18F-FDG PET/CT as predictor of tumour biology and prognosis in epithelial ovarian carcinoma. / PET/TC con 18F-FDG como predictor de la biología tumoral y del pronóstico en el cáncer epitelial ovárico.

OBJECTIVE: To investigate the relationship between maximum standardised uptake value (SUVmax) of ovarian lesions and histopathology subtypes, and their involvement in the response and prognosis of patients with epithelial ovarian carcinoma (EOC). MATERIAL AND METHODS: A retrospective analysis of 31 patients with EOC and 18F-FDG-PET/CT before treatment, including an assessment of the SUVmax of ovarian lesion. Histopathological diagnosis and follow-up was performed. A study was made on the relationship between the SUVmax and histological type (type I and II) and tumour stage, as well as the role of various parameters (SUVmax, histology, stage) on the patient outcomes (complete response [CR], overall survival [OS], disease-free survival [DFS], and disease-free [DF] status, at 12 and 24 months). RESULTS: The medium SUVmax in type I lesions was lower than in type II (6.3 and 9.3, respectively; P=.03). A 7.1 cut-off was set for SUVmax in order to identify type II EOC (sensitivity: 77.8%, specificity: 69.2%; AUC=0.748; P=.02). No significant relationship was found between tumour stage and SUVmax. CR was more common in early stages; relative risk (RR) of 1.64; P=.003, as well as in type I tumours and a lower SUVmax. Tumour stage was decisive in DFS (P=.04), LE24m (0.07) and OS (P=.08). Longer DFS and a higher percentage of DF 24m were observed in type I tumours (RR: 1.32; P=.26). CONCLUSIONS: SUVmax was related to EOC histology, so could predict the response and prognosis of these patients. No association was found between glycolytic activity of the primary tumor with the response and prognosis.

Is a selective brain (18)F-FDG PET/CT study profitable in patients with small cell lung cancer?

AIM: To evaluate the diagnostic yield of a selective brain (18)F-FDG PET/CT in neurologically asymptomatic patients with small cell lung cancer. MATERIAL AND METHODS: Twenty-one neurologically asymptomatic patients referred to our service between July 2008 and December 2009 for staging of small cell lung cancer were included in the study. All underwent a standard (18)F-FDG PET/CT study followed by a selective brain PET/CT. The neurological findings were confirmed by CT scan with intravenous contrast, MRI or minimum clinical follow-up of 6 months. The brain PET/CT was considered positive if any alteration was observed in the FDG distribution that was not related with previously known benign lesion in the CT image. RESULTS: Brain metastases were detected in 5 of the 21 patients (23.8%), these being correctly classified in 3 of them by the selective brain PET/CT. The stage was upgraded in one of them with the selective brain study. Only one patient showed a hypermetabolic lesion in the PET images in relationship to the lesions observed in the CT images. Sensibility, specificity, positive predictive value and negative predictive value were 60, 100, 100 and 88.89%, respectively. CONCLUSION: Hypometabolic areas in the cerebral parenchyma are frequently associated to metastatic lesions in patients with small cell lung cancer. The selective brain PET/CT in these patients allows correct staging and early treatment of unsuspected metastasis.

[Prevalence of micrometastases and isolated tumor cells in the sentinel node at early stage breast cancer]. / Prevalencia de micrometástasis y células aisladas en el ganglio centinela en estadios iniciales del cáncer de mama.

