Jean-Louis Alberini

18F-Fluorodeoxyglucose Positron Emission Tomography for the Diagnosis of Adrenocortical Tumors: A Prospective Study in 77 Operated Patients

CONTEXT Most adrenal incidentalomas are nonfunctioning adrenocortical adenomas (ACAs). Adrenocortical carcinomas (ACCs) are rare but should be recognized at an early stage. OBJECTIVE The objective of the study was to evaluate the usefulness of (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) to predict malignancy in patients without a previous history of cancer. DESIGN This was a prospective, multicenter study from 2001 to 2006. SETTING The study was conducted at a network of seven university hospitals in Paris. PATIENTS Seventy-seven patients were included. All underwent surgery because of hypersecretory and/or growing benign lesions (n = 18), obvious ACCs (n = 21), or radiologically indeterminate lesions (n = 38). MAIN OUTCOME MEASURE The degree of (18)F-FDG PET uptake [maximum standardized uptake value (maxSUV)] was related to the pathological findings serving as a reference, and its diagnostic value was compared with that of computerized tomography (CT) scan. RESULTS Pathology eventually diagnosed 43 ACAs, 22 ACCs, and 12 nonadrenocortical lesions. Using a cutoff value above 1.45 for adrenal to liver maxSUV ratio, the sensitivity and specificity to distinguish ACAs from ACCs were, respectively, 1.00 (95% confidence interval 0.85-1.00) and 0.88 (95% confidence interval 0.75-0.96). Among the 38 indeterminate lesions at CT scan, we could analyze a subgroup of 16 adrenocortical tumors with high unenhanced density (>10 HU) and an inappropriate washout: (18)F-FDG PET correctly predicted the benignity in 13 of 15 ACAs. CONCLUSIONS In a multidisciplinary team approach, (18)F-FDG PET helps to manage suspicious CT scan lesions. An adrenal to liver maxSUV ratio less than 1.45 is highly predictive of a benign lesion.

High and typical 18F-FDG bowel uptake in patients treated with metformin

PurposeThis prospective and bi-centric study was conducted in order to determine the impact of antidiabetic treatments (AD) on 18F-FDG bowel uptake in type 2 diabetic patients.MethodsFifty-five patients with previously diagnosed and treated type 2 diabetes mellitus (group 1) were divided in two subgroups: AD treatment including metformin (n=32; group 1a) and AD treatment excluding metformin (n=23; group 1b). The 95 patients without diabetes mellitus made up controls (group 2). 18F-FDG uptake in small intestine and colon was visually graded and semi-quantitatively measured using the maximum standardized uptake value.Results18F-FDG bowel uptake was significantly increased in AD patients (group 1) as compared to controls (group 2) (p<0.001). Bowel uptake was significantly higher in AD patients including metformin (group 1a) as compared to AD patients excluding metformin (group 1b) (p<0.01), whose bowel uptake was not significantly different from controls (group 2). A metformin treatment was predictive of an increased bowel uptake in the small intestine (odds ratio OR=16.9, p<0.0001) and in the colon (OR=95.3, p<0.0001), independently of the other factors considered in the multivariate analysis. Bowel uptake pattern in the patients treated with metformin was typically intense, diffuse and continuous along the bowel, strongly predominant in the colon, in both the digestive wall and lumen.ConclusionThis study emphasizes that metformin significantly increases 18F-FDG uptake in colon and, to a lesser extent, in small intestine. It raises the question of stopping metformin treatment before an 18F-FDG PET/CT scan is performed for intra-abdominal neoplasic lesion assessment.

18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) imaging in the staging and prognosis of inflammatory breast cancer

To prospectively assess fluorodeoxyglucose positron emission tomography/computed tomography (FDG‐PET/CT) staging and prognosis value in patients with suspected inflammatory breast cancer (IBC).

Breast cancer recurrence diagnosis suspected on tumor marker rising: value of whole-body 18FDG-PET/CT imaging and impact on patient management.

