Zurich, January 19, 2018

Size: px
Start display at page:

Download "Zurich, January 19, 2018"

Transcription

1 Brain metastases as first presentation of malignancy: Immediate management, differential diagnosis; prevalence of primaries and suggested work-up Symposium on Brain Metastasis Cancer Center Zurich Zurich, January 19, 2018 Michael Weller Department of Neurology & Brain Tumor Center University Hospital Zurich Frauenklinikstrasse 26 CH-8091 Zurich

2 Brain (and leptomeningeal) metastasis: clinical presentation and differential diagnosis Incidentaloma Seizures Stroke Side effect of drug therapy Paraneoplastic syndrome Comorbidity Cognitive decline Typical signs of leptomeningeal metastases

3

4 Brain metastases from cancer of unknown primary site (BM-CUPS) 25% of cancer patients may develop brain metastases (BM), associated with unfavorable outcome 30% of BM patients exhibit neurological symptoms as first manifestation of systemic malignancy (BM-CUPS) Detection of primary tumor and assessment of extracranial metastases are crucial for therapy planning and probably outcome Gavrilovic & Posner. J Neurooncol 2005;75:5-14, Barnholtz-Sloan et al. Neuro Oncol 2012;14:910-8

5 Diagnostic work-up of BM-CUPS patients Most BM-CUPS stem from lung cancer, melanoma and renal cell cancer Chest (abdomen) CT traditionally diagnostic gold standard in BM-CUPS patients Agazzi et al. Acta Neurochir (Wien) 2004;146:153-7, Mavrakis et al. Neurology 2005;65: F-fluordesoxyglucose positron emission tomography (FDG- PET)/CT data for primary detection and staging in BM-CUPS patients limited Klee et al. Eur J Neurol 2002;9: Staging by FDG-PET/CT versus CT chest/abdomen may reduce futile diagnostic procedures in patients with systemic cancer Reinhardt et al. J Clin Oncol 2006;24: , Fischer et al. N Engl J Med 2009;361:32-9

6 Figure 1 Consort chart BM-CUPS cohort of the University Hospital Zurich Alternative Diagnosis N=292 Incomplete chart N=44 Only extracranial metastases N=82 Search-term BM positive N=985 Confirmed diagnosis of BM N=565 Diagnosis of BM before detection of primary (CUPS) N=126 Diagnosis of BM after detection of primary (non-cups) N=439 CT only N=31 PET only N=18 CT and PET N=77 CT thorax only N=13 Sensitivity to spot primary lesion Staging capabilities N=64

7 BM-CUPS cohort Zurich Patients characteristics Figure 2 A Histology Gastrointestinal Mamma Gynecological other Hematological Hepatobiliar Lung (NSCLC) Lung (SCLC) Lung (not conclusive) Melanoma Prostatic Renal cell Sarcoma Testicular Thyroid Urogenital Pancreatic Not conclusive CUPS non-cups Patients [number] B Age (median (range)) 61.1 (38-85) Gender (number F/M) 31/33 Number of metastases (median (range)) 1.0 (1-7) Days to detect primary (median (range)) 3.0 (0-50) C Primary not identified Renal cell 4.0 % carcinoma 4.0 % Melanoma 7.9 % Lung (not conclusive) 2.4 % Colorectal cancer 1.6 % Lung (SCLC) 12.7 % Lung (NSCLC) 65.9 %

8 Patient characteristics in the validation cohort Lille & Vienna Figure A.2 (online only): Characteristics of BM-CUPS patients in the validation cohort A Median Age (range) 58.0 (25-87) Gender (number, F/M) 35/90 Median number of metastases (range) 1 (1-10) Days until detection of primary (median) 8 (0-371) C Diagnosis of BM before detection of primary (CUPS) N=220 B Histology not Renal cell carcinoma conclusive 1% 1% Melanoma 5% other 1% Colorectal cancer 10% CT only N=93 PET only N=0 CT and PET N=127 CT thorax only N=2 Lung 82% Sensitivity to spot primary lesion Staging capabilities N=125

9 Detection of the primary tumor Zurich versus Lille / Vienna

10 Staging properties of CT versus PET-CT Zurich cohort Figure A.1 (online only): Staging pathway. No further lesion N=36 Patients with FDG-PET/CT and chest/abdomen CT N=64 Further lesion by FDG-PET/CT N=28 Extracranial lesion assessed by biopsy N=18 No biopsy, significance unclear N=10 Further tumor lesion - metastasis N=9 - other tumor N=1 Pathologic lymph node N=4 Benign lesion N=4 Not covered by chest/ abdomen CT N=4 Not covered by chest/abdomen CT N=2

11 CONCLUSIONS Diagnostic work-up of BM-CUPS patients FDG-PET does not detect (statistically) more primary tumors than chest/abdomen CT FDG-PET detects more extracranial metastases and thereby induces GPA migration FDG-PET is more expensive, may trigger expensive further work-up and may trigger procedures with risk: does this benefit/risk/ratio justify its use and how could this be explored in a clinical trial?

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type.

