Patrick Paulus - Academia.edu (original) (raw)
Papers by Patrick Paulus
Annals of Hematology, 2001
Accurate staging is essential in order to determine appropriate treatment in Hodgkin&... more Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy.
European journal of nuclear medicine, Feb 1, 1996
Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG up... more Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has been proven useful to differentiate malignant from benign tissue. We undertook a prospective study in 61 patients to compare the accuracy of whole-body FDG PET and conventional imaging (CI) methods for the staging of nonsmall-cell lung cancer (NSCLC). CI included chest and abdomen computed tomographic scanning and bone scintigraphy. When CI or PET study suggested metastatic disease, confirmation was obtained by biopsy or clinicai or radiological follow-up. As compared to CI, PET correctly changed the N stage in 13 patients (21%) and the M stage in six patients (10%). There were three false-positive and no false-negative distant PET findings. Our preliminary results show that whole-body FDG PET can improve the diagnostic accuracy in the staging of NSCLC.
PubMed, Mar 1, 1999
Background: Positron emission tomography (PET) has been shown useful for the staging of patients ... more Background: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. Methods: We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. Results: PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. Conclusion: We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study.
PubMed, Jul 1, 1996
Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT... more Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT) or magnetic resonance (MR) imaging and mediastinoscopy. Despite advances in morphologic imaging, some lung cancer patients are found to have unresectable disease at surgery. In contrast to CT scan or MR imaging, which depend primarily on anatomic and morphological criteria, positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) depends mainly of the metabolic characteristics of a tissue for the diagnosis of disease. We perform a prospective study to compare FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in patients with newly diagnosed non-small cell lung cancer. Thirty patients have been included. CT and PET-scans were interpreted separately and results were compared to surgical staging during thoracotomy. In assessing mediastinal involvement, CT scan had a sensitivity of 56% and a specificity of 64%. For diagnosis mediastinal nodal disease, FDG-PET was 87% sensitive and 78% specific. Its positive predictive value was 82%, and the negative value was 83%. In conclusion, our preliminary results show that FDG-PET appears more accurate than CT in staging of mediastinal non-small cell lung cancer.
PubMed, Apr 8, 1998
PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the ... more PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver staging. Overall, FDG-PET affects the clinical management of 30 to 40% of these patients. Quantitative assessment of therapeutic response to chemotherapy regimen appears to be one of the most promising applications of FDG-PET. Since the most effective therapy of colorectal cancer are often surgical, the role of chemotherapy in colorectal cancer remains limited to adjuvant therapy and in advanced disease. However, FDG-PET could be of great value in assessing the response of oesophageal carcinomas to chemo-radio therapy, before surgery. In our experience, FDG-PET appears to be the first line diagnostic method in the detection and staging of colorectal recurrence and differential diagnosis of pancreatic tumour versus chronic pancreatitis.
PubMed, Mar 1, 2001
Background and objectives: Accurate staging is essential in order to determine appropriate treatm... more Background and objectives: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. Design and methods: Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. Results: Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. Interpretation and conclusions: (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy.
The Journal of Nuclear Medicine, 1996
Comparison of positron emission tomography and computed tomography in the mediastinal and extrath... more Comparison of positron emission tomography and computed tomography in the mediastinal and extrathoracic staging of non-small cell lung cancerPeer reviewe
European Journal of Cancer Prevention, Feb 1, 1998
Blood, Jul 15, 1999
A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vit... more A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vital tumor as well as tissue fibrosis. Metabolic imaging by 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) offers the advantage of functional tissue characterization that is largely independent of morphologic criteria. We compared 18 F-FDG PET to computed tomography (CT) in the posttreatment evaluation of 54 patients with Hodgkin's disease (HD) or intermediate/high-grade non-Hodgkin's lymphoma (NHL). Residual masses on CT were observed in 13 of 19 patients with HD and 11 of 35 patients with NHL. Five of 24 patients with residual masses on CT versus 1 of 30 patients without residual masses presented a positive 18 F-FDG PET study. Relapse occurred in all 6 patients (100%) with a positive 18 F-FDG PET, 5 of 19 patients (26%) with residual masses on CT but negative 18 F-FDG PET, and 3 of 29 patients (10%) with negative CT scan and 18 F-FDG PET studies (P I .0001). We observed a higher relapse and death rate in patients with residual masses at CT compared with patients without residual masses at CT (progression-free survival at 1 year: 62 ؎ 10 v 88 ؎ 7%, P ؍ .0045; overall survival at 1 year: 77 ؎ 5 v 95 ؎ 5%, P ؍ .0038). A positive 18 F-FDG PET study was even more consistently associated with poorer survival: compared with patients with a negative 18 F-FDG PET study, the 1-year progression-free survival was 0% versus 86% ؎ 5% (P F .0001) and the 1-year overall survival was 50% ؎ 20% versus 92% ؎ 4% (P F .0001). The detection of vital tumor by 18 F-FDG PET after the end of treatment has a higher predictive value for relapse than classical CT scan imaging (positive predictive value: 100% v 42%). This could help identify patients requiring intensification immediately after completion of chemotherapy. However, 18 F-FDG PET mainly predicts for early progression but cannot exclude the presence of minimal residual disease, possibly leading to a later relapse.
