Prognostic role and characteristics of the indeterminate response in differentiated thyroid cancer: a systematic review.

PURPOSE: The management of differentiated thyroid cancer (DTC) is actually based on a dynamic risk stratification based on classes of response to the therapy. Indeterminate response (IR) includes a heterogeneous group of patients with different characteristics, particularly different Tg and AbTg levels and/or imaging findings. The aim of systematic review (SR) is to evaluate the prognosis, diagnostic findings and other characteristics of patients in the IR class. METHODS: A wide literature search in the Scopus, PubMed/MEDLINE and Web of Science databases was performed to find published articles on patients with DTC and IR after treatment. The quality assessment of studies was carried out using QUADAS-2 evaluation. RESULTS: Eight articles were included in the systematic review. Six studies evaluated the prognosis and the prognostic factor in patients with IR, one study evaluated the role of 2-[18F]FDG PET-CT in the management of patients with IR and biochemical incomplete response and one study the risk factors for IR. CONCLUSION: Patients with DTC and IR to therapy have a probability of disease relapse < 15%. Tg value could be a predictor of disease progression. The role of 2-[18F]FDG PET-CT needs to be further investigated.

Development of a pediatric differentiated thyroid carcinoma registry within the EuRRECa project: rationale and protocol.

Background: Although differentiated thyroid carcinoma (DTC) is the most frequent endocrine pediatric cancer, it is rare in childhood and adolescence. While tumor persistence and recurrence are not uncommon, mortality remains extremely low. Complications of treatment are however reported in up to 48% of the survivors. Due to the rarity of the disease, current treatment guidelines are predominantly based on the results of small observational retrospective studies and extrapolations from results in adult patients. In order to develop more personalized treatment and follow-up strategies (aiming to reduce complication rates), there is an unmet need for uniform international prospective data collection and clinical trials. Methods and analysis: The European pediatric thyroid carcinoma registry aims to collect clinical data for all patients ≤18 years of age with a confirmed diagnosis of DTC who have been diagnosed, assessed, or treated at a participating site. This registry will be a component of the wider European Registries for Rare Endocrine Conditions project which has close links to Endo-ERN, the European Reference Network for Rare Endocrine Conditions. A multidisciplinary expert working group was formed to develop a minimal dataset comprising information regarding demographic data, diagnosis, treatment, and outcome. We constructed an umbrella-type registry, with a detailed basic dataset. In the future, this may provide the opportunity for research teams to integrate clinical research questions. Ethics and dissemination: Written informed consent will be obtained from all participants and/or their parents/guardians. Summaries and descriptive analyses of the registry will be disseminated via conference presentations and peer-reviewed publications.

Correlación entre el metabolismo de la glucosa cerebral (18F-FDG) y el flujo sanguíneo cerebral con marcadores de amiloide (18F-florbetapir) en práctica clínica: evidencias preliminares / Correlation between brain glucose metabolism (18F-FDG) and cerebral blood flow with amyloid tracers (18F-florbetapir) in clinical routine: Preliminary evidences

Este estudio comparó el rendimiento de las adquisiciones tempranas de 18F-florbetapir PET/TC con el de 18F-FDG PET/TC. Métodos: Se incluyó a 12 pacientes que se sometieron a PET/TC con 18F-FDG y una PET/TC con 18F-florbetapir en dos tiempos (exploración temprana de 1 a 6 min y exploración tardía de 50 min). La PET/TC fue analizada visualmente por 3médicos de medicina nuclear con diferente experiencia utilizando una escala de 4puntos (0=sin reducción, 1=leve, 2=moderada, 3=reducción severa) para 18F-florbetapir en fase temprana y 18F-FDG imágenes en 10 regiones corticales (frontal bilateral, temporal, parietal, occipital, cingulado/precúneo posterior) y fase tardía de 18F-florbetapir en las mismas regiones corticales utilizando una escala de 3puntos (0=normal, 1=anormal con placas menores, 2=anormal con placas importantes). Usamos SPM12 para el análisis semicuantitativo aplicando un análisis de correlación basado en ROI (considerando precúneo como región objetivo y normalizado para la unión global media), un análisis de covarianza tomando precúneo como objetivo y una comparación de DMN global (red de modo predeterminado). resultados: La concordancia entre lectores fue alta (kappa de Cohen 0,762 para 18F-FDG, 0,775 para 18F-florbetapir en la fase temprana y 0,794 para la fase tardía). Las puntuaciones visuales regionales de la fase temprana y la 18F-FDG se correlacionaron significativamente (ρ=0,867). También el análisis basado en el ROI, el análisis visual cerebral global y la comparación de DMN revelaron resultados concordantes, especialmente en parietal y precúneo (p <0,001). Conclusiones: Las exploraciones de fase temprana de 18F-florbetapir se correlacionan significativamente en imágenes cuantitativas y visuales con las exploraciones de 18F-FDG-PET/TC, lo que sugiere que se podría usar un marcadore de amiloide en lugar de 18F-FDG (AU)