AIM: To analyze the prevalence of isolated tumor cells (ITC) and micrometastases in the sentinel node of early stage breast cancer. MATERIAL AND METHODS: A total of 234 patients diagnosed of breast cancer, stages T1 or T2, with no axillary involvement detected by palpation or ultrasound-FNA, were studied. The sentinel node (SN) was identified by lymphoscintigraphy and removed in the operating room. Serial sections and immunohistochemical staining were then performed, classifying them as negative (SN-), negative with ITC (SN-ITC), positive with micrometastases (SN+mic) and positive with macrometastases (SN+mac). A complete axillary lymphadenectomy (CAL) was carried out in those cases with micro- or macrometastases, the former being classified as negative (CAL-), positive with micrometatases (CAL+mic), and positive with macrometastases (CAL+mac). The follow-up ranged from 6-71 months. RESULTS: ITC were found in 12 patients (5.1%) and micrometastases in 24 (10.3%). Thus, a total of 36 patients were affected by some of these conditions (15.4%). In the group with micrometastases, the result of CAL was CAL- in 19/24 (79.1%), CAL+mic in 2 (8.3%) and CAL+mac in 3 (12.5%). No axillary recurrences have occurred up to date. CONCLUSIONS: ITC and micrometastases were found in the sentinel node in a significant percentage of patients in the early stages of breast cancer. The low percentage of further axillary invasion in the group of micrometastases may open up the possibility of avoiding CAL in favor of other adjuvant treatments (chemotherapy, radiotherapy).

[18F-FDG PET/CT with retrograde filling of the urinary bladder in the assessment of malignant pelvic disease]. / PET-TAC con (18)F-FDG tras llenado retrógrado vesical en el estudio de patología pélvica maligna.

AIM: To assess the role of PET/CT with retrograde filling of urinary bladder (RFUB) in the assessment of pelvic malignancy in patients with urothelial or gynecological tumors. MATERIAL AND METHODS: A retrospective longitudinal analysis based on 62 studies belonging to 52 patients was performed. All of them had a history of pelvic malignancy (29 urothelial and 23 gynecological) and 42 had undergone previous treatments. All patients underwent a standard PET/CT protocol. Inclusion criteria were radiological alterations in pelvic organs or increased urinary activity of (18)F-FDG that hindered evaluation of the pelvic structures. Pathological pelvic locations were assessed as the additional value of PET/CT with RFUB. The pathologic lesions were histologically or clinically evaluated with a minimum follow-up of 12 months. RESULTS: Pelvic malignancy was confirmed in 33 cases, 16 of which were of urothelial origin. A total of 35/62 studies showed a pathologic PET/CT in pelvis, 4 of them were false positive and 2 false negative. In 19 cases, malignancy was detected in the bladder wall, 16 of which were true positive. No false negative was detected. Regarding standard imaging acquisition, RFUB helped to confirm or rule out bladder and/or gynecological disease in 54 cases. CONCLUSION: Retrograde bladder filling is a highly recommended technique in the assessment of malignant pelvic disease, especially of bladder origin.

[Utility of PET-CT on radiotherapy planning of head and neck cancer. Our initial experience]. / Utilidad de la PET-TAC en la planificación radioterápica en el cáncer de cabeza y cuello. Nuestra experiencia inicial.

OBJECTIVE: To describe the methods used for the incorporation of FDG-PET-CT on radiotherapy planning of patients with head and neck cancer and also to evaluate the impact of FDG-PET-CT on staging and tumor volume definition. MATERIAL AND METHODS: A prospective study in which 20 patients with head and neck tumor submitted for radiotherapy treatment were included. All underwent a whole body PET- CT (GE DSTE 16) for staging and restaging, also acquiring an additional 3h delayed PET image with diagnostic CT parameters for planning. A CT scan with diagnostic protocol, tabletop available for radiotherapy treatment and the same personalized head-shoulder mask were used in the latter. Lymph node involvement and/or distant involvement were evaluated, considering the changes in staging. We also evaluated the differences in volumes obtained between the different techniques. The threshold value used for delineating PET gross tumor volume (GTV) was empirically established and ranged from 20-40% of the maximum SUV. RESULTS: Radiotherapy planning was performed with PET-CT in 20 patients between October 2007 to September 2008. A total of 29 lesions (18 primary lesions because 2 patients were excluded as no tumor was observed on the PET CT images, and 11 nodes). The most frequent location was oropharynx (5 patients). Mean maxSUV of the 29 lesions was 14.4 (range 5.0 and 26.4). No statistically significant differences were found between the GTV PET and GTV CT (mean 21.9cm³ and 19.3cm³, respectively). PET-CT modified the staging in 20% of the patients, with a diagnostic and therapeutic impact of 50 and 25%, respectively. CONCLUSION: The incorporation of PET-CT in routine radiotherapy planning is a promising technique that requires close collaboration between the nuclear medicine and radiotherapy oncology departments. PET-CT achieves better staging in patients and has a significant diagnostic and therapeutic impact. The use of the hybrid technique avoids problems arising from co-registry as well as a second examination for planning with the consequent advantage for the patient. Nonetheless, more prospective and randomized studies with pathology specimens are needed to evaluate the real impact in the tumor volume definition.

