Case report

Hou, Shasha; Shen, Jie; Tan, Jian Liang

doi:10.1097/md.0000000000007248

Cited by 12 publications

(7 citation statements)

References 9 publications

(8 reference statements)

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“…Although the exact rate of patients classified as having advanced stage disease nationwide due to their bone marrow status is unknown, Brazil presents a higher rate of advanced stage HL patients than other populations, thus, it also has a relatively greater number of eligible patients for bone marrow disease assessment, given the higher incidence in advanced stage groups. 15 Furthermore, there is still a relatively high incidence of chronic infectious diseases in Brazil, such as tuberculosis, paracoccidioidomycosis, leishmaniasis, histoplasmosis, etc., 9 , 16 , 17 , 18 that can potentially involve bone marrow and could increase the rate of false-positive results of FDG-PET. 19 In addition, the possibility of simultaneous occurrence of lymphoma and specific chronic infections has been reported.…”

Section: Discussionmentioning

confidence: 99%

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group

Cerci¹,

Bogoni²,

Buccheri

et al. 2018

Hematology, Transfusion and Cell Therapy

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ObjectiveTo investigate, in a large prospective multicenter study, whether 2-[18F]-fluoro-2-deoxy-d-glucose-positron emission tomography is sufficiently accurate to identify clinically important bone marrow involvement by Hodgkin's lymphoma to replace routine bone marrow biopsy in a developing tropical country.MethodsPatients newly diagnosed with Hodgkin's lymphoma were recruited from six cancer centers in Brazil. All were staged by the results of positron emission tomography/computed tomography that were centrally reviewed and by iliac crest bone marrow biopsy. Patients were classified as having marrow disease if they had lymphoma identified by marrow biopsy histology or had focal 2-[18F]-fluoro-2-deoxy-d-glucose marrow uptake that resolved following chemotherapy.ResultsA total of 246 participants were recruited from six different centers and 62 (25.2%) were judged to have Hodgkin's lymphoma in the bone marrow. Positron emission tomography and biopsies were concordant in 206 patients (83%). Positron emission tomography correctly identified marrow disease in 59/62 patients (95.1%) and marrow biopsy in 25/62 patients (40.3%). In 22/62 (35.4%) patients, the two techniques were concordant in the diagnosis of marrow involvement. Of the forty discordant results, positron emission tomography found bone marrow involvement in 37 patients, upstaging 22 to stage IV and having an impact on therapeutic decision in nine cases given their reallocation from early to advanced stage. Three false negative positron emission tomography results were obtained with bone marrow biopsy giving positive findings. All three cases were classified as stage IV regardless of bone marrow findings implying no modification in the clinical management. The sensitivity, specificity and accuracy of positron emission tomography for detecting bone marrow disease were 95%, 100% and 98% and for bone marrow biopsy they were 40%, 100% and 84%, respectively.ConclusionWe conclude that positron emission tomography can replace marrow biopsy in Brazilian patients with Hodgkin's lymphoma without compromising clinical management.

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Section: Discussionmentioning

confidence: 99%

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group

Cerci¹,

Bogoni²,

Buccheri

et al. 2018

Hematology, Transfusion and Cell Therapy

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“…PET/CT can provide metabolic differences between normal cells and malignant cells. However, false-positive cases are constantly reported, as the F-18 FDG could be absorbed not only by tumor cells but also by inflammatory or infective lesions [ 7 , 8 ]. Although various imaging examinations are available for the diagnosis of different kinds of disease.…”

Section: Discussionmentioning

confidence: 99%

Multifocal tuberculosis simulating a cancer-a case report

et al. 2020

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Background: Tuberculosis is a disease that may affect any organ of the body. Multifocal tuberculosis involving multiple systems with associated symptoms are rare, which makes the diagnosis challenging. Distinguishing multifocal tuberculosis from lesions metastatic from system malignancy is difficult. Single detection method is difficult to make a diagnosis. A combination of multiple methods is essential. Case presentation: A 17-year-old male presented with a 20 days weakness of lower limbs, which aggravated for 6 days. The PET/CT showed increased metabolism of ileocecal intestinal and terminal ileum wall, multiple enlarged lymph node (LNs), multiple osteolytic bone lesions, and soft tissue intensity belong T7 and T8 vertebrae. To confirm the diagnosis of the disease, a biopsy of the mediastinum lymph nodes was carried out. Polymerase chain reaction (PCR) test of the specimen was positive for the Mycobacterium tuberculosis, the T-SPOT and Xpert MTB/RIF test were also positive, which suggested the presence of Mycobacterium tuberculosis. The final diagnosis was multifocal tuberculosis, the patients received the resection of the mass in the spine. Anti-tuberculosis drugs were given. The myodynamia and muscle tension of the patients recovered following the therapy. Conclusions: Our results indicated that Multifocal tuberculosis should also be taken into consideration when lesions metastatic from system malignancy were suspected from images results even without the clinical symptoms of tuberculosis, and combination of multiple diagnosis methods were essential for the diagnosis of multifocal disease.