This study compared the performance of 18F-florbetapir PET/CT early acquisitions to 18F-FDG PET/CT. Methods: We included 12 patients who underwent 18F-FDG PET/CT and a dual-time 18F-florbetapir PET/CT (1-6minutes early-scan and 50minutes late-scan). PET/CT were analyzed visually by 3nuclear medicine physicians with different experience using a four-point scale (0=no reduction, 1=slight, 2=moderate, 3=severe reduction) for 18F-florbetapir early-phase and 18F-FDG images in 10 cortical regions (bilateral frontal, temporal, parietal, occipital, posterior cingulate/precuneus), and 18F-florbetapir late-phase in the same cortical regions using a three-point scale (0=normal, 1=abnormal with minor plaques, 2=abnormal with major plaques). We used SPM12 for semiquantitative analysis applying a ROI-based correlation analysis (considering precuneus as target region and normalized for the mean global binding), a covariance-analysis taking precuneus as target and a comparison of global DMN (default mode network). esults: Inter-reader agreement was high (Cohen's kappa 0.762 for 18F-FDG, 0.775 for 18F-florbetapir early-phase and 0.794 for late-phase). Regional visual scores of early-phase and 18F-FDG were significantly correlated (ρ=0.867). Also ROI-based analysis, global brain visual analysis and DMN comparison revealed concordant results, especially at parietal and precuneus(p<0.001). Conclusions: 18F-florbetapir early-phase scans significantly correlate on quantitative and visual images with 18F-FDG-PET/CT scans, suggesting that amyloid tracer could be used instead of 18F-FDG (AU)

Evaluation of mental foramen and inferior alveolar nerve canal and its relationship to adjacent anatomical landmarks using cone-beam computer tomography.

The objective of the research was to evaluate the location, size, variability, and morphologic features of mental foramen (MF) and the inferior alveolar nerve canal (IAN) on cone-beam CT. We evaluated the morphologic findings of mental foramen (MF) and inferior alveolar nerve (IAN) canal of 88 mandibular hemiarches of 65 Caucasian subjects (35 males, 30 females; age range 25-75 years) using cone beam CT. The most common horizontal position of MF was type 3 (53.4%), followed by type 4 (39.8%), type 1 (2.3%), type 2 (2.3%), and type 5 (2.3%). Regarding the vertical position, in 71.6% of cases (63/88) we found type 3 position, followed by type 2 (22.7%) and type 1 (5.7%). MF presented as oval in 51.1% and round in 42%, with double oval and triple foramens having been observed in 5.7% and 1.1% respectively. In 36.9% of cases, we found an anterior loop of the IAN. The mean depth of MF was 6.12±1.65mm; width and height were 3.7±0.83mm and 3.14±0.78mm. Width and height of the IAN distal to MF were 2.27±0.53mm and 2.74±0.51mm, while those of the incisive nerve canal mesial to MF were 1.37±0.44mm and 1.54±0.58mm, respectively. An increase in the width of MF was correlated to oval shape (r=0.45; P < 0.01), and there was a low but significant correlation (r=0.23; P < 0.05) between the round shape of MF and the size of the IAN. MF shape appears to be correlated to MF width and size of the IAN. The individual anatomical variability of this structure is a factor that must be considered when dealing with mandibular surgery.

Disruption of bone densitometry practice in a Northern Italy Orthopedic Hospital during the COVID-19 pandemic.

