RESUMO
The application of PET/CT with radiopharmaceuticals targeting PSMA is significantly transforming the diagnostic and therapeutic strategies of patients with prostate cancer. In Spain, the availability and access to positron-emitting radiopharmaceuticals targeting Prostate-Specific Membrane Antigen (PSMA) have significantly changed in recent months. These changes are affecting their use in diagnostic procedures. As a result, its use within diagnostic protocols for patients with prostate cancer is undergoing significant modifications. In this collective and cooperative document, the authors have selected the most robust evidence accumulated to date to generate a clinical guide to achieve appropriate use of this technology. A format that presents the most frequent clinical situations and the patient profiles in which PSMA PET/CT plays a significant role or will do so in the immediate future has been chosen. It should be taken into account that regulatory restrictions mediate the current indications for its use in Spain, as well as its current cost and the production capacity of radiopharmaceuticals. The guideline presents a review of the established methodology for optimized imaging with each of the radiopharmaceutical variants targeting PSMA and recommendations for structured and accurate reporting of metabolic findings in combination with CT.
Assuntos
Antígenos de Superfície , Glutamato Carboxipeptidase II , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Guias de Prática Clínica como Assunto , Neoplasias da Próstata , Compostos Radiofarmacêuticos , Humanos , Masculino , Antígenos de Superfície/análise , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Neoplasias da Próstata/diagnóstico por imagemRESUMO
Neoplasms are composed of malignant tumor cells, which are surrounded by other non-tumor cellular elements, in what has been defined as the microenvironment or tumor stroma. Evidence on the importance of the tumor microenvironment has not stopped growing in recent years. It plays a central role in cell proliferation, tissue invasion, angiogenesis and cell migration. The paradigm is the family of new FAPI radiopharmaceuticals that show the density of the fibroblast activation protein (FAP) which is overexpressed in the cell membrane of activated cancer-associated fibroblasts (CAF), and its presence is related to poor prognosis. This educational document includes the procedure for performing PET/CT FAPI, biodistribution and the main potentially clinical applications in oncology to date.
Assuntos
Oncologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Distribuição Tecidual , Proliferação de Células , Compostos RadiofarmacêuticosRESUMO
Prostate cancer (PC) is the most common tumor in men in the West and the fifth leading cause of cancer-related death. The use of PSMA radioligands has represented an important advance both in its diagnosis, through PET molecular imaging, and in its treatment in advanced stages of the disease. This article reviews the contribution of PET studies with PSMA radioligands in initial staging, in tumor detection in biochemical recurrence (elevation of PSA) after treatment with curative intent, and in the more advanced stages of the disease (castration resistant PC or CRPC). The contribution of PSMA radioligand therapy (PSMA-RLT) in CRPC patients who progress to standard therapy is also analyzed.
Assuntos
Carcinoma , Neoplasias de Próstata Resistentes à Castração , Dipeptídeos , Compostos Heterocíclicos com 1 Anel , Humanos , Masculino , Próstata/patologia , Neoplasias de Próstata Resistentes à Castração/patologiaAssuntos
Achados Incidentais , Glicoproteínas de Membrana , Tumores Neuroendócrinos/diagnóstico por imagem , Compostos Organometálicos , Neoplasias Pancreáticas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Adenocarcinoma/sangue , Adenocarcinoma/patologia , Adenocarcinoma/radioterapia , Idoso de 80 Anos ou mais , Isótopos de Gálio , Radioisótopos de Gálio , Humanos , Calicreínas/sangue , Masculino , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapiaRESUMO
Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique.
Assuntos
Neoplasias do Colo/diagnóstico por imagem , Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Compostos Radiofarmacêuticos , Neoplasias Retais/diagnóstico por imagem , Neoplasias do Colo/patologia , Humanos , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Recidiva Local de Neoplasia/diagnóstico por imagem , Estadiamento de Neoplasias/métodos , Guias de Prática Clínica como Assunto , Neoplasias Retais/patologiaRESUMO
PURPOSE: To assess the feasibility of performing same-day vascular flow redistribution and Yttrium-90 radioembolization (90Y-RE) for hepatic malignancies. MATERIALS AND METHODS: From November 2015 to February 2019, patients undergoing same-day hepatic flow redistribution during work-up angiography, 99mTechnetium-labeled macroaggregated albumin (99mTc-MAA) SPECT/CT and 90Y microsphere-RE, were recruited. Within 18 h following the delivery of 90Y resin microspheres, an 90Y-PET/CT study was performed. According to patients' vascular anatomy, flow redistribution was performed by microcoil embolization of extrahepatic branches (group A), intrahepatic non-tumoral vessels (group B) and intrahepatic tumoral arteries (group C). The accumulation of 99mTc-MAA particles and microspheres in the redistributed areas was qualitatively evaluated using a 5-point visual scale (grade 1 = < 25% accumulation; grade 5 = 100% accumulation). Differences in the distribution of microspheres among groups were assessed with Mann-Whitney U test. RESULTS: Twenty-two patients were treated for primary (n = 17) and secondary (n = 5) hepatic malignancies. The MAA-SPECT/CT showed uptake in all the redistributed areas. Regarding the accumulation of microspheres within the redistributed segments in all the groups, perfusion patterns were classified as 2 in 1 case, 4 in 6 cases and 5 in 15 cases. No statistically significant differences were observed between groups A and B-C (U value = 34, p = 0.32) and between groups B and C (U value = 26, p = 0.7). Mean predicted absorbed doses by the tumoral and normal hepatic tissues were 163.5 ± 131.2 Gy and 60.4 ± 69.3 Gy, respectively. Mean total procedure time (from work-up angiography to 90Y delivery) was 401 ± 0.055 min. CONCLUSION: Performing same-day redistribution of the arterial hepatic flow to the target and 90Y-microsphere delivery is feasible in the treatment of liver tumors. Clinical Trials Registry NCT03380130.