Index. Surg Oncol Clin N Am 16 (2007) Note: Page numbers of article titles are in boldface type. Surg Oncol Clin N Am 16 (2007) 465 469 Index Note: Page numbers of article titles are in boldface type. A Adjuvant therapy, preoperative for gastric cancer, staging and, 339 B Breast cancer, metabolic

More information

Cancers of unknown primary : Knowing the unknown. Prof. Ahmed Hossain Professor of Medicine SSMC

Cancers of unknown primary : Knowing the unknown. Prof. Ahmed Hossain Professor of Medicine SSMC Cancers of unknown primary : Knowing the unknown Prof. Ahmed Hossain Professor of Medicine SSMC Definition Cancers of unknown primary site (CUPs) Represent a heterogeneous group of metastatic tumours,

More information

Ryan Niederkohr, M.D. Slides are not to be reproduced without permission of author

Ryan Niederkohr, M.D. Slides are not to be reproduced without permission of author Ryan Niederkohr, M.D. CMS: PET/CT CPT CODES 78814 Limited Area (e.g., head/neck only; chest only) 78815 78816 Regional (skull base to mid-thighs) True Whole Body (skull vertex to feet) SELECTING FIELD

More information

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C.

Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Role of Whole-body Diffusion MR in Detection of Metastatic lesions Prof. Dr. NAGUI M. ABDELWAHAB,M.D.; MARYSE Y. AWADALLAH, M.D. AYA M. BASSAM, Ms.C. Cancer is a potentially life-threatening disease,

More information

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET

PET IMAGING (POSITRON EMISSION TOMOGRAPY) FACT SHEET Positron Emission Tomography (PET) When calling Anthem (1-800-533-1120) or using the Point of Care authorization system for a Health Service Review, the following clinical information may be needed to

More information

Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010

Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Los Angeles Radiological Society 62 nd Annual Midwinter Radiology Conference January 31, 2010 Self Assessment Module on Nuclear Medicine and PET/CT Case Review FDG PET/CT IN LYMPHOMA AND MELANOMA Submitted

More information

Positron Emission Tomography in Lung Cancer

Positron Emission Tomography in Lung Cancer May 19, 2003 Positron Emission Tomography in Lung Cancer Andrew Wang, HMS III Patient DD 53 y/o gentleman presented with worsening dyspnea on exertion for the past two months 30 pack-year smoking Hx and

More information

Lung Cancer Staging: The Revised TNM Classification

Lung Cancer Staging: The Revised TNM Classification Norwegian Society of Thoracic Imaging Oslo, October 2011 Lung Cancer Staging: The Revised TNM Classification Sujal R Desai King s College Hospital, London Lung Cancer The Scale of the Problem Leading cause

More information

Nuclear medicine in oncology. 1. Diagnosis 2. Therapy

Nuclear medicine in oncology. 1. Diagnosis 2. Therapy Nuclear medicine in oncology 1. Diagnosis 2. Therapy Diagnosis - Conventional methods - Nonspecific radiopharmaceuticals cumulating in tumours - Specific radiopharmaceuticals (receptor- and immunoscintigraphy)

More information

Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017

Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD. November 18, 2017 Diagnosis and Staging of Non-Small Cell Lung Cancer Carlos Eduardo Oliveira Baleeiro, MD November 18, 2017 Disclosures I do not have a financial interest/arrangement or affiliation with one or more organizations

More information

Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center

Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients at a tertiary care center Clinical & Experimental Metastasis (2018) 35:727 738 https://doi.org/10.1007/s10585-018-9947-1 RESEARCH PAPER Brain metastases as first manifestation of advanced cancer: exploratory analysis of 459 patients

More information

Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors

Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors Bone PET/MRI : Diagnostic yield in bone metastases and malignant primitive bone tumors Lars Stegger, Benjamin Noto Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to

More information

PET-MRI in malignant bone tumours. Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany

PET-MRI in malignant bone tumours. Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany PET-MRI in malignant bone tumours Lars Stegger Department of Nuclear Medicine University Hospital Münster, Germany Content From PET to PET/MRI General considerations Bone metastases Primary bone tumours

More information

Molecular Imaging and Cancer

Molecular Imaging and Cancer Molecular Imaging and Cancer Cancer causes one in every four deaths in the United States, second only to heart disease. According to the U.S. Department of Health and Human Services, more than 512,000

More information

Page: 1 of 29. For this policy, PET scanning is discussed for the following 4 applications in oncology:

Page: 1 of 29. For this policy, PET scanning is discussed for the following 4 applications in oncology: Emission Tomography Scanning Page: 1 of 29 Last Review Status/Date: June 2015 Description Positron emission tomography (PET) scans are based on the use of positron-emitting radionuclide tracers coupled

More information

F NaF PET/CT in the Evaluation of Skeletal Malignancy

F NaF PET/CT in the Evaluation of Skeletal Malignancy F NaF PET/CT in the Evaluation of Skeletal Malignancy Andrei Iagaru, MD September 26, 2013 School of of Medicine Ø Introduction Ø F NaF PET/CT in Primary Bone Cancers Ø F NaF PET/CT in Bone Metastases

More information

R.G.C.C.-RESEARCH GENETIC CANCER CENTRE. Florina, 28 / 12 / 2006 Dear Dr. Gilbard and Dr. Hammon, LIPOMAS, UNDIAGNOSED PAIN, FAMILY HISTORY OR CANCER

R.G.C.C.-RESEARCH GENETIC CANCER CENTRE. Florina, 28 / 12 / 2006 Dear Dr. Gilbard and Dr. Hammon, LIPOMAS, UNDIAGNOSED PAIN, FAMILY HISTORY OR CANCER Florina, 28 / 12 / 2006 Dear Dr. Gilbard and Dr. Hammon, LIPOMAS, UNDIAGNOSED PAIN, FAMILY HISTORY OR CANCER We send you the results from the analysis made about a patient (????????????) for screening.

