Diagnostic performance of 18F-fluciclovine PET/CT for regional lymph node metastases in patients with primary prostate cancer: a multicenter phase II clinical trial.

OBJECTIVE: This multicenter, phase II clinical trial evaluated the diagnostic performance of 18F-fluciclovine, a novel amino acid for positron-emission tomography (PET), for detection of small lymph node metastases with short-axis diameters of 5-10 mm in patients with prostate cancer. METHODS: Patients with prostate cancer were eligible after screening of laboratory tests and pelvic contrast-enhanced computed tomography (CT). Pelvic region 18F-fluciclovine PET/CT was then acquired within 28 days and dissection of regional lymph nodes was performed within 60 days of pelvic contrast-enhanced CT. Diagnostic performance of 18F-fluciclovine-PET/CT was evaluated by comparison with standard histopathology of lymph nodes. RESULTS: In a total of 28 patients, 40 regional lymph nodes with short-axis diameters of 5-10 mm were eligible for efficacy evaluation; seven of these showed metastases confirmed by histopathology. The sensitivity of 18F-fluciclovine PET/CT was 57.1% (4/7). All four true positive lymph nodes detected by 18F-fluciclovine PET/CT had a metastatic lesion with a long-axis diameter of ≥7 mm and a high proportion of cancer volume (60-100%) according to pathology evaluation. The specificity, diagnostic accuracy, positive predictive value, and negative predictive value of 18F-fluciclovine PET/CT in lymph node-based analysis were 84.8% (28/33), 80.0% (32/40), 44.4% (4/9), and 90.3% (28/31), respectively. No clinically significant adverse events occurred. CONCLUSIONS: 18F-fluciclovine PET/CT detected small lymph node metastases; however it also showed positive findings in benign lymph nodes. Refinement of the image assessment criteria may improve the diagnostic performance of 18F-fluciclovine PET/CT for small lymph node metastases in patients with prostate cancer.

Serum protein binding displacement: theoretical analysis using a hypothetical radiopharmaceutical and experimental analysis with 123I-N-isopropyl-p-iodoamphetamine.

INTRODUCTION: The binding of radiopharmaceutical to serum proteins is thought to be an important factor that restricts its excretion and accumulation in tissue. We calculated the effect of inhibitors of serum protein binding using a hypothetical radiopharmaceutical. In vitro experiments and protein binding inhibitor-loaded monkey scintigraphy were then conducted using (123)I-N-isopropyl-p-iodoamphetamine (IMP) as the radiopharmaceutical. METHODS: Free fraction ratios of radiopharmaceutical were calculated with one radiopharmaceutical, two serum proteins and two specific inhibitors in the steady state at various serum protein concentrations. In vitro protein binding inhibition studies using human, rat and monkey sera were performed with site-selective displacers of specific binding sites: 400 microM 6-methoxy-2-naphthylacetic acid (6MNA; a major nabumeton metabolite) as a serum albumin Site II inhibitor and 400 microM erythromycin (ETC) as an alpha(1)-acid glycoprotein (AGP) site inhibitor. Scintigraphy with or without 6MNA loading of monkeys was performed. RESULTS: The theoretical findings roughly corresponded to the experimental results. Approximately 75% of IMP bound to serum albumin Site II and AGP in the species examined. The free fraction of IMP (25.0+/-0.6% for human, 22.8+/-0.4% for monkey, 23.7+/-0.3% for rat) increased with loading of specific protein binding inhibitors (6MNA: 28.0+/-0.3% for human, 24.5+/-0.7% for monkey, 24.3+/-0.2% for rat; ETC: 26.3+/-0.4% for human, 29.5+/-1.1% for monkey, 26.0+/-0.7% for rat) and was serum protein concentration dependant based on the results of calculations. Simultaneous administration of 6MNA and ETC produced a higher free fraction ratio of IMP (31.9+/-1.0% for human, 34.6+/-0.4% for monkey, 27.0+/-0.3% for rat) than summation of the single administrations of 6MNA and ETC (domino effect) in human, rat and monkey sera. Rapid cerebral accumulation was observed with 6MNA loading in monkey scintigraphy. CONCLUSIONS: 6MNA appears to change the pharmacokinetics and brain accumulation of IMP in monkeys. Further studies in human are required.

