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ABSTRACT: The 5-year survival for patients with resected stage II (N1) non-small cell lung cancer ranges from 40% to 55%. No data exist addressing the benefit of neoadjuvant therapy for patients with stage II disease. This is largely in part due to the lack of a reliable, minimally invasive method to assess hilar nodes. This study is aimed at determining the ability of fusion positron emission/computed tomography (PET/CT) to identify hilar metastases in patients with resected non-small cell lung cancer.
A retrospective review of surgically resected patients with fusion PET/CT within 30 days of resection was performed. The sensitivity, specificity, positive predictive value, and negative predictive value for PET/CT in detecting hilar nodal metastases was calculated for a range of maximum standardized uptake values (SUVmax). Hilar nodes from patients with falsely positive PET/CT scans were analyzed for the presence of histoplasmosis. Additionally, the impact of hilar node size greater than 1 centimeter on the calculated values was assessed.
There were 119 patients evaluated. The number of lymph nodes resected ranged from 1 to 12 (X=2.98). There was decreased sensitivity and increased specificity with higher SUVmax cutoff values. At the standard SUVmax value of 2.5, the sensitivity and specificity were only 48.5% and 80.2%. The addition of size of hilar node by CT led to a modest improvement in sensitivity at all SUVmax cutoff values.
Fusion PET/CT lacks sensitivity and specificity in identifying hilar nodal metastasis in patients with resected non-small cell lung cancer. Further prospective studies assessing the utility of PET/CT versus alternative sampling techniques are warranted.
The Annals of thoracic surgery 03/2012; 93(5):1621-4. · 3.74 Impact Factor
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Journal of Cardiovascular Magnetic Resonance 02/2012; 14 Suppl 1:P1. · 3.72 Impact Factor
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Peng Zou,
Stephen Povoski, Nathan Hall,
Michelle Carlton,
George Hinkle,
Ronald Xu,
Cathy Mojzisik,
Morgan Johnson,
Michael Knopp,
Edward Martin,
Duxin Sun
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ABSTRACT: Abstract
Background
<sup>18</sup>F-fluorodeoxyglucose positron emission tomography (<sup>18</sup>F-FDG-PET) is widely used in diagnostic cancer imaging. However, the use of <sup>18</sup>F-FDG in PET-based imaging is limited by its specificity and sensitivity. In contrast, anti-TAG (tumor associated glycoprotein)-72 monoclonal antibodies are highly specific for binding to a variety of adenocarcinomas, including colorectal cancer. The aim of this preliminary study was to evaluate a complimentary determining region (CDR)-grafted humanized C<sub>H</sub>2-domain-deleted anti-TAG-72 monoclonal antibody (HuCC49deltaC<sub>H</sub>2), radiolabeled with iodine-124 (<sup>124</sup>I), as an antigen-directed and cancer-specific targeting agent for PET-based imaging.
Methods
HuCC49deltaC<sub>H</sub>2 was radiolabeled with <sup>124</sup>I. Subcutaneous tumor implants of LS174T colon adenocarcinoma cells, which express TAG-72 antigen, were grown on athymic Nu/Nu nude mice as the xenograft model. Intravascular (i.v.) and intraperitoneal (i.p.) administration of <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2 was then evaluated in this xenograft mouse model at various time points from approximately 1 hour to 24 hours after injection using microPET imaging. This was compared to i.v. injection of <sup>18</sup>F-FDG in the same xenograft mouse model using microPET imaging at 50 minutes after injection.
Results
At approximately 1 hour after i.v. injection, <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2 was distributed within the systemic circulation, while at approximately 1 hour after i.p. injection, <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2 was distributed within the peritoneal cavity. At time points from 18 hours to 24 hours after i.v. and i.p. injection, <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2 demonstrated a significantly increased level of specific localization to LS174T tumor implants (p = 0.001) when compared to the 1 hour images. In contrast, approximately 50 minutes after i.v. injection, <sup>18</sup>F-FDG failed to demonstrate any increased level of specific localization to a LS174T tumor implant, but showed the propensity toward more nonspecific uptake within the heart, Harderian glands of the bony orbits of the eyes, brown fat of the posterior neck, kidneys, and bladder.
Conclusions
On microPET imaging, <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2 demonstrates an increased level of specific localization to tumor implants of LS174T colon adenocarcinoma cells in the xenograft mouse model on delayed imaging, while <sup>18</sup>F-FDG failed to demonstrate this. The antigen-directed and cancer-specific <sup>124</sup>I-radiolabled anti-TAG-72 monoclonal antibody conjugate, <sup>124</sup>I-HuCC49deltaC<sub>H</sub>2, holds future potential for use in human clinical trials for preoperative, intraoperative, and postoperative PET-based imaging strategies, including fused-modality PET-based imaging platforms.
