AimWe evaluated whether Magnetic Resonance Imaging (MRI)-Derived T Stage independently predicts nodal disease on Prostate-Specific Membrane Antigen (PSMA) PET/CT in patients with high-risk primary prostate cancer, and developed a predictive model for clinical decision support.Materials and methodsMRI-derived T Stage, Prostate-Specific Antigen (PSA), Gleason score, age and PSMA node status were analysed using univariable and multivariable logistic regression in 152 men with high-risk primary prostate cancer who underwent pre-treatment multiparametric MRI and PSMA PET/CT. Model performance was assessed with area under the receiver operating characteristic (ROC) curve (AUC), calibration plots, and decision curve analysis. Subgroup analyses evaluated Gleason 3 + 4 and 4 + 3 disease separately.ResultsMRI T3b and T4 stages were independently and significantly associated with increased risk of PSMA-positive nodal disease (p < 0.001 and p = 0.016, respectively). T3a disease was not significantly independently associated with PSMA-positive nodal disease (p = 0.086). T3b remained an independent predictor even in Gleason 4 + 3 cases (p = 0.026; odds ratio ≈ 23.57). The final model (AUC = 0.863) was well-calibrated and demonstrated clinical net benefit on decision curve analysis. In our cohort, patients with PSA < 20 ng/mL, MRI-derived T2 disease, and Gleason score < 8 (including both 3 + 4 and 4 + 3 patterns) demonstrated a 0% rate of PSMA-positive nodal disease.ConclusionMRI-derived T stage T3b disease is a strong independent predictor of PSMA-positive nodal disease. These findings support guideline-based staging criteria and support the integration of MRI-derived T Stage into PSMA PET/CT triage workflows.

AIM:This study investigates the potential of positron emission tomography-computed tomography (PET-CT) as a reliable tool for the diagnosis of osteoporosis, using attenuation values as a marker for bone mineral density (BMD) assessment. MATERIALS AND METHODS:We retrospectively identified 305 patients who underwent both PET-CT and dual-energy X-ray absorptiometry (DEXA) within a six-month interval at a tertiary healthcare centre. Attenuation values were measured from the first lumbar vertebra (L1) on noncontrast CT images acquired during PET-CT scans. These values were then compared with corresponding DEXA T-scores to determine their diagnostic performance. Statistical analyses, including one-way Analysis of Variance (ANOVA), Pearson correlation, and receiver operating characteristic (ROC) curve analysis were employed to assess the correlation between PET-CT attenuation values and DEXA-defined osteoporosis. RESULTS:The mean Hounsfield units (HU) differed significantly between groups classified by DEXA as osteoporosis, osteopenia, or normal BMD (P < 0.001). A strong correlation was found between HU and DEXA T-scores (Pearson coefficient = 0.65). Using logistic regression, we identified HU thresholds of 120 for 90% sensitivity and 98 for 90% specificity. The optimal balanced threshold was 109 HU, achieving both 80% sensitivity and specificity. The ROC curve for the model showed an area under the curve (AUC) of 0.88, indicating high diagnostic accuracy. CONCLUSION:PET-CT can effectively screen for osteoporosis, offering a noninvasive, opportunistic diagnostic tool that requires no additional radiation exposure or resources. This study establishes 109 HU as the optimal threshold for diagnosing osteoporosis on PET-CT, providing a significant opportunity for early intervention and improved patient care.

