Detection of relevant colonic neoplasms with PET/CT: promising accuracy with minimal CT dose and a standardised PET cut-off.

OBJECTIVE: To determine the performance of FDG-PET/CT in the detection of relevant colorectal neoplasms (adenomas > or =10 mm, with high-grade dysplasia, cancer) in relation to CT dose and contrast administration and to find a PET cut-off. METHODS: 84 patients, who underwent PET/CT and colonoscopy (n = 79)/sigmoidoscopy (n = 5) for (79 x 6 + 5 x 2) = 484 colonic segments, were included in a retrospective study. The accuracy of low-dose PET/CT in detecting mass-positive segments was evaluated by ROC analysis by two blinded independent reviewers relative to contrast-enhanced PET/CT. On a per-lesion basis characteristic PET values were tested as cut-offs. RESULTS: Low-dose PET/CT and contrast-enhanced PET/CT provide similar accuracies (area under the curve for the average ROC ratings 0.925 vs. 0.929, respectively). PET demonstrated all carcinomas (n = 23) and 83% (30/36) of relevant adenomas. In all carcinomas and adenomas with high-grade dysplasia (n = 10) the SUV(max) was > or =5. This cut-off resulted in a better per-segment sensitivity and negative predictive value (NPV) than the average PET/CT reviews (sensitivity: 89% vs. 82%; NPV: 99% vs. 98%). All other tested cut-offs were inferior to the SUV(max). CONCLUSION: FDG-PET/CT provides promising accuracy for colorectal mass detection. Low dose and lack of iodine contrast in the CT component do not impact the accuracy. The PET cut-off SUV(max) > or = 5 improves the accuracy.

[Surgical surveillance and endoscopy. The problem of secondary complication and local recurrence]. / Chirurgische Nachuntersuchung und Endoskopie. Das Problem der Sekundärkomplikation und des Lokalrezidivs.

Minimal access techniques in surgery are improving. At the same time, the significance of interventional flexible endoscopy is increasing. Postoperative complications can be treated endoscopically with low rates of morbidity and mortality. Anastomotic strictures after resection of the esophagus, colon or rectum are mostly treated with success by endoscopy. Reoperations are almost never necessary in these cases today. Although the efficient detection of locoregional recurrence of gastrointestinal carcinoma is still the subject of controversial discussion, in contrast, endoscopic therapy for palliation by ablation, dilatation or stenting leads to a clear benefit for many of these patients.

Expression of G1 phase cyclins in human gastric cancer and gastric mucosa of first-degree relatives.

The aim of this study was to investigate the expression of D-type cyclins and cyclin E in gastric cancer patients (N = 34), in healthy first-degree relatives of gastric cancer patients (N = 29), and in control subjects (N = 18). Expression of cyclins D1, D2, D3, and E was determined by RT-PCR. Localization of cyclin expression was determined by immunohistochemistry. Expression of cyclins D2, D3, and E was more frequently detected in tumor tissue compared with tumor-free gastric mucosa (P < 0.05) and was associated with the presence of intestinal metaplasia. In contrast, cyclin D1 was frequently expressed in both tumor- and tumor-free tissue. Cyclin D3 expression was more frequently detected in the antrum mucosa of first-degree relatives compared to controls (P < 0.01) and was associated with the presence of Helicobacter pylori. Our data suggest that deregulation of G1 phase cyclins may play a role in gastric carcinogenesis, and may point to the presence of molecular alterations in individuals at an increased risk for gastric cancer.