Ayse Mavi

Comparison of Triple-negative and Estrogen Receptor- positive/Progesterone Receptor-positive/HER2-negative Breast Carcinoma Using Quantitative Fluorine-18 Fluorodeoxyglucose/Positron Emission Tomography Imaging Parameters A Potentially Useful Method for Disease Characterization

This study was designed to investigate the fluorine‐18 fluorodeoxyglucose (FDG)‐positron emission tomography (PET) imaging characteristics of triple‐negative (estrogen receptor‐negative [ER−]/progesterone receptor‐negative [PR−]/HER2‐negative [HER2−]) breast carcinoma and compare the results with characteristics of ER+/PR+/HER2− breast carcinomas, which usually carry a favorable prognosis.

Comparison of triple-negative and estrogen receptor-positive/progesterone receptor-positive/HER2-negative breast carcinoma using quantitative fluorine-18 fluorodeoxyglucose/positron emission tomography imaging parameters: a potentially useful method for disease characterization.

This study was designed to investigate the fluorine‐18 fluorodeoxyglucose (FDG)‐positron emission tomography (PET) imaging characteristics of triple‐negative (estrogen receptor‐negative [ER−]/progesterone receptor‐negative [PR−]/HER2‐negative [HER2−]) breast carcinoma and compare the results with characteristics of ER+/PR+/HER2− breast carcinomas, which usually carry a favorable prognosis.

FDG-PET imaging in primary bilateral adrenal lymphoma: a case report and review of the literature.

Primary adrenal lymphoma is an extremely rare entity. Only 70 cases have been reported in the English literature. Most of the patients are elderly men with bilateral adrenal masses without extraadrenal involvement. The most common presenting symptoms are fever, weight loss, lumbar pain, and/or symptoms of adrenal insufficiency. Of the cases reported, CT, ultrasound, and MRI were the imaging modalities used to describe the lesions. FDG PET has been used successfully to differentiate benign and malignant adrenal masses. The authors report a 67-year-old man diagnosed as having primary bilateral adrenal lymphoma and having no evidence of extraadrenal spread who was evaluated from the time of diagnosis to complete remission with FDG PET scanning. The literature of this unusual neoplasm is reviewed in detail.

The Effects of Estrogen, Progesterone, and C-erbB-2 Receptor States on 18F-FDG Uptake of Primary Breast Cancer Lesions

The purpose of this prospective study was to investigate whether correlations exist between 18F-FDG uptake of primary breast cancer lesions and predictive and prognostic factors such as estrogen receptor (ER), progesterone receptor (PR), and C-erbB-2 receptor (C-erbB-2R) states. Methods: Before undergoing partial or total mastectomy, 213 patients with newly diagnosed breast cancer underwent 18F-FDG PET (5.2 MBq/kg of body weight). The maximum standardized uptake value (SUV) of the primary lesion was measured in each patient. Standard immunohistochemistry was performed on a surgical specimen of the cancer lesion to characterize the receptor state of the tumor cells. Pearson χ2 tests were performed on the cross-tables of different receptor states to test any association that may exist among ER, PR, and C-erbB-2R. Maximum SUV measurements for different receptor states were compared using factorial ANOVA in a completely random design. Results: After exclusion of certain lesions, 118 lesions were analyzed for this study. The mean maximum SUVs of ER-positive and ER-negative lesions were 3.03 ± 0.26 and 5.64 ± 0.75, whereas those of PR were 3.24 ± 0.29 and 4.89 ± 0.67, respectively, and those of C-erbB-2R were 4.64 ± 0.70 and 3.70 ± 0.35, respectively. χ2 tests for ER and PR showed that if one is positive then the other tends to be positive as well (χ2 = 71.054, P < 0.01). For ER and C-erbB-2R states, if ER is positive, C-erbB-2R will more likely be negative (χ2 = 13.026, P < 0.01). No relationship was detected between PR and C-erbB-2R states (χ2 = 3.695, P > 0.05). ANOVAs showed that PR state alone (F = 0.095, P > 0.05) and C-erbB-2R state alone (F = 0.097, P > 0.05) had no effect on 18F-FDG uptake but ER state alone had an effect (F = 9.126, P < 0.01). ER and PR being together had no additional effect on 18F-FDG uptake. Our study also demonstrated that interactions exist between ER and C-erbB-2R state and between PR and C-erbB-2R state. Conclusion: SUV measurements may provide valuable information about the state of ER, PR, and C-erbB-2R and the associated glucose metabolism as measured by 18F-FDG uptake of the primary breast cancer lesions. Such an association may be of importance to treatment planning and outcome in these patients.

