The 18F 2-fluoro-2-deoxyglucose (FDG) PET/CT scan is an imaging modality used in the management of patients with various types of malignancies. 18F-FDG PET/CT has demonstrated significant efficacy in the staging and detection of metastatic disease in malignancies of the gastrointestinal tract. The assessment of the metabolic response to chemotherapy and improvements of overall survivals in malignancies of esophagus and stomach has been demonstrated in several studies. This review focuses on the role of 18F-FDG PET/CT scan in staging, metastasis, predict of recurrence and assessment of metabolic response in malignancies of the upper gastrointestinal tract.
Esophageal Neoplasms/pathology/*radionuclide imaging ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Lymphatic Metastasis ; Neoplasm Metastasis ; Neoplasm Staging ; Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Recurrence ; Stomach Neoplasms/pathology/*radionuclide imaging

The objective of this study was to evaluate the feasibility of sentinel lymph node biopsy by using a radiotracer lymphatic mapping technique in patients with squamous cell carcinoma of the oral cavity, and the diagnostic value of this technique. We studied twenty patients with previously untreated squamous cell carcinomas of the oral cavity and N0 necks. After the peritumoral injection of 99mTc filtered tin colloid preop-eratively, lymphoscintigraphy and intraoperative mapping using a gamma detector were performed to localize sentinel nodes. An open biopsy of the sentinel node was followed by complete neck dissection. We identified the sentinel nodes in 19 of 20 patients (95.0%) by lymphoscintigraphy and in all (100%) by intraoperative gamma detector. In all cases, the status of the sentinel node accurately predicted the pathologic status of the neck with the false negative rate being 0%. The negative predictive value for the absence of cervical metastases was 100%. In conclusion, our radio-localization technique of sentinel nodes using 99mTc filtered tin colloid in N0 squamous cell carcinomas of the oral cavity is technically feasible and appears to accurately predict the presence of the occult metastatic disease.
Tin Compounds/*diagnostic use ; Technetium Compounds/*diagnostic use ; *Sentinel Lymph Node Biopsy ; Radiopharmaceuticals/*diagnostic use ; Mouth Neoplasms/*pathology/*radionuclide imaging ; Middle Aged ; Male ; Lymphatic Metastasis ; Lymph Nodes/*radionuclide imaging ; Humans ; Female ; Carcinoma, Squamous Cell/*pathology/*radionuclide imaging ; Aged ; Adult

OBJECTIVETo test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer.

METHODSThe subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of [(T-B)/(NT-B)] was calculated as radioactivity of mass to that of opposite corresponding tissue, and [(T-B)/(NT-B)] > or = 1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects.

RESULTSUsing Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92.9% and 90.6% respectively, the positive predictive value 89.7%, the negative predictive value 93.5%, and the accuracy 91.7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88.6% and 85% respectively.

CONCLUSIONSIt is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer.

Adolescent ; Adult ; Aged ; Axilla ; Breast ; diagnostic imaging ; Breast Neoplasms ; diagnostic imaging ; pathology ; Female ; Humans ; Lymphatic Metastasis ; Middle Aged ; Radionuclide Imaging ; Technetium Tc 99m Sestamibi

OBJECTIVETo assess the value of (18)F-FDG dual head coincidence imaging in the prediction of the efficacy of radioiodine therapy in patients with cervical lymph node (LN) metastasis of papillary thyroid carcinoma (PTC).

METHODSThirty-six patients undergoing thyroidectomy and radioiodine ablation of the residual normal thyroid tissue received (18)F-FDG dual head coincidence imaging and then therapeutic (131)I-whole body imaging ((131)I-WBI) in the same week. According to those imaging results, the patients were divided into group I with positive results of both imaging examinations and group II with positive results by (131)I-WBI but negative results by(18)F-FDG dual head coincidence imaging. All the patients were followed up for 6 months.

RESULTSIn group I (14 patients), a total of 49 lesions were diagnosed as cervical LN metastases, and the total sensitivity differed significantly between (18)F-FDG dual head coincidence imaging and (131)I- WBI (67.3% vs 89.8%, P=0.027). In both groups, the total sensitivity of (18)F-FDG dual head coincidence imaging and (131)I-WBI showed a significant difference (26.0% vs 94.5%, P<0.001). The target and non-target ratio (T/NT) was identified as one of the factors affecting the radioiodine efficacy (P<0.001). In group II (22 patients), 76 lesions were diagnosed as cervical LN metastases. The effective rates of groups I and II were 35.7% and 81.8%, respectively, showing a significant difference between them (P=0.011).