European Journal of Nuclear Medicine and Molecular Imaging, 1997
Peer reviewe
European Journal of Nuclear Medicine and Molecular Imaging, 1997
Peer reviewe
18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in ... more 18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in conjunction with whole-body positron emission tomography. This review details some of the indications of PET at various stages of the cancerous process: differential diagnosis, preoperative staging, diagnosis of residual or recurrent disease as well as follow-up of therapy. Consideration of several potential improvements in clinical PET and of the need for careful patients selection conclude this review.
Annals of Oncology, 1998
Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective o... more Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases. Sixty-four patients with malignancy and possible liver involvement were included. Liver metastases were present in 31 cases, demonstrated by histopathological analysis in 15 cases and by follow-up in 16 cases. The negative cases were confirmed by pathology in four cases, peroperative ultrasonography in 12 cases, and follow-up in 17 cases. Whole-body FDG PET was compared to CT (n = 53) and US (n = 43). PET demonstrated a 97% sensitivity, an 88% specificity and a 92% accuracy, compared to 93%, 75% and 85%, respectively, for CT (P = NS). Concordant results were obtained in 44 of 64 patients (69%: 19 TP. 25 TN). PET provided new and accurate information in 15 of 64 patients (23.4%). PET demonstrated liver metastases in 11 patients in whom conventional methods yielded negative (two cases) or doubtful (nine cases) results. Four patients free of liver involvement were correctly staged with PET, while CT/US were equivocal. PET was erroneous in five of 64 cases (7.8%, four FP, one FN). FDG PET allows an accurate screening of liver involvement in patients with malignancy. Combined with CT, it provides additional diagnostic information that could directly affect the management of these patients.
Revue medicale de Liege, 1999
Imaging and endoscopic techniques have taken an increasing part in the management of gastroentero... more Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract.
Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node ... more Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to com- puted tomography (CT), which depends primarily on anatomical imaging features, positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) depends mainly on the metabolic characteristics of a tissue for the diagnosis of disease. We have performed a prospective study comparing FDG-PET
Acta gastro-enterologica Belgica
PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the ... more PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver st...
Revue médicale de Liège, 1996
Peer reviewe
Thorax, 1997
In this preliminary report we have investigated the ability of FDG-PET to differ-Background-Posit... more In this preliminary report we have investigated the ability of FDG-PET to differ-Background-Positron emission tomography (PET) with 18-fluorodeoxyglucose entiate between malignant and non-malignant pleural disease. (FDG) is an accurate method for differentiating benign from malignant disease. The use of FDG-PET for the aetiological diagnosis of pleural disease was in-Methods vestigated in 25 patients. Methods-PET was performed on each Twenty five subjects of mean age 60 years subject before invasive procedures were (range 36-80) undergoing evaluation of pleural used to determine the aetiological diadisease were enrolled in the study. Each subject gnosis. The PET data were analysed by was examined by chest radiography, CT scanvisual interpretation of coronal, sagittal, ning (PQ 2000 4th generation, Picker, Cleveand transverse slices. land, Ohio, USA) and pleural fluid analysis. A Results-Sixteen patients were found to PET study was performed on each subject have malignant pleural disease and nine before invasive procedures were carried out. had benign disease. All patients with histologically confirmed malignant disease showed FDG uptake within the pleural thickening which was intense in 14 cases PET was performed with an UGM Penn PET and moderate in two. PET imaging showed 240H scanner as previously described 4 and the the absence of FDG uptake and correctly data were analysed by visual interpretation of categorised seven non-malignant lesions. coronal, sagittal, and transverse slices alone Two patients with infectious pleural disand by cross referencing. PET images were eases showed a localised and moderate read independently by two nuclear physicians, FDG uptake. who had knowledge of the standard chest radio-Conclusion-Our preliminary results suggraph only, by evaluation of the presence or gest that FDG-PET could be an effective absence of 18 FDG uptake in the pleural space. tool for differentiating between benign and When increased 18 FDG uptake was observed, malignant pleural diseases. two levels were identified-moderate or intense.