FDG PET in detecting primary and recurrent malignant salivary gland tumors.

Purpose: The aim of this study was to assess the role of PET in the management of patients with primary malignant salivary gland (SG) tumor. Material and Methods: Sixty-one FDG PET studies in 48 patients (median age 58, range 28–89 years, 20 female, 28 male) who were diagnosed with malignant SG tumors were retrospectively analyzed. Thirteen were referred for initial diagnosis and staging while there was a suspicion of recurrence and/or metastatic disease in 48 patients during the follow-up period. Results: On PET examinations of 13 patients on initial presentation, 12 showed increased uptake in the primary lesion, while conventional methods (CT, MRI) were positive in 11 and were equivocal for 2 patients. Six patients with multiple nodal and 2 patients with distant metastases were detected by PET. Conventional methods demonstrated lymph node metastases in 5 of these patients. In the follow-up patient group, PET was inaccurate (false-negative or positive) in 4 (8%) patients with local recurrence, and in 4 (8%) with metastatic disease. However, 15 (31%) studies for recurrence and 7 (15%) for metastasis were false-negative with conventional radiologic methods. The sensitivity, specificity, and positive and negative predictive values for the detection of recurrent disease were 83%, 93%, 63%, and 98% for PET; 67%, 69%, 24%, and 94% for conventional methods, respectively. Overall sensitivity, specificity, positive and negative predictive values of PET for detecting metastatic disease were 93%, 96%, 82%, and 99%, while those of conventional methods were 80%, 95%, 75%, and 96%, respectively. Conclusion: These results demonstrate that FDG PET is not only superior to CT and/or MRI for staging at the initial presentation but also superior to conventional imaging methodologies for detecting local recurrence and regional lymph node and distant metastases in patients with malignant SG tumor.

Potential of Dual Time Point FDG-PET Imaging in Differentiating Malignant from Benign Pleural Disease

AimThe aim of this study was to assess the utility of dual time point 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) imaging in differentiating benign from malignant pleural disease.MethodsFifty-five consecutive patients of suspected malignant pleural mesothelioma (MPM) and recurrence of MPM who were referred for the evaluation underwent two sequential 18F-FDG-PET scans (dual time point imaging). The average percent change in the maximum standardized uptake values (Δ%SUVmax) of the lesion/lesions between time point 1 (SUVmax1) and time point 2 (SUVmax2) was calculated. All PET results were correlated with the histopathological or cytopathology results. Patients were divided into three principal groups (A = newly diagnosed MPM, B = recurrent MPM, and C = benign pleural disease). The parameters of 18F-FDG uptake (SUVmax values and its changes over time) were compared among groups.ResultsAmong the 55 patients who had undergone dual time point 18F-FDG-PET studies, 44 were diagnosed with MPM (28 newly diagnosed and 16 had recurrence). The PET studies demonstrated 229 malignant pleural lesions in these patients. The remaining 11 patients were proven to have benign pleural disease. The mean ± SD of the SUVmax1, SUVmax2, and the Δ%SUVmax of the all lesions of each patient in groups A, B, and C were 5.0 ± 2.2%, 5.8 ± 2.8%, and 12.8 ± 8.4%; 4.6 ± 1.7%, 5.3 ± 2.0%, 13.8 ± 9.2%; and 1.6 ± 0.4%, 1.4 ± 0.3%, and–9.6 ± 19.1%, respectively. The mean ± SD of the SUVmax1, SUVmax2, and Δ%SUVmax in patients with both newly diagnosed and recurrent MPM were significantly higher than those of benign pleural disease group (p < 0.0001). For each patient, the most intense (hottest) lesion’s SUVmax1, SUVmax2, and Δ%SUVmax were also compared among the aforementioned groups, and these results again confirmed that MPM lesions had significantly higher values than those of benign pleural lesions (p < 0.0001).ConclusionsThere is an increasing uptake of 18F-FDG over time in pleural malignancies, whereas the uptake in benign pleural disease generally stays stable or decreases over time. Therefore, dual time point imaging appears to be an effective approach in differentiating benign from malignant pleural disease, which increases the sensitivity and is also helpful in guiding the biopsy site for a successful diagnosis.

