Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up <sup>18</sup>F-FDG PET/CT Scans in Oncology Patients

Taghipour, Mehdi; Marcus, Charles; Sheikhbahaei, Sara; Mena, Esther; Prasad, Shwetha; Jha, Abhinav K.; Solnes, Lilja B.; Subramaniam, Rathan M.

doi:10.2967/jnumed.116.183111

Cited by 10 publications

(6 citation statements)

References 32 publications

(34 reference statements)

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“…Currently, no NCCN clinical practice guideline recommendations for routine use of 18 F-FDG PET/CT for assessing treatment response or posttreatment follow-up for lung cancer have been established. However, the value of 18 F-FDG PET/CT for assessment of response to therapy is widely recognized (4,7), with Centers for Medicare and Medicaid Services Coverage approval including at least 3 posttherapy 18 F-FDG PET/CT scans per patient and per tumor type (8). All lung cancer patients at our institution are followed by 18 F-FDG PET/CT examinations regardless of tumor subtype.…”

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confidence: 99%

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Nia

Garland

Eshghi

et al. 2017

J. Nucl. Med. Technol.

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The brain is the most common site of distant metastasis from lung cancer. Thus, MRI of the brain at initial staging is routinely performed, but if this examination is negative a follow-up examination is often not performed. This study evaluates the incidence of asymptomatic brain metastases in non-small cell lung cancer patients detected on follow-up 18 F-FDG PET/CT scans. Methods: In this Institutional Review Board-approved retrospective review, all vertex to thigh 18 F-FDG PET/CT scans in patients with all subtypes of lung cancer from August 2014 to August 2016 were reviewed. A total of 1,175 18 F-FDG PET/CT examinations in 363 patients were reviewed. Exclusion criteria included brain metastases on initial staging, histologic subtype of small-cell lung cancer, and no follow-up 18 F-FDG PET/CT examinations. After our exclusion criteria were applied, a total of 809 follow-up 18 F-FDG PET/CT scans in 227 patients were included in the final analysis. The original report of each 18 F-FDG PET/CT study was reviewed for the finding of brain metastasis. The finding of a new brain metastasis prompted a brain MRI, which was reviewed to determine the accuracy of the 18 F-FDG PET/CT. Results: Five of 227 patients with 809 follow-up 18 F-FDG PET/CT scans reviewed were found to have incidental brain metastases. The mean age of the patients with incidental brain metastasis was 68 y (range, 60-77 y). The mean time from initial diagnosis to time of detection of incidental brain metastasis was 36 mo (range, 15-66 mo). When MRI was used as the gold standard, our false-positive rate was zero. Conclusion: By including the entire head during follow-up 18 F-FDG PET/CT scans of patients with non-small cell lung cancer, brain metastases can be detected earlier while still asymptomatic. But, given the additional scan time, radiation, and low incidence of new brain metastases in asymptomatic patients, the cost-to-benefit ratio should be weighed by each institution.

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confidence: 99%

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Nia

Garland

Eshghi

et al. 2017

J. Nucl. Med. Technol.

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“…In Korea, FDG PET for recurrence surveillance used to be covered limitedly by the National Health Insurance until 2014, which is currently not allowed by the National Guidance. In the USA, three posttreatment FDG PET scans are covered by Medicare and Medicaid Services, and Taghipour et al [15] had conducted a retrospective institutional review of 433 cancer patients, including a total of 1659 fourth and subsequent follow-up PET/ CT scans after completion of primary treatment. In this study, fourth and subsequent follow-up FDG PET/CT scans led to management change in 31.6% of cases when scans were obtained for clear needs.…”

Section: Discussionmentioning

confidence: 99%

“…Whole-body FDG PET is a non-invasive, high-resolution molecular imaging technique that can detect recurrences or metastases. Many studies have reported high sensitivity and specificity of FDG PET for detecting recurrence or metastases [9][10][11][12][13][14][15], which are superior to those of conventional imaging methods. However, FDG PET has not been included in recommendations or guidelines for routine surveillance of cancers [15,16], probably because of unconfirmed comparative cost-effectiveness.…”

Section: Introductionmentioning

confidence: 99%

Recurrence of Melanoma After Initial Treatment: Diagnostic Performance of FDG PET in Posttreatment Surveillance

