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See detailClinical added-value of 18FDG PET in neuroendocrine-merkel cell carcinoma
Belhocine, Tarik; Pierard, Gérald ULg; Frühling, Janos et al

in Oncology Reports (2006), 16(2), 347-352

Merkel cell carcinoma (MCC) is a rare and highly malignant skin cancer with neuroendocrine differentiation. We studied the potential value of 18FDG PET in the management of MCC. Eleven patients with MCC ... [more ▼]

Merkel cell carcinoma (MCC) is a rare and highly malignant skin cancer with neuroendocrine differentiation. We studied the potential value of 18FDG PET in the management of MCC. Eleven patients with MCC were examined by 18FDG PET and PET-CT for staging purpose (n=4) or for detection of recurrence (n=7). Qualitative and quantitative interpretation of PET studies was performed routinely. 18FDG PET observations were compared to clinical and radiological findings. In 6 patients, PET findings were also compared to histology. In 7 patients, the 18FDG tumor uptake was compared to the MCC proliferative activity expressed by the Ki-67 index. 18FDG PET was contributive in 10/11 MCC patients. In 7 patients, 18FDG PET detected focal lesions or a disseminated stage of the disease including dermal, nodal and visceral metastases. In 3 patients, a normal 18FDG PET confirmed complete remission of disease. Most MCC patients exhibited highly 18FDG-avid sites suggestive of increased glucose metabolism. This imaging pattern was related to a high proliferative activity (Ki-67 index >50%). In 1 patient with a weakly proliferative nodal MCC (Ki-67<10%), a false negative result was yielded by metabolic imaging. In 4/11 patients, 18FDG PET revealed an unsuspected second neoplasm in addition to MCC. It is concluded that whole-body 18FDG PET may be useful in the management of MCC patients. However, a normal 18FDG PET aspect cannot rule out MCC with low proliferative activity. [less ▲]

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See detailPET and PET/CT Imaging in Lung Cancer
Rigo, Pierre ULg; Hustinx, Roland ULg; Bury, Thierry ULg

in Valk, PE; Delbeke, D; Bailey, DL (Eds.) et al Positron Emission Tomography - Clnical practice (2006)

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See detailPET imaging in lung cancer
Rigo, Pierre ULg; Hustinx, Roland ULg; Bury, Thierry ULg

in Valk, Peter E.; Delbeke, Dominique; Bailey, Dale L. (Eds.) et al Positron emission tomography (2006)

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See detailPET and PET/CT imaging in lymphomas.
Jerusalem, Guy ULg; Hustinx, Roland ULg; Rigo, Pierre ULg

in Valk, Peter E.; Delbeke, Dominique; Bailey, Dale L. (Eds.) et al Positron emission tomography (2006)

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See detailF-18-FDG PET in children with lymphomas
Depas, Gisèle ULg; De Barsy, Caroline; Jerusalem, Guy ULg et al

in European Journal of Nuclear Medicine and Molecular Imaging (2005), 32(1), 31-38

Purpose: The aim of this study was to retrospectively evaluate the performance of positron emission tomography (PET) with F-18-fluorodeoxyglucose (F-18-FDG) in children with lymphomas, at various stages ... [more ▼]

Purpose: The aim of this study was to retrospectively evaluate the performance of positron emission tomography (PET) with F-18-fluorodeoxyglucose (F-18-FDG) in children with lymphomas, at various stages of their disease. Methods: Twenty-eight children (mean age 12.5 years, 14 girls, 14 boys) with Hodgkin's disease (HD, n=17) or non-Hodgkin's lymphoma (NHL, n= 11) were evaluated. Patients were investigated at initial staging (n=19), early in the course of treatment (n=19), at the end of treatment (n=16) and during long-term follow-up (n=19). A total of 113 whole-body PET studies were performed on dedicated scanners. PET results were compared with the results of conventional methods (CMs) such as physical examination, laboratory studies, chest X-rays, computed tomography, magnetic resonance imaging, ultrasonography and bone scan when available. Results: At initial evaluation (group 1), PET changed the disease stage and treatment in 10.5% of the cases. In early evaluation of the response to treatment (group 2), PET failed to predict two relapses and one incomplete response to treatment. In this group, however, PET did not show any false positive results. There were only 4/75 false positive results for PET among patients studied at the end of treatment (group 3, specificity 94%) or during the systematic follow-up (group 4, specificity 95%), as compared with 27/75 for CMs (specificity 54% and 66%, respectively). Conclusion: F-18-FDG-PET is a useful tool for evaluating children with lymphomas. Large prospective studies are needed to appreciate its real impact on patient management. [less ▲]

