The use of positron emission tomography in detecting hepatoblastoma recurrence—a cautionary tale

Wong, Kenneth K.; Lan, Lawrence C L; Lin, Steve C.L.; Tam, Paul Kwong‐Hang

doi:10.1016/j.jpedsurg.2004.08.033

Cited by 22 publications

(8 citation statements)

References 22 publications

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“…The gold standard to detect hepatoblastoma recurrence is elevated levels of a-fetoprotein (AFP). Wong et al performed FDG-PET imaging along with measurement of AFP during post-treatment follow-up and the conclusion made was that PET may be useful to find recurrence but caution must be taken in the interpretation of positive results [60]. Mody et al performed 11 FDG PET scans on seven children with pathologically proven hepatic malignancies for staging (one patient) or restaging (six patients) and concluded that PET scan is probably most useful for assessing response to therapy, in following AFP-negative cases and for detecting metastatic disease but large prospective studies are needed to establish it fully [61].…”

Section: Hepatoblastomamentioning

confidence: 99%

Clinical applications of PET and PET/CT in pediatric malignancies

Kumar

Shandal

Shamim

et al. 2010

Expert Review of Anticancer Therapy

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The common childhood cancers are leukemia, CNS tumors, lymphomas, soft-tissue tumors (such as rhabdomyosarcoma and fibrosarcoma), neuroblastoma, malignant bone tumors, germ cell tumors with neoplasms of gonads and hepatic tumors. Usually the conventional imaging modalities, such as x-ray, ultrasound, computed tomography (CT) and MRI, are being routinely used for the management of these pediatric malignancies. However, most of these modalities provide structural information and are lacking in functional/metabolic status of these malignancies. Recently, PET and PET/CT have emerged as a functional diagnostic imaging modality for the management of various cancers in adult population. Up to now most of the data published in the literature are on PET alone. PET used in conjunction with CT is useful as it provides an enhanced view of the anatomical details and the malignant focus then can be located with highest accuracy. PET and PET/CT has been found to be useful in, for example, CNS tumors, lymphomas, soft-tissue tumors, neuroblastoma, malignant bone tumors and germ cell tumors. PET/CT has a limited role in early diagnosis, however, it plays an important role in initial staging, treatment response evaluation and detection of metastatic disease in these cancers. Despite the fact that PET/CT has better diagnostic value when compared with conventional imaging, such as CT and MRI, in the management of many pediatric cancers, there are certain limitations. PET/CT has a limited role in detection of lesions smaller than 5 mm, well-differentiated tumors and tumors with low metabolic rate. Many infections and inflammation can lead to false-positive PET/CT results. In the present review we will discuss the various clinical indications of PET and PET/CT in pediatric cancers.

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Section: Hepatoblastomamentioning

confidence: 99%

Clinical applications of PET and PET/CT in pediatric malignancies

Kumar

Shandal

Shamim

et al. 2010

Expert Review of Anticancer Therapy

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“…In one patient, intense uptake was due to necrotizing granulomas [17]. Another important study is that of Wong et al [15], who suggest caution in the interpretation of PET studies due to the risk of false positive results. In this retrospective article including sixteen children, three posttreatment patients had PET results suggestive of tumor recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…The other 2 patients underwent further liver resections because of mildly raised α -FP levels. The histology results showed regenerative liver tissue only in both patients with no hepatoblastoma recurrence [15]. …”

Section: Discussionmentioning

confidence: 99%

“…Besides, as described for other tumors, an acute hyperglycaemia at the time of the exam can compete with tracer uptake and lead to false negative reports [17]. Conditions leading to false positive 18 F-FDG-PET/CT examinations include regenerating liver tissue and areas of inflammation (like necrotizing granulomas) and should be reminded when α -FP levels are only slightly or moderately elevated [15, 17]. …”

Section: Discussionmentioning

confidence: 99%

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A Comparison between¹⁸F-FDG PET/CT Imaging and Biological and Radiological Findings in Restaging of Hepatoblastoma Patients