Implications of standardized uptake value measurements of the primary lesions in proven cases of breast carcinoma with different degree of disease burden at diagnosis: does 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography predict tumor biology?

ObjectivesTumor glycolytic activity as determined by 2-deoxy-2-[F-18]fluoro-d-glucose-positron emission tomography (FDG-PET) imaging is an important marker of tumor biology and provides critical information about the behavior of most malignancies at different stages of the disease. This study was undertaken to determine whether the degree of FDG uptake differs between the primary breast lesions with varying disease burden at diagnosis in proven cases of breast carcinoma.Materials and MethodsAmong 250 patients enrolled for this prospective study, 174 patients with newly diagnosed breast carcinoma at different disease stages who had undergone dual time point FDG-PET before any therapeutic or surgical interventions were considered for inclusion in this analysis. These patients prospectively underwent multimodality imaging techniques, such as magnetic resonance imaging (MRI), ultrasonography, digital mammography, computed tomography (CT), and dual time point FDG-PET, as a component of a National Institutes of Health-funded project for characterizing primary breast lesions and local–regional staging. The slice with maximum FDG uptake in the region of interest (ROI) was chosen for the first time point and the second time point images for quantitative measurement of the metabolic activity of the tracer (SUVmax1 and SUVmax2, respectively). Furthermore, the percent change in SUVmax (%ΔSUVmax) between SUVmax1 and SUVmax2 was calculated.ResultsThe patient population (n = 174) were divided into three groups for the purposes of this study. Sixty-four patients with primary and metastatic axillary lymphadenopathy (designated as group I) and 18 patients with both axillary and distant metastases (designated as group II) met the inclusion criteria for this analysis. The third group (group III) comprised of a population of 92 patients without any metastasis either at the lymph nodes or at distant sites. The mean SUVmax1, SUVmax2, and the %ΔSUVmax in the early and delayed FDG-PET in group I (n = 64) patients were as follows: primary lesion 4.8 ± 3.9, 5.3 ± 4.5, and 9.4 ± 12.8%, respectively, and axillary lesions 3 ± 2.6, 3 ± 2.7, and 1.1 ± 21.3%, respectively. Among the group II patients (n = 18), the mean values of the primary lesion with regard to the SUVmax1, SUVmax2, and the %ΔSUVmax were 7.7 ± 6.2, 8.9 ± 7.1, and 15.7 ± 10.8%, respectively. The corresponding figures for the axillary lesions were 3.5 ± 3.1, 3.7 ± 3.1, and 6.3 ± 20.9%, respectively, and those for the distant metastatic lesions were 3 ± 1.4, 3.1 ± 1.2, and 8.5 ± 21.2%, respectively. The mean SUVmax1, SUVmax2, and the %ΔSUVmax of the primary lesion of group III patients (n = 92) without any metastasis were 2.9 ± 2.7, 3.4 ± 2.4, and 4.5 ± 4.2%, respectively. Unifactorial ANOVA of the three parameters among the primary lesions of these three groups were statistically significant with regard to the mean SUVmax1 (p = 0.01) and SUVmax2 (p = 0.01). These values in the primary lesions were highest in group II (those with both axillary and distant metastases), followed by group I (those with only metastatic axillary adenopathy) and group III (patients without any metastasis), and could be related to the more aggressive tumor biology in group II.ConclusionThe findings provide evidence that among the lesions with varying disease burden at diagnosis, the FDG uptake is highest in cases with both axillary and distant metastasis, followed by those with axillary metastasis and then by those with no metastatic disease. These provide in vivo insight into tumor biology as FDG uptake is regarded as a surrogate marker of the same.