[Diagnostic and therapeutic impact of 18F-FDG-PET/CT in patients with suspected breast cancer recurrence]. / Impacto diagnóstico y terapéutico de la (18)F-FDG-PET/TAC en pacientes con sospecha de recidiva de cáncer de mama.

Breast cancer is a tumor with high prevalence in our environment. Thus, it is essential to make an early diagnosis in both the primary disease and its recurrence, given the high mortality of the cases with the advanced disease. Our study has aimed to evaluate the impact of (18)F-FDG-PET/CT in patients with suspected breast cancer recurrence and their therapeutic management. This study analyzed the PET/CT of 70 patients with a background of breast cancer and suspicion of recurrence, either because of elevation of tumor markers (n=28), doubtful findings on other imaging techniques (n=56) and/or suspicious symptoms (n=1). All the patients underwent a standard FDG-PET study acquired in combination with low-dose CT. The studies were considered pathological in 34 of the 70 patients, with 29 true positive, 32 true negative, 5 false positive and 4 false negative results. The final diagnosis was established either by histopathologic confirmation (n=17), other imaging techniques (n=26) and/or clinical radiological follow-up (n=27, mean 12.7 months). The sensitivity, specificity, positive predictive value and negative predictive values obtained were 87.8%, 86.4%, 85.2% and 88.8%, respectively. Therapeutic management was modified in 41% of the patients. In conclusion, PET/CT is a technique with high diagnostic yield in patients with suspected breast cancer recurrence.

[Micrometastasis in the sentinel node and axillary lymph node macro-metastasis in breast cancer]. / Micrometástasis en el ganglio centinela y macrometástasis ganglionares axilares en el cáncer de mama.

AIM: The study of the sentinel node has made it possible to obtain more comprehensive knowledge about the extent of axillary involvement in breast cancer. It has also decreased the surgical morbidity associated to the surgical examination of the axilla. The systematic use of immunohistochemical staining and molecular biology techniques improves the ability to detect the presence of micrometastasis or isolated tumor cells in a significant number of cases when this is the only sign of the lymph node extension of the disease. The possibility of avoiding complete axillary lymphadenectomy in those patients who are only affected by micrometastasis is proposed because of the low incidence of further involvement of the remaining lymph nodes. MATERIAL AND METHOD: 159 patients diagnosed of stage T1 or T2 breast cancer, in which the sentinel node had been identified by scintigraphy and intraoperative localization, were included in the study. Complete axillary lymphadenectomy was performed when micro- or macrometastases were found in the sentinel node, in order to determine the degree of axillary involvement. RESULTS: A total of 40 patients (25%) showed infiltration of the sentinel node. This infiltration was only by micrometastasis in 17 of them (10.7%). Of these 17 patients, only 2 (11.8%) showed macro-metastasis in the lymphadenectomy. In the remaining subjects, the final staging reached after the sentinel node study was not modified. CONCLUSION: It is possible to speculate that, in the future, axillary dissection can be avoided in those patients diagnosed of micrometastasis in the sentinel node, pending the conclusions of the on-going multicenter studies.