The Laryngoscope, 1998
Objectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emiss... more Objectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer. Study Design: Retrospective review of 38 patients with biopsy‐proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG‐PET examinations. Twenty‐five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence. Methods: All patients were operated and clinical data, CT, and FDG‐PET results were correlated with histopathological findings. Results: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG‐PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal....
Annals of Hematology, 2001
Accurate staging is essential in order to determine appropriate treatment in Hodgkin&... more Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy.
European journal of nuclear medicine, Feb 1, 1996
Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG up... more Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has been proven useful to differentiate malignant from benign tissue. We undertook a prospective study in 61 patients to compare the accuracy of whole-body FDG PET and conventional imaging (CI) methods for the staging of nonsmall-cell lung cancer (NSCLC). CI included chest and abdomen computed tomographic scanning and bone scintigraphy. When CI or PET study suggested metastatic disease, confirmation was obtained by biopsy or clinicai or radiological follow-up. As compared to CI, PET correctly changed the N stage in 13 patients (21%) and the M stage in six patients (10%). There were three false-positive and no false-negative distant PET findings. Our preliminary results show that whole-body FDG PET can improve the diagnostic accuracy in the staging of NSCLC.
PubMed, Mar 1, 1999
Background: Positron emission tomography (PET) has been shown useful for the staging of patients ... more Background: Positron emission tomography (PET) has been shown useful for the staging of patients with various carcinomas. Methods: We have applied this technique to 54 cases of colorectal carcinoma and compared it to conventional imaging techniques. Results: PET had moderately higher sensitivity and specificity than conventional techniques to detect individual lesion sites (75% vs 70.8% and 63% vs 21% respectively). It detected the same number of patients with recurrences (35/39) but overestimated disease less frequently (5 cases vs 12). PET favorably influenced therapeutic management in 17 patients, indicating different or additional surgery in 9 while avoiding surgery with curative intent or unnecessary surgery in 8. In 5 cases, erroneous information provided by PET could be corrected by conventional imaging techniques. Conclusion: We conclude that PET appears to provide complementary information useful for staging patients with colorectal carcinomas. It can significantly modify patients management. These data should be confirmed by a prospective study.
PubMed, Jul 1, 1996
Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT... more Current methods for evaluating the mediastinum include chest radiography, computed tomography (CT) or magnetic resonance (MR) imaging and mediastinoscopy. Despite advances in morphologic imaging, some lung cancer patients are found to have unresectable disease at surgery. In contrast to CT scan or MR imaging, which depend primarily on anatomic and morphological criteria, positron emission tomography (PET) with 18fluorodeoxyglucose (FDG) depends mainly of the metabolic characteristics of a tissue for the diagnosis of disease. We perform a prospective study to compare FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in patients with newly diagnosed non-small cell lung cancer. Thirty patients have been included. CT and PET-scans were interpreted separately and results were compared to surgical staging during thoracotomy. In assessing mediastinal involvement, CT scan had a sensitivity of 56% and a specificity of 64%. For diagnosis mediastinal nodal disease, FDG-PET was 87% sensitive and 78% specific. Its positive predictive value was 82%, and the negative value was 83%. In conclusion, our preliminary results show that FDG-PET appears more accurate than CT in staging of mediastinal non-small cell lung cancer.
PubMed, Apr 8, 1998
PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the ... more PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver staging. Overall, FDG-PET affects the clinical management of 30 to 40% of these patients. Quantitative assessment of therapeutic response to chemotherapy regimen appears to be one of the most promising applications of FDG-PET. Since the most effective therapy of colorectal cancer are often surgical, the role of chemotherapy in colorectal cancer remains limited to adjuvant therapy and in advanced disease. However, FDG-PET could be of great value in assessing the response of oesophageal carcinomas to chemo-radio therapy, before surgery. In our experience, FDG-PET appears to be the first line diagnostic method in the detection and staging of colorectal recurrence and differential diagnosis of pancreatic tumour versus chronic pancreatitis.