We report the impact of the COVID-19 pandemic on bone densitometry practice in a Northern Italy Orthopedic Hospital, comparing the first 4 months of 2020 with the corresponding period of 2019. COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry (about - 50% of examinations). INTRODUCTION: The Coronavirus Disease 2019 (COVID-19) pandemic radically changes hospital organization to guarantee patient and staff safety, with the unavoidable cessation of normal outpatient activities. We report the impact of the COVID-19 pandemic on dual energy x-ray absorptiometry (DXA) testing in a Northern Italy Orthopedic Hospital. METHODS: We analyzed the number of DXA examinations performed at our Institution before, during the lockdown, and immediately after outpatient practice reopening (January 24th to May 27th, 2020), comparing them with the corresponding period of 2019. RESULTS: The number of DXA examinations showed a tremendous reduction from n = 1247 performed from January to May 2019 to n = 623 of 2020 (- 49.9%). No exams were performed in April 2020 (- 100%). On May 2020, a faint resume was observed, with n = 43 DXA (- 84.4% compared to 2019). CONCLUSION: COVID-19 pandemic had a disruptive effect on the daily practice of bone densitometry with DXA. After reopening, we observed a persistence of DXA examination reduction, confirming the fact that returning to normality will probably be a slow process.

Papel de la 18F-FDG PET o PET/TC en el plasmocitoma: una revisión sistemática / 18F-FDG PET or PET/CT role in plasmacytoma: a systematic review

ANTECEDENTES: El comportamiento metabólico del plasmocitoma en la PET/TC con 18F-FDG no está claro. OBJETIVO: Realizar una revisión sistemática sobre la utilidad diagnóstica de la PET o PET/TC con 18F-FDG en pacientes afectos de plasmocitoma. MÉTODOS: Se ha realizado una búsqueda exhaustiva bibliográfica de artículos relevantes en las bases de datos de Scopus, PubMed/MEDLINE, Embase y Cochrane Library desde julio de 2019. RESULTADOS: La búsqueda exhaustiva bibliográfica ha revelado 371 artículos; al revisar los títulos y los resúmenes, se excluyeron 363 artículos porque los datos que aportaban no estaban dentro del campo de interés de esta revisión. En total, en esta revisión sistemática se incluyeron 8 artículos. Los principales hallazgos del análisis de los artículos seleccionados han sido: 1) El plasmocitoma generalmente es un tumor ávido de 18F-FDG y la PET/TC muestra un buen rendimiento diagnóstico, con alta sensibilidad; 2) en la mayoría de los casos la PET/TC con 18F-FDG ha influido en el manejo de los pacientes, permitiendo seleccionar el tratamiento y evitando terapias ineficaces; 3) el valor pronóstico de los parámetros cualitativos y semicuantitativos de la PET/TC con 18F-FDG sigue mostrando un carácter controvertido con los resultados obtenidos. CONCLUSIÓN: A pesar de las limitaciones de estos hallazgos, dado el reducido número de trabajos y pacientes estudiados, el plasmocitoma parece ser un tumor ávido de 18F-FDG en la mayoría de los casos. La PET o PET/TC con 18F-FDG muestra un buen rendimiento diagnóstico, con impacto clínico significativo en el cambio de enfoque terapéutico. Finalmente, parece existir un probable valor pronóstico de la PET/TC con 18F-FDG

BACKGROUND: The metabolic behavior of plasmacytoma at 18F-FDG PET/CT is not yet clear. OBJECTIVE: The aim of this systematic review was to analyze published data about the role of 18F-FDG PET or PET/CT in patients affected by plasmacytoma. METHODS: Acomprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase and Cochrane Library databases was conducted including articles up to July 2019 to find relevant published papers about the performance of 18F-FDG PET and PET/CT in plasmacytoma. RESULTS: The comprehensive computer literature search revealed 371 articles. On reviewing the titles and abstracts, 363 articles were excluded because the reported data were not within the field of interest of this review. Eight articles were selected and retrieved in full-text version. From the analyses of the selected studies, the following main findings have been founded: 1) plasmacytoma generally is a 18F-FDG-avid tumor and PET/CT had good diagnostic performance with high sensitivity; 2) 18F-FDG PET/CT influenced patient management in most cases avoiding useless therapies and choosing the best therapeutic approach; 3) prognostic value of PET/CT qualitative and semiquantitative parameters is only suggested with controversial reports. CONCLUSION: Despite several limitations affect this analysis, especially related to the low number of articles and patients studied, plasmacytoma looks to be an 18F-FDG-avid tumor in most of the cases; 18F-FDG PET or PET/CT had good diagnostic performance and had a significant clinical impact in change of therapeutic approach. Moreover, a possible prognostic role of PET/CT features is described

18F-FDG PET or PET/CT role in plasmacytoma: A systematic review. / Papel de la 18F-FDG PET o PET/TC en el plasmocitoma: una revisión sistemática.