Perineural tumour spread in head and neck cancer can be a challenging diagnosis for radiologists; head and neck anatomy is intimidating and perineural tumour spread can be subtle and difficult to detect. It results in significant morbidity for patients, can upstage disease and will frequently result in more prolonged treatment courses. This pictorial review provides a thorough examination of the imaging characteristics of perineural tumour spread in head and neck malignancy. It highlights key imaging features, from initial diagnosis to its post therapy appearance, emphasising the clinical relevance and role of imaging in post-therapy assessment. Multi-modality imaging examples are included with a focus on MRI and PET/CT. MRI features of perineural tumour spread include intermediate T2 signal expansion of a nerve, abnormal enhancement extending along a nerve, expansion of a skull or neural foramen and loss of normal fat planes surrounding nerve pathways. 18F-FDG PET/CT is a useful adjunct to MRI, perineural tumour spread results in abnormal FDG accumulation in a linear fashion anatomically spreading along a nerve pathway. Knowledge of these features and useful check areas will ensure that radiologists can be confident both making the diagnosis and in re-assessment post therapy.

Background The optimum curative approach to adenocarcinoma of the oesophagus and oesophagogastric junction is unknown. We aimed to compare trimodality therapy (preoperative radiotherapy with carboplatin plus paclitaxel [CROSS regimen]) with optimum contemporaneous perioperative chemotherapy regimens (epirubicin plus cisplatin or oxaliplatin plus fluorouracil or capecitabine [a modified MAGIC regimen] before 2018 and fluorouracil, leucovorin, oxaliplatin, and docetaxel [FLOT] subsequently).Methods Neo-AEGIS (CTRIAL-IE 10-14) was an open-label, randomised, phase 3 trial done at 24 centres in Europe. Patients aged 18 years or older with clinical tumour stage T2-3, nodal stage N0-3, and M0 adenocarcinoma of the oesophagus and oesophagogastric junction were randomly assigned to perioperative chemotherapy (three preoperative and three postoperative 3-week cycles of intravenous 50 mg/m(2) epirubicin on day 1 plus intravenous 60 mg/m(2) cisplatin or intravenous 130 mg/m2 oxaliplatin on day 1 plus continuous infusion of 200 mg/m(2) fluorouracil daily or oral 625 mg/m(2) capecitabine twice daily up to 2018, with four preoperative and four postoperative 2-week cycles of 2600 mg/m(2) fluorouracil, 85 mg/m2 oxaliplatin, 200 mg/m(2) leucovorin, and 50 mg/m(2) docetaxel intravenously on day 1 as an option from 2018) or trimodality therapy (41.4 Gy in 23 fractions on days 1-5, 8-12, 15-19, 22-26, and 29-31 with intravenous area under the curve 2 mg/mL per min carboplatin plus intravenous 50 mg/m(2) paclitaxel on days 1, 8, 15, 22, and 29). The primary endpoint was overall survival, assessed in all randomly assigned patients who received at least one dose of study drug, regardless of which study drug they received, by intention to treat. Secondary endpoints were disease-free survival, site of treatment failure, operative complications, toxicity, pathological response (complete [ypT0N0] and major [tumour regression grade 1 and 2]), margin-free resection (R0), and health-related quality of life. Toxicity and safety data were analysed in the safety population, defined as patients who took at least one dose of study drug, according to treatment actually received. The initial power calculation was based on superiority of trimodality therapy (n=366 patients); it was adjusted after FLOT became an option to a non-inferiority design with a margin of 5% for perioperative chemotherapy (n=540). This study is registered with ClinicalTrials.gov, NCT01726452.Findings Between Jan 24, 2013, and Dec 23, 2020, 377 patients were randomly assigned, of whom 362 were included in the intention-to treat population (327 [90%] male and 360 [99%] White): 184 in the perioperative chemotherapy group and 178 in the trimodality therapy group. The trial closed prematurely in December, 2020, after the second interim futility analysis (143 deaths), on the basis of similar survival metrics and the impact of the COVID-19 pandemic. At a median follow-up of 38 center dot 8 months (IQR 16.3-55.1), median overall survival was 48 center dot 0 months (95% CI 33.6-64.8) in the perioperative chemotherapy group and 49 center dot 2 months (34.8-74.4) in the trimodality therapy group (3-year overall survival 55% [95% CI 47-62] vs 57% [49-64]; hazard ratio 1.03 [95% CI 0.77-1.38]; log-rank p=0.82). Median disease-free survival was 32.4 months (95% CI 22.8-64.8) in the perioperative chemotherapy group and 24 center dot 0 months (18 center dot 0-40.8) in the trimodality therapy group [hazard ratio 0.89 [95% CI 0.68-1.17]; log-rank p=0.41). The pattern of recurrence, locoregional or systemic, was not significantly different (odds ratio 1.35 [95% CI 0.63-2.91], p=0.44). Pathological complete response (odds ratio 0.33 [95% CI 0.14-0.81], p=0.012), major pathological response (0.21 [0.12-0.38], p<0.0001), and R0 rates (0.21 [0.08-0.53], p=0.0003) favoured trimodality therapy. The most common grade 3-4 adverse event was neutropenia (49 [27%] of 183 patients in the perioperative chemotherapy group vs 11 [6%] of 178 patients in the trimodality therapy group), followed by diarrhoea (20 [11%] vs none), and pulmonary embolism (ten [5%] vs nine [5%]). One (1%) patient in the perioperative chemotherapy group and three (2%) patients in the trimodality therapy group died from serious adverse events, two (one in each group) of which were possibly related to treatment. No differences were seen in operative mortality (five [3%] deaths in the perioperative chemotherapy group vs four [2%] in the trimodality therapy group), major morbidity, or in global health status at 1 and 3 years.Interpretation Although underpowered and incomplete, Neo-AEGIS provides the largest comprehensive randomised dataset for patients with adenocarcinoma of the oesophagus and oesophagogastric junction treated with perioperative chemotherapy (predominantly the modified MAGIC regimen), and CROSS trimodality therapy, and reports similar 3-year survival and no major differences in operative and health-related quality of life outcomes. We suggest that these data support continued clinical equipoise.

