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Query: UMLS:C0677930 (primary tumor)
 20,210 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

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: Currently available imaging modalities, including CT, ultrasound, and MRI are unsatisfactory in the detection of metastatic gastric cancer, especially lymph node metastases and peritoneal spread. The aim of this study is to evaluate FDG-PET in the diagnosis of primary as well as metastatic gastric cancer.METHOD: All patients (18M/5F; mean age 62, range 33-81) with gastric cancer referred for FDG-PET scan from 1/1/97 to 3/20/98 were studied. PET images of the neck, chest, and abdomen were acquired using a dedicated whole body scanner. A final diagnosis was reached in 21 patients by histology, surgical findings, or clinical follow-up.RESULTS: All but 1 primary tumor (12 out of 13) and both cases with local recurrence showed a high degree of FDG uptake, with mean SUV of 8.9 (range 4.8-17.6). The one false negative (FN) occurred in a poorly controlled diabetic with blood sugar of >400 at the time of study. Six cases with prior gastrectomy were true negative (TN) in the region of the stomach. This translates to a sensitivity of 93%, specificity of 100%, and accuracy of 95% for the primary site. In contrast, for intra-abdominal lymph node (LN) stations PET was true positive (TP) in 2, FN in 7, false positive (FP) in 1, and TN in 32, yielding a sensitivity of 22% and accuracy of 81%. PET detected only 2 out of 9 perigastric lymph node metastases. For the 8 patients in this series who had documented M1 disease, PET detected two with liver metastasis, one with colon metastasis, and one with submandibular LN. However, four cases of peritoneal spread were missed.CONCLUSION: FDG-PET is highly sensitive in detecting the primary lesion in gastric cancer and shows promise in the detection of liver and extra-abdominal metastasis. However, PET appears limited in the detection of perigastric lymphadenopathy as distinct from the primary tumor and in assessing peritoneal spread. Our preliminary assessment suggests that staging of gastric cancer with FDG-PET scanning is relatively effective at detecting distant metastatic disease and will complement standard staging methods such as laparoscopy, which are more effective at staging local nodal spread and peritoneal disease.
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PMID:Accuracy of FDG-PET in Gastric Cancer. Preliminary Experience. 1451 55

A woman with islet cell carcinoma of the pancreas proven by biopsy at an exploratory laparotomy underwent six cycles of chemotherapy with paclitaxel and carboplatin. After the chemotherapy to monitor her primary tumor and hepatic metastases, she had three consecutive 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography (FDG-PET) determinations that correlated with an In-111 octreotide single photon emission computer tomography. FDG-PET might have utility in monitoring islet cell carcinoma of the pancreas in evaluating metabolic changes following chemotherapy.
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PMID:2-Deoxy-2-[18F]fluoro-D-glucose positron emission tomography monitoring disease progress in a patient with islet carcinoma of the pancreas. 1453 18

Most positron emission tomography (PET) imaging studies in head and neck cancer are performed using the radiotracer 18-fluorodeoxyglucose ((18)FDG). PET with FDG has become a standard clinical imaging modality in patients with head and neck cancer. It contributes valuable information in localizing a primary tumor in patients with neck nodal metastases from an unknown primary, in the staging of primary head and neck cancer, and in the detection of recurrent disease. In addition, FDG-PET provides independent prognostic information in patients with newly diagnosed and recurrent head and neck cancer. PET/CT improves lesion localization and accuracy of FDG-PET and is strongly recommended in patients with head and neck cancer. After thyroidectomy, FDG-PET has proven useful in patients with clinical or serological evidence of recurrent or metastatic thyroid carcinoma but negative whole body iodine scan. PET shows metastatic disease in up to 90% of these patients, thereby providing a rational basis for further studies and therapy. In patients with medullary thyroid cancer with elevated calcitonin levels following thyroidectomy, FDG-PET has a sensitivity of 70-75% for localizing metastatic disease. Occasionally incidental intense FDG uptake is observed in the thyroid gland on whole body PET studies performed for other indications. Although diffuse FDG uptake usually indicates thyroiditis, focal uptake has been related to thyroid cancer in 25-50% of cases and should therefore be evaluated further if a proven malignancy would cause a change in patient management.
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PMID:Positron emission imaging of head and neck cancer, including thyroid carcinoma. 1520

Positron emission tomography using (18)F-fluorodeoxyglucose (FDG-PET) has been used for the detection, staging, and response monitoring in breast cancer patients. Although studies have proven its accuracy in detection of the primary tumor and axillary staging, its most important current clinical application is in detection and defining the extent of recurrent or metastatic breast cancer and for monitoring response to therapy. PET is complementary to conventional methods of staging in that it provides better sensitivity in detecting nodal and lytic bone metastases; however, it should not be considered a substitute for conventional staging studies, including computed tomography and bone scintigraphy. FDG uptake in the primary tumor carries prognostic information, but the underlying biochemical mechanisms that are responsible for enhanced glucose metabolism have not been completely elucidated. Future work using other PET tracers besides FDG will undoubtedly help our understanding of tumor biology, improve our ability to measure and predict response and help tailor therapy to individual patients.
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PMID:Current and future uses of positron emission tomography in breast cancer imaging. 1520 3

Whole-body positron emission tomography (PET) scanning with the radiolabeled glucose analogue 2-[fluorine-18]-fluoro-2-deoxy-D-glucose ( superset 18 F-FDG) can identify areas of cancerous involvement and distinguish malignant from benign lesions and therefore, plays an important role in the diagnosis and management of patients with cancer. PET facilitates the evaluation of metabolic and molecular characteristics of a wide variety of cancers, but it is limited in its ability to visualize anatomical structures. Whole-body magnetic resonance imaging (MRI) is a promising diagnostic modality for the diagnosis and management of patients with cancer, because of its high anatomical resolution. Whole-body PET and whole-body MRI allow to evaluate both the primary tumor and for the presence of metastasis at the same time. The combination of these two excellent diagnostic imaging modalities into a single scanner offers several advantages in comparison to PET and MRI alone. A hybrid PET/MRI facilitates the accurate registration of metabolic and molecular aspects of the diseases with exact correlation to anatomical findings, improving the diagnostic value in identifying and characterizing of malignancies and tumor staging. Thus, hybrid PET/MRI could be a very important diagnostic imaging modality in oncological applications in the decades to come, and possibly for use in cancer screening and cardiac imaging.
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PMID:Whole-body imaging with PET/MRI. 1525 72

The presence of internal mammary (IM) lymph node metastases in breast cancer predicts outcome and may alter treatment. Standard imaging has limited usefulness for evaluation of the IM chain because of low sensitivity. Our preliminary studies suggested that [F-18]-2-fluoro-d-glucose positron emission tomography (FDG-PET) improves the detection of IM and mediastinal metastases. We therefore performed a retrospective review of women who underwent FDG-PET prior to treatment to determine the benefit of PET for imaging IM disease. The records of 28 consecutive patients undergoing FDG-PET prior to neoadjuvant chemotherapy for suspected locally advanced breast cancer (LABC) were reviewed. The presence of abnormal IM uptake on FDG-PET was noted. IM uptake on FDG PET was compared with standard radiographic imaging and was correlated with putative risk factors for IM involvement and with clinical patterns of failure. Patients did not undergo IM biopsy; however, patterns of failure were assessed to validate the FDG-PET findings. Clearly abnormal FDG uptake in the IM nodes was seen in 7 of 28 women (25%). Prospective conventional chest imaging failed to identify IM metastases in any patient. IM uptake on PET was associated with large size of the primary tumor (P = 0.03) and with inflammatory disease (P = 0.04). The presence of IM FDG uptake predicted failure by a pattern consistent with spread from IM lymph node metastasis. FDG-PET appears to be a useful noninvasive modality to detect IM metastases in LABC. Pathologic verification in a prospective study is necessary to confirm these findings.
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PMID:Evaluation of the internal mammary lymph nodes by FDG-PET in locally advanced breast cancer (LABC). 1528 36

Carcinoma of the esophagus must be staged accurately before a treatment plan is initiated, and imaging studies play a major role in this process. Imaging for esophageal carcinoma involves evaluation of the locoregional extent of the tumor and distant metastatic disease. A CT scan of the chest and upper abdomen provides the most comprehensive information about esophageal carcinoma; however, accurate assessment of the depth of primary tumor invasion and lymph node status remains limited, even with newer generation scanners. Endoscopic US is a user-dependent modality that has emerged as a highly accurate technique in experienced hands to evaluate the depth of penetration of esophageal tumors, but its ability to detect metastatic lymph nodes is less impressive, leading some investigators to perform confirmatory needle aspiration of suspicious nodes. FDG-PET is a physiologic examination that is the subject of intense investigation in patients who have esophageal carcinoma. Preliminary studies have suggested that FDG-PET can detect otherwise radiographically occult distant metastatic disease in these patients, and changes in FDG uptake might correlate with the response to therapy. These findings need to be confirmed in larger studies. More sophisticated technology continues to be developed for imaging carcinoma of the esophagus, which will more than likely affect staging algorithms in the future.
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PMID:Imaging for esophageal tumors. 1538 9

Patients suspected of recurrent differentiated thyroid cancer (DTC) may require "blind" (131)I therapy, with the disadvantage of unpredictable efficacy and toxicity. Alternatively, positron emission tomography (PET) with [(18)F]fluorodeoxyglucose ((18)FDG) can document the recurrence, thereby rationalizing therapeutic options. This study compared (18)FDG uptake in vivo with biomarkers expected to be involved in the underlying biological mechanisms. Additionally, we investigated whether such features were present in the primary tumors. Preoperatively, 19 patients with recurrent DTC underwent PET. (18)FDG uptake was compared with histological and immunohistochemical features in surgical specimens of recurrent and primary tumor. Thirteen of 19 recurrences were positive at PET, and (18)FDG uptake was associated with the expression of hexokinase type I (HK I; P = 0.011). All lesions with HK I overexpression were positive on (18)FDG PET. HK I expression in the original primary tumor and the metastases was similar in 82% (rho = 0.648; P = 0.005). In suspected recurrent thyroid cancer, stratification for (18)FDG PET may benefit from pretest immunohistochemical analysis of HK I of the primary tumor, as HK I negativity indicates a low likelihood of PET positivity.
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PMID:[18F]fluorodeoxyglucose uptake in recurrent thyroid cancer is related to hexokinase i expression in the primary tumor. 1550 40


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