BACKGROUND: The metabolic behavior of plasmacytoma at 18F-FDG PET/CT is not yet clear. OBJECTIVE: The aim of this systematic review was to analyze published data about the role of 18F-FDG PET or PET/CT in patients affected by plasmacytoma. METHODS: Acomprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase and Cochrane Library databases was conducted including articles up to July 2019 to find relevant published papers about the performance of 18F-FDG PET and PET/CT in plasmacytoma. RESULTS: The comprehensive computer literature search revealed 371 articles. On reviewing the titles and abstracts, 363 articles were excluded because the reported data were not within the field of interest of this review. Eight articles were selected and retrieved in full-text version. From the analyses of the selected studies, the following main findings have been founded: 1) plasmacytoma generally is a 18F-FDG-avid tumor and PET/CT had good diagnostic performance with high sensitivity; 2) 18F-FDG PET/CT influenced patient management in most cases avoiding useless therapies and choosing the best therapeutic approach; 3) prognostic value of PET/CT qualitative and semiquantitative parameters is only suggested with controversial reports. CONCLUSION: Despite several limitations affect this analysis, especially related to the low number of articles and patients studied, plasmacytoma looks to be an 18F-FDG-avid tumor in most of the cases; 18F-FDG PET or PET/CT had good diagnostic performance and had a significant clinical impact in change of therapeutic approach. Moreover, a possible prognostic role of PET/CT features is described.

Paraganglioma no funcionante detectado incidentalmente en la 18F-FDG PET/TC y confirmado mediante gammagrafía con 123I-MIBG / Nonfunctioning paraganglioma incidentally detected by 18F-FDG PET/CT and confirmed by 123I-MIBG M scintigraphy

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Detección de grasa parda en la PET/TC con 18F-FDG: diferencias entre la población adulta y pediátrica en una experiencia de 12 años / 18F-FDG PET/CT brown fat detection: differences between adult and pediatric population in a 12 year experience

OBJETIVO: Analizar las características epidemiológicas y antropométricas de los pacientes con activación de la grasa parda detectada por tomografía por emisión de positrones con fluoruro 18-fluorodeoxiglucosa/tomografía computarizada (18F-FDG PET/TC). MATERIAL Y MÉTODOS: De 2005 a 2017, se incluyeron retrospectivamente 818 estudios PET/TC con 18F-FDG positivos para detección de grasa parda, 742 exámenes realizados en población adulta y 76 PET/TC en población pediátrica. Se realizó una prueba de Chi cuadrado para comparar la distribución de las características entre pacientes adultos y pediátricos. RESULTADOS: Los adultos mostraron una tasa más alta de detección de grasa parda en mujeres (79% vs.61%, p < 0,001) y en pacientes con hiperglucemia (> 100mg/dl) (24% vs.16%, p = 0,02), no se encontraron diferencias significativas considerando el sobrepeso (IMC>25kg/m2) (22% vs.20%, p = 0,55). Teniendo en cuenta solo a mujeres, los adultos mostraron una tasa más alta de detección de grasa parda tanto en pacientes con hiperglucemia (83% frente a 42%, p < 0,001), como en pacientes con sobrepeso (80% frente a 67%, p = 0,005). En ambas poblaciones, la activación de la grasa parda ocurrió con mayor frecuencia en las estaciones frías; no hubo diferencias significativas en la distribución considerando la temporada de nacimiento (p = 0,2). CONCLUSIONES: El sexo, la glucemia y el IMC desempeñan un papel importante en la predicción de la activación de la grasa parda, con diferencias significativas entre adultos y niños. Se confirma que la exposición al frío es un factor de predicción importante, mientras que la temporada de nacimiento no es significativa