Reflux esophagitis secondary to chemotherapy detected by serial FDG-PET.

A 69-year-old man with colon carcinoma underwent serial fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET) scans for restaging and monitoring the treatment response. He was having symptoms of possible persistent reflux esophagitis following chemotherapy. Serial FDG-PET scans obtained during and after completion of chemotherapy revealed abnormal diffuse FDG uptake in the esophagus in all 3 PET studies. These findings of FDG-PET scans were suggestive of possible postchemotherapy reflux esophagitis.

The Effect of Age, Menopausal State, and Breast Density on 18F-FDG Uptake in Normal Glandular Breast Tissue

Theoretically, the degree of 18F-FDG uptake in the glandular tissues of the normal breast can affect the detection of breast cancer. The aim of this prospective study was to investigate relationships among age, menopausal state, and breast density and determine whether they affect 18F-FDG uptake in normal glandular breast tissue. Methods: Among 250 newly diagnosed breast cancer patients, 149 patients (mean age ± SD, 50.9 ± 9.70 y; range, 32–77 y) were analyzed because they had normal contralateral breasts confirmed by MRI, mammography, and 18F-FDG PET examinations. PET images were acquired 60 ± 2 min after the administration of 18F-FDG (5.2 MBq/kg of body weight). The maximum and average standardized uptake value (SUVmax and SUVavg, respectively) of 18F-FDG were calculated in the normal breast. Patients were divided into groups according to qualitative breast density and menopausal state. Descriptive statistics and 2-factorial analysis of covariance were used to assess the effects of qualitative breast density, menopausal state, and age on SUVmax and SUVavg. Pearson χ2 was used to test the relationship between menopausal state and qualitative breast density. Results: The average age of patients with nondense breasts was significantly higher than that of patients with dense breasts (P < 0.01). Also, breast density related to menopausal state (P < 0.05). Dense breasts had an average SUVmax of 1.243 and mean SUVavg of 0.694, whereas nondense breasts had a mean SUVmax of 0.997 and mean SUVavg of 0.592. Analysis of covariance indicated that density and the linear effect of age were significant with regard to both SUVmax and SUVavg. After removing the linear effect of age, menopausal state had no effect on SUVmax and SUVavg. Conclusion: 18F-FDG uptake significantly decreases as age increases and breast density decreases. Age and qualitative breast density are independent factors and significantly affect 18F-FDG uptake for both SUVmax and SUVavg. Menopausal state had no effect on SUVmax and SUVavg.

Evaluating the Role of Fluorodeoxyglucose PET Imaging in the Management of Patients with Sarcoidosis

Sarcoidosis as a distinct disease entity was introduced more than 100 years ago. Most patients are asymptomatic and are never diagnosed, but a segment of the affected population is detected by incidental findings. The signs and symptoms of the disease are nonspecific, and this poses a challenge for accurate diagnosis. Along with many clinical specialties that take part in managing these patients, imaging techniques are playing an increasingly important role in the diagnosis, determining the extent of the disease, monitoring the response to therapy, and detecting recurrence. This article briefly describes the role of the existing diagnostic imaging studies, including radiography, CT, MRI, and conventional nuclear medicine imaging studies, in this disease entity. The major emphasis is placed on PET, however, as a new and exciting modality for assessing inflammatory diseases. This review discusses the utility of 18F-fluorodeoxyglucose PET in assessing disease activity at various anatomic sites, including the lungs, heart, central nervous system, and other organs.