Objective: Definitive staging for cervical (CC) and endometrial cancer (EC) takes place once surgery is performed. The aim of this study was to evaluate the role of PET/CT in detecting lymphatic metastasis in patients with CC and EC using dual-time-point imaging (DPI), taking the histopathological results of sentinel lymph node (SLN) and lymphadenectomy as the reference.Material and methods: A prospective study was conducted on 17 patients with early CC, and 13 patients with high-risk EC. The patients had a pre-operative PET/CT, MRI, SLN detection, and lymphadenectomy, when indicated. PET/CT findings were compared with histopathological results.Results: In the pathology study, 4 patients with CC and 4 patients with EC had lymphatic metastasis. PET/CT showed hypermetabolic nodes in 1 patient with CC, and 5 with EC. Four of these had metastasis, one detected in the SLN biopsy. Four patients who had negative PET/CT had micrometastasis in the SLN biopsy, 1 patient with additional lymph nodes involvement. The overall patient-based sensitivity, specificity, positive and negative predictive values, and accuracy of PET/CT to detect lymphatic metastasis was 20.0%, 100.0%, 100.0%, 87.9%, and 88.2%, respectively, in CC, and 57.1%, 88.9%, 66.7%, 84.2% and 80.0%, respectively, in EC. DPI showed higher retention index in malignant than in inflammatory nodes, although no statistically significant differences were found.Conclusions: PET/CT has low sensitivity in lymph node staging of CC and EC, owing to the lack of detection of micrometastasis. Thus, PET/CT cannot replace SLN biopsy. Although no statistically significant differences were found, DPI may help to differentiate between inflammatory and malignant nodes. (C) 2016 Elsevier Espana, S.L.U. y SEMNIM. All rights reserved.

Objective: Metabolic tumour volume (MTV) and total lesion glycolysis (TLG) from F-18-FDG PET/CT are emerging prognostic biomarlcers in various solid neoplasms. These volumetric parameters and the SUVmax have shown to be useful criteria for disease prognostication in preoperative and post-treatment epithelial ovarian cancer (EOC) patients. The purpose of this study was to evaluate the utility of F-18-FDG PET/CT measurements to predict survival in patients with recurrent EOC.Material and methods: Twenty-six patients with EOC who underwent a total of 31 F-18-FDG PET/CT studies for suspected recurrence were retrospectively included. SUVmax and volumetric parameters whole-body MTV (wbMTV) and whole-body TLG (wbTLG) with a threshold of 40% and 50% of the SUVmax were obtained. Correlation between PET parameters and progression-free survival (PFS) and the survival analysis of prognostic factors were calculated.Results: Serous cancer was the most common histological subtype (76.9%). The median PFS was 12.5 months (range 10.7-20.6 months). Volumetric parameters showed moderate inverse correlation with PFS but there was no significant correlation in the case of SUVmax. The correlation was stronger for first recurrences. By Kaplan-Meier analysis and log-rank test, wbMTV 40%, wbMTV 50% and wbTLG 50% correlated with PFS. However, SUVmax and wbTLG 40% were not statistically significant predictors for PFS.Conclusion: Volumetric parameters wbMTV and wbTLG 50% measured by F-18-FDG PET/CT appear to be useful prognostic predictors of outcome and may provide valuable information to individualize treatment strategies in patients with recurrent EOC. (C) 2015 Elsevier Espana, S.L.U. and SEMNIM. All rights reserved.

To evaluate the impact of the angioscintigrapy of the three phase bone scan as screening method to rule out infection of the hip and knee prosthesis prior to performing the (99m)Tc-HMPAO leukocyte scintigraphy.A total of 120 (70 women, 50 men; mean age 71±11years) with clinical suspicion of hip (n=63) or knee (n=57) infection of the prosthesis and clinical suspicion of infection were evaluated prospectively. All patients underwent three-phase bone scan (angioscintigraphy, vascular and bone phase) and (99m)Tc-HMPAO-labelled white blood cell scintigraphy. Final diagnosis of infection was made by microbiological documentation or clinical follow-up for at least 12months.Eighteen out of 120 patients were diagnosed of infection of hip prosthesis (n=10) or knee prosthesis (n=8). The angioscintigraphy was positive in 15/18 infected cases and in 21/102 of the non-infected cases with a sensitivity of 83%, specificity of 79% and negative predictive value of 97%. Sensitivity and specificity of (99m)Tc-HMPAO leukocyte scintigraphy were 72% and 95%, respectively. If the leukocyte labeled scintigraphies had been used exclusively for patients with positive angioscintigraphy, this would have saved up to 70% of the (99m)Tc-HMPAO leukocyte scintigraphies performed. There were no cases of infection with positive labeled leukocyte scintigraphy and negative angioscintigraphy.Angioscintigraphy (blood flow phase of bone scan) is a useful technique for screening for hip and knee joint prosthesis infection, significantly reducing the need for (99m)Tc-HMPAO leukocyte scintigraphy without affecting the sensitivity of the technique.