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“…Granulomatous nodules such as inflammatory and tuberculoid nodules include a high number of inflammatory cells such as macrophages, lymphocytes, and granulocytes that are very high in glucose metabolism, the expression of Glut-1 and Glut-3 and the transfer efficiency of glucose, and a subsequent increase in the uptake of 18 F-FDG. [ 8 , 11 ] When the obsolete pulmonary TB is in a stable condition, the TB lesions usually do not take up or take up very little of the 18 F-FDG. The TB with high intake is often in a cell breeding period, because of a large number of these cells in the lesions.…”

Section: Discussionmentioning

confidence: 99%

“…Although the SUVmax of benign and malignant lesions sometimes overlap, our study analyzed and compared the SUVmax between benign and malignant groups and found that the average SUVmax of malignant nodules was obviously higher than that of benign nodules, and the comparison of the 2 groups were statistically significant. We can see that although benign lesions also seem to have a slightly higher metabolic rate and even higher metabolic rate in the lungs in PET/CT, [ 11 , 12 ] it is generally lower than the nodules of lung cancer. Subgroup analysis found that the average SUVmax of squamous cell carcinoma was higher than the average SUVmax of adenocarcinoma, and it was statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Combination of positron emission tomography/computed tomography and chest thin-layer high-resolution computed tomography for evaluation of pulmonary nodules

et al. 2018

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This study aimed to analyze the imaging findings of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and chest thin-layer high-resolution computed tomography (HRCT), correlate the maximum standardized uptake value (SUVmax), and the pathological type of benign or malignant pulmonary nodules (PNs), and assess the diagnostic accuracy in differentiating malignant from benign PNs.A retrospective review of 18F-FDG PET/CT scans from 88 patients with PNs confirmed by pathology or clinical follow-up were included. They both accepted PET/CT and HRCT scan conventional. The final results were determined by a combination of PET/CT and HRCT. Independent samples t test was used for statistical analysis. Receiver operating curves (ROC) were generated and the optimal threshold of SUVmax was determined.The sensitivity, specificity, and accuracy of HRCT, PET/CT, and PET/CT combined with HRCT in the diagnosis of PNs were 83.3%, 70%, 77.3%; 91.7%, 62.5%, 78.4%; and 95.8%, 75%, 86.4%, respectively. The SUVmax of malignant nodules was significantly higher than that of benign nodules, and the difference was statistically significant (t = –5.668, P < .001). In the subgroup analysis, the SUVmax of squamous cell carcinoma was higher than that of the denocarcinoma (t = –5.442, P < .001), and that of bronchioloalveolar carcinoma (t = 4.678, P < .001), the difference were both statistically significant. There were both no significant difference between adenocarcinoma and bronchioloalveolar carcinoma (t = 0.36, P = .722), tuberculosis and inflammatory nodules (t = –0.18, P = .858). Higher the value of SUVmax, greater the risk of malignancy. However, when the SUVmax ranges between 2.5 and 8.0, the lesion may be benign or malignant, and a comprehensive evaluation using combination methods with HRCT are required. When SUVmax <2.5, there is still a 9.5% chance of PN malignancy. ROC curve shows SUVmax >3.635 as the best threshold, and the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of PET/CT in diagnosis of PNs were 83.3%, 62.5%, 79.2%, 71.7%, and 71.4%, respectively.PET/CT combined with HRCT should be advocated to improve the sensitivity, specificity, and accuracy of PET/CT in diagnosis of PNs.

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Case report

Cited by 12 publications

References 9 publications

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group

Fluorodeoxyglucose-positron emission tomography staging can replace bone marrow biopsy in Hodgkin's lymphoma. Results from Brazilian Hodgkin's Lymphoma Study Group

Multifocal tuberculosis simulating a cancer-a case report

Combination of positron emission tomography/computed tomography and chest thin-layer high-resolution computed tomography for evaluation of pulmonary nodules

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