More information

Clinical indications for positron emission tomography

Clinical indications for positron emission tomography Clinical indications for positron emission tomography Oncology applications Brain and spinal cord Parotid Suspected tumour recurrence when anatomical imaging is difficult or equivocal and management will

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association PET Scanning: Oncologic Applications Page 1 of 42 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: See also: Positron Emission Tomography (PET) Scanning: Oncologic

More information

Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node

Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node 2012 66 5 417 421 Esophageal Cancer Initially Thought to be Accompanied by a Solitary Metastasis to an Intrathoracic Paraaortic Lymph Node a b* a a a a a a a b ʼ 418 Horio et al. Acta Med. Okayama Vol.

More information

CONTINUING PROFESSIONAL DEVELOPMENT

CONTINUING PROFESSIONAL DEVELOPMENT 23/09/15 POSTGRADUATE SCHOOL OF MEDICINE BRAIN METASTASES Prof M Brada and Dr John Green MDSC156/199: Acute Clinical Oncology A MEMBER OF THE RUSSELL GROUP CONTINUING PROFESSIONAL DEVELOPMENT Brain Metastases

More information

Oncologic Applications of PET Scanning

Oncologic Applications of PET Scanning 6.01.26 Oncologic Applications of PET Scanning Section 6.0 Radiology Subsection Effective Date February 15, 2015 Original Policy Date January 26, 2009 Next Review Date December 2015 Description Positron

More information

Bekir Tasdemir, 1 Zeki Dostbil, 1 Ali Inal, 2 Kemal Unal, 3 Sule Yildirim, 1 andf.selcuksimsek Introduction

Bekir Tasdemir, 1 Zeki Dostbil, 1 Ali Inal, 2 Kemal Unal, 3 Sule Yildirim, 1 andf.selcuksimsek Introduction BioMed Research International, Article ID 129683, 5 pages http://dx.doi.org/10.1155/2014/129683 Research Article Evaluation of Clinical Contributions Provided by Addition of the Brain, Calvarium, and Scalp

More information

PET/CT Frequently Asked Questions

PET/CT Frequently Asked Questions PET/CT Frequently Asked Questions General Q: Is FDG PET specific for cancer? A: No, it is a marker of metabolism. In general, any disease that causes increased metabolism can result in increased FDG uptake

More information

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services. Cancer of Unknown Primary Network Site Specific Group. Clinical Guidelines

Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services. Cancer of Unknown Primary Network Site Specific Group. Clinical Guidelines Somerset, Wiltshire, Avon and Gloucestershire (SWAG) Cancer Services Cancer of Unknown Primary Network Site Specific Group Revision due: April 2019 Page 1 of 11 VERSION CONTROL THIS IS A CONTROLLED DOCUMENT.

More information

PATHWAY FOR INVESTIGATION OF ADULTS PRESENTING WITH ASCITES. U/S Abdo/pelvis shows ascites without obvious evidence of 1 liver disease

PATHWAY FOR INVESTIGATION OF ADULTS PRESENTING WITH ASCITES. U/S Abdo/pelvis shows ascites without obvious evidence of 1 liver disease PATHWAY FOR INVESTIGATION OF ADULTS PRESENTING WITH ASCITES U/S Abdo/pelvis shows ascites without obvious evidence of 1 liver disease Refer back to original requester with this paperwork and review previous

More information

Molecular Imaging in the Development of Cancer Therapeutics. Johannes Czernin

Molecular Imaging in the Development of Cancer Therapeutics. Johannes Czernin Molecular Imaging in the Development of Cancer Therapeutics Johannes Czernin Ahmanson Biological Imaging Division University of California Los Angeles Cancer Statistics Cancer Type 5-year Survival Rate

More information

Title: What is the role of pre-operative PET/PET-CT in the management of patients with

Title: What is the role of pre-operative PET/PET-CT in the management of patients with Title: What is the role of pre-operative PET/PET-CT in the management of patients with potentially resectable colorectal cancer liver metastasis? Pablo E. Serrano, Julian F. Daza, Natalie M. Solis June

More information

Setting The setting was a hospital. The economic study was carried out in Australia.

