OBJECTIVE: We investigated the prognostic value of intratumoral [18F]fluorodeoxyglucose (FDG) uptake heterogeneity (IFH) derived from positron emission tomography/computed tomography (PET/CT) in patients with cervical cancer. METHODS: Patients with uterine cervical cancer of the International Federation of Obstetrics and Gynecology (FIGO) stage IB to IIA were imaged with [18F]FDG PET/CT before radical surgery. PET/CT parameters such as maximum and average standardized uptake values (SUV(max) and SUV(avg)), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and IFH were assessed. Regression analyses were used to identify clinicopathological and imaging variables associated with progression-free survival (PFS). RESULTS: We retrospectively reviewed clinical data of 85 eligible patients. Median PFS was 32 months (range, 6 to 83 months), with recurrence observed in 14 patients (16.5%). IFH at an SUV of 2.0 was correlated with primary tumor size (p<0.001), SUV(tumor) (p<0.001), MTV(tumor) (p<0.001), TLG(tumor) (p<0.001), depth of cervical invasion (p<0.001), and negatively correlated with age (p=0.036). Tumor recurrence was significantly associated with TLG(tumor) (p<0.001), MTV(tumor) (p=0.001), SUV(LN) (p=0.004), IFH (p=0.005), SUV(tumor) (p=0.015), and FIGO stage (p=0.015). Multivariate analysis identified that IFH (p=0.028; hazard ratio, 756.997; 95% CI, 2.047 to 279,923.191) was the only independent risk factor for recurrence. The Kaplan-Meier survival graphs showed that PFS significantly differed in groups categorized based on IFH (p=0.013, log-rank test). CONCLUSION: Preoperative IFH was significantly associated with cervical cancer recurrence. [18F]FDG based heterogeneity may be a useful and potential predicator of patient recurrence before treatment.
Adult ; Aged ; Aged, 80 and over ; Carcinoma, Squamous Cell/metabolism/*radionuclide imaging/secondary ; Disease-Free Survival ; Female ; Fluorodeoxyglucose F18/*pharmacokinetics ; Glycolysis ; Humans ; Middle Aged ; Multimodal Imaging ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/metabolism/radionuclide imaging ; Neoplasm Staging ; *Positron-Emission Tomography ; Predictive Value of Tests ; Radiopharmaceuticals/*pharmacokinetics ; Retrospective Studies ; Tomography, X-Ray Computed ; Tumor Burden ; Uterine Cervical Neoplasms/metabolism/pathology/*radionuclide imaging

PURPOSE: Both 18F-fluorodeoxyglucose (18F-FDG) uptake and epidermal growth factor receptor (EGFR) status are prognostic variables of colorectal cancer (CRC). The aim of this study was to investigate a possible association between 18F-FDG uptake on preoperative positron emission tomography/computed tomography (PET/CT) and EGFR status in primary CRC. MATERIALS AND METHODS: Records of 132 patients (66 men and 66 women; mean age=67.1+/-11.1 years) who underwent 18F-FDG PET/CT for CRC staging and subsequent bowel resection were reviewed. In primary lesions, 18F-FDG uptake was semiquantitatively evaluated in terms of maximum standardized uptake value (SUVmax), and EGFR status was determined by immunohistochemistry. Associations of clinicopathological parameters and EGFR status were analyzed by Pearson's chi-square test, multiple logistic regression, and receiver operating characteristic curves. RESULTS: Eighty-six patients (65.2%) showed EGFR expression. SUVmax was significantly lower in EGFR-negative tumors than in EGFR-expressing tumors (10.0+/-4.2 vs. 12.1+/-2.1; p=0.012). It was the only significant parameter correlated with EGFR expression (odds ratio=2.457; relative risk=2.013; p=0.038). At the SUVmax threshold of 7.5, the sensitivity and specificity for predicting EGFR expression were 84.9% and 40.4%, respectively (area under the curve=0.624; p=0.019). CONCLUSION: Preoperative 18F-FDG uptake is slightly correlated with EGFR status in primary CRC. Preoperative SUVmax of 18F-FDG may have a limited role in predicting EGFR expression in such tumors because of its poor specificity.
Adult ; Aged ; Aged, 80 and over ; Colorectal Neoplasms/metabolism/pathology/*radiography/*radionuclide imaging ; Female ; Fluorodeoxyglucose F18/*pharmacokinetics ; Humans ; Immunohistochemistry ; Male ; Middle Aged ; Multimodal Imaging/*methods ; Neoplasm Staging ; Positron-Emission Tomography/*methods ; Predictive Value of Tests ; Prognosis ; ROC Curve ; Radiopharmaceuticals/*pharmacokinetics ; Receptor, Epidermal Growth Factor/*metabolism ; Sensitivity and Specificity

