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ABSTRACT: Aim: To perform a meta-analysis of published data on the prevalence and risk of malignancy of focal thyroid incidental uptake (FTIs) detected by Fluorine-18-Fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) or PET/CT. Methods: A comprehensive literature search of studies published up to and including December 2012 was performed. Pooled prevalence and malignancy risk of FTIs were calculated, including a sub-analysis for the geographic areas of origin of the studies. Results: 34 studies including 215 057 patients were selected. Pooled prevalence of FTIs was 1.92% (95% confidence interval [95%CI]: 1.87-1.99%). Overall, 1522 FTIs underwent histopathology evaluation. Pooled risk of malignancy was 36.2% (95%CI: 33.8-38.6%), without significant differences among various geographic areas. Conclusions: FTIs are observed in about 2% of 18F-FDG-PET or PET/CT scans and carry a significant risk of malignancy. Therefore, further investigation is warranted whenever FTIs are detected by 18F-FDG-PET or PET/CT.
Nuklearmedizin 06/2013; 52(4). · 1.28 Impact Factor
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ABSTRACT: We describe a rare case of primary pulmonary epithelioid angiosarcoma detected by F-FDG PET/CT. A 54-year-old female patient with history of non-Hodgkin lymphoma underwent F-FDG PET/CT for follow-up. PET/CT detected an area of increased F-FDG uptake corresponding to a 4-cm mass located in the inferior lobe of the left lung. Based on this PET/CT finding, the patient underwent left inferior pulmonary lobectomy. Histology demonstrated the presence of a pulmonary epithelioid angiosarcoma. Other sites of disease were excluded. In our case, F-FDG PET/CT has been useful in detecting and staging this rare primary pulmonary tumor.
Clinical nuclear medicine 05/2013; · 3.92 Impact Factor
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ABSTRACT: PURPOSE: The present study was undertaken to evaluate the ablation rate after administration of 1.1 or 3.7 GBq of iodine-131 (I) to patients with low-risk differentiated thyroid carcinoma (DTC) primarily treated by lobectomy. PATIENTS AND METHODS: Enrolled were 136 consecutive patients affected by histologically proven low-risk DTC previously treated by lobectomy. Patients were randomized to receive a single dose of 1.1 or 3.7 GBq of I in an equivalence trial. Successful thyroid ablation was defined as a negative diagnostic whole-body scan and stimulated thyroglobulin levels lower than 2 ng/ml in the absence of thyroglobulin antibodies. RESULTS: The patient demographic and clinical data were well balanced at baseline. The ablation rate was significantly (P<0.01) higher in patients treated with 3.7 GBq (75%) than in those treated with 1.1 GBq (54%) of radioiodine. No relevant side effects occurred in either group. CONCLUSION: Radioiodine lobe ablation with a single administration of 3.7 GBq is a simple and safe mode of treatment, achieving an ablation rate higher than that of 1.1 GBq. This procedure may be offered as an alternative to completion thyroidectomy in highly selected DTC patients who had experienced complications during initial surgery or for whom completion thyroidectomy is contraindicated.
Nuclear Medicine Communications 05/2013; · 1.40 Impact Factor
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European Journal of Nuclear Medicine 05/2013; · 4.53 Impact Factor
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Pancreas 05/2013; 42(4):726-728. · 2.39 Impact Factor
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ABSTRACT: A 33-year old man underwent an F-FDG PET/CT searching for the cause of a fever of unknown origin. F-FDG PET/CT incidentally detected a focal area of markedly increased radiopharmaceutical uptake corresponding to a 2.5-cm nodule in the right adrenal gland. Laboratory data ruled out the presence of a functioning adrenal lesion. All these findings were suggestive of adrenal malignancy. After right adrenalectomy, histology showed a benign solitary fibrous tumor of the adrenal gland. This case highlights that benign solitary fibrous tumor should be considered as possible false-positive F-FDG PET/CT finding for malignancy in evaluating adrenal incidentalomas.
Clinical nuclear medicine 05/2013; · 3.92 Impact Factor
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ABSTRACT: OBJECTIVES: We reviewed the available literature on the accuracy of sentinel node (SN) mapping in the inguinal lymph node staging of vulvar squamous cell carcinoma (SCC). METHODS: Medline and SCOPUS were searched by using "sentinel AND vulv*" as key words. Studies evaluating the accuracy of SN mapping in the inguinal lymph node staging of vulvar SCC were included if enough data could be extracted for calculation of detection rate and/or sensitivity. Only studies validated by inguinal lymph node dissection were included for sensitivity meta-analysis. RESULTS: Forty-nine studies were included in the systematic review. Pooled patient and groin basis SN detection rates were 94.4% [92.4-95.9] and 84.6% [80.5-88], respectively. Pooled patient and groin basis sensitivity were 92%[90-95] and 92%[89-94], respectively (or 8%[5-10] and 8%[6-11] false negative rates). Pooled negative predictive values were 97%[96-98] and 98%[97-99] for patient and groin basis analyses respectively. SN detection rate and sensitivity were related to mapping method (blue dye, radiotracer, or both) and location of the tumor (midline vs. lateral tumors). Patients with palpable inguinal nodes had lower detection rate and sensitivity. CONCLUSION: SN mapping is an accurate method for inguinal node staging in vulvar SCC. Combining radiotracer and blue dye methods and excluding patients with palpable inguinal nodes results in the highest detection rate and sensitivity. For midline tumors possible false negative results of SN mapping should be taken into account.
