Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0007097 (carcinoma)
 152,788 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Inflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer. It can be diagnosed based on a clinical or pathologic basis. We evaluated the usefulness of (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scans for diagnosing and staging IBC. We retrospectively reviewed the medical records of seven consecutive patients with IBC who underwent FDG-PET scanning for the initial staging. Four patients had follow-up PET scans after chemotherapy. All seven patients presented with diffuse breast enlargement, redness, and peau d'orange for 1 to 5 months' duration. In addition, four patients had a palpable breast mass, and three had axillary lymph node enlargement. Mammography showed diffuse, increased parenchymal density and skin thickening in 85% and parenchymal distortion in 43%. There was no evidence of distant metastasis on computed tomography of the chest or abdomen. Pathologic examination of breast biopsy specimens showed infiltrating ductal carcinoma in six patients, and one had lobular carcinoma. All patients had prechemotherapy whole-body PET scans that showed diffuse FDG uptake in the breast with superimposed intense foci in the primary tumor. Furthermore, there was skin enhancement in 100%, axillary lymph node in 85%, and skeletal metastases in 14% of the patients, confirmed by bone scintigraphy. Postchemotherapy FDG-PET scans performed in four patients showed response in the primary tumor, axillary lymph nodes, and skeletal metastases. The FDG-PET scan is thus useful for displaying the pattern of FDG breast uptake that reflects the extent of the pathologic involvement in IBC (i.e., diffuse breast involvement and dermal lymphatic spread). It can also detect the presence of lymph node and skeletal metastases, demarcating the extent of the disease locally as well as distally.
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PMID:18-Fluorodeoxyglucose-positron emission tomography in inflammatory breast cancer. 1291 70

The therapeutic approach to recurrent well-differentiated thyroid cancer is based on the detection of active disease. While a measured increase of thyroglobulin level in an ablated patient is highly suggestive of recurrence, localization of the tumour is necessary for adequate treatment planning. A whole body scan with 131I yields false negative results in the presence of non-iodophyllic foci of disease. Hypermetabolic foci of differentiated thyroid carcinoma can be detected by gamma PET with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG). This study retrospectively evaluated the therapeutic impact of the 18F-FDG scan in patients with suspected recurrent thyroid carcinoma in whom the iodine scan was negative. Twenty patients (five male, 15 female) aged 19-77 years, were suspected of having recurrent thyroid carcinoma due to elevated thyroglobulin levels and/or palpable neck findings. All whole body iodine scans obtained with diagnostic doses (74-148 MBq (2-4 mCi) of 131I), were reported normal, i.e., no iodophyllic foci were detected. Whole body gamma positron emission tomography (PET) imaging was performed in fasting patients following i.v. administration of 370 MBq (10 mCi) 18F-FDG, with a strict 1 h immobilization post-injection. Gamma PET results were validated either by anatomical imaging, repeat iodine scanning after administration of a therapeutic dose (at least 3,700 MBq (100 mCi) of 131I) or surgery. The impact of the FDG scan on patient management was evaluated by the referring physicians. Positive gamma PET results confirmed the presence of active disease in 14/15 patients. One false positive finding (fibrosis) and one false negative (carcinoid) were reported. Localization of hypermetabolic foci supported treatment decisions in 10 patients, and significantly altered therapeutic management in six others. Treatment was withheld in four patients with negative findings. The clinical impact of the scan in this patient group is similar to that reported in the literature and justifies its future implementation.
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PMID:The clinical impact of 18F-FDG gamma PET in patients with recurrent well differentiated thyroid carcinoma. 1296 May 94

Use of F-18 fluorodeoxyglucose positron emission tomography (F-18 FDG PET) in patients with known thyroid cancer is well documented, but the role of this imaging modality in the initial workup of a thyroid nodule has not been defined. The incidental finding of a hypermetabolic focus in the thyroid on F-18 FDG PET in patients with a variety of primary malignancies is reported. Based on the authors' literature search, this is the first documented case of a thyroid cancer resulting from papillary carcinoma detected in a patient with a history of non-Hodgkin lymphoma.
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PMID:Fortuitous detection of papillary carcinoma of the thyroid with F-18 FDG positron emission tomography in a patient with non-Hodgkin lymphoma. 1297 10

We performed fluorine-18 fluorodeoxyglucose-positron emission tomography (FDG-PET) in 23 women with carcinoma of the uterine cervix to determine sites of metastatic disease. PET results were compared with those of computed tomography (CT) or lymphangiography. Increased FDG uptake was seen in the primary tumor in 10 of 11 patients with newly diagnosed disease. Additional sites of FDG uptake were identified in pelvic lymph nodes in 8, in extrapelvic lymph nodes in 5, and at distant metastatic sites in 3. In 12 patients with suspected recurrent disease, FDG uptake was present in 11; the presence of tumor was confirmed by CT in 10 and by biopsy in 9. For both patient groups, FDG-PET demonstrated more sites of tumor metastasis than did conventional imaging studies. Our results suggest that FDG-PET is a sensitive method for detecting regional and distant metastasis in patients with cervical carcinoma and has the potential to replace conventional imaging studies and allow more rational treatment planning.
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PMID:FDG-PET Evaluation of Carcinoma of the Cervix. 1451 47

