Bridging the imaging gap: PSMA PET/CT has a high impact on treatment planning in prostate cancer patients with biochemical recurrence - a narrative review of literature.

Gallium-68 and Fluor-18 labeled prostate specific membrane antigen (PSMA) molecules have created new opportunities for the unmet diagnostic needs in prostate cancer. The purpose of this study is to give an overview of the studies that have examined the role of PSMA PET scan in treatment planning in prostate cancer patients with biochemical recurrence. Medline, Embase, Web of Science, Google Scholar, and Cochrane Central were searched for relevant articles. After excluding the articles that did not fulfill the required criteria, 12 publications that reported the impact of PSMA-PET on the treatment plan in prostate cancer patients with biochemical recurrence (BCR) were included in the review. All the studies in our review emphasized the impact of PSMA PET images on therapy management in prostate cancer patients with biochemical recurrence. Overall, the impact of PSMA PET/CT on therapy management varied between 30-76% among the 1,346 patients included in the review. Upstaging was reported in 32% to 67% of the patients. Patients with low PSA values (< 0.5 ng/ml) also demonstrated positive lesions, which could not have been detected by means of conventional imaging techniques. Important modifications to the original treatment plan included avoidance of systemic therapy (17-40%) and PET-directed local therapy (in up to 60% of the patients). PSMA imaging demonstrated a high clinical impact in patients with BCR with modifications to the original treatment plan among half of the patients. Detecting recurrence in BCR can prevent unnecessary toxicity and lead to individualized therapy

Is FDG -PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT

Is FDG -PET-CT A Valuable Tool in Prediction of Persistent Disease in Head and Neck Cancer

Objectives: To evaluate accuracy of FDG-PET CT in prediction of persistent disease in head and neck cancer cases and to determine prognostic value of metabolic tumor response. Materials and Methods: Between 2009 and 2011, 46 patients with squamous cell carcinoma of head and neck receiving PET-CT were treated with definitive radiotherapy, with or without chemotherapy. There were 29 nasopharyngeal, 11 hypopharyngeal, 3 oropharyngeal and 3 laryngeal cancer patients, with a median age of 50.5 years (range 16-84), 32 males and 14 females. All patients were evaluated with PET-CT median 3-5 months (2.4-9.4) after completion of radiotherapy. Results: After a median 20 months of follow up, complete metabolic response was observed in 63% of patients. Suspicious residual uptake was present in 10.9% and residual metabolic uptake in 26.0% of patients. The overall sensitivity, specificity, positive predictive value and negative predictive value of FDG-PET-CT for detection of residual disease was 91% and 81%, 64% and 96% respectively. Two year LRC was 95% in complete responders while it was 34% in non-complete responders. Conclusions: FDG PET CT is a valuable tool for assessment of treatment response, especially in patients at high risk of local recurrence, and also as an indicator of prognosis. Definitely more precise criteria are required for assessment of response, there being no clear cut uptake value indicating residual disease. Futhermore, repair processes of normal tissue may consume glucose which appear as increased uptake in control FDG PET CT

Use of 18F-FDG PET CT for Evaluation of Rarely Seen Adenocarcinoma of Cervix Uteri Before and After Therapy

Adenocarcinoma is the second most frequent (%15-20) cervical carcinoma, following squamous cell carcinoma (%80) (Fujiwara et al. in Curr Oncol Rep 16:416, 2014 Dec). Other rare type of cancers can occur in cervix, such as adenosquamous, small cell, lymphomas and sarcomas. Here, we present the 44-year-old woman diagnosed with usual type of cervix adenocarcinoma with low FDG uptake, staged and followed up with 18F-FDG PET CT

Correlation of F-18-fluorodeoxyglucose uptake with histopathological prognostic factors in breast carcinoma

ObjectiveThis study investigated the prognostic value of [F-18]-fluorodeoxyglucose (F-18-FDG) uptake in breast carcinomas by comparing F-18-FDG PET/computed tomography (CT) images with histopathological and immunohistochemical prognostic factors.MethodsThis study included 136 women and four men with positive biopsy breast carcinomas who underwent F-18-FDG PET/CT imaging for initial staging. Maximum standardized uptake values (SUVmax) and tumour-to-background SUVmax ratios were calculated and compared with histopathological and immunohistochemical tumour characteristics, patient properties and axillary lymph node involvement. Calculations of SUVmax for men were performed separately.ResultsFor the tumours in women, the mean SUVmax was 10.066.91 and the median SUVmax was 9.05 (0.7-35.0). Primary tumour F-18-FDG uptake and tumour-to-background SUVmax ratios were correlated with tumour size (P<0.001), histological type (P<0.001), histological grade (P=0.004), pleomorphism (P=0.010), mitosis count (P<0.001), lymphatic invasion (P=0.009), necrosis (P=0.005), oestrogen negativity (P=0.004), high Ki-67 level (P<0.001), axillary lymph node involvement (P<0.001) and triple negativity (P=0.002). High Ki-67 level (odds ratio=16; 95% confidence interval=1.6-160; P=0.016) and tumour size (odds ratio=4; 95% confidence interval=1.5-11; P=0.007) were determining factors for high F-18-FDG uptake values. Other clinicopathological and immunohistopathological parameters including progesterone receptor (P=0.211), CerbB2 overexpression (P=0.170), perineural invasion (P=0.053), intratumoural calcification (P=0.438), desmoplasia (P=0.112), tubular formation (P=0.768) and age (P=0.675) were not significantly correlated with F-18-FDG uptake. No significant relationship was observed between the tumour/contralateral breast SUVmax ratio and mitotic count, oestrogen receptor status or triple negativity.Conclusion(18)F-FDG uptake may serve as a prognostic indicator for biological behaviour in breast tumours. (C) 2013 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins