Purpose: The estimated prevalence of cryptorchidism in young males is close to 2%. In oncological PET/CT studies, it might be difficult to recognize false-positive (18)FDG uptake due to an ectopic testis.Materials and methods: In this pilot study, we report on three patients with lymphoma referred for assessment of response to treatment and in whom cryptorchidism was not known at the time of (18)FDG-PET/CT imaging.Results: In each of these patients, moderate (18)FDG uptake corresponding to an ovoid mass in the inguinal canal was (or could has been) misinterpreted as a lymphoma-involved inguinal lymph node. Clues to avoid misinterpretation are discussed.Conclusion: Moderate (18)FDG uptake in ectopic testes represents a potential source of false-positive at initial staging or evaluation of therapeutic response of lymphomas and other malignancies that needs to be recognized. (C) 2013 Elsevier Masson SAS. All rights reserved.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (<= 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations. triangle

We report a case of hepatosplenic candidiasis imaged with F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT). A 22-year-old man receiving treatment for acute myeloid leukemia presented with fever. Hepatosplenic candidiasis was diagnosed based on the presence of hepatosplenic micro abscesses on CT. Fever persisted in spite of fluconazole treatment. F-18 FDG PET/CT scan was performed to rule out persistent hepatosplenic infection or other organ involvement. PET showed multiple intense uptake foci throughout the liver and spleen. The fungicidal drug was changed. The patient improved. We conclude that it would be interesting to investigate the use of F-18 FDG PET/CT in the work-up of systemic candidiasis.

INTRODUCTION:Although the prognosis of patients with esophageal cancer has been improved by extended dissection, the incidence of recurrence still remains high. In esophageal cancer, positron emission tomography (PET) using (18)F-fluorodeoxyglucose (FDG) already demonstrated to be useful for initial staging and monitoring response to therapy. This prospective study compared the ability of FDG-PET and conventional imaging to detect early recurrence of esophageal cancer after initial surgery in asymptomatic patients.MATERIALS AND METHODS:Between October 2003 and September 2006, 41 patients with esophageal cancer were included in a prospective study after initial radical esophagectomy. FDG-PET, thoracoabdominal computed tomography (CT), abdominal ultrasonography, and endoscopy were performed every 6 months after initial treatment.RESULTS AND DISCUSSION:Twenty-three patients had recurrent disease (56%), mostly within the first 6 months after surgery (70%). Despite two false-positive scans due to postoperative changes, FDG-PET was more accurate than CT (91% vs. 81%, p = 0.02) for the detection of recurrence with a sensitivity of 100% (vs. 65%), a specificity of 85% (vs. 91%), and a negative predictive value of 100% on a patient-by-patient-based analysis. For the detection of locoregional recurrence, FDG-PET was more accurate than CT (96.2% vs. 88.9%). FDG-PET was also more accurate than CT for the detection of distant metastases (92.5% vs. 84.9%), especially when involving either bones (100%) or liver (98.1%). A lower sensitivity of FDG-PET (57%) for the early detection of small lung metastases did not affect patient management (accuracy = 92.5%).CONCLUSION:FDG-PET appears to be very useful for the systematic follow-up of asymptomatic patients after esophagectomy with an initial scan performed 6 months after surgery.

The authors discuss the various roles of 18F-FDG PET/CT in the management of breast cancer. Roles of new tracers such as F-18 fluoro-L-thymidine (a marker of cell proliferation), 18-fluoro-17-B-estradiol (marker of estrogen receptor) and sodium fluoride (marker of bone matrix) are also mentioned. There is little justification for the use of FDG-PET/CT in patient with clinically T1 (< or = 2 cm) N0 tumours. Notably, it cannot be used as a substitute to SLNB "sentinel lymph node biopsy" for axillary staging due to limited sensitivity for the detection of small metastases. The case is different in higher risk patients, and especially so in patients with locally advanced disease. FDG-PET/CT in these patients might depict lymph node involvement in the level III of Berg or in supraclavicular or internal mammary basins. It might also uncover occult distant metastases, notably, early osteomedullary infiltration. Thus, for these tumors, initial PET/CT can enable better intramodality treatment planning or a change in treatment. PET/CT as a whole-body examination is also very efficient in case of suspicion of recurrence. On the other hand, many studies show that this functional imaging could be used to assess early response to neoadjuvant chemotherapy or to chemotherapy of metastatic disease. 18FDG-PET/CT could thus become an unavoidable modality to answer various clinical situations.

