RESUMO
BACKGROUND: Of women between 15 and 29 years of age, 13.6% will die from breast cancer. For women between 30 and 64 years of age, 19% will die from breast cancer. METHODS: We studied 1728 oncological patients and 295 patients were included, 293 with breast cancer (17%) and two patients with primary breast lymphoma (0.1%). RESULTS: There were 98% females and 2% males. SUVmax for the primary tumor was 4.2 +/- 2.6 SD. Mean SUVmax for patients with primary breast lymphoma were 3.2 and 1.4. Sites of metastases were lymph nodes in the neck (4.4% SUVmax 2.7), internal mammary lymph nodes (5% SUVmax 5.3), mediastinum (8.3% SUVmax 5.0), retroperitoneal (6 % SUVmax 5.4), ipsilateral axilla (94% SUVmax 4.5), contralateral axilla (4.4% SUVmax 2.8), pectoral muscle (10.2% SUVmax 2.6), pleura (4.4% SUVmax 3.9), lung (32.3% SUVmax 2.9), liver (19.1% SUVmax 4.5), bone (36.7%), adrenal gland (4.4% SUVmax 2.4), brain (4.4%), spleen and contralateral breast, one case each. One patient presented thymic hyperplasia after chemotherapy. Mean SUVmax for blastic lesions was 5.4 +/- 2.9 SD, for lytic lesions it was 6.7 +/- 2.4 SD and for lesions not apparent on the CT it was 4.6 +/- 2.4 SD. The incidence of a second primary was 4.7%, 2.1% ovarian, 1.4% lung, 0.3% lymphoma, 0.3% endometrium, 0.3% pancreas and 0.3% thyroid. CONCLUSIONS: Mean SUVmax for the primary tumor was similar to that reported in the literature. Values for metastatic bone lesions are higher in this study. Inclusion of PET/CT in the followup of breast lesions is cost efficient.
Assuntos
Neoplasias da Mama/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Adulto , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/secundário , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/secundário , Neoplasias da Mama/epidemiologia , Neoplasias da Mama Masculina/diagnóstico por imagem , Análise Custo-Benefício , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Hiperplasia , Metástase Linfática/diagnóstico por imagem , Linfoma não Hodgkin/diagnóstico por imagem , Masculino , Mamografia , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons/economia , Compostos Radiofarmacêuticos , Estudos Retrospectivos , Sensibilidade e Especificidade , Timo/diagnóstico por imagem , Timo/patologiaRESUMO
BACKGROUND: Of women between 15 and 29 years of age, 13.6% will die from breast cancer. For women between 30 and 64 years of age, 19% will die from breast cancer. METHODS: We studied 1728 oncological patients and 295 patients were included, 293 with breast cancer (17%) and two patients with primary breast lymphoma (0.1%). RESULTS: There were 98% females and 2% males. SUVmax for the primary tumor was 4.2 +/- 2.6 SD. Mean SUVmax for patients with primary breast lymphoma were 3.2 and 1.4. Sites of metastases were lymph nodes in the neck (4.4% SUVmax 2.7), internal mammary lymph nodes (5% SUVmax 5.3), mediastinum (8.3% SUVmax 5.0), retroperitoneal (6 % SUVmax 5.4), ipsilateral axilla (94% SUVmax 4.5), contralateral axilla (4.4% SUVmax 2.8), pectoral muscle (10.2% SUVmax 2.6), pleura (4.4% SUVmax 3.9), lung (32.3% SUVmax 2.9), liver (19.1% SUVmax 4.5), bone (36.7%), adrenal gland (4.4% SUVmax 2.4), brain (4.4%), spleen and contralateral breast, one case each. One patient presented thymic hyperplasia after chemotherapy. Mean SUVmax for blastic lesions was 5.4 +/- 2.9 SD, for lytic lesions it was 6.7 +/- 2.4 SD and for lesions not apparent on the CT it was 4.6 +/- 2.4 SD. The incidence of a second primary was 4.7%, 2.1% ovarian, 1.4% lung, 0.3% lymphoma, 0.3% endometrium, 0.3% pancreas and 0.3% thyroid. CONCLUSIONS: Mean SUVmax for the primary tumor was similar to that reported in the literature. Values for metastatic bone lesions are higher in this study. Inclusion of PET/CT in the followup of breast lesions is cost efficient.
Assuntos
Humanos , Masculino , Feminino , Adulto , Carcinoma , Neoplasias da Mama , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Neoplasias Ósseas , Neoplasias Encefálicas , Análise Custo-Benefício , Carcinoma , Compostos Radiofarmacêuticos , Hiperplasia , Metástase Linfática , Linfoma não Hodgkin , Mamografia , Neoplasias Primárias Múltiplas , Neoplasias da Mama Masculina , Neoplasias da Mama Masculina , Neoplasias da Mama/epidemiologia , Estudos Retrospectivos , Radioisótopos de Flúor , Sensibilidade e Especificidade , Timo , Tomografia por Emissão de Pósitrons/economiaRESUMO
BACKGROUND: Lung cancer is the most frequent cause of death due to neoplasm in Western populations, with >660,000 new diagnoses of lung cancer per year according to the World Health Organization. METHODS: We undertook this study to emphasize the role of positron emission tomography to all health care professionals involved in lung cancer diagnosis. RESULTS: There are false negatives with PET-(18)FDG in carcinoids and broncheoalveolar carcinoma in almost 40% of the cases. One relatively common cause of false positives is the vocal cord and adjacent muscles contralateral and compensatory to the lung lesion that show an increased uptake of (18)FDG because of lesions in the laryngeal nerve by the tumor or secondary to surgery. It should not be confounded with metastases. CONCLUSIONS: There is sufficient scientific evidence pointing to the usefulness of PET studies and its evolution to PET/CT, especially in patients with lung cancer. This can resolve doubts by the oncologist and patient when there is a suspicious malignant lesion by the following: characterizing solitary pulmonary nodules (benign or malignant), localizing the optimal site for the biopsy, diagnosis of the primary tumor for initial staging, evaluation of mediastinal involvement and distant metastasis, evaluate and restage residual tumor, assessment of recurrence, monitoring response, prognostic prediction and radiotherapy planning.
Assuntos
Neoplasias Pulmonares/diagnóstico , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Diagnóstico Diferencial , Humanos , Metástase Neoplásica , Estadiamento de Neoplasias , Nódulo Pulmonar Solitário/diagnósticoRESUMO
BACKGROUND: Fluordeoxyglucose ((18)FDG) is the most common radiotracer used for PET/CT studies. It enters the cell because of the glucose transporter proteins (GLUTs): 1) erythrocytic membrane, skeletal muscle, lymphocytes, ovaries, breast; 2) pancreas, retina, erythrocytes; 3) adipocytes, ovaries, testis; 4) skeletal muscle, adipocytes, ovaries, myocardium; 5) breast, small intestine, testis, kidney, erythrocytes; 6) spleen, leucocytes, brain; 7) liver; 8) testis, brain; 9) liver, kidney; 10) liver, pancreas; 11) heart, muscle; 12) heart, prostate; 13) brain. We undertook this study to expand the knowledge about physiological uptake. Physiological uptake of (18)FDG was in brain, Waldeyer ring (adenoids, palatine tonsils, lingual tonsils), salivary glands (parotids, submandibular), tongue, vocal cords, cricoarythenoid muscle, thyroid, brown fat (supraclavicular, mediastinal, neck, pericardial fat, around kidney, around great vessels in the thorax, subdiaphragmatic, intercostals, paravertebral), myocardium, breast, thymus, contractive muscles, liver, spleen (similar to the liver), stomach, intestine, kidneys, bladder, uterus, ovaries, testes, bone marrow, esophagus, and atherosclerotic inflammatory plaque. DISCUSSION: False positives were as follows: pneumoniae, tuberculosis, sarcoidosis, cryptococcosis, thrombosis, bronchitis, costochondritis, radiation pneumonitis, misregistration for respiratory movements, catheters, thyroid and adrenal adenomas, osteophytes, fractures, abscess, foreign body, surgical wounds, ostomies, prosthesis, degenerative joint diseases, osteomyelitis, amyloidosis, pancreatitis, myositis, gastritis, colitis, herpes zoster. (18)FDG should be injected 4-6 h after insulin administration because it will be concentrated in the muscles. The brown fat raises its uptake 50% in late images. CONCLUSIONS: It is vital to know the most frequent sites of physiological uptake in the (18)FDG PET/CT studies to identify those regions that occasionally present hypermetabolism but that are not related to neoplastic tumors. This must be taken into consideration in the evaluation of PET/CT studies.