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See detailFluorinated tracers for imaging cancer with positron emission tomography
Couturier, Olivier; Luxen, André ULg; Chatal, Jean-François et al

in European Journal of Nuclear Medicine and Molecular Imaging (2004), 31(8), 1182-1206

2-[F-18]fluoro-2-deoxy-D-glucose (FDG) is currently the only fluorinated tracer used in routine clinical positron emission tomography (PET). Fluorine-18 is considered the ideal radioisotope for PET ... [more ▼]

2-[F-18]fluoro-2-deoxy-D-glucose (FDG) is currently the only fluorinated tracer used in routine clinical positron emission tomography (PET). Fluorine-18 is considered the ideal radioisotope for PET imaging owing to the low positron energy (0.64 MeV), which not only limits the dose rate to the patient but also results in a relatively short range of emission in tissue, thereby providing high-resolution images. Further, the 110-min physical half-life allows for high-yield radiosynthesis, transport from the production site to the imaging site and imaging protocols that may span hours, which permits dynamic studies and assessment of potentially fairly slow metabolic processes. The synthesis of fluorinated tracers as an alternative to FDG was initially tested using nucleophilic fluorination of the molecule, as performed when radiolabelling with iodine-124 or bromide-76. However, in addition to being long, with multiple steps, this procedure is not recommended for bioactive molecules containing reactive groups such as amine or thiol groups. Radiochemical yields are also often low. More recently, radiosynthesis from prosthetic group precursors, which allows easier radiolabelling of biomolecules, has led to the development of numerous fluorinated tracers. Given the wide availability of 18F, such tracers may well develop into important routine tracers. This article is a review of the literature concerning fluorinated radiotracers recently developed and under investigation for possible PET imaging in cancer patients. Two groups can be distinguished. The first includes "generalist" tracers, i.e. tracers amenable to use in a wide variety of tumours and indications, very similar in this respect to FDG. These are tracers for non-specific cell metabolism, such as protein synthesis, amino acid transport, nucleic acid synthesis or membrane component synthesis. The second group consists of "specific" tracers for receptor expression (i.e. oestrogens or somatostatin), cell hypoxia or bone metabolism. [less ▲]

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See detailPET in lung cancer
Rigo, Pierre ULg; Hustinx, Roland ULg; Bury, Thierry ULg

in Bailey, D. L.; Townsend, D. W.; Valk, P. E. (Eds.) et al Positron emission tomography. Principles and practice (2004)

Positron Emission Tomography - basic science and clinical practice thoroughly explains the principles, clinical applications and economic aspects of PET today. Chapters go into detail on PET applications ... [more ▼]

Positron Emission Tomography - basic science and clinical practice thoroughly explains the principles, clinical applications and economic aspects of PET today. Chapters go into detail on PET applications in oncology, the central nervous system, cardio-respiratory systems, infectious diseases and pediatrics. Discussions are also found on technology design and evaluation, PET in drug discovery and development, and in imaging gene expression and therapy. [less ▲]

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See detailWhole-body positron emission tomography using fluorodeoxyglucose in patients with metastases of unknown primary tumours (CUP syndrome)
Alberini, J. L.; Belhocine, Tarik; Hustinx, Roland ULg et al

in Nuclear Medicine Communications (2003), 24(10), 1081-1086

The aim of this study was to evaluate the clinical performances of whole body 2-[F-18]fluorodeoxyglucose positron emission tomography (FDG PET) imaging for the detection of the primary tumour in patients ... [more ▼]