Cistaro

Treglia

Pagano³

et al. 2013

BioMed Research International

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Background. In this study we retrospectively evaluated if 18F-FDG-PET/CT provided incremental diagnostic information over CI in a group of hepatoblastoma patients performing restaging. Procedure. Nine patients (mean age: 5.9 years; range: 3.1–12 years) surgically treated for hepatoblastoma were followed up by clinical examination, serum α-FP monitoring, and US. CI (CT or MRI) and PET/CT were performed in case of suspicion of relapse. Fine-needle aspiration biopsies (FNAB) were carried out for final confirmation if the results of CI, PET/CT, and/or α-FP levels were suggestive of relapse. PET/CT and CI findings were analyzed for comparison purposes, using FNAB as reference standard. Results. α-FP level was suggestive of disease recurrence in 8/9 patients. Biopsy was performed in 8/9 cases. CI and PET/CT resulted to be concordant in 5/9 patients (CI identified recurrence of disease, but 18F-FDG-PET/CT provided a better definition of disease extent); in 4/9 cases, CI diagnostic information resulted in negative findings, whereas PET/CT correctly detected recurrence of disease. 18F-FDG-PET/CT showed an agreement of 100% (8/8) with FNAB results. Conclusions. 18F-FDG-PET/CT scan seems to better assess HB patients with respect to CI and may provide incremental diagnostic value in the restaging of this group of patients.

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“…[27,29] However, caution must be taken in interpretation of positive results, as false positive results do occur due to inflammatory processes like necrotizing granuloma and also due to regenerative liver tissue. [30] These tumors being rare, many more prospective multicenter studies are necessary to determine the true clinical utility of FDG-PET imaging in the management of children with primary hepatic malignancies.…”

Section: Lymphomasmentioning

confidence: 99%

Positron emission tomography and positron emission tomography-computerized tomography in pediatric patients

Patel

Kumar

2007

J Indian Assoc Pediatr Surg

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Positron emission tomography (PET) is a functional diagnostic modality, which is routinely used in oncology for diagnosis, staging, monitoring the response to therapy, and restaging of various tumors. PET used in conjunction with computerized tomography (CT) (PET-CT) is more useful as it provides anatomical details and the abnormal uptake on PET can be localized with highest accuracy. Much work has been done regarding PET/PET-CT in the adults but there is paucity in the same in pediatric group. A child must receive special attention when embarking on what is uncertain and often a frightening procedure. While performing PET in pediatric patients, emphasis is given to patient consent, intravenous access, bladder catheterization, and sedation. Based on existing literature and our own experience, we understand that PET-CT can play a very important role in initial staging, restaging, and evaluation of treatment response in lymphoma, neuroendocrine tumors and bone, and soft tissues sarcoma.

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The use of positron emission tomography in detecting hepatoblastoma recurrence—a cautionary tale

Cited by 22 publications

References 22 publications

Clinical applications of PET and PET/CT in pediatric malignancies

Clinical applications of PET and PET/CT in pediatric malignancies

A Comparison between¹⁸F-FDG PET/CT Imaging and Biological and Radiological Findings in Restaging of Hepatoblastoma Patients

Positron emission tomography and positron emission tomography-computerized tomography in pediatric patients

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The use of positron emission tomography in detecting hepatoblastoma recurrence—a cautionary tale

Cited by 22 publications

References 22 publications

Clinical applications of PET and PET/CT in pediatric malignancies

Clinical applications of PET and PET/CT in pediatric malignancies

A Comparison between18F-FDG PET/CT Imaging and Biological and Radiological Findings in Restaging of Hepatoblastoma Patients

Positron emission tomography and positron emission tomography-computerized tomography in pediatric patients

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A Comparison between¹⁸F-FDG PET/CT Imaging and Biological and Radiological Findings in Restaging of Hepatoblastoma Patients