As compared to conventional axillary dissection, the sentinel node technique is accompanied by reduced morbidity and shorter hospital stay. Based on available data, the use of this technique does not seem to yield higher rates of axillary recurrence. A combination of both radioisotope detection and blue dye increases the identification rate, while also reducing false-negative rate. Surgical results are optimized when preoperative lymphoscintigraphy mapping is obtained in addition to peroperative probe detection. Considering the site of injection, the subareolar injection can be easy to apply even in case of non-palpable tumours, and gives higher count rates. However, the intraparenchymal, peritumoral, injection is necessary to evidence cases of extra-axillary drainage (internal mammary, infra- or supraclavicular) that is present in about 20% of patients. With the advent of hybrid cameras (SPECT-CT), the topography of these extra-axillary nodes can be given with high precision. Use of the sentinel node technique has been accompanied by an increase in the percent of patients with node involvement, due to an increased detection of micrometastases inferior or equal to 2 mm. Following an overview of basic principles, and of the main results with the sentinel node technique we focus the discussion on several points that are still open to debate, such as: 1) which group of patients can benefit from the sentinel node technique? 2) What is the optimal methodology? 3) What is the prognostic significance of micrometastases and of isolated tumour cells? 4) What attention should be given to extra-axillary drainage?

Après une courte introduction rappelant l’intérêt du ciblage de l’hypoxie tumorale, les progrès sur la compréhension des mécanismes mis en jeu à l’échelon cellulaire sont décrits, en insistant sur le rôle clé du facteur induit par l’hypoxie-HIF-1α, ainsi que ses liens avec l’angiogenèse, les différentes méthodes d’exploration de l’hypoxie sont rapidement passées en revue. Les traceurs confirmés en tomographie par émission de positons (18F-fluoromisonidazole et 18F-fluoroérythronitroimidazole) sont brièvement rappelés. Les récentes publications sur deux nouveaux traceurs prometteurs, le Cu(II)-diacétyl-bis(N(4)-méthylthiosemicarbazone) et le AZA marqué au 18F sont présentées et l’intérêt de ces traceurs est discuté.

Le pronostic du cancer de l’œsophage dépend essentiellement du stade initial de la maladie. Nos objectifs ont été d’évaluer la valeur pronostique de la TEP réalisée dans le bilan initial de ce cancer et notamment d’étudier le lien entre la survie globale et l’intensité de fixation du FDG au niveau de la tumeur primitive d’une part, et la présence d’adénopathies et de métastases visibles en TEP d’autre part. Cinquante-deux patients porteurs d’un cancer de l’œsophage ayant bénéficié d’une TEP au FDG dans leur bilan d’extension initial ont été inclus. Le SUVmaximum (SUVmax) a été mesuré pour chaque lésion primitive et nous avons noté la présence éventuelle d’adénopathies et de métastases. La survie globale a été étudiée en utilisant la méthode de Kaplan-Meier. La valeur pronostique des données de la TEP a été déterminée par une analyse de régression de Cox. Une chirurgie à visée curative a été proposée à la moitié des patients (52 %). La chirurgie, un SUVmax supérieur à 9, la présence d’au moins deux anomalies en TEP et la présence de ganglions fixant le FDG se sont avérés être des facteurs pronostiques de la survie globale en analyse univariée. En analyse multivariée, seul un SUVmax supérieur à 9 et la présence de ganglions fixant le FDG étaient des facteurs pronostiques péjoratifs indépendants. Cette étude prospective montre que la TEP au FDG apporte des informations pronostiques, ce qui peut apporter une nouvelle raison d’inclure cet examen dans le bilan d’extension initial des cancers de l’œsophage.

Le cancer de l’œsophage est au 3e rang des cancers digestifs en France. Son pronostic est sombre. Nous avons étudié l’intérêt de la TEP au 18FDG pour détecter les récidives et nous avons comparé nos résultats à ceux de la TDM. Quarante et un patients opérés d’un cancer de l’œsophage ont été suivis. Ces patients ont bénéficié d’une TEP-TDM au 18FDG 6, 12, 18 mois après chirurgie ainsi que d’une TDM. La sensibilité, la spécificité, l’exactitude respectives de ces 2 examens pour détecter les récidives ont été comparées. La sensibilité, la spécificité, l’exactitude étaient pour la TEP de 100 %, 85,3 %, 90,7 % et pour la TDM de 72,2 %, 91,7 %, 85,2 %. La TEP était plus sensible pour détecter les métastases hépatiques, osseuses, surrénaliennes avec une spécificité comparable. La TDM était plus sensible en cas de métastases pulmonaires infracentimétriques. La TEP était plus sensible que la TDM pour détecter les récidives avec une spécificité comparable à celle de la TDM. La VPN de la TEP est excellente (100 %), une TEP normale éliminant une récidive.

This study evaluated the incidence of de novo bone metastasis across all primary cancer sites and their impact on survival by primary cancer site, age, race, and sex.Our objectives were (I) characterize the epidemiology of de novo bone metastasis with respect to patient demographics, (II) characterize the incidence by primary site, age, and sex (2010–2015), and (III) compare survival of de novo metastatic cancer patients with and without bone metastasis.This is a retrospective, population-based study using nationally representative data from the Surveillance, Epidemiology, and End Results program, 2010–2015. Incidence rates by year of diagnosis, annual percentage changes, Kaplan-Meier, univariate and multiple Cox regression models are included in the analysis.Of patients with cancer in the SEER database, 5.1% were diagnosed with metastasis to bone, equaling ~18.8 per 100,000 bone metastasis diagnoses in the US per year (2010–2015). For adults >25, lung cancer is the most common primary site (2015 rate: 8.7 per 100,000) with de novo bone metastases, then prostate and breast primaries (2015 rates: 3.19 and 2.38 per 100,000, respectively). For patients <20 years old, endocrine cancers and soft tissue sarcomas are the most common primaries. Incidence is increasing for prostate (Annual Percentage Change (APC) = 4.6%, P < 0.001) and stomach (APC = 5.0%, P = 0.001) cancers. The presence of de novo bone metastasis was associated with a limited reduction in overall survival (HR = 1.02, 95%, CI = [1.01–1.03], p < 0.001) when compared to patients with other non-bone metastases.The presence of bone metastasis versus metastasis to other sites has disease site-specific impact on survival. The incidence of de novo bone metastasis varies by age, sex, and primary disease site.

Esophageal cancer outcome greatly depends on pathological stage. Our objectives were to assess prognosis based on the initial FDG PET scan, focusing on correlation between overall survival and FDG uptake in the primary, as well as the presence of FDG positive lymph nodes or metastases. Fifty-two esophageal cancer patients undergoing FDG PETas part of initial routine staging procedure before treatment were included. The maximum standardized uptake value (SUVmax) was determined in each primary lesion and the number of abnormalities including primary, lymph nodes or distant metastases was recorded. Correlation with overall survival was performed using the Kaplan-Meier method and Cox regression analysis was used to assess the prognostic value of PET parameters. Half of the patients were planned for initial curative surgery (52%). Using univariate survival analysis, either surgery, SUVmax superior than 9, two or more PET abnormalities, or the presence of FDG positive nodes were significant overall survival prognostic predictors. After multivariate analysis, only SUVmax superior than 9 and FDG positive lymph nodes were found as independent predictors of poor outcome. In this prospective study FDG PET was found to provide prognostic information supporting a new indication for initial FDG PET examination in esophageal cancer. (C) 2008 Elsevier Masson SAS. All rights reserved.