Effect of clinicopathologic factors on visibility of colorectal polyps with FDG PET.

OBJECTIVE: The objective of our study was to clarify which clinicopathologic factors affect the FDG PET visibility of colorectal polyps. MATERIALS AND METHODS: We used statistical methods in a retrospective examination of factors affecting the visibility of 87 colorectal polyps in 50 patients who underwent PET for cancer screening. RESULTS: PET depicted 37% (32/87) of polyps. Univariate analysis revealed significant associations between polyp visibility and polyp size, histologic grade (p < 0.001 each), type (p = 0.004), and patient age (p = 0.049) but not sex or polyp location. The visualization rate increased with increases in polyp size (< or = 5 mm, 12%; 6-10 mm, 47%; > or = 11 mm, 59%) and severity of dysplasia (indefinite or low-grade dysplasia, 13%; high-grade dysplasia, 67%; polyp with early carcinoma, 75%) and was higher for pedunculated polyps (59%) than for nonpedunculated polyps (27%). Multivariate analysis showed that histologic grade was the strongest factor (p < 0.001) among three independent factors (histologic grade, type, and age). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for visualization of high-grade or early carcinoma polyps to be removed were 71%, 87%, 78%, 82%, and 80%. Maximum standardized uptake values did not differ significantly between visualized polyps with indefinite or low-grade dysplasia and visualized polyps with high-grade dysplasia or early carcinoma. CONCLUSION: Histologic grade is the strongest independent factor in FDG PET visibility of colorectal polyps. FDG PET visibility may be helpful for predicting whether a polyp should be removed or observed. FDG PET findings also may suggest the need to alter the treatment of patients with colorectal polyps.

[Assessment of diagnostic criteria for FDG-PET cancer screening program according to the interpretation of FDG-PET and combined examination].

OBJECTIVE: The aim of this study is to establish the diagnostic criteria for FDG-PET cancer screening program of four kinds of organ (breast, thyroid, lung and colon/rectum) according to the interpretation of FDG-PET cancer screening program of the case with proved clinical outcome. METHODS: Among FDG-PET cancer screening examinations performed in two PET centers during 2003 to 2006, two hundreds of examinations with proved clinical outcome were evaluated. Interpretation of breast ultrasonography, thyroid ultrasonography, chest CT and fecal occult blood testing, which were regarded as combined examinations, were performed together with the interpretation of FDG-PET images. RESULTS: As a result of the interpretation, localized FDG accumulating site in all four organs should be recommended for further inspections. In addition, essential point for diagnosis was considered as follows; (1) check over the slight localized FDG accumulation with screening of breast region, (2) combine chest CT with FDG-PET for the evaluation of lung region and (3) check up the shift of FDG accumulation between early and delayed phase with screening of colon/rectum region. CONCLUSIONS: According to the interpretation results of this study, we establish diagnostic criteria of FDG-PET and combined examination of four kinds of organ.

Decreased cerebral blood flow and prognosis of Alzheimer's disease: a multicenter HMPAO-SPECT study.

PURPOSE: To determine the usefulness of brain perfusion SPECT for evaluating the severity and progression of Alzheimer's disease (AD). METHODS: Eighty-four AD patients were included. At entry, 99mTc-HMPAO-SPECT, the Mini Mental State Examination (MMSE), Mental Function Impairment Scale (MENFIS), and the Raven Colored Progression Matrix (RCPM) were performed for all 84 patients. During the follow-up periods, two individual MMSE evaluations in 34 patients, two MENFIS evaluations in 30 patients, and two RCPM evaluations in 20 patients were performed. Based on the regions of decreased cerebral blood flow demonstrated on 3D-SSP images of SPECT, the cases were classified as type A (no decrease), type B (decreased blood flow in the parietal or temporal lobe), type C (decreased blood flow in the frontal lobe and parietal or temporal lobe), type Pc (decreased blood flow in posterior cingulate gyrus only), and "other types". The types of decreased blood flow, scores on neuropsychological evaluations, and symptom progression were analyzed. RESULTS: The MENFIS, MMSE, and RCPM scores were poorest in type C patients at entry. The degree of decrease of these scores during the follow-up periods was also greatest in type C. The greatest difference between patients with and without rapid progression in SPECT data of the mild AD patients (MMSE score > or = 24) was in the frontal lobe. CONCLUSION: Decreased blood flow in the frontal lobe of AD patients is correlated not only with reduced cognitive function at the time of the evaluation but with rapid progression in the subsequent clinical course.

