Prognostic significance of mediastinal 18F-FDG uptake in PET/CT in advanced ovarian cancer.

PURPOSE: To evaluate the prognostic significance of increased mediastinal (18)F-FDG uptake in PET/CT for the staging of advanced ovarian cancer. METHODS: We retrospectively evaluated patients managed for FIGO stage III/IV ovarian cancer between 1 January 2006 and 1 June 2009. Patients were included if they had undergone (18)F-FDG PET/CT and surgery for initial staging. Exclusion criteria were age younger than 18 years, inability to undergo general anaesthesia, recurrent ovarian cancer, and borderline or nonepithelial malignancy. Whole-body PET/CT was performed after intravenous (18)F-FDG injection. The location of abnormal hot spots and (18)F-FDG maximal standard uptake values (SUV(max)) were recorded. We compared the complete cytoreduction and survival rates in groups defined based on mediastinal (18)F-FDG uptake and SUV(max) values. Kaplan-Meier curves of overall survival and disease-free survival were compared using the log-rank test. Hazard ratios with their 95% confidence intervals were computed. Adjusted hazard ratios were obtained using a multivariate Cox model. RESULTS: We included 53 patients, of whom 17 (32%) had increased mediastinal (18)F-FDG uptake. Complete cytoreduction was achieved in 14 (87.5%) of the 16 patients managed with primary surgery and in 21 (75%) of the 28 patients managed with interval surgery. Complete cytoreduction was achieved significantly more often among patients without increased mediastinal (18)F-FDG uptake (80.6% vs. 35.3%; p = 0.001). Disease-free survival was comparable between the two groups. By univariate analysis, overall mortality was significantly higher among patients with increased mediastinal (18)F-FDG uptake (hazard ratio 5.70, 95% confidence interval 1.74-18.6). The only factor significantly associated with overall survival by multivariate analysis was complete cytoreduction (adjusted hazard ratio 0.24, 95% confidence interval 0.07-0.89). CONCLUSION: Increased mediastinal (18)F-FDG uptake was common in patients with advanced ovarian cancer. However, complete cytoreduction, which was significantly more frequent among patients without mediastinal (18)F-FDG uptake, was the only factor independently associated with survival.

Arterial wall uptake of fluorodeoxyglucose on PET imaging in stable cancer disease patients indicates higher risk for cardiovascular events.

BACKGROUND: We aimed to evaluate the additional information of 18 fluorodeoxyglucose (FDG) arterial uptake with respect to other conventional cardiovascular risk factors and arterial calcifications in patients with stable cancer. METHODS AND RESULTS: We compared the rate of cardiovascular events in 2 groups of patients with (n = 45) and without (n = 56) enhanced arterial 18FDG uptake, matched for the main clinical parameters. The extent and intensity of 18FDG uptake were quantified. A calcification index was also determined. About one third of the selected patients had a history of cardiovascular events and thus could be defined as "vulnerable patients." Old cardiovascular events (>6 months before or after positron emission tomography [PET]) and recent cardiovascular events (<6 months before or after PET) were significantly more frequent in the high-FDG uptake group than in the low-FDG uptake group (48% vs 15%, respectively [P = .0006], and 30% vs 1.8%, respectively [P = .0002]). The extent of 18FDG arterial uptake was the unique factor significantly related to the occurrence of a recent event by either logistic regression or discriminant analysis (P = .004 for all). Conversely, calcium index was the single factor related to old events (P = .004 and P = .002, respectively). CONCLUSIONS: Extensive arterial 18FDG uptake might be an indicator of an evolving atherosclerotic process and should be mentioned in PET/computed tomography reports.

Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients.

OBJECTIVES: To map sentinel lymph nodes (SLNs) detected by intracervical injection in patients with endometrial cancer and to determine the prevalence of node micrometastases. METHODS: Radionuclide and blue dye injections were used for SLN detection in 43 patients with clinical stage I endometrial cancer. Lymphoscintigraphy was done before surgery. Intraoperatively, the pelvic and para-aortic territories were examined for blue and/or radioactive nodes. Pelvic lymphadenectomy was performed with or without para-aortic lymphadenectomy. SLNs stained with hematoxylin-eosin-saffron were examined and, when negative, evaluated using step sectioning and immunohistochemistry. RESULTS: Feasibility was 100%. No adverse effects occurred. SLNs were identified in 30 patients (69.8%), usually in an interiliac location (28/30 patients, 93.3%). SLNs were found only in the common iliac chain in 1 (3%) patient and in both the common iliac chain and promontory area in another (3%). No patients had para-aortic SLNs or SLNs confined to the promontory. Node metastases were identified in eight patients and were confined to SLNs in six. In 2 (2/30, 6%) patients, SLNs contained micrometastases. No false-negatives occurred. CONCLUSIONS: Intracervical injection of radionuclide and blue dye chiefly revealed pelvic SLNs. The prevalence of micrometastases was within the expected range. Comparisons with peritumoral injection are needed.