Setting The setting was a hospital. The economic study was carried out in Australia. Positron emission tomography with selected mediastinoscopy compared to routine mediastinoscopy offers cost and clinical outcome benefits for pre-operative staging of nonsmall cell lung cancer Yap K K,

More information

Doppler ultrasound of the abdomen and pelvis, and color Doppler

Doppler ultrasound of the abdomen and pelvis, and color Doppler - - - - - - - - - - - - - Testicular tumors are rare in children. They account for only 1% of all pediatric solid tumors and 3% of all testicular tumors [1,2]. The annual incidence of testicular tumors

More information

Radiotherapy for Patients with Symptomatic Intramedullary Spinal Cord Metastasis

Radiotherapy for Patients with Symptomatic Intramedullary Spinal Cord Metastasis J. Radiat. Res., 52, 641 645 (2011) Regular Paper Radiotherapy for Patients with Symptomatic Intramedullary Spinal Cord Metastasis Haruko HASHII 1,4 *, Masashi MIZUMOTO 1,4 *, Ayae KANEMOTO 1,4, Hideyuki

More information

Triage of Limited Versus Extensive Disease on 18 F-FDG PET/CT Scan in Small Cell lung Cancer

Triage of Limited Versus Extensive Disease on 18 F-FDG PET/CT Scan in Small Cell lung Cancer Triage of Limited Versus Extensive Disease on F-FDG PET/CT Scan in Small Cell lung Cancer Riaz Saima 1*, Bashir Humayun 1, Niazi Imran Khalid 2 1 Department of Nuclear Medicine, Shaukat Khanum Memorial

More information

Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC)

Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC) Utility of PET-CT for detection of N2 or N3 nodal mestastases in the mediastinum in patients with non-small cell lung cancer (NSCLC) Poster No.: C-1360 Congress: ECR 2015 Type: Scientific Exhibit Authors:

More information

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

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

More information

Follow-up investigations. Omgo E. Nieweg

Follow-up investigations. Omgo E. Nieweg Follow-up investigations Omgo E. Nieweg Systematic literature review follow-up investigations identify few patients with recurrence frequent false positive findings impact on survival unclear Nieweg, Surg

More information

Dr Sneha Shah Tata Memorial Hospital, Mumbai.

Dr Sneha Shah Tata Memorial Hospital, Mumbai. Dr Sneha Shah Tata Memorial Hospital, Mumbai. Topics covered Lymphomas including Burkitts Pediatric solid tumors (non CNS) Musculoskeletal Ewings & osteosarcoma. Neuroblastomas Nasopharyngeal carcinomas

More information

PET/CT in lung cancer

PET/CT in lung cancer PET/CT in lung cancer Andrei Šamarin North Estonia Medical Centre 3 rd Baltic Congress of Radiology 08.10.2010 Imaging in lung cancer Why do we need PET/CT? CT is routine imaging modality for staging of

More information

SCBT-MR 2015 Incidentaloma on Chest CT

SCBT-MR 2015 Incidentaloma on Chest CT SCBT-MR 2015 Incidentaloma on Chest CT Reginald F. Munden MD, DMD, MBA I have no conflicts of interest to report Incidentaloma Pulmonary Nodule Mediastinal Lymph Node Coronary Artery Calcium Incidental

More information

The Itracacies of Staging Patients with Suspected Lung Cancer

The Itracacies of Staging Patients with Suspected Lung Cancer The Itracacies of Staging Patients with Suspected Lung Cancer Gerard A. Silvestri, MD,MS, FCCP Professor of Medicine Medical University of South Carolina Charleston, SC silvestri@musc.edu Staging Lung

More information

Medical Policy An independent licensee of the Blue Cross Blue Shield Association

Medical Policy An independent licensee of the Blue Cross Blue Shield Association PET Scanning: Oncologic Applications Page 1 of 88 Medical Policy An independent licensee of the Blue Cross Blue Shield Association Title: Positron Emission Tomography (PET) Scanning: Oncologic Applications

More information

A 64 y.o. man presents to the hospital with persistent cough and hemoptysis. Fernando Mut Montevideo - Uruguay

A 64 y.o. man presents to the hospital with persistent cough and hemoptysis. Fernando Mut Montevideo - Uruguay A 64 y.o. man presents to the hospital with persistent cough and hemoptysis Fernando Mut Montevideo - Uruguay Teaching case Bone # 1 A 64 y.o. man presents to the hospital with persistent cough and hemoptysis.

More information

Subject Index. Dry desquamation, see Skin reactions, radiotherapy

Subject Index. Dry desquamation, see Skin reactions, radiotherapy Subject Index Actinic keratosis disseminated disease 42 surgical excision 42 AIDS, see Kaposi s sarcoma Amifostine, skin reaction prophylaxis 111 Basal cell carcinoma, superficial X-ray therapy Bowen s

More information

A Case of Pancreatic Carcinoma with Bilateral Hilar

A Case of Pancreatic Carcinoma with Bilateral Hilar Shinshu Med J, 66⑵:151~155, 2018 A Case of Pancreatic Carcinoma with Bilateral Hilar 18 F-FDG and 67 Ga Hyperaccumulation Satoshi Kawakami 1 )*, Yasunari Fujinaga 1), Shin Yanagisawa 1) Masumi Kadoya 1),