Performance profile of FDG-PET and PET/CT for cancer screening on the basis of a Japanese Nationwide Survey.

OBJECTIVE: The aim of this study is to survey the situation of (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening in Japan and to describe its performance profile. METHODS: "FDG-PET for cancer screening" was defined as FDG-PET or positron emission tomography and computed tomography (PET/CT) scan with or without other tests performed for cancer screening of healthy subjects. We sent questionnaires regarding FDG-PET cancer screening to 99 facilities in which FDG-PET tests were performed during the fiscal year 2005. Replies were obtained from 68 of the 99 facilities, of which 46 facilities performed FDG-PET cancer screening. The total number of subjects who underwent FDG-PET cancer screening was 50 558. From 38 of 46 facilities, reliable results of thorough examinations were obtained for the subjects who were positive by FDG-PET and/or one or more of the combined screening tests was performed and were referred for further evaluation. The total number of subjects in these 38 facilities amounted to 43 996. RESULTS: A total of 50,558 healthy subjects underwent FDG-PET (including PET/CT) scanning with or without other tests for cancer screening in 46 PET centers during the fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases as a result of positive findings suggesting possible cancer. On analyzing 43 996 cases from 38 PET centers from which detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% were PET positive and 0.24% were PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of the thyroid, colon/rectum, lung, and breast were most frequently found (107, 102, 79, and 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, and 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had a better detection rate, sensitivity, and positive predictive value than dedicated PET (P < 0.01). CONCLUSIONS: We were able to clarify the performance profile of "FDG-PET for cancer screening" on the basis of a Japanese nationwide survey. The number of facilities possessing PET is increasing steadily, highlighting the necessity of evaluating the usefulness of "FDG-PET cancer screening" as soon as possible by undertaking long-term investigations of large series of subjects.

FDG PET findings of chronic myeloid leukemia in the chronic phase before and after treatment.

We report 2 patients with chronic myeloid leukemia in the chronic phase showing diffusely increased F-18 fluorodeoxyglucose (FDG) uptake in the bone marrow before treatment. Follow-up FDG positron emission tomography (PET) scans were performed in a patient after cessation of treatment and in the other under treatment. Both FDG PET findings showed reduced FDG uptake in the bone marrow. A series of these FDG PET findings suggest the usefulness of FDG PET for the diagnosis and monitoring of chronic myeloid leukemia after treatment.

FDG PET and PET/CT monitoring of autoimmune pancreatitis associated with extrapancreatic autoimmune disease.

We report a series of FDG PET findings of a 69-year-old male patient with autoimmune pancreatitis (AIP) associated with extrapancreatic disease. The first FDG PET revealed diffuse uptake of FDG in AIP and retroperitoneal fibrosis (RF). The second FDG PET after cessation of steroid treatment indicated subsiding of disease activity in AIP, continuous disease activity in RF, and new extrapancreatic lesions, including enlargement of a right salivary gland, nephritis, and lymphadenopathy. The last FDG PET under steroid treatment revealed reduced FDG uptake in the above abnormal FDG uptake lesions. A series of these FDG PET findings suggest the usefulness of FDG PET for the diagnosis and monitoring of AIP associated with extrapancreatic autoimmune diseases.

[Performance profile of FDG-PET and PET/CT for cancer screening based on a Japanese nationwide survey].

A total of 50,558 healthy subjects underwent an FDG-PET (including PET/CT) scan with or without combination of other tests for cancer screening in 46 PET centers during fiscal year of 2005 in Japan. Thorough examination was indicated for 9.8% of the cases due to positive findings suggesting possible cancer. On analyzing 43,996 cases from 38 PET centers, where detailed information was obtained, 500 cases of cancers (1.14%) were found, of which 0.90% was PET positive and 0.24% was PET negative, resulting in the relative sensitivity of PET being 79.0%. Cancers of thyroid, colon/rectum, lung and breast were most frequently found (107, 102, 79, 35 cases, respectively) with high PET sensitivity (88%, 90%, 80%, 92%). PET showed an overall positive predictive value of 29.0%. PET/CT had better detection rate, sensitivity, and positive predictive value than dedicated PET (p<0.01).