World Journal of Surgical Oncology. 01/2010;
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ABSTRACT: The concept of radioguided surgery, which was first developed some 60 years ago, involves the use of a radiation detection probe system for the intraoperative detection of radionuclides. The use of gamma detection probe technology in radioguided surgery has tremendously expanded and has evolved into what is now considered an established discipline within the practice of surgery, revolutionizing the surgical management of many malignancies, including breast cancer, melanoma, and colorectal cancer, as well as the surgical management of parathyroid disease. The impact of radioguided surgery on the surgical management of cancer patients includes providing vital and real-time information to the surgeon regarding the location and extent of disease, as well as regarding the assessment of surgical resection margins. Additionally, it has allowed the surgeon to minimize the surgical invasiveness of many diagnostic and therapeutic procedures, while still maintaining maximum benefit to the cancer patient. In the current review, we have attempted to comprehensively evaluate the history, technical aspects, and clinical applications of radioguided surgery using gamma detection probe technology.
World Journal of Surgical Oncology 02/2009; 7:11. · 1.12 Impact Factor
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The Laryngoscope 11/2008; 118(12):2190-4. · 1.75 Impact Factor
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ABSTRACT: The purpose of the current study was to comprehensively evaluate occupational radiation exposure to all intraoperative and perioperative personnel involved in radioguided surgical procedures utilizing (18)F-fluorodeoxyglucose ((18)F-FDG).
Radiation exposure to surgeon, anesthetist, scrub technologist, circulating nurse, preoperative nurse, and postoperative nurse, using aluminum oxide dosimeters read by optically stimulated luminescence technology, was evaluated during ten actual radioguided surgical procedures involving administration of (18)F-FDG.
Mean patient dosage of (18)F-FDG was 699 +/- 181 MBq (range 451-984). Mean time from (18)F-FDG injection to initial exposure of personnel to the patient was shortest for the preoperative nurse (75 +/- 63 min, range 0-182) followed by the circulating nurse, anesthetist, scrub technologist, surgeon, and postoperative nurse. Mean total time of exposure of the personnel to the patient was longest for the anesthetist (250 +/- 128 min, range 69-492) followed by the circulating nurse, scrub technologist, surgeon, postoperative nurse, and preoperative nurse. Largest deep dose equivalent per case was received by the surgeon (164 +/- 135 microSv, range 10-580) followed by the anesthetist, scrub technologist, postoperative nurse, circulating nurse, and preoperative nurse. Largest deep dose equivalent per hour of exposure was received by the preoperative nurse (83 +/- 134 microSv/h, range 0-400) followed by the surgeon, anesthetist, postoperative nurse, scrub technologist, and circulating nurse.
On a per case basis, occupational radiation exposure to intraoperative and perioperative personnel involved in (18)F-FDG radioguided surgical procedures is relatively small. Development of guidelines for monitoring occupational radiation exposure in (18)F-FDG cases will provide reassurance and afford a safe work environment for such personnel.
European Journal of Nuclear Medicine 08/2008; 35(11):2026-34. · 4.53 Impact Factor
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ABSTRACT: Abstract
Background
The use of diagnostic <sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography/computed tomography (PET/CT) imaging for the staging, restaging, and treatment monitoring of melanoma patients has become a well-recognized standard of care. It plays a key role in detecting sites of occult disease and is widely utilized in the medical and surgical planning of such patients. In the current report, we describe an innovative multimodality approach of perioperative <sup>18</sup>F-FDG PET/CT imaging, intraoperative <sup>18</sup>F-FDG handheld gamma probe detection, and intraoperative ultrasound for tumor localization and verification of resection of all sites of hypermetabolic tumor foci in a case of occult recurrent metastatic melanoma.
Case presentation
This report discusses a case of occult recurrent metastatic melanoma, isolated to three separate sites within the subcutaneous tissues of the left thigh region, which was not clinically apparent but was found on diagnostic restaging whole body <sup>18</sup>F-FDG PET/CT scan utilizing an intravenous injection of 14.8 mCi <sup>18</sup>F-FDG. Then, on the day of surgery, the patient received an intravenous injection of 12.8 mCi <sup>18</sup>F-FDG. A multimodality approach of intraoperative handheld gamma probe detection, intraoperative ultrasound tumor localization, specimen PET/CT imaging, and postoperative PET/CT imaging was utilized for accomplishing and verifying the excision of all three sites of occult recurrent metastatic melanoma within the left thigh region.
Conclusion
This innovative multimodality approach of perioperative <sup>18</sup>F-FDG PET/CT imaging, intraoperative <sup>18</sup>F-FDG handheld gamma probe detection, and intraoperative ultrasound is promising combined technology for aiding in tumor localization and verification of excision and may ultimately impact positively upon long-term outcome of selected patients.