Assuntos
Humanos , Compostos Radiofarmacêuticos , Compostos Radiofarmacêuticos/farmacocinética , /farmacocinética , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Fluordeoxyglucose ((18)FDG) is the most common radiotracer used for PET/CT studies. It enters the cell because of the glucose transporter proteins (GLUTs): 1) erythrocytic membrane, skeletal muscle, lymphocytes, ovaries, breast; 2) pancreas, retina, erythrocytes; 3) adipocytes, ovaries, testis; 4) skeletal muscle, adipocytes, ovaries, myocardium; 5) breast, small intestine, testis, kidney, erythrocytes; 6) spleen, leucocytes, brain; 7) liver; 8) testis, brain; 9) liver, kidney; 10) liver, pancreas; 11) heart, muscle; 12) heart, prostate; 13) brain. We undertook this study to expand the knowledge about physiological uptake. Physiological uptake of (18)FDG was in brain, Waldeyer ring (adenoids, palatine tonsils, lingual tonsils), salivary glands (parotids, submandibular), tongue, vocal cords, cricoarythenoid muscle, thyroid, brown fat (supraclavicular, mediastinal, neck, pericardial fat, around kidney, around great vessels in the thorax, subdiaphragmatic, intercostals, paravertebral), myocardium, breast, thymus, contractive muscles, liver, spleen (similar to the liver), stomach, intestine, kidneys, bladder, uterus, ovaries, testes, bone marrow, esophagus, and atherosclerotic inflammatory plaque. DISCUSSION: False positives were as follows: pneumoniae, tuberculosis, sarcoidosis, cryptococcosis, thrombosis, bronchitis, costochondritis, radiation pneumonitis, misregistration for respiratory movements, catheters, thyroid and adrenal adenomas, osteophytes, fractures, abscess, foreign body, surgical wounds, ostomies, prosthesis, degenerative joint diseases, osteomyelitis, amyloidosis, pancreatitis, myositis, gastritis, colitis, herpes zoster. (18)FDG should be injected 4-6 h after insulin administration because it will be concentrated in the muscles. The brown fat raises its uptake 50% in late images. CONCLUSIONS: It is vital to know the most frequent sites of physiological uptake in the (18)FDG PET/CT studies to identify those regions that occasionally present hypermetabolism but that are not related to neoplastic tumors. This must be taken into consideration in the evaluation of PET/CT studies.
Assuntos
Fluordesoxiglucose F18/farmacocinética , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos/farmacocinética , Tomografia Computadorizada por Raios X , HumanosRESUMO
UNLABELLED: The breast cancer is one of the most frequent in the world, with an incidence that has been raising despite the many different prevention programs. In the early 1980s, two groups of investigators report a new tumor marker and called it cancer antigen 15-3 (CA 15-3). CA 15-3 in the diagnostic and follow up of patients with breast cancer has a sensitivity ranging from 75-76.9% and the specificity ranging from 85.5-93%. METHODS: We review the files of 100 female patients in the Nuclear Medicine Department, which was done bone scan and CA 15-3 from January to December 2000. All patients were in stage III and IV. For the bone scan every patient received 20 mCi of Medroxi-Di Phosphonate (MDP). The CA 15-3 was quantify in the radioimmunoanalysis (RIA) laboratory. The CA 15-3 reference protocol is equal or less than 30 U/mL. RESULTS: The mean patient's age was 59.39 years. The mean value from CA 15-3 for the patients with the absence of metastatic disease is 16.18 U/mL and 164.02 U/mL in the presence of metastatic disease mL (p < 0.00001). In our research the high level was 35 U/mL (percentil 95). The sensitivity founded was 82% and the specificity was 87%. High CA 15-3 levels are present when the patient has the tumor and get down to normal when the tumorectomy of the mastectomy was done; in the absence of metastatic disease. CONCLUSIONS: Skeletal scintigraphy is reserved for patients with clinical stage III and IV disease. Image those patients who have skeletal pain or high levels of CA 15-3 although an early stage disease. In patients with skeletal metastases and chemotherapy protocol there is a significative diminish of the value of the tumor marker in comparison with the previous one. In patients with metastatic disease and normal CA 15-3, the tumor marker will increase gradually. CA 15-3 can be use as a simple method that reflects the presence of bone metastases in association with bone scan.