18F-FDG PET/CT findings of a right subphrenic foreign-body granuloma.

We report a case of an 85-year-old woman with a foreign-body granuloma which accumulated 18F-fluorodeoxyglucose (FDG). Unenhanced computed tomography showed a hyperdense mass with a hypodense rim in the right subphrenic space. FDG PET/CT images showed intense FDG uptake in the hypodense rim and little FDG uptake in the center of the mass, showing a ring-shaped appearance. The fusion imaging of FDG PET/CT represented the metabolic features of the foreign-body granuloma. When a ring-shaped FDG uptake is noted in the abdomen of a patient with a history of abdominal surgery, a foreign-body granuloma should be included in the differential diagnosis.

Detection of breast cancer in an FDG-PET cancer screening program: results of a nationwide Japanese survey.

BACKGROUND: The [18F]-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program is defined as cancer screening for asymptomatic subjects using FDG-PET/computed tomography with or without combination of other screening tests. The aim of this study was to analyze the detection rate and effectiveness of the FDG-PET cancer screening program for breast cancer between 2006 and 2009 in Japan. PATIENTS AND METHODS: A total of 62,054 asymptomatic female subjects underwent FDG-PET cancer screening. We analyzed 473 cases with findings of possible breast cancer in any screening tests. RESULTS: Among 473 possible cases, 161 were verified as breast cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET for breast cancer were 83.9% and 41.7%, respectively. The relative sensitivity and PPV of mammography (MMG) for breast cancer was less than for FDG-PET; results for breast ultrasonography (US) were close to FDG-PET. The combination of FDG-PET with MMG and US might contribute to increased sensitivity but does not improve PPV. Most breast cancer cases (83.0%) detected using the FDG-PET cancer screening program were stage 0 or I based on the Union for International Cancer Control criteria. CONCLUSION: The FDG-PET screening program in Japan detected breast cancer at an early stage. A combination of FDG-PET and MMG and/or breast US yields the best results for detecting breast cancer. The FDG-PET cancer-screening program alone cannot detect all breast cancers.

Prediction of plasma concentration-time curve of orally administered theophylline based on a scintigraphic monitoring of gastrointestinal transit in human volunteers.

The plasma concentration-time profile of theophylline after oral administration in human volunteers was predicted using the individual gastrointestinal (GI) transit data monitored by a gamma scintigraphic technique. Theophylline was administered as aminophylline under fasted and fed condition, along with 99mTc-labeled diethylenetriamine-pentaacetic acid (DTPA), an unabsorbable marker to evaluate the GI transit by a gamma scintigraphic technique. Two healthy male volunteers participated under fasted and fed conditions in a crossover study. The GI transit was evaluated by dividing the GI tract to four segments, stomach, jejunum, ileum and cecum/colon. Under the fed condition, the GI transit pattern for each segment was confirmed to alter considerably, causing a delay in the gastric emptying mainly. Further, the plasma concentration curves of theophylline after oral administration were predicted using the GI-Transit-Absorption Model on the basis of individual GI transit parameters calculated by the fitting of the observed data to the GI-Transit Kinetic Model. The absorption rate constant in each segment and the pharmacokinetic parameters after intravenous administration used for the prediction were the values extrapolated from the data in rats and the ones normalized from the values in literatures, respectively. The plasma concentration-time curves for theophylline were well predicted using obtained individual GI transit parameters. The analysis using this method could estimate the variable absorption behavior governed by the GI transit in detail.

Serial change in 123I-MIBG myocardial scintigraphy in non-insulin-dependent diabetes mellitus.