The aim of this study was to evaluate the clinical performances of whole body 2-[F-18]fluorodeoxyglucose positron emission tomography (FDG PET) imaging for the detection of the primary tumour in patients with metastases of unknown origin. Forty-one patients, without previous history of known cancer (18 women and 23 men; average age 64.1 years) with metastasis confirmed by histopathological analysis were included in a retrospective study. Results of PET were compared with those of techniques used in the current conventional diagnostic procedure. All known metastatic lesions were detected by PET. There were 26 true-positive and two false-negative results. Primary tumour remained undetermined in eight patients after conventional investigations and PET. PET was superior to conventional diagnostic procedure in 11 patients and led to modify treatment in 11 patients. Sensitivity of PET was superior than computed tomography in detecting abdominal primary tumours. FDG PET is useful in patients with unknown primary tumour because its sensitivity is good and it could modify the disease management. Otherwise, PET allows the evaluation of the extent of the disease and could be used to monitor treatment efficiency. Its contribution has to be evaluated particularly in patients with primary tumour with a specific treatment. ((C) 2003 Lippincott Williams Wilkins). [less ▲]

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See detailStaging of primary cervical cancers: the role of nuclear medicine
Belhocine, Tarik; Kridelka, Frédéric ULg; Thille, Alain ULg et al

in Critical Reviews in Oncology/Hematology (2003), 46(3), 275-284

In nuclear medicine, [F-18]-fluorodeoxyglucose positron emission tomography ((18)FDG PET) and lymphatic mapping and sentinel lymphadenectomy (LM/SL) may significantly improve the staging of primary ... [more ▼]

In nuclear medicine, [F-18]-fluorodeoxyglucose positron emission tomography ((18)FDG PET) and lymphatic mapping and sentinel lymphadenectomy (LM/SL) may significantly improve the staging of primary cervical cancers. Indeed, the disease progresses in a 'level by level' fashion to regional nodes through the lymphatic channels, and also to extra-nodal sites via the hematogenous stream. Additionally, the sub-optimal efficacy of routine radiological protocols, while new combined therapies are proving to be more efficient, stresses the need for alternative staging procedures. Current data suggest that LM/SL accurately reflects the regional lymph node status in early stage cervical cancers, and thus could avoid unnecessary complete lymphadenectomies. Also, whole body (18)FDG PET may provide valuable insights on extra-pelvic and distant tumor spreading, with a significant impact on treatment choices. If these promising results are confirmed on large controlled trials, LM/SL and (18)FDG PET imaging could be incorporated in the routine staging work-up of primary cervical cancers. (C) 2003 Elsevier Science Ireland Ltd. All rights reserved. [less ▲]

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See detailEarly detection of relapse by whole-body positron emission tomography in the follow-up of patients with Hodgkin's disease.
Jerusalem, Guy ULg; Beguin, Yves ULg; Fassotte, Marie-France ULg et al

in Annals of Oncology (2003), 14(1), 123-30

BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron ... [more ▼]