CONCLUSION(131)I-WBI is more sensitive than (18)F-FDG dual head coincidence imaging in detecting cervical LN metastasis in patients with PTC. Patients with cervical LN metastases who have positive results in both (131)I-WBI and (18)F-FDG dual head coincidence imaging tend to have a poorer response to the therapy than the patients with negative results in (18)F-FDG dual head coincidence imaging. The T/NT of the cervical LN metastases in (18)F-FDG dual head coincidence imaging is associated with the efficacy of radioiodine therapy.

Carcinoma ; diagnostic imaging ; pathology ; radiotherapy ; Carcinoma, Papillary ; Female ; Fluorodeoxyglucose F18 ; Humans ; Iodine Radioisotopes ; therapeutic use ; Lymphatic Metastasis ; diagnostic imaging ; Male ; Neck ; diagnostic imaging ; pathology ; Radionuclide Imaging ; Thyroid Neoplasms ; diagnostic imaging ; pathology ; radiotherapy ; Treatment Outcome ; Whole Body Imaging

To reduce extensive radical procedures and decrease morbidity in gynecologic malignancies, much effort is being focused on implementing less aggressive interventions. Two different approaches such as lymphatic mapping and lymphoscintigraphy are currently used to identify sentinel lymph nodes. In vulvar and cervical carcinomas, metastatic spread of disease commonly follows stepwise progressive drainage. Thus, sentinel lymph node identification may significantly reduce the number of patients undergoing unnecessary, extensive lymphadenectomy in the absence of metastatic disease. The addition of novel techniques, such as histopathologic ultrastaging, step sectioning, and immunohistochemistry staining, will help increase the accuracy and rate of detection of the disease. Any definitive statements can be made to the validity of sentinel lymphadenectomy until we got data with long-term follow-up.
Endometrial Neoplasms ; pathology ; Female ; Genital Neoplasms, Female ; pathology ; surgery ; Humans ; Lymph Node Excision ; methods ; Lymph Nodes ; diagnostic imaging ; pathology ; Lymphatic Metastasis ; Radionuclide Imaging ; Sentinel Lymph Node Biopsy ; Uterine Cervical Neoplasms ; pathology ; Vaginal Neoplasms ; pathology ; Vulvar Neoplasms ; pathology

OBJECTIVE: To evaluate the prognostic value of volume-based metabolic parameters measured with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) in patients with clinically node-negative (cN0) oral tongue squamous cell carcinoma (OTSCC) as compared with other prognostic factors. MATERIALS AND METHODS: In this study, we included a total of 57 patients who had been diagnosed with cN0 tongue cancer by radiologic, 18F-FDG PET/CT, and physical examinations. The maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) for primary tumors were measured with 18F-FDG PET. The prognostic significances of these parameters and other clinical variables were assessed by Cox proportional hazards regression analysis. RESULTS: In the univariate analysis, pathological node (pN) stage, American Joint Committee on Cancer (AJCC) stage, SUVmax, SUVavg, MTV, and TLG were significant predictors for survival. On a multivariate analysis, pN stage (hazard ratio = 10.555, p = 0.049), AJCC stage (hazard ratio = 13.220, p = 0.045), and MTV (hazard ratio = 2.698, p = 0.033) were significant prognostic factors in cN0 OTSCC patients. The patients with MTV > or = 7.78 cm3 showed a worse prognosis than those with MTV < 7.78 cm3 (p = 0.037). CONCLUSION: The MTV of primary tumor as a volumetric parameter of 18F-FDG PET, in addition to pN stage and AJCC stage, is an independent prognostic factor for survival in cN0 OTSCC.
Adult ; Aged ; Carcinoma, Squamous Cell/diagnosis/mortality/pathology/*radionuclide imaging ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Lymphatic Metastasis ; Magnetic Resonance Imaging ; Male ; Middle Aged ; *Positron-Emission Tomography and Computed Tomography ; Prognosis ; Radiopharmaceuticals/*diagnostic use ; Survival Rate ; Tomography, X-Ray Computed ; Tongue Neoplasms/diagnosis/mortality/pathology/*radionuclide imaging ; Young Adult