PURPOSE: We performed 123I-MIBG (MIBG) myocardial scintigraphy twice in patients with non-insulin-dependent diabetes mellitus (NIDDM) to investigate whether MIBG distribution was improved by pertinent clinical control. To determine the influential factors for MIBG distribution, we investigated the association between various clinical parameters and the serial change in MIBG uptake parameters. PATIENTS AND METHODS: Twenty NIDDM patients with no cardiac disorders were evaluated. Planar images were taken at 30 minutes (early) and 3 hours (delayed) after MIBG injection. The heart-to-upper-mediastinum uptake ratio (H/M) and washout ratio (WR) were calculated as parameters for estimating cardiac sympathetic function. Patients were divided into two groups, eight in the improved group and twelve in the unimproved group, according to the serial change in H/M. The mean interval between the baseline and the follow up study was 2.1 +/- 0.6 year. Differences between the means of the laboratory data in patients in both groups were compared for the baseline and the follow up study by using the paired t-test. As a means of determining the influential factors for a serial change of MIBG uptake, Fisher's exact test was performed to evaluate the association between the serial change in cardiac MIBG parameters and changes in other clinical parameters, such as blood sugar (BS) control, BS control method (insulin therapy), serum cholesterol control, and severity of diabetic complications. We also analyzed the association between the changes in CV(R-R) (coefficient variance of R-R intervals at rest ECG) or NCV (velocity of posterior tibial nerve) and those of other clinical parameters. Associations among these neurological parameters (MIBG parameters, CV(R-R) and NCV) were also analyzed. RESULTS: Paired t-tests showed a significant decrease in fasting blood sugar and fructosamine in the improved group in the follow up study compared to those in the baseline study. Nevertheless, Fisher's exact test showed no significant association between FBS, HbA1C, fructosamine and the improvement in cardiac MIBG uptake. The only significant association was observed between the serial change in H/M and the BS-control method (insulin therapy). Within the neurological parameters, a significant association was noted between the serial changes in H/M and CV(R-R). CONCLUSION: Although BS control was likely to be an important factor, it did not always ameliorate cardiac MIBG uptake. Based on the significant association between the BS-control method (insulin therapy) and MIBG uptake change, the severity of diabetes mellitus was likely to be a more influential factor. It was suggested that cardiac MIBG uptake could improve within the mild stage if controlled by diet therapy or an oral hypoglycemic agent in NIDDM.

Cerebral blood flow abnormalities induced by transient hypothyroidism after thyroidectomy--analysis by tc-99m-HMPAO and SPM96.

UNLABELLED: The current study is an investigation of alterations in regional cerebral blood flow (rCBF) distribution in patients with transient hypothyroidism after thyroidectomy. In addition, the effects of thyroxine treatment on rCBF changes were studied. METHODS: Noninvasive rCBF measurements using 99mTc-HMPAO SPECT were performed on 24 post-thyroidectomy patients who were in a hypothyroidic state. The measurements were conducted before 131I therapy and after thyroid hormone (thyroxine) replacement. We used adjusted rCBF images (normalization of global CBF for each subject to 50 ml/100 g/min with proportional scaling) to compare these data with age-matched normal control groups (n =15) using SPM96. We also compared the absolute rCBF value of hypothyroidic patients with those of normal control groups. In addition, the association between rCBF alteration and the severity of depression was also analyzed. Finally, the effect of thyroid hormone replacement on rCBF was investigated individually using the Jack-knife test, in which patient data were compared with those from healthy volunteers. According to the result of this test, all cases were categorized into three subgroups, namely, improved, unchanged group and normal. To prove the reversibility of rCBF alteration after thyroid hormone replacement, a group comparison test between the normal controls and the improved group was done before and after thyroid hormone replacement. Similarly a group comparison test between the unchanged group and normal controls was also performed. RESULTS: In the hypothyroidic condition, there was a significant decrease in the posterior part of the bilateral parietal lobes and in part of the bilateral occipital lobes, including the cuneus. These decreased rCBF areas extended to the bilateral prefrontal cortices as deterioration became more profound. On individual analysis, 16 of 24 patients (66.7%) demonstrated rCBF reduction, while 8 patient did not show significant rCBF change (33.3%, the normal group). After thyroxine replacement, improvement of rCBF was noted in nine of 16 patients (56.3%, the improved group). In seven of 16 patients (43.7% the unchanged group), the significant low rCBF area remained unchanged. Compared with the normal controls, the improved group showed significantly decreased rCBF of the bilateral parietal lobe and the occipital lobe in the hypothyroic condition. After thyroid hormone replacement, these abnormal rCBF areas disappeared. In contrast, in the unchanged group, the significant hypoperfusion area became localized but remained. CONCLUSION: 99mTc-HMPAO SPECT and SPM96 analysis demonstrated a significant rCBF decrease in the parietal lobe and part of the occipital lobe in patients with induced transient hypothyroidism after thyroidectomy. This phenomenon might contribute to understanding of the depressive state. Recovery of rCBF after thyroid hormone replacement was confirmed in some patients. However, rCBF improvement did not always occur in every patient during the follow up period. The reversibility of rCBF in transient hypothyroidism may be dependent on individual characteristics during a short-term period.