BACKGROUND: Relapse after treatment of Hodgkin's disease (HD) is usually identified as a result of the investigation of symptoms. We undertook this study to examine the value of whole-body positron emission tomography (PET) for the detection of preclinical relapse. PATIENTS AND METHODS: Thirty-six patients underwent 2-[fluorine-18]fluoro-2-deoxy-D-glucose ((18)F-FDG) PET at the end of treatment and than every 4-6 months for 2-3 years after the end of polychemotherapy and/or radiotherapy. In those cases of abnormal (18)F-FDG accumulation a confirmatory study was performed 4-6 weeks later. RESULTS: One patient had residual tumor and four patients relapsed during a follow-up of 5-24 months. All five events were correctly identified early by (18)F-FDG PET. Residual tumor or relapse was never first diagnosed based on clinical examination, laboratory findings or computed tomography (CT) studies. Two patients presented B symptoms and the three others were asymptomatic at the time of residual disease or relapse. Confirmation of residual disease or relapse was obtained by biopsy in four patients 1, 1, 5 and 9 months after PET and by unequivocal clinical symptoms and CT studies in one patient 3 months after PET. False-positive (18)F-FDG PET studies incorrectly suggested possible relapse in six other patients, but the confirmatory PET was always negative. Our study also provides important information about physiological (18)F-FDG uptake in the thymus. CONCLUSIONS: Our data suggest the potential of (18)F-FDG PET to detect preclinical relapse in patients with HD. This could help identify patients requiring salvage chemotherapy at the time of minimal disease rather than at the time of clinically overt relapse. Further studies are warranted to determine the impact of PET on treatment management and outcome. In fact, the aim of follow-up procedures is not only to detect preclinical relapse but mainly to obtain better results by starting salvage treatment earlier. A cost-benefit analysis will also be necessary before (18)F-FDG PET can be used routinely in the follow-up of patients with HD. [less ▲]

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See detailMalignant melanoma
Paquet, Philippe ULg; Hustinx, Roland ULg; Rigo, Pierre ULg et al

in Oehr, Peter; Biersack, Hans_jürgen; Coleman, Edward R (Eds.) PET and PET-CT in Oncology (2003)

PET and PET-CT in Oncology describes the principles of positron emission tomography and is a useful resource for incorporating the technique in clinical practice. In a clear and straightforward fashion ... [more ▼]

PET and PET-CT in Oncology describes the principles of positron emission tomography and is a useful resource for incorporating the technique in clinical practice. In a clear and straightforward fashion, this heavily-illustrated text offers instructive information and overviews of the basic principles of PET and PET-CT as well as the routine clinical PET scanning procedures for all important oncological indications. It is designed to serve as a reference work for specialists in nuclear medicine and radiology (including therapy planning) and for oncologists. It also provides student and physicians in other medical specialities with a general introduction to the effective integration of this modern technique into routine clinical diagnostics. Above all, this volume illustrates the importance of PET and PET-CT in comparison with other imaging techniques. [less ▲]

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See detailPET Imaging in Lymphoma
Jerusalem, Guy ULg; Rigo, Pierre ULg

in Valk, P. E.; Bailey, D. L.; Townsend, D. W. (Eds.) et al Positron emission tomography (2003)

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See detailPET and PET/CT of lymphoma
Jerusalem, Guy ULg; Rigo, Pierre ULg; Israel, Ora

in von Schulthess, Gustav K (Ed.) Clinical Molecular Anatomic Imaging (2003)

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See detailContribution of whole-body (18)FDG PET imaging in the management of cervical cancer
Belhocine, T.; Thille, Alain ULg; Fridman, Viviana ULg et al

in Gynecologic Oncology (2002), 87(1), 90-97

OBJECTIVE: The objective of this study was to assess the contribution of [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG PET) imaging in the management of cervical cancer. METHODS ... [more ▼]