Abstract Background While PET-CT is considered the gold standard imaging investigation in diagnosing esophageal cancer, its role in determining management is controversial. It demonstrates increased sensitivity for detection of occult M1 disease in comparison with endosonography or CT alone, however its accuracy in assessment of histopathologic response to neoadjuvant therapy is unclear. The aim of this study was to evaluate the clinical utility of PET-CT in staging, response evaluation and prognostication in esophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC). Methods Patients with esophageal cancer undergoing treatment with curative intent were studied prospectively. Baseline imaging (PET1) was carried out at diagnosis. Repeat scanning (PET2) was performed at 4 weeks post-completion of neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). Pathological complete response (pCR) was defined as TRG1, ypN0. Major pathologic response was defined as TRG1–2, ypN0. Metabolic complete response (mCR) was defined as absence of abnormal FDG uptake at the primary site, nodal sites or suspected metastatic sites. The association between 18F-FDG-uptake (SUVmax) and PET-predicted nodal status, histopathologic parameters and survival were determined using univariable and multivariable regression models. Results 730 patients were studied. PET identified CT-occult M1 disease in 2.9% and synchronous neoplasms in 1.4%. The relative reduction in SUVmax was greater among patients treated with nCRT compared with nCT (P = 0.021). SUVmax correlated with pT stage among patients treated with primary surgery (P < 0.001), however 32.3% with AC and 15.8% with SCC who were predicted node negative were pN+. Post neoadjuvant therapy, PET parameters showed modest associations with mCR, but no parameter accurately predicted pCR. Among patients with mCR, 90.9% with AC post-nCT, 84.1% with AC post-nCRT and 54.8% with SCC post-nCRT had residual disease. Lower preoperative SUVmax was independently associated with improved survival in AC, but not SCC. Conclusion PET-CT identifies CT-occult M1 disease or synchronous neoplasms in 4.3% at initial staging. PET-CT poorly predicts ypN status, particularly in AC. After neoadjuvant therapy, PET-CT is poorly predictive of histopathologic response—the majority of patients with an mCR have residual disease. Nonetheless, improvements in SUVmax may reflect a greater chance of achieving major pathologic response and more favourable long-term outcomes in AC.