World Journal of Surgical Oncology. 01/2008;
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ABSTRACT: Abstract
Background
<sup>18</sup>F-fluorodeoxyglucose (<sup>18</sup>F-FDG) positron emission tomography/computed tomography (PET/CT) has become an established method for detecting hypermetabolic sites of known and occult disease and is widely used in oncology surgical planning. Intraoperatively, it is often difficult to localize tumors and verify complete resection of tumors that have been previously detected on diagnostic PET/CT at the time of the original evaluation of the cancer patient. Therefore, we propose an innovative approach for intraoperative tumor localization and verification of complete tumor resection utilizing <sup>18</sup>F-FDG for perioperative PET/CT imaging and intraoperative gamma probe detection.
Methods
Two breast cancer patients were evaluated. <sup>18</sup>F-FDG was administered and PET/CT was acquired immediately prior to surgery. Intraoperatively, tumors were localized and resected with the assistance of a handheld gamma probe. Resected tumors were scanned with specimen PET/CT prior to pathologic processing. Shortly after the surgical procedure, patients were re-imaged with PET/CT utilizing the same preoperatively administered <sup>18</sup>F-FDG dose.
Results
One patient had primary carcinoma of breast and a metastatic axillary lymph node. The second patient had a solitary metastatic liver lesion. In both cases, preoperative PET/CT verified these findings and demonstrated no additional suspicious hypermetabolic lesions. Furthermore, intraoperative gamma probe detection, specimen PET/CT, and postoperative PET/CT verified complete resection of the hypermetabolic lesions.
Conclusion
Immediate preoperative and postoperative PET/CT imaging, utilizing the same <sup>18</sup>F-FDG injection dose, is feasible and image quality is acceptable. Such perioperative PET/CT imaging, along with intraoperative gamma probe detection and specimen PET/CT, can be used to verify complete tumor resection. This innovative approach demonstrates promise for assisting the oncologic surgeon in localizing and verifying resection of <sup>18</sup>F-FDG positive tumors and may ultimately positively impact upon long-term patient outcomes.
World Journal of Surgical Oncology. 01/2007;
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ABSTRACT: Abstract
Background
Although frequently used for tumor surveillance, the sensitivity of carcinoembryonic antigen (CEA) to detect recurrent colorectal cancer (CRC) is not optimal. Fluorine 18-fluoro-2-deoxy-glucose-positron emission tomography (<sup>18</sup>F FDG-PET) scans promise to improve recurrent CRC detection. We aimed to review PET scans of patients with clinically and/or radiologically suspicious tumor recurrence but normal CEA.
Methods
A retrospective review of an electronic database of 308 patients with CRC who had PET scans was performed. Only PET studies of patients with normal CEAs and suspected tumor recurrence who had pathological verification were selected for further analysis. Thirty-nine patients met the inclusion criteria.
Results
PET was positive in 26 patients (67%) and normal in 13 (33%). Histopathologic evidence of tumor recurrence was seen in 27 of the 39 patients (69%). When correlated with histopathology, PET was true positive in 22 patients, false positive in 4, true negative in 8 and false negative in 5. Overall, the accuracy of PET was 76.9%, negative predictive value (NPV) was 61.5%, and positive predictive value (PPV) was 84.6%. PPV value of PET for liver metastases was 88.8% compared to 73.3% for local recurrence. In two patients with confirmed recurrence, CEA became positive 2 months after PET scan indicating earlier detection of disease with PET. The false positive PET findings were mainly in the bowel and were secondary to acute/chronic inflammation and granulation tissue. In 3 patients with false negative PET, histopathology was consistent with mucinous adenocarcinoma.
Conclusion
PET yields high PPV for recurrent CRC, particularly for liver metastases, in spite of normal CEA levels and should be considered early in the evaluation of patients with suspected tumor recurrence.
World Journal of Surgical Oncology. 01/2007;
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ABSTRACT: (18)FDG is used widely to enhance PET and PET-CT images. However, this radiotracer tends to be taken up by brown fat, which can lead to false-positive diagnoses. Purpose To determine which patients, areas of the body and circumstances are more likely to be associated with false-positive diagnoses due to (18)FDG uptake in brown fat.
A review of the literature was conducted on factors that contribute to false-positive diagnoses caused by (18)FDG uptake in brown fat.
Brown fat commonly is found in women and children and can be located in the supraclavicular, mediastinal, paravertebral and perirenal areas of the body. Research has shown that these areas can be sources of a false-positive diagnosis because of (18)FDG uptake. Studies also have indicated that cold climate affects the uptake of (18)FDG, contributing to false-positive results on PET-CT examinations.
This literature review should stimulate continued research into and awareness of the potential for false-positive PET findings in women and children during the winter months and in cold climates. This information is especially applicable to young female patients undergoing PET or PET-CT.
Radiologic technology 78(5):361-6.