PubMed, Mar 1, 2001
Background and objectives: Accurate staging is essential in order to determine appropriate treatm... more Background and objectives: Accurate staging is essential in order to determine appropriate treatment in Hodgkin's disease (HD). (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) offers the advantage of metabolic imaging that is largely independent of morphologic criteria. In the present study we evaluated the role of (18)F-FDG PET compared to routine procedures for the staging of patients with HD. Design and methods: Thirty-three patients with HD underwent standard staging procedures (clinical examination, laboratory screening, chest X-ray, computed tomography (CT) of the chest and abdomen and bilateral bone marrow biopsies) and a whole-body (18)F-FDG PET study. In clinical examination, an isolated lymph node > 1 cm or multiple lymph nodes > or = 1 cm in size were considered abnormal. Positive findings at both clinical examination or CT and (18)F-FDG PET were regarded as actual locations of disease. Negative findings with both methods were regarded as true negative (no involvement by HD). In cases of discrepancy, response to treatment and follow-up data were used to assess the overall accuracy of the patient's original evaluation. Results: Completely concordant results in lymph node staging were observed in 20 patients. The two staging procedures indicated complementary information in 1 patient. Conventional staging indicated more pathologic lymph node areas in 6 patients (at least 1 false positive). (18)F-FDG PET showed more sites in 6 patients. The sensitivity of (18)F-FDG PET in detecting all known pathologic lymph nodes was 83% for peripheral lymph nodes, 91% for thoracic lymph nodes and 75% for abdominal and pelvic lymph nodes. Conventional staging procedures and (18)F-FDG PET indicated the same tumor stage in 26 patients. Based on (18)F-FDG PET, downstaging was suggested in 4 patients, including a biopsy-proven case. However in 1 of these cases this was incorrect. (18)F-FDG PET suggested upstaging in 3 patients. Based on conventional staging or (18)F-FDG PET the same treatment strategy was defined in 32 patients. In one patient (18)F-FDG PET downstaged disease extension (stage IIIA-->IIA) that would have suggested radiotherapy as a possible treatment option. Interpretation and conclusions: (18)F-FDG PET provides an easy and efficient whole-body method for the evaluation of patients with HD. (18)F-FDG PET never missed tumor masses >1 cm. (18)F-FDG PET detected additional sites of disease not seen by conventional procedures and identified absence of disease in some sites suspected to be involved. However, in our patients this did not translate into changes in treatment strategy.
The Journal of Nuclear Medicine, 1996
Comparison of positron emission tomography and computed tomography in the mediastinal and extrath... more Comparison of positron emission tomography and computed tomography in the mediastinal and extrathoracic staging of non-small cell lung cancerPeer reviewe
European Journal of Cancer Prevention, Feb 1, 1998
Blood, Jul 15, 1999
A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vit... more A residual mass after treatment of lymphoma is a clinical challenge, because it may represent vital tumor as well as tissue fibrosis. Metabolic imaging by 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography (PET) offers the advantage of functional tissue characterization that is largely independent of morphologic criteria. We compared 18 F-FDG PET to computed tomography (CT) in the posttreatment evaluation of 54 patients with Hodgkin's disease (HD) or intermediate/high-grade non-Hodgkin's lymphoma (NHL). Residual masses on CT were observed in 13 of 19 patients with HD and 11 of 35 patients with NHL. Five of 24 patients with residual masses on CT versus 1 of 30 patients without residual masses presented a positive 18 F-FDG PET study. Relapse occurred in all 6 patients (100%) with a positive 18 F-FDG PET, 5 of 19 patients (26%) with residual masses on CT but negative 18 F-FDG PET, and 3 of 29 patients (10%) with negative CT scan and 18 F-FDG PET studies (P I .0001). We observed a higher relapse and death rate in patients with residual masses at CT compared with patients without residual masses at CT (progression-free survival at 1 year: 62 ؎ 10 v 88 ؎ 7%, P ؍ .0045; overall survival at 1 year: 77 ؎ 5 v 95 ؎ 5%, P ؍ .0038). A positive 18 F-FDG PET study was even more consistently associated with poorer survival: compared with patients with a negative 18 F-FDG PET study, the 1-year progression-free survival was 0% versus 86% ؎ 5% (P F .0001) and the 1-year overall survival was 50% ؎ 20% versus 92% ؎ 4% (P F .0001). The detection of vital tumor by 18 F-FDG PET after the end of treatment has a higher predictive value for relapse than classical CT scan imaging (positive predictive value: 100% v 42%). This could help identify patients requiring intensification immediately after completion of chemotherapy. However, 18 F-FDG PET mainly predicts for early progression but cannot exclude the presence of minimal residual disease, possibly leading to a later relapse.
European Journal of Nuclear Medicine and Molecular Imaging, 1997
Peer reviewe
European Journal of Nuclear Medicine and Molecular Imaging, 1997
Peer reviewe
18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in ... more 18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in conjunction with whole-body positron emission tomography. This review details some of the indications of PET at various stages of the cancerous process: differential diagnosis, preoperative staging, diagnosis of residual or recurrent disease as well as follow-up of therapy. Consideration of several potential improvements in clinical PET and of the need for careful patients selection conclude this review.