Abstract Aim The role of PET-CT in oesophageal cancer is controversial. The aim of this study was to evaluate the utility of PET-CT in staging and response evaluation in oesophageal squamous cell carcinoma (SCC) and adenocarcinoma (AC). Method Patients undergoing curative-intent treatment were studied prospectively. PET1 was carried out at diagnosis and repeat scanning (PET2) was performed 2-4 weeks post-completion of neoadjuvant chemotherapy (nCT) or chemoradiation (nCRT). The association between PET parameters, histopathologic response and survival was determined using univariable and multivariable regression models. Results 730 consecutive patients were studied. PET identified CT-occult M1 disease in 2.9% and synchronous neoplasm in 1.4%. Similar PET1 SUVmax values were observed in AC and SCC. The reduction in SUVmax was greater post-nCRT versus nCT (P = 0.021). SUVmax correlated with pT stage among patients treated with primary surgery (P<0.001), however 32.3% with AC and 15.8% with SCC who were predicted node negative were pN+. Post neoadjuvant therapy, PET parameters showed modest associations with major pathologic response, but no parameter accurately predicted complete pathologic response. Among patients with a metabolic complete response (mCR), 90.9% with AC post-nCT, 84.1% with AC post-nCRT and 54.8% with SCC post-nCRT had residual disease. Lower preoperative SUVmax was independently associated with improved survival outcomes in AC, but not SCC. Conclusions PET-CT identified CT-occult M1 disease or synchronous neoplasms in 4.3% at initial staging. After neoadjuvant therapy, PET is poorly predictive of histopathologic response – most patients with an mCR have residual disease. Nonetheless, improvements in SUVmax may reflect a more favourable long-term outcome in AC.

Prostate cancer is the most common malignancy in men with high incidence of recurrence following treatment. Biochemical recurrence, as indicated by rising PSA levels following successful treatment of the primary disease, is a frequent encounter in routine clinical practice. 68Gallium-PSMA positron emission tomography/computer tomography has been widely accepted as the modality of choice with the highest impact in management of this group of patients. Pitfalls of this diagnostic technique stem from the diversity of histological entities, other than prostate tumour cells, which can demonstrate increased uptake of the radiotracer. We present a case of intracranial uptake of PSMA by meningioma in a patient with BCR, as a pitfall in imaging of prostate cancer. Knowledge of normal distribution of the tracer is of utmost importance when reading positron emission tomography/computer tomography imaging especially given the relative novelty of usage of 68Gallium-PSMA.

Prostate cancer is the most common malignancy in men with high incidence of recurrence following treatment. Biochemical recurrence, as indicated by rising PSA levels following successful treatment of the primary disease, is a frequent encounter in routine clinical practice. 68 Gallium-PSMA positron emission tomography/computer tomography has been widely accepted as the modality of choice with the highest impact in management of this group of patients. Pitfalls of this diagnostic technique stem from the diversity of histological entities, other than prostate tumour cells, which can demonstrate increased uptake of the radiotracer. We present a case of intracranial uptake of PSMA by meningioma in a patient with BCR, as a pitfall in imaging of prostate cancer. Knowledge of normal distribution of the tracer is of utmost importance when reading positron emission tomography/computer tomography imaging especially given the relative novelty of usage of 68 Gallium-PSMA. Keywords Nuclear medicine , radionuclide studies , gallium68 , PSMA PET/CT

ABSTRACT Bone is one of the most common sites of prostate cancer recurrence, and 68Ga-prostate-specific membrane antigen (PSMA) uptake by benign bone entities poses a diagnostic dilemma. We describe the case of a 60-year-old man with recurrence in a small presacral node on 68Ga-PSMA PET/CT. Of note, the images also demonstrated bilateral asymmetrical sacroiliac joint uptake. A history of ankylosing spondylitis was subsequently elicited, confirming the radiographic suspicion of sacroiliitis, therefore confirming the nonmalignant nature of 68Ga-PSMA uptake related to sacroiliitis rather than osseous recurrence from prostate carcinoma. 68Ga-PSMA uptake may indicate angioneogenesis in sacroiliitis and consequently may be helpful in assessing disease activity and therapy response.