OBJECTIVE AND METHODS: This study was undertaken to find the role of fluorine-18-fluorodeoxyglucose (F18-FDG) in the diagnostic work-up of febrile Acquired Immune Deficiency Syndrome (AIDS) patients. Forty-seven (42 male and 5 female; mean age = 40.3 years) febrile patients with AIDS underwent imaging with F18-FDG by Dual Head Coincidence Imaging (DHCI). Findings were correlated with other imaging modalities.RESULTS: Our data show good sensitivity for scanning with F18-FDG by DHCI in determining the extent of Castleman's disease, lymphoma, Kaposi's sarcoma (KS), adenocarcinoma, and germ cell carcinoma. Various opportunistic infections also manifest with increased F18-FDG uptake.CONCLUSION: Total-body imaging can be done with F18-FDG with better resolution and a shorter procedure time compared to imaging with Gallium-67 (Ga-67). Furthermore, F18-FDG is more sensitive than Ga-67 for evaluating extent of involvement in various pathologies affecting AIDS patients. The new technology of DHCI is a good alternative for hospitals with no dedicated positron emission tomography (PET) scanner.
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PMID:Role of Fluorine-18-Fluorodeoxyglucose in the Work-up of Febrile AIDS Patients. Experience with Dual Head Coincidence Imaging. 1451 12

Dual time-point imaging has been proposed as a means of improving the accuracy of 2-[18F]fluoro-2-deoxy-D-glucose positron emission tomography (18F-FDG PET) for the diagnosis of malignant pulmonary nodules. The purpose of this study was to evaluate a dual time-point protocol that has a narrow time window between its initial and its delayed imaging sessions. All patients examined during a 16-month time period, either for the diagnosis of a radiographically indeterminate thoracic lesion or for the staging of non-small-cell carcinoma, were included in the study provided that they completed the dual-point protocol and had either biopsy evidence of malignancy, biopsy evidence of a benign condition involving the thoracic lesion of concern, or clinical and radiographic follow-up consistent with the absence of malignancy. The entire study population was further divided into a central subpopulation, whose index lesions were adjacent to or within the hilum or mediastinum, and a peripheral subpopulation, whose index lesions were non-central. The maximum standardized uptake value (SUV) was measured for each lesion, and various body surface areas (BSAs) and glucose corrections on the SUV were compared using discriminant analysis. BSA corrected SUVs for the initial (iSUV) and the delayed (dSUV) imaging sessions, along with their absolute difference (deltaSUV) and fractional difference (fSUV) were also compared using discriminant analysis and receiver operating characteristic (ROC) analysis. The study population consisted of 132 patients, of whom 81 had malignancy and 51 were classified as having a benign condition. Thirty-three index lesions were central and 99 were peripheral; 109 had visible uptake and 23 had such low uptake that they were not visible above background. The mean time (+/-SD) between initial and delayed imaging for the visible lesions was 31.1+/-9.4 min. With respect to the entire study population, the BSA replacement for body weight gave the best performance among the various SUV corrections examined. In addition, the BSA corrected delayed SUV (dSUV) gave a performance superior to either initial SUV (iSUV), absolute difference in SUV (deltaSUV) and fractional difference in SUV (fSUV) alone. Performance gains achieved by BSA correction and by dSUV appeared to derive primarily from the central subpopulation, thereby indicating that central lesions tend to behave differently to peripheral ones. For the central subpopulation, ROC analysis also demonstrated improved detection of malignancy from dual-point imaging. The best performance was achieved when the BSA corrected dSUV was at least 2.4, or when the fSUV showed at least a 5% increase from initial to delayed imaging. With the optimal combined dSUV/fSUV strategy, the area under the ROC curve was 0.99, as opposed to 0.96 for dSUV alone, or 0.93 for iSUV alone. The ability of 18F-FDG PET to discriminate between benign and malignant conditions of the central thorax can be improved by correcting the SUV for BSA and by increasing the 'incubation time' between 18F-FDG injection and imaging, or by performing narrow time-window dual-point imaging.
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PMID:Narrow time-window dual-point 18F-FDG PET for the diagnosis of thoracic malignancy. 1456 66

