Onkolojide PET-BT ile multimodal görüntüleme

Pozitron-emisyon tomografi (PET) ile bilgisayarlı tomografinin (BT) birlikte kullanımı (PET-BT) PET'in klinik kullanımını önemli ölçüde artırmıştır. PET-BT, BT'nin yüksek çüzünürlüğünü PET'in yüksek duyarlığıyla birleştirmektedir. PET ve BT sonuçlarının tek incelemede ve aynı cihazla elde edilmesi nedeniyle her iki prosedürün en uygun birleşimi mümkündür. PET ve BT görüntülerinin klasik birleştirilmesine oranla, PET-BT ile PET'in doğruluğu yaklaşık %15 oranında artırılabilir. PET-BT'nin gücünden tam olarak yararlanmak sadece oral veya intravenöz kontrast ajanların kullanılmasıyla mümkündür. BT'nin X- ışını aynı zamanda atenüasyon düzeltmesi için kullanılır. Bu makalede ağırlıklı olarak akciğer kanseri, malign melanom, baş-boyun tümörleri, tiroid tümörleri ve kolorektal kanserler üzerinde durulmuş ve PET-BT'nin görsel gücü olgulara ait görüntüler aracılığıyla ortaya konmuştur.The combination of PET (positron emission tomography) with CT (computed tomography) has considerably enhanced the clinical application of PET. PET-CT combines the high resolution of CT with the high sensitivity of PET. As PET and CT results are obtained with one machine during one investigation, an optimal fusion of both procedures is possible. The accuracy of PET can be increased by about 15% by PET-CT, compared to conventional fusion of PET and CT images. The potential of PET-CT can only be fully used if contrast agents -either orally or intravenously- are applied. The Xrays of CT may also be used for attenuation correction. This article focuses mainly on PET-CT in lung cancer, malignant melanoma, head and neck tumors, thyroid tumors, and colorectal cancer, with illustrations of some cases documenting the potentials of PET-CT

Multidisciplinary Postoperative Validation of ¹⁸F-FDG PET/CT Scan in Nodal Staging of Resected Non-Small Cell Lung Cancer

Background: The aim of this study was to examine the validity of PET/CT scans in the preoperative identification of lymph node metastases (LNM) and compare them with postoperative outcomes. Methods: In this retrospective study, we included 87 patients with a solitary lung nodule or biopsy-proven non-small cell lung cancer treated in our institution from 2009 to 2015. Patients were divided into two groups and four subgroups, depending on pre- and postoperative findings. Results: According to our analysis, PET/CT scan has a sensitivity of 50%, a specificity of 88.89%, a positive predictive value of 63.16%, and a negative predictive value of 82.35%. Among the patients, 13.8% were downstaged in PET-CT, while 8% were upstaged. In 78.2% of cases, the PET/CT evaluation was consistent with the histology. Metastases without extracapsular invasion were seldom recognized on PET/CT. Conclusions: This analysis showed the significance of extracapsular tumor invasion, which causes an inflammatory reaction, on LNM, which is probably responsible for preoperative false-positive findings. In conclusion, PET/CT scans are very effective in identifying patients without tumors. Furthermore, it is highly probable that patients with negative findings are free of disease

Pain Outcomes in Patients with Metastatic Castration-Resistant Prostate Cancer Treated with 223Ra:PARABO, a Prospective, Noninterventional Study

Ra, a targeted a-therapy, is approved for the treatment of patients with metastatic castration-resistant prostate cancer (mCRPC) who have bone metastases. In the phase 3 ALSYMPCA study, Ra prolonged survival and improved quality of life versus placebo. Our real-world study, PARABO, investigated pain and bone pain-related quality of life in patients with mCRPC and symptomatic bone metastases receiving Ra in clinical practice. PARABO was a prospective, observational, noninterventional single-arm study conducted in nuclear medicine centers across Germany (NCT02398526). The primary endpoint was a clinically meaningful pain response (=2-point improvement from baseline for the worst-pain item score in the Brief Pain Inventory-Short Form). The analysis included 354 patients, who received a median of 6 Ra injections (range, 1-6). Sixty-seven percent (236/354) received 5-6 injections, and 33% (118/354) received 1-4 injections. Of 216 patients with a baseline worst-pain score of more than 1, 59% (128) had a clinically meaningful pain response during treatment. Corresponding rates were 67% (range, 98/146) with 5-6 Ra injections versus 43% (range, 30/70) with 1-4 injections, 60% (range, 60/100) in patients with no more than 20 lesions versus 59% (range, 65/111) in those with more than 20 lesions, and 65% (range, 69/106) in patients without prior or concomitant opioid use versus 54% (range, 59/110) in those with prior or concomitant opioid use. Mean subscale scores (pain severity and pain interference) on the Brief Pain Inventory-Short Form improved during treatment. Ra reduced pain in patients with mCRPC and symptomatic bone metastases, particularly in patients who received 5-6 injections. The extent of metastatic disease did not impact pain response

Sentinel node in breast cancer procedural guidelines

Procedure guidelines for scintigraphic detection of sentinel node in breast cancer are presented. The paper was written by several experts in this field on behalf of the European Association of Nuclear Medicine Oncology and Dosimetry committees and approved by the Executive Committee