Prostate cancer is the most common malignancy in men with high incidence of recurrence following treatment. Biochemical recurrence, as indicated by rising PSA levels following successful treatment of the primary disease, is a frequent encounter in routine clinical practice. 68 Gallium-PSMA positron emission tomography/computer tomography has been widely accepted as the modality of choice with the highest impact in management of this group of patients. Pitfalls of this diagnostic technique stem from the diversity of histological entities, other than prostate tumour cells, which can demonstrate increased uptake of the radiotracer. We present a case of intracranial uptake of PSMA by meningioma in a patient with BCR, as a pitfall in imaging of prostate cancer. Knowledge of normal distribution of the tracer is of utmost importance when reading positron emission tomography/computer tomography imaging especially given the relative novelty of usage of 68 Gallium-PSMA.

Purpose: To determine the diagnostic accuracy and optimum cut-off value of SUVmax on PET to predict malignancy of supraclavicular lymph nodes (SCLNs) in patients with oesophageal carcinoma. Material and methods: All diagnosed cases of oesophageal cancer were retrospectively reviewed (2010-2016). Patients that had a confirmed diagnosis of oesophageal cancer with avid SCLNs on staging PET were included in the study. 33 SCLNs that subsequently underwent ultrasound guided biopsy for staging were analysed. The maximum uptake values (SUVmax) of the SCLNs and primary tumours were measured. A receiver operating characteristic (ROC) analysis was performed to determine the optimum cut off of SUVmax in predicting malignancy. Results: 24/33 PET-detected SCLNs were malignant. ROC analysis identified the best nodal SUVmax cut-off to be 3.0. The diagnostic accuracy of PET was 76.0 % (sensitivity = 78.9 %, specificity = 66.6 %). For SCLNs with SUVmax > 3.0, PET showed a positive predictor value of 88.2 %; for SCLNs < 3.0, PET showed a negative predictor value of 50 %. The median SUVmax of pathologically negative and positive nodes were 2.8 (range 1.8-6.0) and 5.3 (range 1.9-13.4). The median primary tumour SUVmax was 13.8 (range 3.7-30.0). The SUVmax of metastatic lymph nodes were significant higher than those of benign lesions (p < 0.05). Conclusion: Our study revealed an accuracy rate of 76 % for PET detected SCLNs in patients with oesophageal carcinoma. For SCLNs with SUVmax > 3.0, PET had a high PPV (88 %), which can minimize the need for further diagnostic tests.

Chest radiography (CXR) is commonly performed in rheumatoid arthritis (RA), particularly for the diagnosis of pulmonary disease. However, other structures are visible on CXR, abnormalities of which may contribute to morbidity and early mortality. This study was undertaken to evaluate the extent of CXR abnormalities in RA patients. Consecutive out-patients meeting the 2010 ACR/EULAR classification criteria for RA were included. The most recent CXR was assessed by two independent reviewers. Abnormalities identified were recorded and compared to the formal CXR report. Predictors of abnormalities on CXR were assessed using chi-squared tests. SPSS 18.0 was used for statistical analysis. One hundred and ninety-eight patients were included. Mean age was 62 years (range 18–90). One hundred and nine (55.1%) were current or ex-smokers. One hundred and fifty-six (79%) patients were seropositive and 123 (62.1%) had joint erosions. A recent CXR was available in 163 (82%) cases. Abnormalities were identified in 129 (79.1%). Ninety-seven (60%) had bony abnormalities. Seventy-one (43.6%) had pulmonary abnormalities; old tuberculosis in 34 (20.9%), hyperinflation in 24 (14.7%), interstitial changes in 20 (13.3%), nodules in 4 (2.4%), consolidation in 2 (1.2%), and pneumothorax in 1 (0.6%). Cardiomegaly was identified in 37 (22.7%) and aortic calcification in 24 (14.7%). Age (p = 0.001), male gender (p = 0.01), and seropositivity (p = 0.04) were significantly associated with lung abnormalities. Cardiomegaly was associated with hypertension (p = 0.012) and ischaemic heart disease (p = 0.018). Abnormalities were identified in 79% of chest radiographs in RA patients. Sixty-six percent of these were not reported. Clinicians need to be aware of the need to check for abnormalities.