More information

Surgical Management of Pulmonary Metastases. Dr AG Jacobs Principal Specialist Dept Cardiothoracic Surgery Steve Biko Academic Hospital

Surgical Management of Pulmonary Metastases. Dr AG Jacobs Principal Specialist Dept Cardiothoracic Surgery Steve Biko Academic Hospital Surgical Management of Pulmonary Metastases Dr AG Jacobs Principal Specialist Dept Cardiothoracic Surgery Steve Biko Academic Hospital Introduction Lungs 2 nd most common site of metastatic deposition

More information

Pre-operative assessment of patients for cytoreduction and HIPEC

Pre-operative assessment of patients for cytoreduction and HIPEC Pre-operative assessment of patients for cytoreduction and HIPEC Washington Hospital Center Washington, DC, USA Ovarian Cancer Surgery New Strategies Bergamo, Italy May 5, 2011 Background Cytoreductive

More information

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management.

performed to help sway the clinician in what the appropriate diagnosis is, which can substantially alter the treatment of management. Hello, I am Maura Polansky at the University of Texas MD Anderson Cancer Center. I am a Physician Assistant in the Department of Gastrointestinal Medical Oncology and the Program Director for Physician

More information

Contents. 3 Pneumology Introduction Positron Emission Tomography: Past and Present 1. 2 Fundamentals. xxx

Contents. 3 Pneumology Introduction Positron Emission Tomography: Past and Present 1. 2 Fundamentals. xxx xxx IX Contents 1 Introduction Positron Emission Tomography: Past and Present 1 1.1 Survey.......................... 1 Physical and Biochemical Fundamentals.... 2 PET in National and International Medical

More information

Adam J. Hansen, MD UHC Thoracic Surgery

Adam J. Hansen, MD UHC Thoracic Surgery Adam J. Hansen, MD UHC Thoracic Surgery Sometimes seen on Chest X-ray (CXR) Common incidental findings on computed tomography (CT) chest and abdomen done for other reasons Most lung cancers discovered

More information

Risk Adapted Follow-Up

Risk Adapted Follow-Up Risk Adapted Follow-Up Individualizing Follow- Up Strategies R Michael Tuttle, MD Clinical Director, Endocrinology Service Memorial Sloan Kettering Cancer Center Professor of Medicine Weill Medical College

More information

Learning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening

Learning Objectives. 1. Identify which patients meet criteria for annual lung cancer screening Disclosure I, Taylor Rowlett, DO NOT have a financial interest /arrangement or affiliation with one or more organizations that could be perceived as a real or apparent conflict of interest in the context

More information

Positron emission tomography Medicare Services Advisory Committee

Positron emission tomography Medicare Services Advisory Committee Positron emission tomography Medicare Services Advisory Committee Authors' objectives To assess the effectiveness of positron emission tomography (PET), the report addressed the following (truncated) six

More information

Radiofrequency ablation combined with conventional radiotherapy: a treatment option for patients with medically inoperable lung cancer

Radiofrequency ablation combined with conventional radiotherapy: a treatment option for patients with medically inoperable lung cancer Radiofrequency ablation combined with conventional radiotherapy: a treatment option for patients with medically inoperable lung cancer Poster No.: C-0654 Congress: ECR 2011 Type: Scientific Paper Authors:

More information

What Radiologists do?

What Radiologists do? Multimodality Imaging in Oncology 2018 March 5 th 9th Diagnostic Imaging in Oncology What Radiologists do? Chikako Suzuki, MD, PhD Department of Diagnostic Radiology, KS Solna Department of Molecular Medicine

More information

POSITRON EMISSION TOMOGRAPHY (PET)

POSITRON EMISSION TOMOGRAPHY (PET) Status Active Medical and Behavioral Health Policy Section: Radiology Policy Number: V-27 Effective Date: 08/27/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members should

More information

INTRODUCTION TO CANCER STAGING

INTRODUCTION TO CANCER STAGING INTRODUCTION TO CANCER STAGING Patravoot Vatanasapt, MD Dept. Otorhinolaryngology Khon Kaen Cancer Registry Faculty of Medicine Khon Kaen University THAILAND Staging is the attempt to assess the size

More information

MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES

MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES MEASUREMENT OF EFFECT SOLID TUMOR EXAMPLES Although response is not the primary endpoint of this trial, subjects with measurable disease will be assessed by standard criteria. For the purposes of this

More information

Original Policy Date

Original Policy Date MP 6.01.17 Oncologic Applications of PET Scanning Medical Policy Section Radiology Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date Reviewed with literature/12:2013 Return to Medical

More information

Cancer of Unknown Primary (CUP)

Cancer of Unknown Primary (CUP) Cancer of Unknown Primary (CUP) Pathways and Guidelines V1.0 London Cancer September 2013 The following pathways and guidelines document has been compiled by the London Cancer CUP technical subgroup and

More information

VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy

VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy CYRIC Annual Report 2003 VIII. 9. FDG-PET for Diagnosis of an Advanced Jejunal Adenocarcinoma with Distant Metastases, Compared with Gallium Scintigraphy Yamaura G., Yoshioka T., Yamaguchi K. *, Fukuda