PURPUSE: To analyze epidemiological and anthropometric features of patients with brown adipose tissue (BAT) activation detected by fluorine18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). MATERIAL AND METHODS: From 2005 to 2017, 818 18F-FDG PET/CT studies positive for BAT detection were retrospectively included, 742 examinations performed on the adult population and 76 PET/CT on the pediatric population. A Chi-squared test was performed to compare features distribution between the adult and pediatric patients. RESULTS: Adults showed a higher rate of BAT detection in females (79% vs.61%, p < 0.001) and in hyperglycaemic patients (>100mg/dL) (24% vs.16%, p = 0.02), no significant difference was found with regard to overweight patients (BMI>25kg/m2) (22% vs.20%, P=.55). Considering females only, the adults showed a higher rate of BAT detection both in hyperglycaemic (83% vs.42%, p < 0.001) and overweight patients (80% vs.67%, p = 0.005). In both populations BAT activation happened more frequently in cold seasons; there was no significant distribution difference with regard to season of birth (p = 0.2). CONCLUSIONS: Sex, glycemia and BMI play a major role in predicting BAT activation, with significant differences between adults and pediatric patients. Cold exposure is confirmed as an important predicting factor, while season of birth is not significant

Cistitis incrustada detectada por PET/TC con 18F-FDG / Encrusted cystitis detected by 18F-FDG PET/CT

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Accuracy of CT and MRI to assess resection margins in primary malignant bone tumours having histology as the reference standard.

AIM: To evaluate the accuracy of magnetic resonance imaging (MRI) and computed tomography (CT) in assessing the resection margins of primary malignant bone tumours. MATERIALS AND METHODS: Resected primary malignant bone tumour specimens removed from 46 patients (27 male; mean age: 48±22 years) were imaged using MRI (fat-saturated proton density-weighted and three-dimensional fat-suppressed T1-weighted gradient-recalled-echo) and CT immediately after surgery. A radiologist and an orthopaedist evaluated bone and soft-tissue margins of the specimens on both examinations. Histological evaluation was performed by a senior orthopaedic oncology pathologist. Margins were classified as R0 (safe margins), R1 (residuals between 0 and 1 mm), and R2 (macroscopic residuals). Cohen's k, chi-square, and McNemar's statistics were used. RESULTS: Having histology as the reference standard, reproducibility of the radiologist ranged from moderate (k=0.544) to substantial (k=0.741) for bone and soft-tissue margins on CT, respectively, while that of the orthopaedist ranged from fair (k=0.316) to moderate (k=0.548). When comparing R2 and R0+R1 scores, reproducibility of readers' evaluation of bone margins increased ranging from substantial (k=0.655) to perfect (k=1.000). Inter-reader agreement ranged from fair (k=0.308) to substantial (k=0.633). Accuracy of the radiologist and orthopaedist ranged from 76% to 83% and from 68% to 72%, respectively. When comparing R2 and R0+R1 scores, the accuracy of both readers ranged from 83% to 100%. There was no association between local recurrence and margin scores of histology, MRI, and CT (p≥0.058). CONCLUSIONS: MRI and CT may be useful for extemporaneous analysis of resection margins of primary malignant bone tumours, although wide accuracy variability between the different imaging methods was observed.

18F-FDG PET/CT brown fat detection: Differences between adult and pediatric population in a 12 year experience. / Detección de grasa parda en la PET/TC con 18F-FDG: diferencias entre la población adulta y pediátrica en una experiencia de 12 años.

PURPOSE: To analyze epidemiological and anthropometric features of patients with brown adipose tissue (BAT) activation detected by fluorine18-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). MATERIAL AND METHODS: From 2005 to 2017, 818 18F-FDG PET/CT studies positive for BAT detection were retrospectively included, 742 examinations performed on the adult population and 76 PET/CT on the pediatric population. A Chi-squared test was performed to compare features distribution between the adult and pediatric patients. RESULTS: Adults showed a higher rate of BAT detection in females (79% vs. 61%, P<0.001) and in hyperglycaemic patients (>100mg/dL) (24% vs. 16%, P=0.02), no significant difference was found with regard to overweight patients (BMI>25kg/m2) (22% vs. 20%, P=.55). Considering females only, the adults showed a higher rate of BAT detection both in hyperglycaemic (83% vs. 42%, P<0.001) and overweight patients (80% vs. 67%, P=0.005). In both populations BAT activation happened more frequently in cold seasons; there was no significant distribution difference with regard to season of birth (P=0.2). CONCLUSIONS: Sex, glycemia and BMI play a major role in predicting BAT activation, with significant differences between adults and pediatric patients. Cold exposure is confirmed as an important predicting factor, while season of birth is not significant.

