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Ōsaka, Japan

Kawada N.,Japan National Cardiovascular Center Research Institute | Kawada N.,Kanazawa Medical University | Uehara H.,Japan National Cardiovascular Center Research Institute | Hosoki T.,Morinomiya Clinic Center | And 4 more authors.
Pancreas | Year: 2015

Objectives The usefulness of dual-phase 18 F-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for pancreatic tumors was investigated including numerous small tumors. Methods Consecutive 116 patients with solid pancreatic tumors were subjected. Maximum standard uptake values (SUV max) at 1 and 2 hours after FDG injection were defined as early and delayed SUV max, respectively. Receiver operating characteristic curve was used to determine the optimal cutoff value of early SUV max. Diagnostic accuracy of dual-phase FDG PET/CT was compared with that of single phase. Results The mean ± SD tumor size was 25 ±12 mm in diameter. The level of early SUV max and proportion of elevated SUV max in delayed phase were significantly higher in malignancy than those in benignancy for less than 25 mm tumors (4.1 ± 2.6 vs 1.9 ± 0.5, P < 0.001; 89% vs 17%, P < 0.0001) although they did not reach statistical significance for greater than or equal to 25 mm tumors. When diagnostic criteria of dual-phase FDG PET/CT for less than 25 mm tumors were determined as (1) early SUV max greater than or equal to 2.1 and/or (2) delayed SUV max greater than early SUV max, sensitivity, specificity, and over all accuracy of dual-phase FDG PET/CT were better than that of single phase for less than 25 mm tumor (93%, 83%, and 91% vs 79%, 83%, and 80%, respectively). Conclusions Dual-phase FDG PET/CT might be useful for diagnosing small pancreatic tumors. © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Kanzaki R.,Japan National Cardiovascular Center Research Institute | Higashiyama M.,Japan National Cardiovascular Center Research Institute | Maeda J.,Japan National Cardiovascular Center Research Institute | Okami J.,Japan National Cardiovascular Center Research Institute | And 4 more authors.
Interactive Cardiovascular and Thoracic Surgery | Year: 2010

Objectives: F18-fluorodeoxyglucose positron emission tomography-computed tomography (FDG-PET/CT), which allows differentiation between malignant and benign lesions based on difference in tissue glucose metabolism, has become increasingly important in lung cancer diagnosis. This study examined the clinical value of FDG-PET/CT in a large number of patients with non-small cell lung cancer (NSCLC) after potentially curative surgery. Methods: Four hundred and ninety FDG-PET/CT of 241 patients (143 males and 98 females; age range 38-87 years; mean 68.0 years) between May 2006 and February 2008 were retrospectively evaluated. All the 241 patients had undergone potentially curative surgery for NSCLC >6 months before FDG-PET/CT and their pathologic stages were stage I and II according to the tumor-node-metastasis (TNM) classification. A final diagnosis of recurrence was confirmed by histologic or cytologic examination of the disease or by clinical and radiologic follow-up image analysis. Confirmation of recurrence-free status was based on a clinical and radiologic image analysis follow-up period of at least 12 months with no evidence of active malignancy. The diagnostic performance of FDG-PET/CT was evaluated. Details of false results and incidental detection of diseases other than recurrent lung cancer by FDG-PET/CT was also analyzed. Results: Recurrences were confirmed in 35 (15%) patients, and 206 patients (85%) had no evidence of recurrence. FDG-PET/CT correctly diagnosed recurrence in 34 of 35 patients and provided true negative findings in 198 of 206 patients who had no evidence of recurrence (sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of 97%, 96%, 96%, 81%, and 99%, respectively), indicating a high diagnostic performance. However, one patient had false negative studies and eight patients had false positive studies; misdiagnosis was more frequently in intrathoracic sites associated with postoperative changes. Malignancies other than recurrence were detected in nine of all 241 patients (4%) including five second primary lung cancers. Conclusions: The present study demonstrated the high diagnostic performance of FDG-PET/CT in detecting recurrences in a large group of patients with NSCLC after potentially curative surgery. FDG-PET/CT is useful not only for diagnosis of recurrence but also for detection of other diseases. © 2010 Published by European Association for Cardio-Thoracic Surgery.


Kanzaki R.,Japan National Cardiovascular Center Research Institute | Higashiyama M.,Japan National Cardiovascular Center Research Institute | Fujiwara A.,Japan National Cardiovascular Center Research Institute | Tokunaga T.,Japan National Cardiovascular Center Research Institute | And 8 more authors.
Lung Cancer | Year: 2011

Background: Integrated F18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) is widely used for mediastinal lymph node (MLN) staging in patients with non-small cell lung cancer (NSCLC). However, FDG-PET/CT has certain limitations. Prediction of occult MLN metastasis could allow selection of candidates for preoperative cervical mediastinoscopy or endobronchial ultrasound-guided transbronchial needle aspiration. This study defined risk factors for occult MLN metastasis in patients with NSCLC patients who were diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT. Methods: Consecutive patients with NSCLC who underwent staging using integrated FDG-PET/CT as an adjunct to CT prior to lung resection from October 2006 to September 2009 were evaluated retrospectively. The prevalence of MLN metastasis in patients diagnosed as clinical N0-1 was analyzed according to clinicopathological factors such as tumor location, tumor size, histology, and FDG uptake by the primary tumor. Risk factors for occult MLN metastasis were defined by multivariate analysis. Patterns of occult MLN metastasis were also analyzed and the involved MLNs were further examined histopathologically. Results: The incidence of MLN metastasis was 11% (24 patients of 224). Multivariate analysis identified adenocarcinoma (P=0.04), tumors located in upper or middle lobe (P=0.02), tumor size >3cm (P=0.01), and SUVmax of primary tumor >4.0g/ml (P=0.04) as significant risk factors for MLN metastasis. The pattern of occult MLN metastasis was typical for NSCLC cases. The size of metastatic foci were small, with 68% of foci smaller than 4.0mm. Conclusions: The present study demonstrated that adenocarcinoma, tumors located in the upper or middle lobe, tumor size >3cm, and SUVmax of primary tumor >4.0g/ml are risk factors for occult MLN metastasis in patients with NSCLC who were diagnosed as clinical N0-1 by preoperative integrated FDG-PET/CT and CT. Patients with tumors located in the right upper or middle lobe are considered candidates for cervical mediastinoscopy because the involved metastatic mediastinal lymph nodes are easily accessible by these modalities. © 2010 Elsevier Ireland Ltd.

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