Positron Emission Tomography (PET) is a functional imaging modality widely used in clinical oncology. Over the years the sensitivity and specificity of PET has improved with the advent of specific radiotracers, increased technical accuracy of PET scanners and incremental experience of Radiologists. However, significant limitations exist-most notably false positives and false negatives. Additionally, the accuracy of PET varies between cancer types and in some cancers, is no longer considered a standard imaging modality. This review considers the relative influence of macroscopic tumour features such as size and morphology on 2-Deoxy-2-[18F]fluoroglucose ([18F]FDG) uptake by tumours which, though well described in the literature, lacks a comprehensive assessment of biomolecular features which may influence [18F]FDG uptake. The review aims to discuss the potential influence of individual molecular markers of glucose transport, glycolysis, hypoxia and angiogenesis in addition to the relationships between these key cellular processes and their influence on [18F]FDG uptake. Finally, the potential role for biomolecular profiling of individual tumours to predict positivity on PET imaging is discussed to enhance accuracy and clinical utility.

Intra-articular melanoma metastases are rare. We present a case of a 65-year-old woman with metastatic melanoma in the right ankle joint. F-FDG PET/CT was performed from the vertex to the toes, which demonstrated FDG-avid inguinal lymphadenopathy and an intensely FDG-avid soft tissue mass adjacent to the neck of the talus within the right ankle joint. The intra-articular mass was subsequently resected and histologically confirmed as metastatic melanoma. This case emphasizes the value of the contemporaneous CT in these studies for accurate anatomical localization in diagnostically challenging clinical scenarios.

To determine the correlation between F-18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT) derived esophageal tumor parameters [maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV)] and endoscopic ultrasound (EUS) derived tumor parameters (T stage, N stage) and their prognostic implications. 150 consecutive patients with cancer of the esophagus or esophagogastric junction underwent staging PET-CT and staging EUS. PET-CT derived SUVmax and MTV of the primary tumor was recorded. EUS evaluated T and N stage. Relationships between parameters were investigated using the Mann-Whitney U tests, survival analysis performed using Kaplan-Meier and independent prognostic factors determined using Cox regression multivariate analysis. A significant difference in MTV was noted between EUS T1/T2 tumors (median 6.7 cm(3)) and EUS T3/T4 tumors (median 35.7 cm(3); P < 0.0001). An MTV of <23.4 cm(3) (P = 0.0001), SUVmax < 4.1 (P = 0014), EUS T stage (P < 0.0001), EUS N stage (P < 0.0001), and clinical stage (P < 0.0001) were all significantly associated with survival, with MTV <23.4 cm(3) (P = 0.004), EUS T stage (P = 0.01), and EUS N stage (P= 0.01) significant in multivariate analysis. MTV, a volumetric parameter of PET-CT, has more prognostic importance than SUVmax and provides valuable prognostic information in esophageal and junctional cancer, along with EUS T and N stage. MTV provides complementary information to EUS and should be included in the staging of esophageal and junctional cancer.

