09-04 15:30:14
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The Relationship Between Clinical and Indocyanine Green Staging in Lymphedema
摘要： Background: Multiple staging systems for classifying the severity of lymphedema exist. The International Society of Lymphology (ISL) stage is considered standard for clinical reporting, but the relationship between clinical and functional/imaging stage remains poorly de?ned. Materials and Methods: We reviewed the prospectively collected data of all patients who underwent physiologic lymphedema surgery for a 3-year period by the senior author. Patients who underwent preoperative clinical staging with limb volume calculations and intraoperative indocyanine green (ICG) staging were included. Correlations were examined between ISL stage, ICG stage, and preoperative volume difference. Results: A total of 212 patients met inclusion criteria. ISL stage and preoperative volume difference had a Pearson correlation coef?cient of 0.579 [p < 0.001, 95% con?dence intervals, CIs (0.479–0.664)]; ICG stage and preoperative volume difference had a Pearson correlation coef?cient of 0.338 [p < 0.001, 95% CIs (0.204–0.460)]; and ISL stage and ICG stage had a Pearson correlation coef?cient of 0.254 [p < 0.001, 95% CIs (0.114–0.383)]. Conclusion: Clinical ISL stage does not correlate well with ICG stage in patients undergoing physiologic lymphedema surgery.
关键词： lymphedema staging,lymphedema surgery,lymphedema
更新于2025-09-04 15:30:14