OBJECTIVE: The objective of this study was to assess the contribution of [(18)F]fluoro-2-deoxy-D-glucose positron emission tomography ((18)FDG PET) imaging in the management of cervical cancer. METHODS: Fully corrected whole-body PET was performed in 60 patients (pts) with proven cervical cancer. In pretreatment staging, 22 pts underwent PET in addition to routine protocol including International Federation of Obstetrics and Gynecology (FIGO) staging and pelvic magnetic resonance imaging (MRI). Eighteen of them had pelvic lymphadenectomy. After treatment, PET was performed in 38 pts routinely followed up by clinical and radiological examinations. Results of PET and routine protocols were compared to final diagnoses, including histological findings in 31 pts and clinical outcomes in the other cases. Median follow-up time was 12 +/- 7.3 months. RESULTS: In all but 2 patients (FIGO stage IA), both PET and MRI detected the primary tumor. In 6 pts, MRI alone noted loco-regional tumor spread but PET localized 9 unsuspected extrapelvic nodal sites (6 para-aortic, 2 mediastinal, and 1 supra-clavicular). However, PET missed 8 microscopic pelvic nodal metastases. In 18% of the patients, PET staging significantly influenced the treatment choices. In follow-up, PET accurately diagnosed a recurrent disease in 13 pts with falsely negative or equivocal conventional imaging (CI). Ten patients with a negative PET were still in complete remission after a minimal follow-up time of 12 months. Overall, the agreement of PET with final diagnosis was significantly better than that of routine protocol (P < 0.05). CONCLUSIONS: Whole-body (18)FDG PET appears useful in the management of cervical cancer, in particular for staging extrapelvic metastases or optimally detecting a recurrence. MRI is better indicated for evaluating the loco-regional status of the disease. [less ▲]

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See detailIncreased uptake of the apoptosis-imaging agent (99m)Tc recombinant human annexin V in human tumors after one course of chemotherapy as a predictor of tumor response and patient prognosis
Belhocine, Tarik; Steinmetz, Neil; Hustinx, Roland ULg et al

in Clinical Cancer Research : An Official Journal of the American Association for Cancer Research (2002), 8(9), 2766-2774

Purpose: Many anticancer therapies exert their therapeutic effect by inducing apoptosis in target tumors. We evaluated in a Phase I study the safety and the feasibility of Tc-99m-Annexin V for imaging ... [more ▼]

Purpose: Many anticancer therapies exert their therapeutic effect by inducing apoptosis in target tumors. We evaluated in a Phase I study the safety and the feasibility of Tc-99m-Annexin V for imaging chemotherapy-induced apoptosis in human cancers immediately after the first course of chemotherapy. Experimental Design: Fifteen patients presenting with lung cancer (n = 10), lymphoma (n = 3), or breast cancer (n = 2) underwent Tc-99m-Annexin V scintigraphy before and within 3 days after their first course of chemotherapy. Tumor response was evaluated by computed tomography and F-18-fluoro-2-deoxy-D-glucose positron emission tomography scans, 3 months in average after completing the treatment. Median follow-up was 117 days. Results: In all cases, no tracer uptake was observed before treatment. However, 24-48 h after the first course of chemotherapy, 7 patients who showed Tc-99m-Annexin V uptake at tumor sites, suggesting apoptosis, had a complete (n = 4) or a partial response In = 3). Conversely, 6 of the 8 patients who showed no significant posttreatment tumor uptake had a progressive disease. Despite the lack of tracer uptake after treatment, the 2 patients with breast cancer had a partial response. Overall survival and progression-free survival were significantly related to tracer uptake in treated lung cancers and lymphomas (P < 0.05). No serious adverse events were observed. Conclusions: Our preliminary results demonstrated the feasibility and the safety of Tc-99m-Annexin V for imaging apoptosis in human tumors after the first course of chemotherapy. Initial data suggest that early Tc-99m-Annexin V tumor uptake may be a predictor of response to treatment in-patients with late stage lung cancer and lymphoma. [less ▲]

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See detailFluorodeoxyglucose positron emission tomography and somatostatin receptor scintigraphy for diagnosing and staging carcinoid tumours: correlations with the pathological indexes p53 and Ki-67
Belhocine, Tarik; Willems, Jacqueline ULg; Rigo, Pierre ULg et al

in Nuclear Medicine Communications (2002), 23(8), 727-734

We performed this study in order to evaluate the diagnostic accuracy of whole-body fluorodeoxyglucose positron emission tomography (FDG PET) imaging and somatostatin receptor scintigraphy (SRS) for ... [more ▼]