[The development of new method for the assessment of perfusion reserve using split dose iodine-123-IMP SPECT: one-day protocol by modified ARG method].

Evaluation of the regional cerebrovascular reactivity (rCVR) to a cerebral vasodilatory stimulus is important in the investigation of patients with ischemic cerebrovascular disease. We devised a simplified one-day protocol technique using [123I]N-isopropyl-p-iodoamphetamine (IMP) autoradiography (ARG) with SPECT. To validate the accuracy of IMP-ARG for quantifying rCVR to acetazolamide, we compared rCVR measured using IMP-ARG with rCVR calculated using IMP split dose method of microsphere model. Twenty patients with chronic steno-occlusive disease in a unilateral major cerebral artery underwent 123I-SPECT. On rCBF SPECT image above 3.5 cm from OM line, large cortical regions of interest (ROI) was bilaterally determined for bilateral middle cerebral artery and anterior cerebral artery. Based on rCBF values in each ROI, rCVR to acetazolamide was calculated. Significant correlation was observed between rCVR values obtained using IMP-ARG and microsphere model IMP methods in the 80 ROIs examined in the 20 patients (r = 0.72; p < 0.001). The result demonstrated that [123I]IMP-ARG split dose method can quantify rCVR non-invasively in a short time.

Detection of prostate cancer by an FDG-PET cancer screening program: results from a Japanese nationwide survey.

OBJECTIVES: The aim of this study was to analyze detection rates and effectiveness of (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program for prostate cancer in Japan, which is defined as a cancer-screening program for subjects without known cancer. It contains FDG-PET aimed at detection of cancer at an early stage with or without additional screening tests such as prostate-specific antigen (PSA) and magnetic resonance imaging (MRI). METHODS: A total of 92,255 asymptomatic men underwent the FDG-PET cancer screening program. Of these, 504 cases with findings of possible prostate cancer in any screening method were analyzed. RESULTS: Of the 504 cases, 165 were verified as having prostate cancer. Of these, only 61 cases were detected by FDG-PET, which result in 37.0% relative sensitivity and 32.8% positive predictive value (PPV). The sensitivity of PET/computed tomography (CT) scanner was higher than that of dedicated PET (44.0% vs. 20.4%). However, the sensitivity of FDG-PET was lower than that of PSA and pelvic MRI. FDG-PET did not contribute to improving the sensitivity and PPV when performed as combined screening. CONCLUSION: PSA should be included in FDG-PET cancer screening programs to screen for prostate cancer.

Detection of colorectal cancer and adenomas by FDG-PET cancer screening program: results based on a nationwide Japanese survey.

PURPOSE: The aim of this study was to analyze the detection rate for CRC and adenomas for asymptomatic subjects in Japan by FDG-PET cancer screening program carried out between 2006 and 2009. METHODS: The "FDG-PET cancer screening program" included both PET and positron emission tomography with computed tomography (PET/CT) with or without other screening tests. A total of 154,783 asymptomatic subjects underwent FDG-PET cancer screening program; we analyzed the 1,808 cases with findings from any detection method that indicated suspected CRC. RESULTS: Among the 1,808 cases, the number of cases verified as CRC and adenoma was 394 and 679, respectively. The sensitivity and positive predictive value (PPV) of FDG-PET were 86.0 and 31.7% for CRC, and 63.6 and 63.8% for CRC and adenoma. The sensitivity and PPV of fecal occult blood test (FOBT) for CRC were lower than those of FDG-PET, but higher for adenoma. Therefore, FDG-PET and FOBT were complementary for screening for CRC, and CRC and adenoma. The majority of CRC detected by the FDG-PET imaging was UICC stage 0 or I, however, detection of smaller or less invasive cancer was limited. CONCLUSION: The FDG-PET screening program in Japan has detected CRC at an early stage and adenomas as premalignant lesions. A combination of FDG-PET and FOBT yields the best results if the intent is to detect either CRC or adenoma. However, it is absolutely clear that an FDG-PET cancer screening program cannot detect all colon lesions.