Detecting recurrent laryngeal carcinoma after radiotherapy for a primary tumour can be difficult. Early detection however, is an important prognostic factor. Although a biopsy should be performed in case of clinical suspicion, repeated negative biopsies do not exclude the presence of viable tumour. The trauma caused by biopsies in irradiated tissue may initiate infection, further oedema and failure to heal. We investigated these problems and evaluated the current care and its usefulness. A survey of the current practice concerning diagnostic procedures for detecting recurrent laryngeal carcinoma after radiotherapy in the major institutions treating head and neck cancer in The Netherlands was performed by means of a questionnaire. Furthermore, we performed a comprehensive analysis of the extent and yield of diagnostic work-up in a cohort of patients clinically suspected of a recurrence, who had undergone direct laryngoscopy between 1986 and 1998 in our institution, with a follow-up of at least 6 months. In case of suspected recurrence, 94% of the departments use direct laryngoscopy under general anaesthesia with the taking of biopsies as a diagnostic technique. Imaging does not play an important role. In our department 207 laryngoscopies were evaluated in 131 patients. In 70 patients the first laryngoscopy was negative. Of these initial negative laryngoscopies, 22 (31%) turned out to be false negative within 6 months. Thirty-seven patients remained disease free. They underwent 65 unnecessary laryngoscopies to come to this conclusion. In the decision to perform direct laryngoscopy, the conventional work up leaves room for improvement. Too many unnecessary laryngoscopies are performed. New imaging techniques such as FDG-PET or new applications of CT or MRI may improve the yield of direct laryngoscopy.
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PMID:Detecting recurrent laryngeal carcinoma after radiotherapy: room for improvement. 1462 79

We used positron emission tomography with 2-deoxy-2-[(18)F]fluoro- d-glucose (FDG-PET) in the diagnosis of two cases of malignant intraductal papillary mucinous tumor (IPMT) of the pancreas. A 56-year-old man and a 72-year-old man, both with tumors in the pancreatic head, were referred to Akita University Medical Center. Computed tomography revealed tumors with multiple cystic components in both patients. FDG-PET images showed markedly high FDG uptake in the area corresponding to a solid component found in one patient and diffuse faint uptake, higher than that of the surrounding tissue, in the other patient, who had no solid component. Histological examination of the resected specimens after pancreatectomy showed invasive carcinoma involving the pancreatic parenchyma in both patients. Although our experience is limited and preliminary, FDG-PET seems to be useful for the detection of malignancy in IPMT, especially in patients not showing any solid component on conventional diagnostic images such as computed tomography.
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PMID:Positron emission tomography with 2-deoxy-2-[(18)F] fluoro- d-glucose for diagnosis of intraductal papillary mucinous tumor of the pancreas with parenchymal invasion. 1471 60

In patients with carcinoma of the head and neck and of the esophagus, metabolic and functional imaging by PET with (18)F-FDG has a pivotal role in the evaluation of tumor response to therapy, specifically, in the prediction of progression-free survival and overall survival. Metabolic imaging allows the detection of biochemical changes within tumor cells as opposed to identifiable morphologic changes. Anatomic imaging modalities do not reliably differentiate between responders and nonresponders early during the course of follow-up. The correlation between histopathologic tumor response after preoperative therapy and clinical prognosis is well established for many cancers. Squamous carcinoma of the head and neck and esophageal carcinoma demonstrate avid (18)F-FDG uptake. For these cancers, (18)F-FDG PET parallels histopathologic findings in its ability to detect residual viable tumor; therefore, it is a valuable tool for the noninvasive assessment of histopathologic tumor response in advanced-stage cases after neoadjuvant therapy before surgery. Early determination of nonresponders is of prime importance, as timely therapy modification can be accomplished for patients who do not demonstrate a response to therapy. This determination is exceptionally important for head and neck and esophageal malignancies, both of which are known for their unfavorable prognosis, as early modifications in therapy regimens for nonresponders may improve patient outcome. There is now evidence that (18)F-FDG PET is a sensitive and specific method for determining therapy response and for providing important prognostic information for these cancers. Therefore, (18)F-FDG PET may change patient management and lead to improved survival for a selected group of patients with carcinoma of the head and neck and of the esophagus.
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PMID:PET in the assessment of therapy response in patients with carcinoma of the head and neck and of the esophagus. 1473 74

Differentiated carcinoma of the thyroid are one of rare malignancies that is associated with excellent prognosis. Follow-up with regular thyroglobulin assay and (131)I whole-body scan is capable of detecting residual or recurrent disease with great sensitivity and specificity. However, there is overwhelming evidence to suggest that this approach is not fail-safe due to increasing reports of false negative and false positive results, which may result in missed or unwarranted therapy with (131)I. This article will review the current management of differentiated carcinoma of the thyroid and the possible causes of the reported inadequacy of thyroglobulin and (131)I whole-body scan to detect residual or recurrent disease, and the increasing role of alternative imaging, particularly (18)F-FDG PET in the management of this curable malignancy.
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PMID:FDG PET and alternative imaging in the management of thyroid carcinoma. 1473 30


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