We report a case of a 74-year-old woman who was incidentally found to have a single thyroid nodule. Laboratory evaluation showed undetectable serum thyroid stimulating hormone and elevated free thyroxine levels. (99m)Tc thyroid scan showed a hyperfunctioning autonomous nodule in a right lobe of the thyroid. Thyroid ultrasonography showed a 2.2 cm sized nonhomogeneous spiculated nodule with microcalcification, and which was identical with the hyperfunctioning nodule confirmed in thyroid scan by (99m)Tc single photon emission computed tomography/computed tomography. Fine needle aspiration was done, and cytology reported as suspicious of malignancy. The patient underwent total thyroidectomy with central neck dissection, and pathology was consistent with papillary thyroid carcinoma. This case report demonstrates that diagnosis of a hyperfunctioning autonomous thyroid nodule does not preclude the possibility of thyroid cancer. Clinicians should consider further evaluation such as ultrasonography and fine needle aspiration in patients with hyperfunctioning autonomous nodules.
Aged ; Biopsy, Fine-Needle ; Diagnosis ; Female ; Humans ; Hyperthyroidism* ; Neck Dissection ; Pathology ; Radionuclide Imaging ; Thyroid Gland* ; Thyroid Neoplasms* ; Thyroid Nodule ; Thyroidectomy ; Thyrotropin ; Thyroxine ; Ultrasonography

No abstract available.
Bone Marrow/*pathology/radiography/radionuclide imaging ; Carcinoma, Adenoid Cystic/*diagnosis ; Eye Neoplasms/*diagnosis ; Female ; Humans ; Lacrimal Apparatus/*pathology/radiography/radionuclide imaging ; Lacrimal Apparatus Diseases/*diagnosis ; Maxilla ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local ; *Positron-Emission Tomography ; *Tomography, X-Ray Computed

BACKGROUND/AIMS: The aim of this study was to evaluate the influence of recent chemotherapy on the patterns of the maximum-standardized uptake value (M-SUV) and sensitivity of 18F-fluoro-deoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) in colorectal cancer. METHODS: We retrospectively analyzed the FDG-PET/CT of 509 patients who underwent surgery for colorectal cancer. Subgroup analysis was performed according to chemotherapy status; 401 patients were not treated with chemotherapy and 108 patients were treated with chemotherapy within 6 months prior to surgery. Pathologic analysis of the surgical specimen was used as the gold standard. RESULTS: The M-SUV was significantly lower in patients treated with chemotherapy than in those not treated with chemotherapy in pathologically confirmed same stages of disease. The difference in the sensitivity of the M-SUV according to chemotherapy status was greatest using a cutoff M-SUV value of 6.4 (p<0.001). The longest diameter of the primary tumor was the most important factor that correlated with M-SUV of the primary tumor irrespective of the chemotherapy effect (p<0.001). The M-SUV of the primary tumor was not an independent predictor of lymph node metastasis in colorectal cancer. CONCLUSIONS: The results indicate that the M-SUV of FDG-PET/CT should be interpreted in the context of concurrent chemotherapy.
Aged ; Antineoplastic Agents/*adverse effects ; Chemoradiotherapy, Adjuvant/adverse effects ; Chemotherapy, Adjuvant/adverse effects ; Colorectal Neoplasms/drug therapy/pathology/*radionuclide imaging ; Female ; Fluorodeoxyglucose F18/diagnostic use/*pharmacology ; Humans ; Male ; Neoplasm Invasiveness ; Neoplasm Metastasis ; Positron-Emission Tomography/methods ; Radiopharmaceuticals/diagnostic use/*pharmacology ; Retrospective Studies

BACKGROUND/AIMS: Accurate preoperative detection of regional lymph nodes and evaluation of tumor resectability is critical to determining the most adequate therapy for gastric cancer. The aim of this study is to identify a possible link between 18F-fluorodeoxyglucose (18F-FDG) uptake on PET scan combined with CT scan (PET/CT) and predictions of lymph node metastasis and non-curative surgery. METHODS: This study included 156 gastric cancer patients who underwent preoperative 18F-FDG PET/CT and surgery. In cases with perceptible FDG uptake in the primary tumor or lymph nodes, the maximum standardized uptake value (SUVmax) was calculated. RESULTS: In multivariate analysis, non-curative surgery (OR, 11.05; 95% CI, 1.10-111.08; p=0.041), tumor size (> or =3 cm) (OR, 7.39; 95% CI, 2.41-22.70; p<0.001), and lymph node metastasis (OR, 5.47; 95% CI, 2.05-14.64; p=0.001) were significant independent predictors for 18F-FDG uptake in the primary tumors. Tumor size (tumor size > or =3 cm) (OR, 3.15; 95% CI, 1.16-8.58; p=0.025) and lymph node metastasis (OR, 3.36; 95% CI, 1.23-9.14; p=0.018) showed significant association with 18F-FDG uptake in lymph node. When the SUVmax of the primary gastric tumor was greater than 3.75, the sensitivity and specificity of PET/CT with regard to the diagnosis of metastatic lymph node were 73.5% and 74.5%. When the SUVmax of the primary gastric tumor was greater than 4.35 and the FDG uptake of lymph nodes was positive, non-curative surgery was predicted with a sensitivity of 58.8% and specificity of 91.6%. CONCLUSIONS: A high FDG uptake of the gastric tumor was related to histologic positive lymph nodes and non-curative surgery.
Adult ; Aged ; Aged, 80 and over ; Area Under Curve ; Carcinoma/*diagnosis/pathology/surgery ; Female ; Fluorodeoxyglucose F18 ; Humans ; Lymph Nodes/surgery ; Lymphatic Metastasis/radionuclide imaging ; Male ; Middle Aged ; Neoplasm Staging ; Odds Ratio ; Peritoneal Neoplasms/diagnosis/secondary ; Positron-Emission Tomography ; ROC Curve ; Regression Analysis ; Stomach Neoplasms/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed

We report a rare case of distant subcutaneous parathyroid carcinoma recurrence. A 50-year-old woman was referred to our hospital because of sustained hypercalcemia despite surgical removal of a parathyroid carcinoma. A focal uptake in the upper mediastinal area was detected in a 99mTc-sestamibi scan, and 18F-fluorodeoxyglucose (FDG) positron-emission tomography (PET)/computed tomography (CT) imaging demonstrated a subcutaneous mass. She underwent tumor resection, and the pathological findings were consistent with a parathyroid carcinoma. The postoperative serum parathyroid hormone (PTH) level remained within normal limits. However, a new palpable solitary mass was identified in the upper portion of the left breast 1 year postoperatively. Both a 99mTc-sestamibi scan and 18F-FDG PET/CT imaging revealed an abnormal lesion in the upper breast, and subsequent pathology reports confirmed parathyroid carcinoma metastasis. Serum PTH and calcium levels fell within normal ranges after tumor resection. Two subcutaneous recurrent lesions appeared likely due to tumor seeding during the previous endoscopic operation at a local hospital.
Biological Markers/blood ; Breast Neoplasms/blood/radiography/*radionuclide imaging/*secondary/surgery ; Carcinoma/blood/radiography/*radionuclide imaging/*secondary/surgery ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Middle Aged ; Multimodal Imaging ; Parathyroid Hormone/blood ; Parathyroid Neoplasms/blood/*pathology/surgery ; *Positron-Emission Tomography ; Predictive Value of Tests ; Radiopharmaceuticals/*diagnostic use ; Technetium Tc 99m Sestamibi/*diagnostic use ; Time Factors ; *Tomography, X-Ray Computed ; Treatment Outcome

No abstract available.
Adosterol/diagnostic use ; Adrenal Cortex/radiography/*radionuclide imaging ; Adrenal Cortex Neoplasms/pathology/radiography/*radionuclide imaging/surgery ; Adrenalectomy/methods ; Adrenocortical Adenoma/pathology/radiography/*radionuclide imaging/surgery ; Aged ; Aldosterone/blood ; Blood Specimen Collection/methods ; Humans ; Hyperaldosteronism/radiography/*radionuclide imaging ; Male ; Radiopharmaceuticals/diagnostic use ; Tomography, X-Ray Computed

Basaloid squamous cell carcinoma is a rare and aggressive variant of squamous cell carcinoma, which mostly occurs in the upper aerodigestive tracts. Basaloid squamous cell carcinoma also typically arises in the anal canal, but is extremely rare in the lower gastrointestinal tract. A 70-year-old man presented with loose stool and intermittent hematochezia 2 months ago. Colonoscopy showed an ulceroinfiltrative mass on the rectosigmoid colon from 16 cm to 18 cm above the anal verge. Conventional colonoscope could not pass through the lesion but it was possible with pediatric colonoscope. Abdominal CT scan showed 1.6 cm sized wall thickening with circumferential luminal narrowing in the rectosigmoid colon and multiple ill-defined low density masses in both lobes of the liver. Therefore, colon cancer with liver metastasis was suspected. However, basaloid cells were noted on histologic examination, and they were weakly positive for synaptophysin on immunohistochemical study. After palliative lower anterior resection, histologic examination of the resected specimen revealed basaloid differentiation with keratin pearls, and tumor cells were positively stained with high molecular weighted cytokeratin (34BE12) and CK 5/6. Thus, the patient was finally diagnosed with basaloid squamous cell carcinoma of rectosigmoid colon with distant metastases.
Aged ; Carcinoma, Squamous Cell/*diagnosis/pathology/surgery ; Colonoscopy ; Colorectal Neoplasms/*diagnosis/pathology/surgery ; Humans ; Immunohistochemistry ; Keratins/metabolism ; Liver Neoplasms/radiography/secondary ; Lung Neoplasms/radionuclide imaging/secondary ; Male ; Positron-Emission Tomography ; Synaptophysin/metabolism ; Tomography, X-Ray Computed

No abstract available.
Bone Marrow Cells/pathology ; Bone and Bones/radionuclide imaging ; Female ; Humans ; Lung Neoplasms/diagnosis/radiography ; Middle Aged ; Multimodal Imaging ; Multiple Myeloma/*diagnosis/pathology/radiography ; Tomography, X-Ray Computed