Aim: To evaluate the impact of the angioscintigrapy of the three phase bone scan as screening method to rule out infection of the hip and knee prosthesis prior to performing the Tc-99m-HMPAO leukocyte scintigraphy.Material and methods: A total of 120 (70 women, 50 men; mean age 71 +/- 11 years) with clinical suspicion of hip (n = 63) or knee (n = 57) infection of the prosthesis and clinical suspicion of infection were evaluated prospectively. All patients underwent three-phase bone scan (angioscintigraphy, vascular and bone phase) and Tc-99m-HMPAO-labelled white blood cell scintigraphy. Final diagnosis of infection was made by microbiological documentation or clinical follow-up for at least 12 months.Results: Eighteen out of 120 patients were diagnosed of infection of hip prosthesis (n = 10) or knee prosthesis (n = 8). The angioscintigraphy was positive in 15/18 infected cases and in 21/102 of the non-infected cases with a sensitivity of 83%, specificity of 79% and negative predictive value of 97%. Sensitivity and specificity of Tc-99m-HMPAO leukocyte scintigraphy were 72% and 95%, respectively. If the leukocyte labeled scintigraphies had been used exclusively for patients with positive angioscintigraphy, this would have saved up to 70% of the Tc-99m-HMPAO leukocyte scintigraphies performed.Conclusion: Angioscintigraphy (blood flow phase of bone scan) is a useful technique for screening for hip and knee joint prosthesis infection, significantly reducing the need for Tc-99m-HMPAO leukocyte scintigraphy without affecting the sensitivity of the technique. (c) 2014 Elsevier Espana, S.L.U. and SEMNIM. All rights reserved.

The use of sentinel lymph node biopsy in squamous cell carcinoma of the oral cavity is still subject to debate although some studies have reported its feasibility. The main reason for this debate is probably due to the high false-negative rate for floor-of-mouth tumors per se. We report the case of a 54-year-old man with a T1N0 floor-of-mouth squamous cell carcinoma who underwent the sentinel lymph node procedure. Lymphoscintigraphy and SPECT/CT imaging were performed for lymphatic mapping with a conventional gamma camera. Sentinel lymph nodes were identified at right Ib, left IIa and Ia levels. However, these sentinel lymph nodes were difficult to detect intraoperatively with a gamma probe owing to the activity originating from the injection site. The use of a portable gamma camera made it possible to localize and excise all the sentinel lymph nodes. This case demonstrates the usefulness of this tool to improve sentinel lymph node detecting in floor-of-mouth tumors, especially those close to the injection area.

This study is aimed to determine the capacity and clinical impact of the 18F-FDG-PET to detect previously unsuspected second primary tumors.This is a retrospective cross-sectional study of 1984 consecutive scans performed between March 2004 and March 2005, identifying those studies that had reported the presence of hypermetabolic lesions, that had not been previously suspected or detected and that could be suggestive of second primary tumors. Diagnosis was made histopathologically or by clinical and radiological follow-up for a period exceeding one year.62 findings suggestive of second primary tumors were detected in 58 patients (3.1%). The reasons for the study for this group of patients were diverse, the most common being the differential diagnosis of solitary pulmonary nodules. A total of 43.5% of lesions were not followed-up. We confirmed the existence of 35 lesions, either by pathology study (21 lesions, 13 second primary tumors, the incidence in our population was 0.65%) or clinical and radiological follow-up (14 lesions, none of which corresponded to second primary tumors). The total clinical impact was the discovery of unexpected 14 lesions in 12 patients.The presence of second primary tumors on 18F-FDG-PET is relatively common. These lesions should be monitored clinically for accurate diagnosis. In a high percentage, they correspond to unexpected second primary tumors in an early stage and therefore amenable to curative treatment or for which tumor treatment planning may be modified.Evaluar la capacidad e impacto clínico de la PET-18F-FDG en el diagnóstico de segundos tumores primarios malignos inesperados.Estudio retrospectivo transversal descriptivo de 1.984 exploraciones PET-18F-FDG consecutivas realizadas entre marzo de 2004 y marzo de 2005, identificándose aquellos estudios en los que se había informado de la presencia de lesiones hipermetabólicas, no sospechadas ni detectadas previamente y que pudiesen ser sugestivas de segundos tumores primarios. Se obtuvo un diagnóstico histopatológico o mediante seguimiento clínico-radiológico durante un período de tiempo superior a un año.Se detectaron 62 hallazgos sugestivos de incidentalomas en 58 pacientes (3,1%). Los motivos de indicación en este grupo de pacientes fueron diversos siendo los más frecuentes el diagnóstico diferencial de benignidad vs malignidad de nódulos pulmonares solitarios. Un 43,5% de las lesiones no tuvieron seguimiento. Se confirmó la existencia de 35 lesiones, bien mediante estudio anatomopatológico (21 lesiones, 13 incidentalomas, la incidencia en nuestra población fue del 0,65%) o por seguimiento clínico-radiológico (14 lesiones, ninguna de ellas correspondió a segundos tumores primarios). El impacto clínico total fue el hallazgo de 14 lesiones no esperadas en 12 pacientes.La presencia de incidentalomas en la PET-18F-FDG es relativamente frecuente. Estas lesiones deben ser objeto de seguimiento clínico para su diagnóstico exacto. En un alto porcentaje se corresponden con segundos tumores primarios inesperados en fase incipiente y, por lo tanto, susceptibles de tratamiento curativo o que pueden modificar la planificación del tratamiento del tumor ya conocido.

Juvenile recurrent respiratory papillomatosis (JRRP) is an infectious disease caused by the growth of papillomas in the airway. Up to 4% of these cases degenerate into squamous cell carcinoma. We present the case of a 17-year-old female patient with JRRP in which the utility of F-18-FDG-PET/CT in the characterization of suspicious papillomatous lesions of malignancy is evaluated. Morphometabolic techniques, CT scan and PET/CT scans were suggestive of malignancy. However, this was not confirmed in the histopathological analysis after its resection.The F-18-FDG-PET/CT does not seem to be a useful tool for early detection of malignancy in JRRP. However, it does increase the diagnostic accuracy of the biopsy as it identifies the most active lesions and, therefore, those most likely to be malignant. (C) 2012 Elsevier Espana, S.L. and SEMNIM. All rights reserved.