Gynecologic Oncology 04/2013; · 3.89 Impact Factor
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ABSTRACT: We describe a pulmonary metastasis of a cystosarcoma phyllodes of the breast (CPB) detected by F-FDG PET/CT. A 65-year-old female patient previously operated on for a cystosarcoma phyllodes of the left breast underwent F-FDG PET/CT for restaging. F-FDG PET/CT showed an area of increased F-FDG uptake corresponding to a 2-cm right pulmonary nodule. Histology suggested the presence of a pulmonary metastasis of CPB.
Clinical nuclear medicine 04/2013; · 3.92 Impact Factor
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The Journal of clinical endocrinology and metabolism 04/2013; · 6.50 Impact Factor
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ABSTRACT: We report a case of thyroid incidentaloma detected by F-choline PET/CT. A 66-year-old male patient with a history of prostate cancer underwent a F-choline PET/CT for restaging. PET/CT revealed a focal area of increased F-choline uptake corresponding to a hypodense nodule in the right lobe of the thyroid. Based on PET/CT findings, the patient underwent a ultrasonography guided fine-needle aspiration biopsy which demonstrated the presence of a benign thyroid nodule.
Clinical nuclear medicine 04/2013; · 3.92 Impact Factor
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ABSTRACT: Several studies have investigated the diagnostic performance of (99m)Tc-MIBI scan in the evaluation of thyroid nodules suspicious for malignancy with conflicting results. The aim of our study is to meta-analyze published data on this topic. A comprehensive literature search of studies published through December 2012 regarding the diagnostic performance of (99m)Tc-MIBI scan in the evaluation of thyroid nodules suspicious for malignancy was carried out. Pooled sensitivity and specificity of (99m)Tc-MIBI scan on a per lesion-based analysis and the area under the ROC curve were calculated. Pathological reports of thyroid nodules were considered as reference standard. Twenty-one studies were included in the meta-analysis. Pooled sensitivity and specificity of (99m)Tc-MIBI scan in detecting malignant thyroid nodules were 85.1 % [95 % confidence interval (95 % CI): 81.1-88.5 %] and 45.7 % (95 % CI: 42.7-48.7 %), respectively, on a per lesion-based analysis, irrespective of eventual results of previous technetium pertechnetate ((99m)TcO4) or iodine-123 ((123)I) scan. The area under the ROC curve was 0.78. A sub-analysis restricted to data on hypofunctioning nodules on (99m)TcO4 or (123)I scans was performed: pooled sensitivity and specificity of (99m)Tc-MIBI scan in these nodules were 82.1 % (95 % CI: 77.2-86.3 %) and 62.8 % (95 % CI: 58.9-66.7 %), respectively, on a per lesion-based analysis. The area under the ROC curve was 0.81. (99m)Tc-MIBI scan is a sensitive diagnostic tool in predicting the malignancy of thyroid nodules. Therefore, this imaging method could be helpful in patients with thyroid nodules in which malignancy is suspected on the basis of conventional diagnostic techniques. Higher specificity can be reached when hypofunctioning thyroid nodules are considered.