BACKGROUND:Positron emission tomography and computed tomography (PET-CT) is established in the staging of esophageal cancer. In this study, an MRI protocol was designed to emulate the anatomical (T1-weighed (T1W) and T2W imaging) and functional information (diffusion-weighted imaging) provided by PET-CT.METHODS:In all, 49 patients with carcinoma of the esophagus underwent PET-CT and whole-body MRI (WBMRI). WBMRI was carried out using dedicated sequences tailored to detect metastatic disease at each area corresponding to the anatomical coverage of PET-CT. Nodal status was determined from histopathology and endoscopic ultrasound biopsy (EUS).RESULTS:PET-CT and WBMRI identified the primary tumor in 46/49 (94%) and 48/49 (98%) patients, respectively. Nodal analysis in patients undergoing surgery (n = 18) yielded sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy of 27, 100, 100, 47 and 56% for PET-CT, compared with 30, 100, 100, 53 and 61% for WBMRI. When nodal analysis included both surgical specimens and EUS criteria (n = 39), sensitivity, specificity, PPV, NPV and accuracy were 46, 91, 93, 40 and 59% for PET-CT compared with 59, 92, 94, 50 and 67% for WBMRI. Both imaging modalities identified distant metastases in 2 patients.CONCLUSION:WBMRI has similar accuracy to PET-CT in detecting the primary tumor, nodal deposits and for exclusion of systemic metastatic disease.

s(N = 51), significantly shorter progression free survival (PFS) [median (month): 2.6 vs. 7.7; hazard ration (HR): 0.25; 95% confidence interval (CI): 0.12-0.525;P = 0.0003] were observed in CRCs with at least one mutation of KRAS, BRAF, PIK3CA, and NRAS (N = 17); however, no significant difference in overall survival (OS) (P = 0.93) was observed between them.High miR-31 expression was significantly associated with shorter PFS [median (month): 2.6 vs. 6.2;HR: 0.36; 95% CI: 0.17-0.69;P = 0.004] and OS [median (month): 4.7 vs. 11.2;HR: 0.49; 95% CI: 0.27-0.94;P = 0.034], respectively.In contrast, none of other miRNAs was associated with the efficacy of anti-EGFR therapy in metastatic CRC.Conclusion: High miR-31 expression was related with the resistance to anti-EGFR agents among patients with CRC.This association was more significant compared with combination analysis of gene mutations in the EGFR downstream pathway.Thus, our data suggest that miR-31 may be a useful biomarker for anti-EGFR therapy in metastatic CRC.

PURPOSE:To assess the clinical benefit of 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography (18F-FDG-PET/CT) in evaluating pelvic lymph nodes in patients with early stage cervical cancer (FIGO stage 1a–1b1), who have magnetic resonance imaging (MRI)-defined lymph node negative disease, with histopathologic results as the reference standard.MATERIALS AND METHODS:We assessed one hundred and seventy nine sequential 18F-FDG-PET/CT scans in women with newly diagnosed cervical carcinoma between January 2009 and September 2011. 47 of these patients had early stage disease (FIGO stage 1a–1b1) with no suspicious lymph nodes on MRI. 18F-FDG-PET/CT images were analyzed and histopathological findings (pelvic lymph node resection) served as the reference standard.RESULTS:The median age of patients was 48 (range 22–86) years. 66 % had squamous histotype. Median number of nodes dissected per patient was 21 (range 8–47), 2 of 47 patients had nodal metastases (4.25 %). All patients in this group had no suspicious lymph nodes on 18F-FDG-PET/CT. Overall patient based sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 18F-FDG-PET/CT for detection of nodal disease were 0 %, 100 %, 0 %, 96 %, and 96 % respectively.CONCLUSION:Pathologic validation of 18F-FDG-PET/CT imaging demonstrates little value for 18F-FDG-PET/CT in patients with early stage (FIGO stage 1a–1b1) MRI-defined lymph node negative cervical carcinoma. Since the likelihood of metastatic nodal disease is very low in women with stage 1a–1b1 cervical cancer, we believe that 18F-FDG-PET/CT should not have a role in the routine pre-treatment evaluation of these women.