[Staging of non-small cell lung cancer. Diagnosis efficacy of structural (CT) and functional (FDG-PET) imaging methods]. / Estadificación del cáncer de pulmón de células no pequeñas. Utilidad de la imagen estructural (TAC) y funcional (FDG-PET).

PURPOSE: To evaluate diagnostic accuracy of FDG-PET in the definition of non-small cell lung cancer (NSCLC) and analyze diagnostic validity of CT scan and FDG-PET in its staging. METHODS: Patients with clinical suspicion of potentially resectable NSCLC (n = 108) were studied by standard procedures in our setting, including fibrobronchoscopy, transthoracic fine-needle aspiration, thoracoabdominal CT scan and FDG-PET. Gold standard was histopathological study in patients who underwent surgery and by specific imaging methods and biopsy, when available, in patients who did not. RESULTS: In 13% of patients, the FDG-PET findings were negative and no tumor was observed in the histological study of the piece. In 22% of patients, FDG-PET detected metastatic disease (M0 by CT scan). For mediastinal involvement, global diagnostic accuracy was 0.90 with FDG-PET and 0.59 with CT scan. False positive FDG-PET findings were produced by inflammatory conditions and false negative findings by the small size or proximity of lymph nodes to primary tumor. Mediastinal staging by CT scan and FDG-PET was correct in 56% and 87% of patients, respectively. CONCLUSIONS: Although complementary, the functional method (FDG-PET) is significantly superior to the structural method (CT) for detection of mediastinal tumor disease.

Vacuna antigripal y PET-FDG / FDG-PET and influenza vaccine

No disponible

No disponible

Tomografía por emisión de positrones con 18F-fluordesoxiglucosa en pacientes con sarcoma uterino / Positron emision tomography with 18F-fluorodeoxyglucose in patients with uterine sarcoma

Objetivo. Describir nuestra experiencia con la tomografía por emisión de positrones con FDG-PET en pacientes con sarcoma uterino, tanto con sospecha de recurrencia como en estadificación tumoral tras hallazgo casual en la pieza de histerectomía. Material y métodos. Se revisaron retrospectivamente (abril 2002-enero 2006) los estudios de FDG-PET realizados a 10 pacientes diagnosticadas de sarcoma uterino, 7 por sospechade recurrencia y 3 por estudio de extensión. La edadmedia fue de 52,2 años. El tiempo de evolución desde el diagnóstico inicial oscilaba entre 1 mes y 15 años (mediana: 14 meses). Histológicamente, las lesiones correspondieron a 8 leiomiosarcomas y 2 carcinosarcomas. La estadificación según la clasificación FIGO de las pacientes fue: 5 casos en estadio I, 1 en estadio III y 4 en estadio IV. Resultados. En 4 de las 7 pacientes con sospecha de recurrencia existió discrepancia entre la información proporcionada por la tomografía por emisión de positrones (PET) y las técnicas de imagen convencionales. En tres casos de tomografía axial computarizada no concluyente la FDG-PET fue negativay las pacientes no presentaron evidencia de enfermedad. La PET resultó negativa en una paciente con metástasis pulmonares. En los 3 estudios de estadificación hubo concordancia entre los hallazgos de la FDG-PET y las técnicas de imagen convencionales. Existió confirmación histológica de las lesiones en 5 pacientes, con un seguimiento medio de 14 meses. Conclusión. La FDG-PET puede ser útil en el seguimiento de las pacientes con sarcoma uterino y cuando el tumor es un hallazgo casual en una histerectomía por otras causas