More information

Cancer Prevention & Control in Adolescent & Young Adult Survivors

Cancer Prevention & Control in Adolescent & Young Adult Survivors + Cancer Prevention & Control in Adolescent & Young Adult Survivors NCPF Workshop July 15-16, 2013 Patricia A. Ganz, MD UCLA Schools of Medicine & Public Health Jonsson Comprehensive Cancer Center + Overview

More information

Assessment of renal cell carcinoma by two PET tracer : dual-time-point C-11 methionine and F-18 fluorodeoxyglucose

Assessment of renal cell carcinoma by two PET tracer : dual-time-point C-11 methionine and F-18 fluorodeoxyglucose Assessment of renal cell carcinoma by two PET tracer : dual-time-point C-11 methionine and F-18 fluorodeoxyglucose Poster No.: C-0805 Congress: ECR 2015 Type: Scientific Exhibit Authors: S. Ito, K. Kato,

More information

Cancer of Unknown Primary (CUP) Protocol

Cancer of Unknown Primary (CUP) Protocol 1 Department of Oncology. Cancer of Unknown Primary (CUP) Protocol Version: Document type: Document sponsor Designation Document author [ s] Designation[s] Approving committee / Group Ratified by: Date

More information

FACULTY MEMBERSHIP APPLICATION Tulane Cancer Center

FACULTY MEMBERSHIP APPLICATION Tulane Cancer Center FACULTY MEMBERSHIP APPLICATION Tulane Cancer Center 1430 Tulane Ave., Box SL-68, New Orleans, LA 70112-2699 J. Bennett Johnston Building, Mezzanine (Floor 1A), Suite A102 (504) 988-6060, fax (504) 988-6077,

More information

Leptomeningeal metastasis: management and guidelines. Emilie Le Rhun Lille, FR Zurich, CH

Leptomeningeal metastasis: management and guidelines. Emilie Le Rhun Lille, FR Zurich, CH Leptomeningeal metastasis: management and guidelines Emilie Le Rhun Lille, FR Zurich, CH Definition of LM LM is defined as the spread of tumor cells within the leptomeninges and the subarachnoid space

More information

Tumor Board Discussions: Case 1

Tumor Board Discussions: Case 1 Tumor Board Discussions: Case 1 David S. Ettinger, MD The Alex Grass Professor of Oncology Johns Hopkins University School of Medicine Baltimore, Maryland Case #1 50-year-old Asian female, never smoker

More information

Pathological, imaging and laboratory diagnostics in oncology; tumor staging

Pathological, imaging and laboratory diagnostics in oncology; tumor staging Pathological, imaging and laboratory diagnostics in oncology; tumor staging The basis of treatment strategy Tumor type, natural history Histological type and other pathological features Stage (TNM?) The

More information

Recommendations for cross-sectional imaging in cancer management, Second edition

Recommendations for cross-sectional imaging in cancer management, Second edition www.rcr.ac.uk Recommendations for cross-sectional imaging in cancer management, Second edition Carcinoma of unknown primary origin (CUP) Faculty of Clinical Radiology www.rcr.ac.uk Contents Carcinoma of

More information

Pathology of Sarcoma ELEANOR CHEN, MD, PHD, ASSISTANT PROFESSOR DEPARTMENT OF PATHOLOGY UNIVERSITY OF WASHINGTON

Pathology of Sarcoma ELEANOR CHEN, MD, PHD, ASSISTANT PROFESSOR DEPARTMENT OF PATHOLOGY UNIVERSITY OF WASHINGTON Pathology of Sarcoma ELEANOR CHEN, MD, PHD, ASSISTANT PROFESSOR DEPARTMENT OF PATHOLOGY UNIVERSITY OF WASHINGTON Presentation outline Background and epidemiology of sarcomas Sarcoma classification Sarcoma

More information

Case Report Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma

Case Report Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma Case Reports in Oncological Medicine Volume 2012, Article ID 192807, 4 pages doi:10.1155/2012/192807 Case Report Cerebral Metastasis from a Previously Undiagnosed Appendiceal Adenocarcinoma Antonio Biroli,

More information

Diffuse high-attenuation within mediastinal lymph nodes on non-enhanced CT scan: Usefulness in the prediction of benignancy

Diffuse high-attenuation within mediastinal lymph nodes on non-enhanced CT scan: Usefulness in the prediction of benignancy Diffuse high-attenuation within mediastinal lymph nodes on non-enhanced CT scan: Usefulness in the prediction of benignancy Poster No.: C-1785 Congress: ECR 2012 Type: Authors: Keywords: DOI: Scientific

More information

The Use of PET Scanning in Urologic Oncology

The Use of PET Scanning in Urologic Oncology The Use of PET Scanning in Urologic Oncology Dr Nicholas C. Buchan Uro-oncology Fellow 1 2 Aims To understand the basic concepts underlying PET scanning. Understand the emerging role of PET Scanning for

More information

Radiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh

Radiological staging of lung cancer. Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Radiological staging of lung cancer Shukri Loutfi,MD,FRCR Consultant Thoracic Radiologist KAMC-Riyadh Bronchogenic Carcinoma Accounts for 14% of new cancer diagnoses in 2012. Estimated to kill ~150,000

More information

Using PET/CT in Prostate Cancer

Using PET/CT in Prostate Cancer Using PET/CT in Prostate Cancer Legal Disclaimer These materials were prepared in good faith by MITA as a service to the profession and are believed to be reliable based on current scientific literature.

