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The role of fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) versus diagnostic CT in surgical management of patients (pts) with lung cancer according to the 7th TNM classification
Full text linkPurpose
In accordance with the new classification, stages from IA to IIIA are considered surgically resectable with a possible role for neoadjuvant or adjuvant chemotherapy and radiotherapy. In pts at stage IIIB-IV of disease, surgical resection is considered impracticable, and chemotherapy-radiation therapy becomes the primary treatment. Actually, the initial diagnosis of lung cancer is often made on a chest radiograph or CT examination, while PET/CT with FDG is able to detect the lymph node and distant
involvment of disease. Therefore, based on these concepts, we aimed to study the comparison between the role of FDG PET/CT vs. diagnostic CT in order to evaluate their impact on surgical management.
Methods and Materials
We retrospectively reviewed both FDG PET/CT and CT scans of 67 pts (44 men and 23 women; 69±9years) with lung cancer. The images were re-viewed by a radiologist and a nuclear medicine physician. Based on their findings, the sites of primary lung lesions, lymph nodes and metastases were tabulated and the final staging was computed according to the new classification. Furthermore, the hospital charts of each patients
were considered for assessing the type of treatment approachs. A comparison across diagnostic and metabolic imaging was performed and the relashionship with the surgical management was evaluated.
Results
Based on CT findings, 19 pts were at stage I; 8 pts at stage II; 13 pts at stage IIIA; 7 pts at stage IIIB and 20 pts at stage IV. No concordance between imaging modalities was reported in 30 pts, particularly based on PET/CT 15 pts were downstaged and 15 pts upstaged. Twenty-nine out of 67 pts underwent surgery. According to PET/CT, 3 patients underwent surgery by a change in staging from IIIB-IV to I and IIIA. On the contrary, no surgical management was adopted in 6 pts due to upstaging (from I - IIIA to IV). Therefore, PET/CT changed the surgical management in 9/67 pts.
Conclusion
The revised 7th edition of the TNM staging system for lung cancer, based on a large international database, is a significant advance in the staging of lung cancer. The development of PET and PET/CT over the past two decades has changed the clinical
staging of lung cancer. According to the new TNM classification and our retrospective study, PET/CT contributes to determine the surgical treatment in about 15%of lung cancer pts, thus improving preoperative staging and reducing the number of needless surgery
CA 19-9 and prediction of unresectability of pancreatic cancer: comparison with CT-scan.
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[The role of echography and computed tomography in distinguishing benign cystic neoplasms of the pancreas and biliary tract. A report of 3 cases].
No full textMucinous cystadenoma of the pancreas as cause of acute pancreatitis.
No full textAcute pancreatitis is only rarely the first presentation of a cystic neoplasm of the pancreas. Mucinous cystadenomas have not been reported to be a cause of acute pancreatitis; however, we present two cases of mucinous cystadenoma of the pancreas which have caused acute pancreatitis. Both patients (female) presented acute abdominal pain, with serum amylase elevation and ultrasound scan (US) and computed tomography (CT) evidence of moderate pancreatitis, which resolved with medical treatment; fluid collection in the distal pancreas had been misinterpreted as a pseudocyst. There was no history of alcohol abuse or gallstone disease. After distal pancreatectomy the diagnosis of mucinous cystadenoma was confirmed; in one case a large pseudocyst was associated with this diagnosis. Pre-operative differential diagnosis between inflammatory and neoplastic cysts is difficult, especially when the patient's first presentation is due to an episode of acute pancreatitis. A neoplastic cyst should be considered when acute pancreatitis attacks occur in non-alcoholic women, who do not have gallstone disease
Early Bone Marrow (BM) Metastases: addition of Metabolic Imaging with Positron Emission Tomography/Computed Tomography (PET/CT) to CT imaging.
No full textImaging of pancreatic metastases from renal cell carcinoma
Full text linkBackground: To describe the main imaging characteristics of pancreatic metastases from renal cell carcinoma
(RCC) with particular attention to CT features, underlining possible criteria for a differential diagnosis.
Methods: 15 patients have been included in this study. 14 patients underwent multislice CT with triphasic
acquisition (unenhanced, pancreatic parenchymal and portal venous phases). In 9 cases a delayed phase (120 sec)
was also acquired. 5 patients underwent MRI, before and after administration of gadolinium.
Results: The mean time interval between nephrectomy and recurrence was 7.5 years (range 1-17 years). On CT
metastases avidly enhanced in the parenchymal phase and then demonstrated a significant wash-out, approaching
isodensity to the normal pancreatic parenchyma in the portal phase. In the portal phase 20 of the 25 lesions found
in the arterial phase were recognizable. On non-enhanced scans, only 13 of the 25 lesions were detected.
On MRI, with the limitations due to the paucity of cases, the metastatic foci appeared hypointense to normal
pancreatic tissue on T1-weighted images, and hyperintense on T2- and diffusion-weighted images. After
gadolinium, the behaviour was similar to that reported for CT, except for one patient in whom two metastatic foci
presented a signal intensity almost isointense to the surrounding parenchyma, accompanied also by an unusual
lowering of the signal on DWI (diffusion-weighted imaging) with high b-values. Compared to CT, with MRI the
lesions appeared all detectable even on non-enhanced acquisitions.
Conclusion: Renal Cell Carcinomas require a prolonged CT or MRI follow-up.
In patients with RCC history, an early arterial or a pancreatic parenchymal phase is always mandatory, as pancreatic
metastases typically present themselves as hypervascular lesions. This behavior is similar to that of neuroendocrine
tumors, while the other primary pancreatic tumors tend to be hypovascular
Unresectable pancreatic cancer. Comparison of CT-scan and CA 19-9 in preoperative evaluation.
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