New Visions in PET: Surgical Decision Making and PET/CT

Transcription

1 New Visions in PET: Surgical Decision Making and PET/CT Stanley J. Goldsmith, MD Director, Nuclear Medicine Professor, Radiology & Medicine New York Presbyterian Hospital- Weill Cornell Medical Center New York

2 Clinical Applications of FDG-PET Presence or absence of tumor Staging/extent of disease Monitoring of treatment response Detection of Recurrence Predicting Response/Prognosis

3 SENSITIVITY AND SPECIFICITY OF PET AND CT IN ONCOLOGY Sensitivity Specificity Management PET CT PET CT Change Lung Diagnosis 98% 67% 73% - Staging 82% 61% 91% 76% 37% Recurrence 98% 72% 92% 95% Colorectal Recurrence 93% 77% 85% 68% 31% Lymphoma Staging 89% 80% 93% 73% 21% Recurrence 83% 95% 10% Melanoma Staging 84% 88% 91% 75% 26%

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5 FDG uptake in Fat obscuring LN F/56 with metastatic lung cancer Courtesy of H. Yeung Memorial Sloan Kettering Cancer Center

6 Pt in remission/lymphoma, Menstruating uterus

7 Pulmonary nodule; bx: granuloma; FDG negative. Incidental finding: FDG + foci Rt. Hilum, midline

8 74 yo M Esophogeal Ca; incidental finding on CT for pulmonary nodule

9 74 yo M Pulmonary nodule on CT; [FDG-]; granuloma on bx incidental finding: esophogeal Ca; FDG + hilar lymph node

10 Accuracy PET vs CT: 86% vs 69%

11 62 yo woman; New dx: Ca Colon; referred to determine EOD Dual detector system [GE Hawkeye 1 ] 1 of 4

12 62 yo woman; New dx: Ca Colon; EOD 2 of 4

13 62 yo woman; New dx: Ca Colon; EOD 3 of 4

14 62 yo woman; New dx: Ca Colon; EOD 4

15 Colon Carcinoma Suspicion of Recurrence 35 yo m; prior resection; rising CEA; CT reported as negative Laparotomy confirmed peritoneal metastases

16 45 yo woman, stage III colorectal Ca resected; returns with rising CEA CT interpreted as Slides negative are not to be reproduced without permission of author Chin, Wahl: Gut 2003

17 Wahl et al JNM Jan 2004

18 Colon Carcinoma Evaluate Response to Therapy Pre-therapy 42 yo m; prior resection; multiple hepatic metastases Posttherapy 5 months chemotherapy

19 Colon Carcinoma Hepatic Metastasis Radiofrequency ablation Pre-RFA coronal Post-RFA transaxial Post-RFA coronal

20 Colon cancer: Rising CEA Remote h/o radiofrequency ablation for metastatic Ca. Stable liver lesion on CT scan; but increasing CEA. PET scan confirmed recurrent tumor at the margin of the prior lesion

21 PET/CT in Lung Ca

22 Lardinois et al: N Eng J Med 2003 Clinical Value of PET/CT in Lung Ca % Accurately Detected CT alone 1 PET 2alone PET 3& CT PET/CT 4 Series1 Tumor Series2 Node Series3

23 Slides are not to be reproduced without permission FDG of author PET: 114 TP; 5 FP

24 63 y/o woman [PM] Breast Cancer Rx: Lumpectomy; no evidence of axillary nodal involvement Initial evaluation: Focal area of mildly increased hypermetabolism, right paratracheal region Clinical decision: Observe

25 63 y/o Woman [PM] history of Breast Cancer FDG PET (7 months after initial PET) Increased metabolism right paratracheal nodes New subcarinal and left hilar nodal involvement

26 Whole-Body 18 F-FDG PET and Conventional Imaging for Predicting Outcome in Previously Treated Breast Cancer Patients J Nucl Med 2002; 43: CT: 9 FN, 6 FP PET: 3 FN, 3 FP

27 37 yo woman thyroid ca, post near total thyroidectomy 1 year post I-131 Rx; elevated Tgb

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29 PET/CT: Imaging Structure and Function PET/CT even with FDG - by combining imaging of structure and function provides increased accuracy in the evaluation and management of patients with neoplastic disease, specifically H & N, thyroid, breast, esophagus, lung and colon carcinoma. Increased sensitivity and specificity provides an opportunity for reevaluation of past staging and treatment paradigms and new surgical approaches.

30 PET/CT: Imaging Structure and Function-II PET/CT is time and cost effective for patients, physicians, surgeons and insurance carriers. Future applications: Additional positron emission tracers/probes Positron detecting probes: intra-operative use Improved radiation therapy treatment planning