More information

Published Evidence. Hicks C, Foss AJE, Hungerford JL: Predictive power of screening tests for metastasis in uveal melanoma. Eye 12: , 1998

Published Evidence. Hicks C, Foss AJE, Hungerford JL: Predictive power of screening tests for metastasis in uveal melanoma. Eye 12: , 1998 Published Evidence Hicks C, Foss AJE, Hungerford JL: Predictive power of screening tests for metastasis in uveal melanoma. Eye 12:945-948, 1998 245 patients UM screened at diagnosis with FBC, LFT, CXR,

More information

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer

Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Physician Follow-Up and Guideline Adherence in Post- Treatment Surveillance of Colorectal Cancer Gabriela M. Vargas, MD Kristin M. Sheffield, PhD, Abhishek Parmar, MD, Yimei Han, MS, Kimberly M. Brown,

More information

LYMPHATIC DRAINAGE IN THE HEAD & NECK

LYMPHATIC DRAINAGE IN THE HEAD & NECK LYMPHATIC DRAINAGE IN THE HEAD & NECK Like other parts of the body, the head and neck contains lymph nodes (commonly called glands). Which form part of the overall Lymphatic Drainage system of the body.

More information

Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients

Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients DOI 10.1007/s00405-014-3120-5 Head and Neck Unfolding the role of PET FDG scan in the management of thyroid incidentaloma in cancer patients Haim Gavriel Adrian Tang Ephraim Eviatar Sor Way Chan Received:

More information

After primary tumor treatment, 30% of patients with malignant

After primary tumor treatment, 30% of patients with malignant ESTS METASTASECTOMY SUPPLEMENT Alberto Oliaro, MD, Pier L. Filosso, MD, Maria C. Bruna, MD, Claudio Mossetti, MD, and Enrico Ruffini, MD Abstract: After primary tumor treatment, 30% of patients with malignant

More information

Survival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery

Survival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery ORIGINAL ARTICLE Survival and Intracranial Control of Patients With 5 or More Brain Metastases Treated With Gamma Knife Stereotactic Radiosurgery Ann C. Raldow, BS,* Veronica L. Chiang, MD,w Jonathan P.

More information

Are the ESMO guidelines adapted to the elderly? D. Schrijvers, MD, PhD Ziekenhuisnetwerk Antwerpen(ZNA)-Middelheim Antwerp Belgium

Are the ESMO guidelines adapted to the elderly? D. Schrijvers, MD, PhD Ziekenhuisnetwerk Antwerpen(ZNA)-Middelheim Antwerp Belgium Are the ESMO guidelines adapted to the elderly? D. Schrijvers, MD, PhD Ziekenhuisnetwerk Antwerpen(ZNA)-Middelheim Antwerp Belgium Clinical practice guidelines Definition > Systemically developed statements

More information

Hybrid systems in Medical Imaging

Hybrid systems in Medical Imaging Hybrid systems in Medical Imaging from PET/CT to PET/MR Osman Ratib, MD, PhD, FAHA Professor and chair Department of Medical Imaging and Information Sciences Head of division of Nuclear Medicine University

More information

Renal Parenchymal Neoplasms

Renal Parenchymal Neoplasms Renal Parenchymal Neoplasms د. BENIGN TUMORS : Benign renal tumors include adenoma, oncocytoma, angiomyolipoma, leiomyoma, lipoma, hemangioma, and juxtaglomerular tumors. Renal Adenomas : The adenoma is

More information

Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index

Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index doi: 10.5761/atcs.oa.14-00241 Original Article Noninvasive Differential Diagnosis of Pulmonary Nodules Using the Standardized Uptake Value Index Satoshi Shiono, MD, 1 Naoki Yanagawa, MD, 2 Masami Abiko,

More information

When do you need PET/CT or MRI in early breast cancer?

When do you need PET/CT or MRI in early breast cancer? When do you need PET/CT or MRI in early breast cancer? Elizabeth A. Morris MD FACR Chief, Breast Imaging Service Memorial Sloan-Kettering Cancer Center NY, NY Objectives What is the role of MRI in initial

More information

Radiological Manifestations of Metastatic Melanoma

Radiological Manifestations of Metastatic Melanoma Radiological Manifestations of Metastatic Melanoma Lia Hojman, Universidad de Chile Year VII Our patient: Clinical Presentation A 24 year old male. Former smoker. 8 months ago, he suffered a burn in his

More information

RESEARCH COMMUNICATION. Occult Micrometastasis to Bone Marrow in Early Lung Cancer: A Clinicopathologic Study from West Bengal, India