Assuntos
Angiografia , Embolização Terapêutica/métodos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/radioterapia , Fígado/irrigação sanguínea , Agregado de Albumina Marcado com Tecnécio Tc 99m/uso terapêutico , Radioisótopos de Ítrio/uso terapêutico , Adulto , Idoso , Albuminas , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Fluxo Sanguíneo Regional/fisiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodosAssuntos
Braquiterapia/métodos , Neoplasias Hepáticas/radioterapia , Compostos Radiofarmacêuticos/uso terapêutico , Radioisótopos de Ítrio/uso terapêutico , Angiografia , Braquiterapia/efeitos adversos , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/radioterapia , Doença Hepática Induzida por Substâncias e Drogas/etiologia , Neoplasias Colorretais/patologia , Terapia Combinada , Contraindicações , Embolização Terapêutica/efeitos adversos , Embolização Terapêutica/métodos , Gastroenteropatias/etiologia , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Pulmão/diagnóstico por imagem , Microesferas , Tumores Neuroendócrinos/diagnóstico por imagem , Tumores Neuroendócrinos/secundário , Pneumonite por Radiação/etiologia , Compostos Radiofarmacêuticos/efeitos adversos , Compostos Radiofarmacêuticos/farmacocinética , Sensibilidade e Especificidade , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios X , Radioisótopos de Ítrio/efeitos adversos , Radioisótopos de Ítrio/farmacocinéticaAssuntos
Metástase Linfática/diagnóstico por imagem , Vasos Linfáticos/diagnóstico por imagem , Melanoma Amelanótico/secundário , Imagem Multimodal , Neoplasias Palatinas/patologia , Tomografia por Emissão de Pósitrons , Biópsia de Linfonodo Sentinela , Tomografia Computadorizada por Raios X , Úvula/patologia , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Masculino , Melanoma Amelanótico/diagnóstico por imagem , Melanoma Amelanótico/cirurgia , Pessoa de Meia-Idade , Esvaziamento Cervical , Neoplasias Palatinas/cirurgia , Compostos Radiofarmacêuticos , Úvula/cirurgiaRESUMO
PET18FDG is an imaging diagnostic technique that shows changes in glycolitic metabolism that appear at a very early phases in the tumoral process. The main limitation of PET in breast cancer is the detection of small tumor lesions and axillary micrometastases. However it offers important information in the staging of high risk patients, in clinical relapse or in therapeutic evaluation. The new PET-CT devices offer advantages over conventional techniques. It provides a greater precision in the localization of tumoral foci. In spite of current difficulties for clinical applications, fluoro-estradiol (18F-ES) offers the possibilty of studying the presence of estrogenic receptors both in the primary and in the metastases. It may prove to be a useful tool to obtain information about therapeutic management and prognosis of breast cancer.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Neoplasias da Mama/patologia , Feminino , Fluordesoxiglucose F18 , Humanos , Estadiamento de Neoplasias , Compostos RadiofarmacêuticosRESUMO
Although needle-wire localization is the most commonly used localization technique for nonpalpable breast lesion biopsy, the technique of radioguided occult lesion localization (ROLL), is becoming increasingly used for open-surgery diagnosis in such cases. Sentinel lymph node biopsy(SLNB) is based on the hypothesis that lymphatic drainage from a tumor reaches the sentinel node(SLN) first and that it can be identified accurately and removed. If SLN exactly reflects the lymph-node status, a negative SLN for metastasis might allow complete axillary lymph node dissection (ALDN) to be avoided.
Assuntos
Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Biópsia de Linfonodo Sentinela/métodos , Neoplasias da Mama/diagnóstico por imagem , Feminino , Humanos , Radiografia , CintilografiaAssuntos
Di-Hidroxifenilalanina/análogos & derivados , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/cirurgia , Tomografia por Emissão de Pósitrons/métodos , Técnica de Subtração , Cirurgia Assistida por Computador/métodos , Tomografia Computadorizada por Raios X/métodos , Adolescente , Feminino , Humanos , Compostos RadiofarmacêuticosRESUMO
Infection following hip arthroplasties can present a diagnostic challenge. No test is 100 % sensitive and 100 % specific; this prospective study was undertaken to evaluate the utility of FDG-PET imaging for diagnosing infected joint replacements. 24 hip joint replacements were studied prospectively and we have complete diagnoses with clinical signs and symptoms, laboratory test, radiography, joint aspiration, radionuclide imaging including FDG-PET, and histopathologic examination. 11 of 24 prostheses were infected. The sensitivity and specificity of PET for detecting infection associated with prostheses were 64,3 % and 64,7 % respectively, in our hands. FDG imaging is not useful in patients with suspected prosthetic infection like a screening test.