Objective. Describe our experience with 18F- fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with uterine sarcomas, under suspicion of recurrence and in tumour staging after hysterectomy as an incidental pathology finding. Material and methods. A retrospective review, between april 2002 and january 2006, of FDG-PET performed in 10 patientswith clinical diagnosis of uterine sarcoma was made (7 patients under recurrence suspicion and three under initial staging). Mean age was 52.2 yrs. Evolution time after initial diagnosis vary from one month to 15 yrs (median time: 14 months). Lesions were classified as 8 leiomyosarcomas and 2 carcinosarcomas. FIGO staging were establish resulting 5 patients stage I, 1 patient stage III, and 4 patients stage IV. Results. 4 of 7 patients under suspicion of recurrence showed discrepancies between positron emission tomography (PET) and conventional imaging techniques (CIT) information. FDG-PET was negative in three cases of non-conclusive CT. PET was negative in one case with pulmonary metastases. The 3 staging studies were concordant both FDG-PET and CIT images. Pathological information was obtained in 5 cases, and a mean time of 14 months of clinical follow up was made. Conclusions. FDG-PET can be useful in the follow up of uterine sarcoma patients, and also when it is an incidental finding in other causes hysterectomy

[Positron emission tomography with 18F-fluorodeoxyglucose in patients with uterine sarcoma]. / Tomografía por emisión de positrones con 18F-fluordesoxiglucosa en pacientes con sarcoma uterino.

OBJECTIVE: Describe our experience with 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), in patients with uterine sarcomas, under suspicion of recurrence and in tumour staging after hysterectomy as an incidental pathology finding. MATERIAL AND METHODS: A retrospective review, between april 2002 and january 2006, of FDG-PET performed in 10 patients with clinical diagnosis of uterine sarcoma was made (7 patients under recurrence suspicion and three under initial staging). Mean age was 52.2 yrs. Evolution time after initial diagnosis vary from one month to 15 yrs (median time: 14 months). Lesions were classified as 8 leiomyosarcomas and 2 carcinosarcomas. FIGO staging were establish resulting 5 patients stage I, 1 patient stage III, and 4 patients stage IV. RESULTS: 4 of 7 patients under suspicion of recurrence showed discrepancies between positron emission tomography (PET) and conventional imaging techniques (CIT) information. FDG-PET was negative in three cases of non-conclusive CT. PET was negative in one case with pulmonary metastases. The 3 staging studies were concordant both FDG-PET and CIT images. Pathological information was obtained in 5 cases, and a mean time of 14 months of clinical follow up was made. CONCLUSIONS: FDG-PET can be useful in the follow up of uterine sarcoma patients, and also when it is an incidental finding in other causes hysterectomy.

[Positron emission tomography with fluordesoxyglucose-F18 in follow-up of endometrial cancer]. / Tomografía de emisión de positrones con fluordesoxiglucosa-F18 en el seguimiento del cáncer de endometrio.

OBJECTIVE: To assess the utility of FDG-PET in the follow-up of patients treated for endometrial cancer and with suspicion of recurrence according to conventional imaging methods (CT, MRI) and/or elevation of serum tumour markers. MATERIALS AND METHODS: Between April 2002 and December 2005, eleven patients underwent 17 FDG-PET studies (six with 2 studies); mean age was 63.4 yrs (range, 52-69 yrs) and time since diagnosis ranged from 11 months to 12 yrs (mean of 56 months). Initially, seven patients were in stage I, three in stage III and one in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid carcinomas and 3 non endometrioid carcinomas. RESULTS: FDG-PET showed infradiaphragmatic uptake in 3 patients and disseminated disease in 7 cases. FDG-PET showed no uptake in one patient. CT (n = 7) or MRI (n = 7) detected infradiaphragmatic lesions in 5 patients and visceral lesions in 2. In 11 patients, tumour markers were elevated (CA125, n = 9; CA19.9, n = 2; CA15.3, n = 2). In 7 patients, FDG-PET modified the information yielded by conventional imaging techniques and in 4 patients, the FDG-PET contributed no additional information. In 2 patients, histologic confirmation of the lesions was obtained and in 9 patients, there were clinical follow-up (from 3 to 20 months, mean of 8.7 months) and imaging studies. CONCLUSIONS: FDG-PET is superior to CT and MRI for detecting recurrences in the follow-up of patients with endometrial cancer.