Annals of Oncology, 1998
Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective o... more Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases. Sixty-four patients with malignancy and possible liver involvement were included. Liver metastases were present in 31 cases, demonstrated by histopathological analysis in 15 cases and by follow-up in 16 cases. The negative cases were confirmed by pathology in four cases, peroperative ultrasonography in 12 cases, and follow-up in 17 cases. Whole-body FDG PET was compared to CT (n = 53) and US (n = 43). PET demonstrated a 97% sensitivity, an 88% specificity and a 92% accuracy, compared to 93%, 75% and 85%, respectively, for CT (P = NS). Concordant results were obtained in 44 of 64 patients (69%: 19 TP. 25 TN). PET provided new and accurate information in 15 of 64 patients (23.4%). PET demonstrated liver metastases in 11 patients in whom conventional methods yielded negative (two cases) or doubtful (nine cases) results. Four patients free of liver involvement were correctly staged with PET, while CT/US were equivocal. PET was erroneous in five of 64 cases (7.8%, four FP, one FN). FDG PET allows an accurate screening of liver involvement in patients with malignancy. Combined with CT, it provides additional diagnostic information that could directly affect the management of these patients.
Revue medicale de Liege, 1999
Imaging and endoscopic techniques have taken an increasing part in the management of gastroentero... more Imaging and endoscopic techniques have taken an increasing part in the management of gastroenterological disorders. Among these techniques, FDG-PET imaging has emerged as a powerful tool in the management of several cancer diseases, including tumors of the digestive tract. In particular, the role of PET for diagnosing and staging recurrent colorectal cancers, and for differentiating mass forming pancreatitis from carcinoma is now well established. In this review, we will briefly discuss the place of PET imaging in the work-up of the tumors of the digestive tract.
Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node ... more Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to com- puted tomography (CT), which depends primarily on anatomical imaging features, positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) depends mainly on the metabolic characteristics of a tissue for the diagnosis of disease. We have performed a prospective study comparing FDG-PET
Acta gastro-enterologica Belgica
PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the ... more PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver st...
Revue médicale de Liège, 1996
Peer reviewe
Thorax, 1997
In this preliminary report we have investigated the ability of FDG-PET to differ-Background-Posit... more In this preliminary report we have investigated the ability of FDG-PET to differ-Background-Positron emission tomography (PET) with 18-fluorodeoxyglucose entiate between malignant and non-malignant pleural disease. (FDG) is an accurate method for differentiating benign from malignant disease. The use of FDG-PET for the aetiological diagnosis of pleural disease was in-Methods vestigated in 25 patients. Methods-PET was performed on each Twenty five subjects of mean age 60 years subject before invasive procedures were (range 36-80) undergoing evaluation of pleural used to determine the aetiological diadisease were enrolled in the study. Each subject gnosis. The PET data were analysed by was examined by chest radiography, CT scanvisual interpretation of coronal, sagittal, ning (PQ 2000 4th generation, Picker, Cleveand transverse slices. land, Ohio, USA) and pleural fluid analysis. A Results-Sixteen patients were found to PET study was performed on each subject have malignant pleural disease and nine before invasive procedures were carried out. had benign disease. All patients with histologically confirmed malignant disease showed FDG uptake within the pleural thickening which was intense in 14 cases PET was performed with an UGM Penn PET and moderate in two. PET imaging showed 240H scanner as previously described 4 and the the absence of FDG uptake and correctly data were analysed by visual interpretation of categorised seven non-malignant lesions. coronal, sagittal, and transverse slices alone Two patients with infectious pleural disand by cross referencing. PET images were eases showed a localised and moderate read independently by two nuclear physicians, FDG uptake. who had knowledge of the standard chest radio-Conclusion-Our preliminary results suggraph only, by evaluation of the presence or gest that FDG-PET could be an effective absence of 18 FDG uptake in the pleural space. tool for differentiating between benign and When increased 18 FDG uptake was observed, malignant pleural diseases. two levels were identified-moderate or intense.
The Laryngoscope, 1998
Objectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emiss... more Objectives: To evaluate the clinical usefulness of FDG‐PET (fluoro‐2‐deoxy‐glucose‐positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer. Study Design: Retrospective review of 38 patients with biopsy‐proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG‐PET examinations. Twenty‐five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence. Methods: All patients were operated and clinical data, CT, and FDG‐PET results were correlated with histopathological findings. Results: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG‐PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal....