ObjectiveTo evaluate 18 F-fluorocholine positron-emission tomography (PET)/computed tomography (CT) in restaging patients with a history of prostate adenocarcinoma who have biochemical relapse after early radical treatment, and to correlate the technique's disease detection rate with a set of variables and clinical and pathological parameters. Patients and MethodsThis was a retrospective multicentre study that included 374 patients referred for choline-PET/CT who had biochemical relapse. In all, 233 patients who met the following inclusion criteria were analysed: diagnosis of prostate cancer; early radical treatment; biochemical relapse; main clinical and pathological variables; and clinical, pathological and imaging data needed to validate the results. Criteria used to validate the PET/CT: findings from other imaging techniques, clinical follow-up, treatment response and histological analysis. Different statistical tests were used depending on the distribution of the data to correlate the results of the choline-PET/CT with qualitative [T stage, N stage, early radical prostatectomy (RP) vs other treatments, hormone therapy concomitant to choline-PET/CT] and quantitative [age, Gleason score, prostate-specific antigen (PSA) levels at diagnosis, PSA nadir, PSA level on the day of the choline-PET/CT (Trigger PSA) and PSA doubling time (PSADT)] variables. We analysed whether there were independent predictive factors associated with positive PET/CT results. ResultsCholine-PET/CT was positive in 111 of 233 patients (detection rate 47.6%) and negative in 122 (52.4%). Disease locations: prostate or prostate bed in 26 patients (23.4%); regional and/or distant lymph nodes in 52 (46.8%); and metastatic bone disease in 33 (29.7%). Positive findings were validated by: results from other imaging techniques in 35 patients (15.0%); at least 6 months of clinical follow-up in 136 (58.4%); treatment response in 24 (10.3%); histological analysis of lesions in 17 (7.3%); and follow-up plus imaging results in 21 (9.0%). The statistical analysis of qualitative variables, corresponding to patients' clinical characteristics, and the positive/negative final PET/CT results revealed that only whether or not early treatment with RP was done was statistically significant (P < 0.001), with the number of positive results higher in patients who did not undergo a RP. Among the quantitative variables, Gleason score, Trigger PSA and PSADT clearly differentiated the two patient groups (positive and negative choline-PET/CT: P = 0.010, P = 0.001 and P = 0.025, respectively). A Gleason score of <5 or ≥8 clearly differentiated positive from negative PET. Trigger PSA: mean of 8 ng/mL for positive PET/CT vs 2.8 ng/mL for negative PET/CT; PSADT: mean of 8 months for positive vs 12.6 months for negative. The optimal threshold values were: 3 ng/mL for Trigger PSA level and 6 months for PSADT (Youden index/receiver operating characteristic curve). Analysing these two variables together showed that PSADT was more conclusive in patients with lower Trigger PSA l...
F-FDG PET/CT should be considered as a useful tool to diagnose septic pulmonary embolism in S. aureus catheter-related bacteremia, especially if conventional diagnostic imaging techniques have failed to reveal possible metastatic foci. Further studies are needed to clarify the usefulness of PET/CT performance in children with CRBSI.
Background: Positron emission tomography / computed tomography with fluorodeoxyglucose (FDG-PET/CT) is widely accepted for staging and for end treatment assessment in patients with DLBCL, and has demonstrated to have prognostic impact when used to evaluate early response to chemotherapy (CT) in this group of patients. In the last years, many changes in the way of interpreting PET/CT have been proposed, both for interim and for end of treatment (Barrington SG, J Clin Oncol 2014;32:3048-3058) We present preliminary data of the first Spanish centralized PET/CT review in a Phase 2 randomized trial in young patients with poor prognosis diffuse large B-cell lymphoma (DLBCL), which compares 6 cycles of RCHOP versus 6 cycles of a modified RCHOP regimen, Bortezomid-R CAP (BRCAP). ClinicalTrials.gov Identifier: NCT01848132. The main objective is to evaluate concordance between reviewers in interim and final PET, in order to stablish the best criteria for PET/CT assessment. PET2 ability to predict PET4 result is also analyzed. Methods: A blinded, prospective, centralized review in real time of PET/CT images was realized by the GELTAMO PET network. For each patient, images of basal (PET0), interim PET2 and PET4 and final PET after completion of chemotherapy (PET 6) were sent to a central platform, and then analysed by the review panel composed of seven expert nuclear medicine physicians. PET2 and PET4 were interpreted visually based on Deauville criteria (considering scores 4 and 5 as positive), and also semiquantitavely (considering a positive PET2 when ΔSUVmax≤66% and a positive PET4 when ΔSUVmax≤70%). PET6 was interpreted following Deauville criteria. Final result of every PET/CT was defined as positive or negative by the central review panel. When discordance between visual and semiquantitative analysis was found in interim PET, semiquantitative method was determinant of final result. A positive PET4 result determined dropped out from trial. Concordance between all readers was analysed using Cohen's kappa coefficient. Results: Of the first 76 patients that underwent PET/CT, 64 patients completed PET0, PET2 and PET4; 34 patients underwent PET0, PET2, PET4 and PET6. In the central review, 44/64 patients (69%) were PET2(-) and 20/64 (31%) were PET2(+); 44/64 (69%) were PET4(-) and 20/64 (31%) PET4(+); 21/34 (62%) were PET6(-) and 13/34 (38%) were PET6(+). We found 43 patients with negative PET2 and PET4, 19 patients with positive PET2 and PET4, 1 patient with positive PET2 and negative PET4, and 1 patient with negative PET2 and positive PET4. PET2 result was predictive of PET4 (p<0.001). Concordance between reviewers for PET2 using visual assessment was good (median kappa=0,74) and very good using semiquantitative analysis (median kappa: 0,83). Concordance between reviewers for PET4 using visual assessment was good (kappa=0,72) and very good when semiquantitative analysis was used (median kappa=0,87). For PET6, concordance between readers was moderate (kappa=0.45). Conclusion: In this homogeneus group of patients, a centralized semiquantitative analysis of interim PET after 2 and 4 cycles of chemotherapy improves concordance between readers in comparison with visual analysis. When semiquantitative method is used, PET2 is predictive of PET4 result. In the same way, visual analysis of PET6 using Deauville criteria seems to have a worse concordance between readers, but more patients need to be analyzed to confirm this result. Disclosures No relevant conflicts of interest to declare.
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