Lee

Paeng

Cheon

et al. 2018

Nucl Med Mol Imaging

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Purpose In malignant melanoma, recurrence is often observed in distant areas from the primary site. While FDG PET is a sensitive imaging for detecting malignant lesions, the role of FDG PET in posttreatment surveillance period has not been investigated sufficiently. The aim of this study was to evaluate the value of PET during posttreatment surveillance in melanoma. Methods A total of 76 melanoma patients who underwent FDG PET during surveillance period after completion of the first treatment were retrospectively enrolled. PET scans were grouped according to the purpose and clinical situations, routine surveillance, or evaluating clinical suspicion. Final diagnosis of recurrence was determined by complete clinical evaluation or long-term follow-up. In each situation, the diagnostic role of FDG PET was assessed. Results A total of 143 scans of 76 patients were analyzed: 51 for clinical suspicion and 92 for routine surveillance. In the clinical suspicion group, PET correctly diagnosed non-recurrence in 10 cases (20%). In routine surveillance group, 16 cases (17%) presented recurrence, all of which was correctly diagnosed on PET. NPVand PPV were 100% and 76%, respectively. In subgroup analysis, sensitivity and NPV were higher in the low-risk group (stages I-II A) than in the high-risk group (stages II B-IV), while specificity and PPV were higher in the high-risk group. Conclusion In conclusion, FDG PET is an effective diagnostic tool in posttreatment surveillance of melanoma. Even in cases without clinical suspicion, melanoma recurs in a considerable proportion of patients, which can be sensitively diagnosed on PET.

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“…It is intuitive to think that the use of improved staging methods should help tailor better treatment regimens, and this has been demonstrated in other cancers. 15 , 19 , 20 The introduction of new technologies needs to be critically assessed, however, based on the potential benefits and harms to the patient as well as the cost to the society. While no formal analysis could be performed during this pilot study, the radiopharmaceutical for PET/CT used is currently more expensive and additional cost to the PET/CT scanners exceed those of a standard gamma camera.…”

Section: Discussionmentioning

confidence: 99%

18-Fluoride labeled sodium fluoride positron emission tomography with computer tomography: the impact of pretreatment staging in intermediate- and high-risk prostate cancer

Harley

Hoffmann

Bartholomeusz

et al. 2018

Prostate International

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Background18-Fluoride labeled sodium fluoride (Na-18-F) positron emission tomography with computer tomography (PET/CT) has a better sensitivity and specificity than whole body bone scan (WBBS) in detecting osseous metastatic prostate cancer. We performed a pilot study of 20 men to examine what level of impact Na-18-F PET/CT has on management plans when used for staging newly diagnosed prostate cancer.Materials and methodsTwenty men were prospectively enrolled into the study in South Australia. Men were eligible if they had newly diagnosed, untreated, and biopsy-confirmed intermediate- or high-risk prostate cancer (D'Amico classification). WBBS and Na-18-F PET/CT scans were performed within 1 week of each other. Following review of the WBBS, treatment type and intent was documented by the treating urologist. The Na-18-F PET/CT scan was then reviewed. The impact of the Na-18-F PET/CT was measured on whether treatment modality or intent was subsequently altered: high impact = treatment intent or modality was changed; medium impact = treatment modality was modified; low impact = no change in treatment.ResultsIn 18 men (90%), the WBBS and Na-18-F PET/CT were negative for osseous metastases. In one man (5%), the WBBS demonstrated widespread osseous metastases which were similarly demonstrated on the Na-18-F PET/CT. One man (5%) had a normal WBBS; however, the Na-18-F PET/CT demonstrated widespread osseous metastases. Subsequently, in 19 men (95%), the results of the two scans were congruent and the addition of the Na-18-F PET/CT scan demonstrated a low impact on management. In one man (5%), the addition of the Na-18-F PET/CT had a high impact as treatment type and intent was altered.ConclusionsOur pilot study is the first of its kind in Australia, and our findings suggest that Na-18-F PET/CT is a safe and feasible modality for staging prostate cancer. However, its true impact on prostate cancer management warrants further investigation.

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Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up ¹⁸F-FDG PET/CT Scans in Oncology Patients

Cited by 10 publications

References 32 publications

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Recurrence of Melanoma After Initial Treatment: Diagnostic Performance of FDG PET in Posttreatment Surveillance

18-Fluoride labeled sodium fluoride positron emission tomography with computer tomography: the impact of pretreatment staging in intermediate- and high-risk prostate cancer

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Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up 18F-FDG PET/CT Scans in Oncology Patients

Cited by 10 publications

References 32 publications

Incidence of Brain Metastases on Follow-up 18F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Incidence of Brain Metastases on Follow-up 18F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Recurrence of Melanoma After Initial Treatment: Diagnostic Performance of FDG PET in Posttreatment Surveillance

18-Fluoride labeled sodium fluoride positron emission tomography with computer tomography: the impact of pretreatment staging in intermediate- and high-risk prostate cancer

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Product

Resources

About

Clinical Indications and Impact on Management: Fourth and Subsequent Posttherapy Follow-up ¹⁸F-FDG PET/CT Scans in Oncology Patients

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?

Incidence of Brain Metastases on Follow-up ¹⁸F-FDG PET/CT Scans of Non–Small Cell Lung Cancer Patients: Should We Include the Brain?