Valor clínico y pronóstico de la PET/TC con 18F-FDG en el cáncer de endometrio recurrente / Clinical and prognostic value of 18F-FDG PET/CT in recurrent endometrial carcinoma

Objetivo: El carcinoma endometrial (CE) es un cáncer con un buen pronóstico general, excepto en los casos de CE recurrente o avanzado. El objetivo de este estudio fue evaluar el rendimiento diagnóstico y pronóstico y el impacto en el manejo terapéutico de la PET/TC con 18F-FDG en la sospecha de CE recurrente. Material y métodos: Se evaluaron retrospectivamente 157 pacientes con CE histológicamente probado y reestadificación de PET/TC con 18F-FDG por sospecha de recurrencia. Las imágenes PET se analizaron visualmente y semicuantitativamente midiendo SUVmax, VMT y GTL. Se tomó como referencia una combinación de seguimiento clínico/radiológico/histopatológico. La supervivencia libre de progresión (SLP) y la supervivencia global (SG) se calcularon usando las curvas de Kaplan-Meier. Resultados: Setenta y nueve pacientes tuvieron una PET/TC con 18F-FDG positiva que mostró la presencia de al menos una lesión hipermetabólica compatible con recurrencia, mientras que los 78 restantes fueron negativos. La sensibilidad, la especificidad, el valor predictivo positivo, el valor predictivo negativo y la precisión de la PET/TC con 18F-FDG fueron del 96, del 99, del 99, del 96 y del 97%, respectivamente, y fueron más altos en comparación con las imágenes convencionales: 97, 62, 72, 96 y 80%. Después de un seguimiento medio de 39meses, la recaída/progresión ocurrió en 58 pacientes y la muerte en 37, con un tiempo promedio de 22,1 y 27,6meses, respectivamente. Una PET/TC con 18F-FDG positiva y un estadio FIGO avanzado se asociaron significativamente con una SLP y SG más cortos. Los resultados de PET/TC tuvieron un impacto significativo en el abordaje terapéutico en 33 pacientes: evitaron terapias innecesarias en 28 y modificaron la terapia en 5. Conclusiones: La 18F-FDG-PET/TC tiene un muy buen rendimiento diagnóstico en pacientes con sospecha de CE recurrente, y tiene un importante valor pronóstico en la evaluación de SLP y SG. Además, la PET/TC permitió un cambio en la decisión de tratamiento en aproximadamente el 20% de los casos

Purpose: Endometrial carcinoma (EC) is a cancer with a good overall prognosis, except in cases of recurrent or advanced EC. The aim of this study was to assess the diagnostic performance, the prognostic value and the impact on therapeutic management of 18F-FDG PET/CT in suspected recurrent EC. Materials and methods: We retrospectively evaluated 157 patients with histologically proven EC and restaging 18F-FDG PET/CT for suspected recurrence. The PET images were analyzed visually and semi-quantitatively by measuring SUVmax, MTV and TLG. A combination of clinical/imaging follow-up and/or histopathology was taken as reference standard. Progression-free survival (PFS) and overall survival (OS) were computed using Kaplan-Meier curves. Results: Seventy-nine patients had positive 18F-FDG PET/CT showing the presence of at least one hypermetabolic lesion consistent with recurrence, while the remaining 78 were negative. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18F-FDG PET/CT were 96%, 99%, 99%, 96%, 97%, respectively, and were higher compared to conventional imaging: 97%, 62%, 72%, 96%, 80%. After a mean follow-up of 39months, relapse/progression occurred in 58 patients and death in 37 with an average time of 22.1 and 27.6months, respectively. A positive 18F-FDG PET/CT and advanced FIGO stage were significantly associated with shorter PFS and OS. PET/CT results had a significant impact on therapeutic approach in 33 patients: avoiding unnecessary therapies in 28 and modifying therapy in 5. Conclusions: 18F-FDG PET/CT has a very good diagnostic performance in patients with suspected recurrent EC and has an important prognostic value in assessing PFS and OS. Moreover, PET/CT allowed for a change in treatment decision in about 20% of cases

18F-FDG PET/TC en reestadificación y seguimiento de pacientes con sarcomas uterinos / Role of 18F-FDG PET/CT in restaging and follow-up of patients with uterine sarcomas