BACKGROUND/AIMS: The usefulness of 18F-fluoro-2-deoxyglucose (FDG)-PET in detecting primary cancer, lymph node metastasis, and distant metastasis were studied in the gastric cancer patients. METHODS: The subjects were 392 gastric cancer patients who received FDG-PET and an abdominal CT test prior to surgery. The results of FDG-PET and CT were compared with the surgical and pathologic results. RESULTS: The primary site detection rate of FDG-PET was 74.4%, 50.3% in early gastric cancer and 92.0% in advanced gastric cancer. Detection rate was higher when tumors were larger than 3.5 cm, had deeper depth of invasion, and at a later stage (p<0.05, respectively). In multivariate analysis, tumor size, spread of tumor cells beyond the muscle layer (> or =T2), and lymph node metastasis were statistically significant factors in primary site detection rate. The sensitivity, specificity, and positive predictive value of FDG-PET to lymph node metastasis were 59.6%, 88.8%, and 81.1% respectively, sensitivity being lower compared to CT while specificity and positive predictive value were higher. Sensitivity, specificity, and positive predictive value to distant metastasis were, respectively, 66.7%, 99.2%, and 88.0%, similar to CT. In 21 of the 392 patients (5.4%), synchronous double primary cancers were detected. CONCLUSIONS: In gastric cancer, usefullness of FDG-PET is limited to the advanced stage. Diagnostic value of this test was not superior to CT. However, FDG-PET may be useful in detecting synchronous double primary cancers.
Aged ; Female ; Fluorodeoxyglucose F18/chemistry/*diagnostic use ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Positron-Emission Tomography ; Predictive Value of Tests ; ROC Curve ; Radiopharmaceuticals/chemistry/*diagnostic use ; Retrospective Studies ; Stomach Neoplasms/*diagnosis/radionuclide imaging ; Tomography, X-Ray Computed

PURPOSE: In this study we evaluated the significance of false positive screening bone scintigraphy (BS) in primary invasive breast cancer patients. Lymphatic vessel invasion (LVI), estrogen receptor (ER), progesterone receptor (PR), nuclear grade, histology grade, epidermal growth factor receptor (EGFR) and C-erb-B2 values were examined in terms of their abilities to predict the accuracy of abnormal BS. We also examined the incidence of bone metastasis in primary invasive breast cancer patients according to the 1988 and 2003 AJCC classifications. METHODS: A retrospective review was performed on 2,044 primary invasive breast cancer patients that had received BS screening, and who were treated by mastectomy or breast conserving surgery at the Seoul National University Hospital between Jan 1995 and Jul 2003. Abnormal screening BS results were divided into "less suspicious" and "highly suspicious" groups. Patient's stages according to the 1988 AJCC classification were reclassified according to the 2003 AJCC classification. Bone metastasis was confirmed by further radiological examination or follow-up BS. All statistical analyses were two-tailed. RESULTS: The incidences of bone metastasis and an abnormal screening BS result were 1.7% (35/2,044) and 13.8% (283/2,044), respectively. The false positive rate of screening BS was 87.6% (248/283). LVI was the only significant predictive factor of bone metastasis in 283 of the abnormal BS patients (p <.001). c-erb-B2 showed no significance to predict bone metastasis in the "less suspicious" group, but was Bone is the most common site of distant metastasis in invasive breast cancer at the time of primary diagnosis. The vertebrae are the most common sites of bone metastasis and the ribs, skull, sternum and proximal long bones are also frequently involved. Bone metastases affect 8% of patients marginally significant in the "highly suspicious" group (p = .046). ER, PR, nuclear grade, histology grade, and EGFR showed no significance in terms of predicting the accuracy of an abnormal BS result. The incidences of bone metastasis were 0.6, 1.3 and 7.6% in stages I, II and III, respectively, according to the 1988 AJCC classification, while these incidences were 0.6, 0.7 and 5.8% according to the 2003 AJCC classification. CONCLUSION: The use of screening bone scintigraphy as a routine screening test is hard to justify due to its high false positive rate. LVI may be a useful factor in that it predicts the accuracy of an abnormal BS result. The incidences of bone metastasis in stages II and III were lower for the 2003 AJCC staging system.
Breast Neoplasms* ; Breast* ; Classification ; Diagnosis ; Estrogens ; Follow-Up Studies ; Humans ; Incidence ; Lymphatic Vessels ; Mass Screening* ; Mastectomy ; Mastectomy, Segmental ; Neoplasm Metastasis* ; Radionuclide Imaging* ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Retrospective Studies ; Ribs ; Seoul ; Skull ; Spine ; Sternum