Endocrine 03/2013; · 1.42 Impact Factor
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ABSTRACT: We report an unusual case of malignant pseudothyroiditis (MPT) occurred in a 35-year-old female patient presenting with symptoms and signs of thyroiditis. Fine-needle aspiration biopsy of the thyroid demonstrated the presence of a MPT induced by a metastatic extrathyroidal carcinoma. F-FDG-PET/CT showed increased radiopharmaceutical uptake in the thyroid, in multiple cervical and mediastinal lymph nodes, and in a right pulmonary nodule. Histological examination demonstrated the presence of a metastatic non-small cell lung cancer (NSCLC). In this unusual case of MPT F-FDG-PET/CT has been useful in staging the disease and in detecting the primary tumor site.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: We report a case of a 75-year-old male patient treated with radiotherapy in 1999 for prostate cancer. Due to a rise in prostate-specific antigen, he underwent C-choline PET/CT. The study was negative for secondary lesions but revealed an incidental pathologic focal brain uptake. A subsequent magnetic resonance examination confirmed the presence of a brain lesion typical for meningioma.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: A 40-year-old female patient with suspected multifocal extra-adrenal paraganglioma, on the basis of biochemical, genetic, and conventional imaging data, underwent F-FDG, F-DOPA and Ga DOTANOC PET/CT. FDOPA- and FDG-PET/CT detected a multifocal mediastinal and cervical paraganglioma. Ga-DOTANOC PET/CT detected 2 additional lesions compared to the other PET/CT methods. In our case, somatostatin receptor PET/CT with Ga-DOTANOC correctly assessed the extent of the disease in a patient with multifocal paraganglioma.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: We report a rare case of ectopic adrenocorticotropic hormone (ACTH) syndrome caused by a metastatic neuroendocrine tumor (NET) of the pancreas detected by PET/CT using different tracers. A 43-year-old female patient with Cushing syndrome (CS) by suspected ectopic ACTH secretion underwent a Ga-DOTANOC and a F-FDG PET/CT. Both these functional imaging techniques revealed increased tracer uptake in a pancreatic mass and multiple liver metastases. Histology showed the presence of a mildly differentiated pancreatic NET. Ga-DOTANOC PET/CT may be a useful functional imaging method, complementary to F-FDG PET/CT, in detecting ACTH-secreting pancreatic NETs.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: A 63-year-old woman underwent F-FDG PET/CT searching for the cause of a fever of unknown origin. F-FDG PET/CT incidentally detected a focal area of markedly increased radiopharmaceutical uptake in the right adrenal gland; this finding was suspicious for an adrenal malignancy or a functioning adenoma. Nevertheless, histology and laboratory data demonstrated the presence of a nonfunctioning adenoma. This case highlights that nonfunctioning adrenal adenomas should be considered as possible false-positive F-FDG PET/CT findings for malignancy in the evaluation of adrenal incidentalomas, even when marked F-FDG uptake is revealed.
Clinical nuclear medicine 03/2013; · 3.92 Impact Factor
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ABSTRACT: PURPOSE: To assess the relationship between serum thyroglobulin (Tg) levels, Tg doubling time (Tg-DT) and the diagnostic performance of 18F-FDG PET/CT in detecting recurrences of 131I-negative differentiated thyroid carcinoma (DTC). METHODS: Included in the present study were 102 patients with DTC. All patients were treated by thyroid ablation (e.g. thyroidectomy and 131I), and underwent 18F-FDG PET/CT due to detectable Tg levels and negative conventional imaging. Consecutive serum Tg measurements performed before the 18F-FDG PET/CT examination were used for Tg-DT calculation. The 18F-FDG PET/CT results were assessed as true or false after histological and/or clinical follow-up. RESULTS: Serum Tg levels were higher in patients with a positive 18F-FDG PET/CT scan (median 6.7 ng/mL, range 0.7-73.6 ng/mL) than in patients with a negative scan (median 1.8 ng/mL, range 0.5-4.9 ng/mL; P < 0.001). In 43 (88 %) of 49 patients with a true-positive 18F-FDG PET/CT scan, the Tg levels were >5.5 ng/mL, and in 31 (74 %) of 42 patients with a true-negative 18F-FDG PET/CT scan, the Tg levels were ≤5.5 ng/mL. A Tg-DT of <1 year was found in 46 of 49 patients (94 %) with a true-positive 18F-FDG PET/CT scan, and 40 of 42 patients (95 %) with a true-negative scan had a stable or increased Tg-DT. Moreover, combining Tg levels and Tg-DT as selection criteria correctly distinguished between patients with a positive and a negative scan (P<0.0001). CONCLUSION: The accuracy of 18F-FDG PET/CT significantly improves when the serum Tg level is above 5.5 ng/mL during levothyroxine treatment or when the Tg-DT is less than 1 year, independent of the absolute value.
European Journal of Nuclear Medicine 03/2013; · 4.53 Impact Factor
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ABSTRACT: We report the case of a pulmonary neuroendocrine tumor (NET) incidentally detected by F choline PET/CT performed during restaging in a 68-year-old patient affected by prostate cancer. To clarify the nature of the pulmonary lesion, the patient underwent a CT-guided biopsy which revealed the presence of a pulmonary NET. A subsequent Ga-DOTANOC PET/CT demonstrated the somatostatin receptor expression in the pulmonary lesion. The patient underwent a right lung lobectomy; at pathology, a well-differentiated NET was confirmed. Our case highlights that pulmonary NETs should be considered in the differential diagnosis of pulmonary lesions showing uptake of radiolabeled choline.
Clinical nuclear medicine 02/2013; · 3.92 Impact Factor
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The Journal of clinical endocrinology and metabolism 02/2013; · 6.50 Impact Factor
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Clinical and experimental rheumatology 02/2013; · 2.15 Impact Factor
