18F-fluorodeoxyglucose positron-emission tomography-computed tomography to diagnose recurrent cancer

Abstract

Background:Sometimes the diagnosis of recurrent cancer in patients with a previous malignancy can be challenging. This prospective cohort study assessed the clinical utility of 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET-CT) in the diagnosis of clinically suspected recurrence of cancer.Methods:Patients were eligible if cancer recurrence (non-small-cell lung (NSCL), breast, head and neck, ovarian, oesophageal, Hodgkin's or non-Hodgkin's lymphoma) was suspected clinically, and if conventional imaging was non-diagnostic. Clinicians were asked to indicate their management plan before and after 18F-FDG PET-CT scanning. The primary outcome was change in planned management after 18F-FDG PET-CT.Results:Between April 2009 and June 2011, 101 patients (age, median 65 years; 55% female) were enroled from four cancer centres in Ontario, Canada. Distribution by primary tumour type was: NSCL (55%), breast (19%), ovarian (10%), oesophageal (6%), lymphoma (6%), and head and neck (4%). Of the 99 subjects who underwent 18F-FDG PET-CT, planned management changed after 18F-FDG PET-CT in 52 subjects (53%, 95% confidence interval (CI), 42–63%); a major change in plan from no treatment to treatment was observed in 38 subjects (38%, 95% CI, 29–49%), and was typically associated with 18F-FDG PET-CT findings that were positive for recurrent cancer (37 subjects). After 3 months, the stated post-18F-FDG PET-CT management plan was actually completed in 88 subjects (89%, 95% CI, 81–94%).Conclusion:In patients with suspected cancer recurrence and conventional imaging that is non-diagnostic, 18F-FDG PET-CT often provides new information that leads to important changes in patient management.

ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease

“…Further to clinical examination and checking for symptoms, CA-125 is the simplest tool to trigger imaging and is a better approach than regular routine imaging for diagnosis of recurrent ovarian cancer [244,251]. Radiographic imaging, such as ultrasound, chest-abdomen-pelvis CT, whole-body MRI or PET-CT, should only be carried out if clinically indicated, based on symptoms, clinical examination or a rising CA-125 level [252][253][254][255]. Mucinous and clear cell ovarian cancers could represent a potential source of PET-negative findings [256].…”

PET/CT implication on bronchogenic carcinoma TNM staging and follow-up using RECIST/PERCIST criteria: a comparative study with CT

“…Our results were close to the result of Jimenez-Bonilla et al and Marcus et al who found that PET/CT resulted in a change in management between 30.19% and 28.1% of their patients, respectively, who did PET/CT to evaluate the therapeutic response [36,37]. This was in controversy to Hicks et al and You et al who found a change in the management and therapeutic plane between 63.5% and 57% of their patients, respectively, when using PET/CT in the evaluation of therapeutic response [18,38]. Fig.…”

Intended Versus Inferred Treatment After 18F-Fluoride PET Performed for Evaluation of Osseous Metastatic Disease in the National Oncologic PET Registry

“…For example, there is a high level of consensus that surgical excision for patients with no evidence of metastases after imaging for IS of lung or many other cancers is appropriate, but much lower consensus would be expected for an intended management plan of chemotherapy for men scanned for FOM of prostate cancer (as well as many women with breast cancer) who have not yet received hormonal therapy. The assessment of change in intended management has been an integral part of the NOPR and evaluations of 18 F-FDG PET in similar analyses in Australia and Canada (12)(13)(14). We previously reported that the concordance between NOPR postscan intended management and claims-inferred actual management is much higher after 18 F-FDG PET done for IS to help plan an initial treatment strategy than when PET is used to evaluate suspected cancer recurrences (6,7).…”