Alessandra Musto

68ga-dota-noc: a new Pet tracer for evaluating patients with bronchial carcinoid

BackgroundConventional imaging techniques [computed tomography (CT), ultrasound, magnetic resonance] and somatostatin receptor scintigraphy are often insufficient to make a conclusive diagnosis of bronchial carcinoid (BC). PET is commonly used for the assessment of lung cancer but 18F-fluorodeoxyglucose, the most frequently used PET tracer, presents a low sensitivity for the detection of neuroendocrine tumours (NETs). New PET radiopharmaceuticals such as 68Ga-DOTA peptides, which directly bind to somatostatin receptors and are usually expressed on NET cell surfaces, have been reported to be superior to both morphological and somatostatin receptor scintigraphy imaging for gastroenteropancreatic NETs. However, their role in BC has never been evaluated. Our aim is to evaluate the role of 68Ga-DOTA-NOC (68Ga-labelled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-Nal3-octreotide) PET for the assessment of BC patients. MethodsTen patients with pathologically proven well-differentiated BC and one patient with highly suggestive CT images for BC were studied by 68Ga-DOTA-NOC PET/CT. PET findings were compared with clinical follow-up, pathology and contrast-enhanced CT findings. Results68Ga-DOTA-NOC PET/CT detected at least one lesion in nine of 11 patients and was negative in two. PET/CT and contrast-enhanced CT were discordant in eight of 11 patients, whereas in only three patients both provided similar results. PET/CT detected a higher number of lesions in five patients and excluded malignancy at sites considered positive on CT in three of 11; follow-up confirmed PET/CT findings in all patients. In PET/CT-positive patients, the mean maximal standardized uptake value was 25.9 [4.4–60.5]. On a clinical basis, PET/CT provided additional information in nine of 11 patients leading to the changes in the clinical management of three of nine patients. ConclusionPET/CT with 68Ga-DOTA-NOC was useful in BC patients because it led to a better evaluation of the extent of the disease.

FDG-PET/CT in advanced ovarian cancer staging: Value and pitfalls in detecting lesions in different abdominal and pelvic quadrants compared with laparoscopy

INTRODUCTION AND AIM Ovarian carcinoma (OC) is a common cancer in the Western Countries, and an important cause of death in patients suffering with gynaecologic malignancies. The majority of patients present with advanced disease at the time of diagnosis. Treatment with debulking surgery followed by chemotherapy is the standard approach while chemotherapy is contemplated when surgery is not possible. A correct pre-operative staging is important to ensure a most appropriate management. Laparoscopy (LPS) is the standard diagnostic tool for the assessment of intraperitoneal infiltration but is invasive and requires general anaesthesia. FDG-PET/CT is increasingly used for staging different types of cancer, and the aim of this study is to assess the value of FDG-PET/CT in staging advanced OC and its sensitivity to detect lesions in different quadrants of the abdominal-pelvic area compared to laparoscopy. MATERIALS AND METHODS From September 2004 till April 2008, 40 patients with high suspicion of OC were referred to our hospital for diagnostic LPS to explore the possibility of optimal debulking surgery. Those who were not suitable for surgery were referred for chemotherapy. Before chemotherapy, the patients underwent an FDG-PET/CT scan. The findings in 9 quadrants of abdominal-pelvic area (total 360 quadrants) for PET/CT and LPS were recorded and compared. RESULTS In 14/360 areas (3.8%), surgical evaluation was not possible because of presence of adhesions, thus the number of areas explored by laparoscopy was 346. Tumour was found in 308 quadrants (38 quadrants free of disease). PET/CT was positive in all 40 patients with true negative results in 26/346 quadrants (7.5%), and true positives results in 243/346 quadrants (70.2%). False positive and negative PET/CT results were found in 12/346 and 65/346 quadrants, respectively. False positive PET/CT findings were evenly present in all quadrants. False negative PET/CT findings were present in 31/109 (28.4%) upper abdominal quadrants (epigastrium and diaphragmatic areas). Final analysis showed a sensitivity and specificity for PET/TC of 78.9 and 68.4% respectively with a positive predictive value of 95.3%. A significant difference was noted between mean SUVmax associated with lesions smaller or larger than 0.5 cm (p=0.006). CONCLUSION Our results suggest that PET/CT may prove a useful tool for pre-surgical staging of ovarian cancer with a sensitivity and specificity of 78 and 68%, respectively. However, it may be used in combination with laparoscopy for better results. PET/CT showed an adequate correlation between SUVmax values and laparoscopy findings of lesions>5mm, but a high rate of false negative results in lesions<5mm such as in carcinomatosis. PET/CT should be used carefully in early stage disease, with low risk of peritoneal infiltration, because of high rate of false positive results, to avoid unnecessary therapy procedures.

Early 18F-2-fluoro-2-deoxy-d-glucose positron emission tomography may identify a subset of patients with estrogen receptor-positive breast cancer who will not respond optimally to preoperative chemotherapy

A pathologic complete response (pCR) and minimal residual disease (pMRD) after preoperative chemotherapy (PCT) for early stage or locally advanced breast cancer (BC) correlates with a good prognosis.