Objetivo: Los sarcomas uterinos son tumores raros con mal pronóstico debido a las altas tasas de recurrencia. El papel actual de la 18F-FDG PET/TC en la vigilancia posterior a la terapia aún no está establecido. Material y metodos: Cuarenta y una mujeres con sarcoma uterino se sometieron a 73 estudios 18F-FDG PET/TC para la reestadificación en la presunta recurrencia o durante el seguimiento en pacientes asintomáticos. Los resultados histopatológicos y/o el seguimiento clínico/de imágenes durante al menos 12 meses se consideraron el estándar de referencia. Se calculó la precisión diagnóstica y el impacto clínico de la 18F-FDG PET/TC. Resultados: treinta y tres estudios 18F-FDG PET/TC fueron positivos, mientras que los 40 estudios restantes fueron negativos. La sensibilidad general, la especificidad, el valor predictivo positivo (VP+), el valor predictivo negativo (VP-) y la precisión de la 18F-FDG PET/TC fueron del 88%, 98%, 97%, 91% y 93%. Considerando pacientes con sospecha clínica o radiológica de recidiva (n=47) y durante el seguimiento (n=26) la sensibilidad y especificidad, VP+, VP− y precisión de 18F-FDG PET/TC fueron del 89%, 100%, 100%, 86% y 94%, y 80%, 95%, 80%, 95% y 92% respectivamente. La 18F-FDG PET/TC tuvo un impacto clínico positivo en 9/73 (12%) estudios y cambió el manejo clínico en 8/41 (20%) pacientes. Conclusion: La 18F-FDG PET/TC es un método preciso para la detección y localización de recidivas a distancia en pacientes con sarcoma uterino con buena sensibilidad y especificidad e impacto significativo en la toma de decisiones clínicas

Purpose: Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of 18F-FDG PET/CT in the post-therapy surveillance is not established yet. Materials and Methods: Forty-one women with uterine sarcoma underwent 73 18F-FDG PET/CT for restaging in suspected recurrence or during follow-up in asymptomatic patients. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered the reference standard. The diagnostic accuracy and clinical impact of 18F-FDG PET/CT was calculated. Results: Thirty-three 18F-FDG PET/CT were positive, while the remaining 40 studies were negative. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F-FDG PET/CT were 88%, 98%, 97%, 91% and 93%, respectively. Considering patients with clinical or radiological suspicion of recurrence (n=47) and those during follow-up (n=26), sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG PET/CT were 89%, 100%, 100%, 86% and 94%, and 80%, 95%, 80%, 95% and 92%, respectively. 18F-FDG PET/CT had a positive clinical impact in 9/73 (12%) studies and changed the clinical management in 8/41 (20%) patients. Conclusions: 18F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in patients with uterine sarcoma with good sensitivity and specificity and significant impact on clinical decision making

Role of 18F-FDG PET/CT in restaging and follow-up of patients with uterine sarcomas. / 18F-FDG PET/TC en reestadificación y seguimiento de pacientes con sarcomas uterinos.

PURPOSE: Uterine sarcomas are rare tumors with poor prognosis due to the high recurrence rates. The current role of 18F-FDG PET/CT in the post-therapy surveillance is not established yet. MATERIALS AND METHODS: Forty-one women with uterine sarcoma underwent 73 18F-FDG PET/CT for restaging in suspected recurrence or during follow-up in asymptomatic patients. Histopathology results and/or clinical/imaging follow-up for at least 12 months were considered the reference standard. The diagnostic accuracy and clinical impact of 18F-FDG PET/CT was calculated. RESULTS: Thirty-three 18F-FDG PET/CT were positive, while the remaining 40 studies were negative. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 18F-FDG PET/CT were 88%, 98%, 97%, 91% and 93%, respectively. Considering patients with clinical or radiological suspicion of recurrence (n=47) and those during follow-up (n=26), sensitivity, specificity, PPV, NPV and accuracy of 18F-FDG PET/CT were 89%, 100%, 100%, 86% and 94%, and 80%, 95%, 80%, 95% and 92%, respectively. 18F-FDG PET/CT had a positive clinical impact in 9/73 (12%) studies and changed the clinical management in 8/41 (20%) patients. CONCLUSIONS: 18F-FDG PET/CT seems to be an accurate method for detection and localization of local and distant recurrence in patients with uterine sarcoma with good sensitivity and specificity and significant impact on clinical decision making.