RESEARCH COMMUNICATION. Occult Micrometastasis to Bone Marrow in Early Lung Cancer: A Clinicopathologic Study from West Bengal, India RESEARCH COMMUNICATION Occult Micrometastasis to Bone Marrow in Early Lung Cancer: A Clinicopathologic Study from West Bengal, India Saumitra Biswas 1*, Supriya Sarkar 2, Jayati Chakraborty 1, Sudipta

More information

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors

Case Scenario 1 Worksheet. Primary Site C44.4 Morphology 8743/3 Laterality 0 Stage/ Prognostic Factors CASE SCENARIO 1 9/10/13 HISTORY: Patient is a 67-year-old white male and presents with lesion located 4-5cm above his right ear. The lesion has been present for years. No lymphadenopathy. 9/10/13 anterior

More information

STAGING AND FOLLOW-UP STRATEGIES

STAGING AND FOLLOW-UP STRATEGIES ATHENS 4-6 October 2018 European Society of Urogenital Radiology STAGING AND FOLLOW-UP STRATEGIES Ahmet Tuncay Turgut, MD Professor of Radiology Hacettepe University, Faculty of Medicine Ankara 2nd ESUR

More information

Slide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology

Slide 1. Slide 2. Slide 3. Investigation and management of lung cancer Robert Rintoul. Epidemiology. Risk factors/aetiology Slide 1 Investigation and management of lung cancer Robert Rintoul Department of Thoracic Oncology Papworth Hospital Slide 2 Epidemiology Second most common cancer in the UK (after breast). 38 000 new

More information

PET imaging of cancer metabolism is commonly performed with F18

PET imaging of cancer metabolism is commonly performed with F18 PCRI Insights, August 2012, Vol. 15: No. 3 Carbon-11-Acetate PET/CT Imaging in Prostate Cancer Fabio Almeida, M.D. Medical Director, Arizona Molecular Imaging Center - Phoenix PET imaging of cancer metabolism

More information

Subject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date:

Subject: PET Scan With or Without CT Attenuation. Original Effective Date: 11/7/2017. Policy Number: MCR: 610. Revision Date(s): Review Date: Subject: PET Scan With or Without CT Attenuation Policy Number: MCR: 610 Revision Date(s): MHW Original Effective Date: 11/7/2017 Review Date: DISCLAIMER This Molina Clinical Review (MCR) is intended to

More information

Special Situation: Brain metastases

Special Situation: Brain metastases ESMO Advanced Course on Unsolved Questions in Immuno-Oncology February 16-17 2018, Amsterdam, Netherlands Special Situation: Brain metastases Matthias Preusser, MD Associate Professor of Medicine Department

More information

THORACIC MALIGNANCIES

THORACIC MALIGNANCIES THORACIC MALIGNANCIES Summary for Malignant Malignancies. Lung Ca 1 Lung Cancer Non-Small Cell Lung Cancer Diagnostic Evaluation for Non-Small Lung Cancer 1. History and Physical examination. 2. CBCDE,

More information

Nuclear Medicine in Oncology

Nuclear Medicine in Oncology Radiopharmaceuticals Nuclear Medicine in Oncology Practice Pharmaceutical Radionuc lide Function Tumor type Diphosphonates Tc-99m Osteoblast Bone tumor & metast. Ga-citrate Ga-67 Fe-analogue Bronchogenous

More information

Management of Neck Metastasis from Unknown Primary

Management of Neck Metastasis from Unknown Primary Management of Neck Metastasis from Unknown Primary.. Definition Histologic evidence of malignancy in the cervical lymph node (s) with no apparent primary site of original tumour Diagnosis after a thorough

More information

Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC. Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW

Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC. Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW Correlation of pretreatment surgical staging and PET SUV(max) with outcomes in NSCLC Giancarlo Moscol, MD PGY-5 Hematology-Oncology UTSW BACKGROUND AJCC staging 1 gives valuable prognostic information,

More information

Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion

Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Early-stage locally advanced non-small cell lung cancer (NSCLC) Clinical Case Discussion Pieter Postmus The Clatterbridge Cancer Centre Liverpool Heart and Chest Hospital Liverpool, United Kingdom 1 2

More information

CT PET SCANNING for GIT Malignancies A clinician s perspective

CT PET SCANNING for GIT Malignancies A clinician s perspective CT PET SCANNING for GIT Malignancies A clinician s perspective Damon Bizos Head, Surgical Gastroenterology Charlotte Maxeke Johannesburg Academic Hospital Case presentation 54 year old with recent onset

More information

PET in Rectal Carcinoma

PET in Rectal Carcinoma Case Report PET in Rectal Carcinoma Josefina Jofré M 1, Paulina Sierralta C 1, José Canessa G 1,2, Pamela Humeres A 3, Gabriel Castro M 4, Teresa Massardo V 1,4 1 Centro PET de Imágenes Moleculares, Hospital

More information

Assessing the lung and mediastinum in cancer-is tissue the issue? George Santis

Assessing the lung and mediastinum in cancer-is tissue the issue? George Santis 1 Assessing the lung and mediastinum in cancer-is tissue the issue? George Santis Optimal management of Cancer Histological diagnosis & accurate staging at presentation Molecular analysis of primary tumour

More information