Present and future of PET and PET/CT in gynaecologic malignancies

OBJECTIVES To review the published data in literature on patients affected by gynaecological malignancies to establish the role of (18)F-FDG positron emission tomography (PET) and PET/CT in comparison to conventional imaging (CI). MATERIALS AND METHODS All papers specifically addressed to the role of (18)F-FDG PET and PET/CT in gynaecological malignancies published on PubMed/Medline, in abstracts from the principal international congresses, in the guidelines from national Societies that had appeared in literature until November 2009 were considered for the purpose of the present study. RESULTS AND CONCLUSIONS The use of (18)F-FDG PET, and even more of (18)F-FDG PET/CT, is increasing in the follow up of patients with gynaecologic malignancies and suspected recurrent disease: there is evidence in the literature that (18)F-FDG PET/CT has a higher sensitivity than CI in depicting occult metastatic spread. An interesting issue is represented by patients with ovarian cancer with an increase of the specific biomarker, CA-125, and negative/inconclusive findings at CI. The use of (18)F-FDG PET in differential diagnosis and staging is more controversial, but there is some evidence that a baseline PET examination performed before commencing therapy, for staging purpose, is also useful to evaluate the response to chemoradiation treatment. In several papers it has been suggested a relevant role of (18)F-FDG PET/CT in evaluating the entity of response to treatment and therefore to plan the subsequent therapeutic strategy.

Colorectal cancer: prognostic role of 18F-FDG-PET/CT.

of F-FDG-PET/CT Gaia Grassetto, Carlo Capirci, Maria Cristina Marzola, Lucia Rampin, Sotirios Chondrogiannis, Alessandra Musto, Giorgio Crepaldi, Anna Maria Minicozzi, Arianna Massaro, Domenico Rubello Department of Nuclear Medicine—PET/CT Centre, Santa Maria della Misericordia Hospital, Via Tre Martiri 89, 45100 Rovigo, Italy Radiotherapy Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Oncology Unit, Santa Maria della Misericordia Hospital, Rovigo, Italy Clinical Surgery, University of Verona, Verona, Italy

Management of epithelial ovarian cancer from diagnosis to restaging: an overview of the role of imaging techniques with particular regard to the contribution of 18F-FDG PET/CT.

Epithelial ovarian carcinoma is a major form of cancer affecting women in the western world. The silent nature of this disease results in late presentation at an advanced stage in many patients. It is therefore important to assess the role of imaging techniques in the management of these patients. This article presents a review of the literature on the role of 18F-FDG-PET/CT in the different stages of management of epithelial ovarian cancer. Moreover, a comparison with other imaging techniques has been made and the relationship between 18F-PET/CT and the assay of serum CA-125 levels has been discussed.

Positron-emission tomography in gynaecologic malignancies

IntroductionThe role of 18F-FDG PET in the management of gynaecologic malignancies remains unclear mainly due to the failure of clinicians to appreciate the significance of this imaging tool. However, this under utilisation is being actively re-addressed with a large number of reviews and studies, particularly in the last few years.Methods and ResultsPET has been shown to have high sensitivity and specificity in the evaluation of relapse and nodal disease in cervical cancer, while other uses such as staging and monitoring response to therapies being under further investigation. Similarly, promising results have been published in the use of PET in patients affected by endometrial cancer and uterine sarcomas for detecting lymph nodes metastasis and recurrent disease. In ovarian cancer, PET appears to have a great potential in staging and assessment of disease relapse. An important utility of PET in gynaecologic tumours, which is shared with a large number of other malignancies, is its value in positively changing the patients’ management.Conclusion The surge in studies using PET in gynaecological malignancies is in its early stages, and further studies are required to optimise the role of PET in these conditions.

Role of 18F-FDG PET/CT in the Carcinoma of the Uterus: A Review of Literature

In the present review we reported the value of 18F-fluorodeoxyglucose (FDG) PET/CT in face of uterine cancer, in terms of sensitivity, specificity and accuracy. Moreover, we made a comparison with the other imaging techniques currently used to evacuate these tumors including contrast-enhanced CT, contrast enhanced-MRI and transvaginal ultrasonography. FDG PET/CT has been reported to be of particular value in detecting occult metastatic lesions, in prediction of response to treatment and as a pro-gnostic factor.

When should F-18 FDG PET/CT be used instead of 68Ga-DOTA-peptides to investigate metastatic neuroendocrine tumors?

A 67-year-old man, previously operated for a pancreatic neuroendocrine tumor (NET), had progressive increase of serum chromogranin A during follow-up. Sequential 68Ga-DOTA-NOC and F-18 FDG PET/CT were performed. 68Ga-DOTA-NOC imaging was negative, whereas F-18 FDG PET/CT showed 2 hypermetabolic hepatic lesions demonstrated at CT-guided biopsy as metastatic deposits from a high-grade (G3) aggressive NET. Despite the large consensus of SPECT or PET with radiolabeled somatostatin analogs as first choice in functional imaging for detecting NETs metastasis, F-18 FDG may occasionally be the right tracer to provide accurate diagnostic and prognostic information in aggressive G3 NET.

Diagnosis of unknown sarcoidosis associated to erythema nodosum with 18F-FDG PET/CT

A 76-year-old woman was referred to our centre to perform (18)F-FDG PET/CT with the clinical suspicion of vasculitis. Whole body PET was negative for vasculitis but it depicted moderate hypermetabolism in several lymph nodes of the mediastinum and intense uptake of the tracer in the parotid glands. Since the patient referred skin lesion on both legs a particular acquisition of the lower extremities was performed which showed diffuse uptake on the perimalleolar region of both legs. On the basis of the PET/CT findings that were suggestive for sarcoidosis the patient performed bronchoalveolar lavage (BAL) and biopsy of a mediastinal lymph node which confirmed the suspicion of sarcoidosis.