Tomografía de emisión de positrones con fluordesoxiglucosa-F18 en el seguimiento del cáncer de endometrio / Positron emission tomography with fluordesoxyglucose-F18 in follow-up of endometrial cancer

Objetivo. Valorar la utilidad de la tomografía de emisión de positrones con 2-[ 18F]fluoro-2-desoxi-D-glucosa (PET-FDG) en el seguimiento del cáncer de endometrio, en pacientes con sospecha de recurrencia por elevación de marcadores tumorales séricos y técnicas convencionales de imagen. Material y métodos. Se revisaron retrospectivamente 17 estudios PET-FDG, realizados entre abril de 2002 y diciembre de 2005, a 11 pacientes previamente diagnosticadas de cáncer de endometrio (6 pacientes se hicieron dos estudios), con una edad media de 63,4 años (rango 52-69), y entre 11 meses y 12 años (media: 56 meses) de evolución desde el diagnóstico. Inicialmente, 7 casos estaban en estadio I, 3 en estadio III y 1 en estadio IV (clasificación FIGO). Histológicamente, correspondían a 8 carcinomas endometrioides y 3 no endometrioides. Resultados. La PET-FDG presentó captación infradiafragmática en 3 pacientes, y enfermedad diseminada en 7 casos. En 1 paciente la PET-FDG fue negativa. La tomografía axial computarizada (TAC) (n = 7) o la resonancia magnética (RM) (n = 7) detectaron lesiones infradiafragmáticas en 5 pacientes y viscerales en 2. En 11 pacientes existió elevación de marcadores tumorales séricos (CA125, n = 9; CA19.9, n = 2; CA15.3, n = 2). En 7 pacientes la PET-FDG modificó la información proporcionada por las técnicas convencionales de imagen, y en 4 no aportó información adicional. En 2 pacientes se obtuvo confirmación histológica de las lesiones y en 9 se realizó seguimiento clínico (3-20 meses, media 8,7 meses) y con técnicas de imagen. Conclusiones. La PET-FDG es superior a la TAC y la RM en la detección de recurrencias en el seguimiento de pacientes con cáncer de endometrio

Objective. To assess the utility of FDG-PET in the follow-up of patients treated for endometrial cancer and with suspicion of recurrence according to conventional imaging methods (CT, MRI) and/or elevation of serum tumour markers. Materials and methods. Between April 2002 and December 2005, eleven patients underwent 17 FDG-PET studies (six with 2 studies); mean age was 63.4 yrs (range, 52-69 yrs) and time since diagnosis ranged from 11 months to 12 yrs (mean of 56 months). Initially, seven patients were in stage I, three in stage III and one in stage IV (FIGO classification). Histologically, they corresponded to 8 endometrioid carcinomas and 3 non endometrioid carcinomas. Results. FDG-PET showed infradiaphragmatic uptake in 3 patients and disseminated disease in 7 cases. FDG-PET showed no uptake in one patient. CT (n = 7) or MRI (n = 7) detected infradiaphragmatic lesions in 5 patients and visceral lesions in 2. In 11 patients, tumour markers were elevated (CA125, n = 9; CA19.9, n = 2; CA15.3, n = 2). In 7 patients, FDG-PET modified the information yielded by conventional imaging techniques and in 4 patients, the FDG-PET contributed no additional information. In 2 patients, histologic confirmation of the lesions was obtained and in 9 patients, there were clinical follow-up (from 3 to 20 months, mean of 8.7 months) and imaging studies. Conclusions. FDG-PET is superior to CT and MRI for detecting recurrences in the follow-up of patients with endometrial cancer

[Quality control dose calibrators]. / Control de calidad de activímetros.

We have reviewed the legislation about the quality control of dose calibrator. The importance of verifying the correct work of these instruments, is fundamental in daily practice of radiopharmacy and nuclear medicine. The Spanish legislation establishes to include these controls as part of the quality control of radiopharmaceuticals, and the program of quality assurance in nuclear medicine. We have reviewed guides and protocols from international eminent organizations, summarizing the recommended tests and periodicity of them.