OBJECTIVE: We aimed to compare the prognoses of patients with pathologically true negative (P-TN) N2 and PET/CT false negative (FN) results in stage T1 non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Our institutional review board approved this retrospective study with a waiver of informed consent. The study included 184 patients (124 men and 60 women; mean age, 59 years) with stage T1 NSCLC who underwent an integrated PET/CT and surgery. After estimating the efficacy of PET/CT for detecting N2 disease, we determined and compared disease-free survival (DFS) rates in three groups (P-TN [n = 161], PET/CT FN [n = 12], and PET/CT true positive [TP, n = 11]) using the Kaplan-Meier analysis and log-rank test. RESULTS: Pathologic N2 disease was observed in 23 (12%) patients. PET/CT had an N2 disease detection sensitivity of 48% (11 of 23 patients), a specificity of 95% (153 of 161), and an accuracy of 89% (164 of 184). The 3-year DFS rate in the PET/CT FN group (31%, 95% confidence interval [CI]; 13.6-48.0%) was similar to that of the TP group (16%, 95% CI; 1.7-29.5%) (p = 0.649), but both groups had significantly shorter DFS rates than the P-TN group (77%, 95% CI; 72.0-81.2%) (p < 0.001). CONCLUSION: The PET/CT shows a high specificity, but low sensitivity for detecting N2 disease in stage T1 NSCLC. Patients with PET/CT FN N2 disease have survival rates similar to PET/CT TP N2 disease patients, which are both substantially shorter than the survival rate of P-TN patients.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Non-Small-Cell Lung/mortality/*radiography/*radionuclide imaging ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Humans ; Lung Neoplasms/mortality/*radiography/*radionuclide imaging ; Lymphatic Metastasis ; Male ; Mediastinum ; Middle Aged ; *Positron-Emission Tomography ; Prognosis ; Radiopharmaceuticals/diagnostic use ; Sensitivity and Specificity ; Survival Rate ; *Tomography, X-Ray Computed

Colloidal particle size is an important characteristic that allows mapping sentinel nodes in lymphoscintigraphy. This investigation aimed to introduce different ways of making a 99mTc-tin colloid with a size of tens of nanometers. All agents, tin fluoride, sodium fluoride, poloxamer-188, and polyvinylpyrrolidone (PVP), were mixed and labeled with 99mTc. Either phosphate or sodium bicarbonate buffers were used to adjust the pH levels. When the buffers were added, the size of the colloids increased. However, as the PVP continued to increase, the size of the colloids was controlled to within tens of nanometers. In all samples, phosphate buffer added PVP (30 mg) stabilized tin colloid (99mTc-PPTC-30) and sodium bicarbonate solution added PVP (50 mg) stabilized tin colloid (99mTc-BPTC-50) were chosen for in vitro and in vivo studies. 99mTc-BPTC-50 (<20 nm) was primarily located in bone marrow and was then secreted through the kidneys, and 99mTc-PPTC-30 (>100 nm) mainly accumulated in the liver. When a rabbit was given a toe injection, the node uptake of 99mTc-PPTC-30 decreased over time, while 99mTc-BPTC-50 increased. Therefore, 99mTc-BPTC-50 could be a good candidate radiopharmaceutical for sentinel node detection. The significance of this study is that nano-sized tin colloid can be made very easily and quickly by PVP.
Animals ; Buffers ; Cell Line, Tumor ; Humans ; Lymph Nodes/*radionuclide imaging ; Lymphatic Metastasis ; Metal Nanoparticles/chemistry/ultrastructure ; Mice ; Neoplasms, Experimental/*radionuclide imaging ; Particle Size ; Povidone/*chemistry ; Rabbits ; Radiopharmaceuticals/*chemical synthesis ; Reproducibility of Results ; Sensitivity and Specificity ; Technetium Compounds/*chemistry ; Tin/*chemistry ; Tin Compounds/*chemistry