Molecular Imaging Insight - September 2007 - (Page 18) node staging (sensitivity 41 to 63 percent; specificity 43 to 57 percent; accuracy 39 to 59 percent). Staging with FDG-PET alone shows greater sensitivity (79 to 84 percent) and specificity (89 to 91 percent), but in areas with granulomatous disease, the accuracy of PET is lower. Since integrated PET/CT provides morphologic and functional information, its diagnostic accuracy proves higher (sensitivity 61 percent; specificity 96 percent; accuracy 86 percent; positive predictive value 84 percent; negative predictive value 87 percent). For example, nodes that show high FDG uptake on PET, but high attenuation or calcification, have been shown to be benign in more than 90 percent of cases. The study showed that 27 percent of patients with NSCLC and 11 percent with nodal involvement by FDG had mediastinal nodal metastasis. PET/CT showed high negative predictive values, with 87 percent on a per-patient basis and 98 percent on a per-nodal station basis—translating to key diagnostic and therapeutic decision-making that patients with negative mediastinal nodes may undergo a curative surgical treatment without mediastinoscopy. Access article: http://www3.interscience.wiley.com/cgi-bin/ abstract/114124515/ABSTRACT?CRETRY=1&SRETRY=0 Time Course of Early response to Chemotherapy in nonSmall Cell lung Cancer Patients with F-FDG PET/CT Ñ J Nucl Med 2007; 48:744-751 FDG PET/CT can be used to monitor the early metabolic response to chemotherapy in patients with non-small cell lung cancer and thus predict success or failure of the New Clinical Practice Guidelines Clinical Practice Guidelines for the utilization of Positron Emission Tomography/Computed Tomography Imaging in Selected oncologic Applications: Suggestions from a Provider Group Mol Imaging Biol (2007) With the guidance of prior clinical studies and a 17-member multispecialty medical advisory board, a group led by Ken Manning of Trident Molecular Imaging in Lawrenceville, Ga., and Emory University Medical Center, has compiled clinical practice guidelines for using PET/CT to diagnose, stage, restage and monitor therapy of breast cancer, colorectal cancer, non-small cell lung cancer, solitary pulmonary nodule and lymphoma. The appropriateness guidelines just published last month identify critical steps in clinical workups and follow-up in a true outpatient clinical setting of a freestanding imaging center. National Comprehensive Cancer Network (NCCN) guidelines also are included as a baseline for clinical workups at various disease stages. The key clinical studies influencing the guidelines are those in which PET/CT improved detection accuracy and those leading to a change in patient management in more than 25 percent of the patients considered. therapy, according to a team lead by Claude Nahmias of the University of Tennessee. This retrospective study of 16 patients with inoperable NSCLC (who had not received chemotherapy or radiotherapy) found that a decrease of 0.5 standardized uptake value (SUV) between studies performed at one and three weeks after the start of chemotherapy is predictive of who will survive more than six months and in whom the chemotherapy was presumably successful. Seven patients died within six months of the end of the study. This group was classified as the non-responders. A second group of four patients survived between 30 and 76 weeks, and the other patients were monitored for up to 20 months. This was the responder group. The researchers found the greatest glucose metabolic response Lung cancer with mediastinal metastases at three or four weeks Beijing Hospital after start of chemotherapy—and once patients exhibited a metabolic response to treatment, their survival was significantly longer than that of non-responders, irrespective of subsequent treatment or disease progression. Thus, the study demonstrated that patients who respond to chemotherapy can be identified early during treatment, and these patients are most likely to have a better long-term survival. The study further suggests that a PET/CT study at the end of the first cycle of chemotherapy is sufficient to identify patients in whom therapy will fail. Access article: http://jnm.snmjournals.org/cgi/content/ abstract/48/5/744 Accuracy of PET/CT in Characterization of Solitary Pulmonary lesions Ñ J Nucl Med 2007; 48:214-220 Researchers from the David Geffen School of Medicine at the University of California in Los Angeles led by Shanna Kim have demonstrated that PET/CT can accurately classify solitary pulmonary nodules (SPNs) as benign or malignant. The retrospective study of 42 patients referred to UCLA for SPN characterization found that PET/CT correctly characterized 39 of the 42 lesions as malignant or benign. When measured against PET and CT, combined PET/CT is superior—with accuracy of 93 percent, sensitivity of 97 percent and specificity of 85 percent. In the study, there was one false-negative PET/CT result. The researchers point out that SPNs—of which about 150,000 are detected in the U.S. each year and 30 to 50 percent turn out to be malignant—tend to be over-diagnosed on CT alone and have an unnecessarily high resection rate. That is not so with PET/CT. Of the 42 lesions PET/CT detected, 50 percent were confirmed by biopsy and the remaining 50 percent were confirmed by resection specimens. Twenty-nine of the lesions were malignant, with 13 being benign. September 2007 To access the PET/CT guideline flow charts, visit: http://www.springerlink.com/content/w245243j8376275k 18 Molecular Imaging Insight http://www3.interscience.wiley.com/cgi-bin/abstract/114124515/ABSTRACT?CRETRY=1&SRETRY=0 http://www3.interscience.wiley.com/cgi-bin/abstract/114124515/ABSTRACT?CRETRY=1&SRETRY=0 http://jnm.snmjournals.org/cgi/content/abstract/48/5/744 http://jnm.snmjournals.org/cgi/content/abstract/48/5/744 http://www.springerlink.com/content/w245243j8376275k
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