Breast cancer recurrence is often suspected on tumor marker rising in asymptomatic patients. The value of fluorine‐18 fluorodeoxyglucose (18FDG)–positron emission tomography/computed tomography (PET/CT) imaging to detect recurrence and its subsequent impact on patient management were retrospectively assessed.

miRNA expression profiling of inflammatory breast cancer identifies a 5‐miRNA signature predictive of breast tumor aggressiveness

IBC (inflammatory breast cancer) is a rare but very aggressive form of breast cancer with a particular phenotype. The molecular mechanisms responsible for IBC remain largely unknown. In particular, genetic and epigenetic alterations specific to IBC remain to be identified. MicroRNAs, a class of small noncoding RNAs able to regulate gene expression, are deregulated in breast cancer and may therefore serve as tools for diagnosis and prediction. This study was designed to determine miRNA expression profiling (microRNAome) in IBC. Quantitative RT‐PCR was used to determine expression levels of 804 miRNAs in a screening series of 12 IBC compared to 31 non‐stage‐matched non‐IBC and 8 normal breast samples. The differentially expressed miRNAs were then validated in a series of 65 IBC and 95 non‐IBC. From a set of 18 miRNAs of interest selected from the screening series, 13 were differentially expressed with statistical significance in the validation series of IBC compared to non‐IBC. Among these, a 5‐miRNA signature comprising miR‐421, miR‐486, miR‐503, miR‐720 and miR‐1303 was shown to be predictive for IBC phenotype with an overall accuracy of 89%. Moreover, multivariate analysis showed that this signature was an independent predictor of poor Metastasis‐Free Survival in non‐IBC patients.

Diagnosis and localization of renal cyst infection by 18F-fluorodeoxyglucose PET/CT in polycystic kidney disease

Renal cyst infection in polycystic kidney disease is a serious complication. Early diagnosis and localization of infected cyst are crucial and usually require conventional imaging modalities, including ultrasound and computed tomography (CT). However, their contribution is limited because of nonspecific results. We report on a patient with suspected renal cyst infection for which 18F-fluorodeoxyglucose positron emission tomography (FDG-PET)/CT scan allowed the exact localization of the infected cyst and guided a drainage procedure. FDG-PET/CT imaging could be a valuable tool for early identification of infected renal cyst infection, and may contribute to better patient management.

Use of single MRI and 18F-FDG PET-CT scans in both diagnosis and radiotherapy treatment planning in patients with head and neck cancer: Advantage on target volume and critical organ delineation

The use of a single MRI and 18F‐fluoro deoxyglucose positron emission tomography‐CT (18F‐FDG PET‐CT) was evaluated, both in diagnostic procedure and radiotherapy planning, in patients with head and neck cancer.

Typical and atypical bronchopulmonary carcinoid tumors on FDG PET/CT imaging.

The authors report 2 cases of bronchial carcinoid tumor (BCT). One had a typical and the other had an atypical histologic pattern. BCTs represent 1 to 2% of all lung cancers and are usually located in the hilar or perihilar areas. They can be associated with infectious processes. Typical carcinoids are considered as having low-grade malignancy although atypical carcinoids are of intermediate grade. The authors showed that even a typical carcinoid can show intense F-18 FDG uptake. The number of reports of BCT in PET imaging using FDG in BCT is very limited, but several cases of FDG-negative BCT have been described.

Single photon emission tomography/computed tomography (SPET/CT) and positron emission tomography/computed tomography (PET/CT) to image cancer

Hybrid systems associating the sharpness of anatomic images coming from computed tomography (CT) and radionuclide functional imaging (SPET or PET) are opening a new era in oncology. This multimodal imaging method is now routinely used for the diagnosis, extent, follow up, treatment response and detection of occult disease in different types of malignancies with a significant impact on the treatment strategy leading for a change for more than 68% of all investigated patients. J. Surg. Oncol. 2011;103:602–606.

SPECT–CT Fusion Imaging Radionuclide Lymphoscintigraphy: Potential for Limb Lymphedema Assessment and Sentinel Node Detection In Breast Cancer

Radionuclide lymphoscintigraphy (RNL) has progressively superseded lymphangiography and may be considered as the most advanced method for the assessment of the limb lymphatic system (1, 2).As a safe, noninvasive, and physiological method, RNL is commonly used in lymphology for the evaluation of limb lymphedemas and in oncology for the detection of the sentinel node (SN) (3, 4).However, conventional planar imaging sometimes failed to preoperatively identify the exact localization of the detected lymph nodes (5). Since 2000 (6), hybrid cameras combining a dual head gamma camera with a low-dose radiograph tube mounted on the same gantry were developed, and image fusion has been successfully introduced in clinical practice.We report our experience of this new imaging method in lymphology and oncology, particularly for the SN detection in patients with breast cancer.