Detection of thyroid cancer by an FDG-PET cancer screening program: a Japanese nation-wide survey.

BACKGROUND/AIM: The [(18)F]-fluorodeoxyglucose positron emission tomography (FDG-PET) cancer screening program is defined as a cancer screening for asymptomatic subjects using FDG-PET (including PET/ computed tomography [CT]) with or without combination of other screening tests. The aim of the present study was to analyze the thyroid cancer detection rate in asymptomatic individuals through a FDG-PET cancer screening program in Japan. MATERIALS AND METHODS: A total of 153,775 asymptomatic individuals underwent FDG-PET cancer screening. We analyzed 1,308 cases for possible thyroid cancer in all screening tests. RESULTS: Among the 1,308 possible cases, 353 were verified as thyroid cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET were 90.7% and 29.5% for thyroid cancer, respectively. The relative sensitivity was equivalent to thyroid ultrasonography (US) (90.9%) and higher than neck computed tomography (CT) (75.7%, p<0.001), thyroglobulin (36.1%, p<0.001), and carcinoembryonic antigen (5.6%, p<0.001). The sensitivity with a PET/CT scanner was higher than that with a dedicated PET scanner (94.1% vs. 85.0%, p<0.001). Combining thyroid US with FDG-PET increased the relative sensitivity and PPV. The majority of thyroid carcinomas detected by FDG-PET screening were Union for International Cancer Control (UICC) stage I, but a significant number of cases were also detected as stage III or IV. CONCLUSION: The FDG-PET cancer screening program in Japan detected thyroid cancer at an early stage. FDG-PET showed high sensitivity in detecting thyroid cancer, and it may be more effective if combined with thyroid US.

Performance profile of a FDG-PET cancer screening program for detecting gastric cancer: results from a nationwide Japanese survey.

PURPOSE: It has been reported that gastric cancer is the sixth most common cancer found during the (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) cancer screening program, which is defined as cancer screening of asymptomatic subjects using FDG-PET(/CT) (in combination with other screening tests or not). The aim of this study was to analyze the detection rate and the effectiveness of the FDG-PET cancer screening program at detecting gastric cancer between 2006 and 2009 in Japan. MATERIALS AND METHODS: A total of 153,775 asymptomatic subjects (92,255 men, 61,520 women) between 30 and 80 years old underwent the FDG-PET cancer screening program. Of these, we analyzed 790 cases with findings of possible gastric cancer in any screening test. RESULTS: The number of cases who were verified to have gastric cancer was 124. Among these, only 47 cases were detected by FDG-PET, which resulted in a relative sensitivity of 37.9% and a positive predictive value of 33.6%. The relative sensitivity of FDG-PET was much lower than those of gastric endoscopy and the serum pepsinogen test. CONCLUSION: The FDG-PET screening program in Japan detected some cases of early-stage gastric cancer, but this was not achieved using FDG-PET alone but in combination with gastric endoscopy. Gastric endoscopy should be included in FDG-PET cancer screening programs to screen for gastric cancer.

Detection of lung cancer by FDG-PET cancer screening program: a nationwide Japanese survey.

AIM: The aim of this study was to analyze the lung cancer detection rate in asymptomatic individuals by the Fluorine-18 fluorodeoxyglucose-positron emission tomography FDG-PET cancer screening program in Japan. MATERIALS AND METHODS: A total of 153,775 asymptomatic individuals underwent the FDG-PET cancer screening program; the 854 cases with findings that indicated suspected lung cancer by any detection method were analyzed. RESULTS: Among the 854 cases, 319 were verified as lung cancer. The relative sensitivity and positive predictive value (PPV) of FDG-PET were 86.5% and 38.9% for lung cancer, respectively. The sensitivity of PET/computed tomography (CT) scanner was higher than that of dedicated PET (100.0% vs. 63.2%), indicating that CT imaging was effective for lung cancer screening. The majority of lung carcinomas detected by FDG-PET screening were UICC stage IA or IB, but detection of smaller or less invasive carcinomas was limited. CONCLUSION: The FDG-PET screening program in Japan detected lung cancer at an early stage.