We performed this study in order to evaluate the diagnostic accuracy of whole-body fluorodeoxyglucose positron emission tomography (FDG PET) imaging and somatostatin receptor scintigraphy (SRS) for localizing primary carcinoid tumours and evaluating the extent of the disease. A secondary aim was to correlate those findings with the histological characteristics of the lesions. FDG PET was performed in 17 patients and SRS in 16. All patients had pathologically proven carcinoids. All lesions were verified by histopathological analysis or by follow-up. Ki-67 and p53 expression were assessed as an indicator of the tumours' aggressiveness. FDG PET correctly identified 4/7 primary tumours and 8/11 metastatic spreads, as compared to six and 10 respectively, for SRS. Most tumours were typical carcinoids with low Ki-67 expression. No correlation was found between the histological features and the tracer's uptake. We conclude that SRS remains the modality of choice for evaluating patients with carcinoid tumours, regardless of their proliferative activity. FDG PET should be reserved to patients with negative results on SRS. ((C) 2002 Lippincott Williams Wilkins). [less ▲]

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See detailMaladie de Horton et atteintes arterielles extratemporales: utilite de la tomographie par emission de positons au 18FDG. A propos de trois observations et d'une revue de la litterature
Belhocine, Tarik; Kaye, Olivier; Delanaye, Pierre ULg et al

in Revue de Médecine Interne (2002), 23(7), 584-91

PURPOSE: We report three cases of Horton's disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels ... [more ▼]

PURPOSE: We report three cases of Horton's disease, in which F18-Fluorine-2-Deoxy-D-Glucose (18FDG) positron emission tomography (PET) demonstrated a clinically unsuspected extra-cranial vessels hypermetabolism. METHODS: Fully corrected whole-body PET was performed in three patients (two women, one man) for exploring a marked inflammatory syndrome. Scanning was acquired 60 min after i.v. injection of 222 MBq of 18FDG in average. RESULTS: In two patients with histologically proven Horton's disease, PET alone showed increased glucose metabolism involving the carotid and sub-clavian arteries as well as the ascending aorta, aortic arch, thoracic and abdominal aorta, and the iliac and femoral arteries. In the third patient, by detecting cervical, thoracic and abdominal vessel hypermetabolism, PET non-invasively contributed to the diagnosis of giant cell arteritis. All patients had complete clinical and biological response to corticoids. PET controls performed 3- to 6-months post-treatment, confirmed the disappearance of the metabolic stigma. CONCLUSION: 18FDG PET may show an increased glucose metabolism in asymptomatic extracranial vessels locations of Horton's arterities. If these observations are confirmed on controlled trials, PET could be particularly useful for non-invasive diagnosing, staging and monitoring atypical clinical forms of Horton's disease. The metabolic imaging could also contribute to a better understanding of the pathogenesis of GCA. [less ▲]

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See detailPositron emission tomography (PET) evaluation of abdominal aortic aneurysm (AAA)
SakalihasanN, Natzi ULg; Van Damme, Hendrik ULg; Gomez, P. et al

in European Journal of Vascular and Endovascular Surgery (2002), 23(5), 431-436

Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal ... [more ▼]

Background: aneurysmal disease is associated with all inflammatory Cell infiltrate and enzymatic degradation of the vessel wall. Aim of the study: to detect increased metabolic activity in abdominal aortic aneurysms (AAA) by means of positron emission tomography (PET-imaging). Study design: twenty-six patients with AAA underwent PET-imaging Results: in tell patients, PET-imaging revealed increased, fluoro-deoxy-glucose (18-FDG) uptake at the level of the aneurysm. Patients with positive PET-imaging had one or more of the following elements in their clinical history: history Of recent non-aortic surgery (n = 4) a painful inflammatory aortic aneurysm (n = 2). moderate low back pain (n = 2), rapid (>5 mm in 6 months) expansion (n = 4), discovery by PET-scan of a previously undiagnosed lung cancer (n = 3) or parotid tumour (n = 1). Five patients with a positive PET scan required urgent surgery within two to 30 days. Among the 16 patients with negative PET-imaging of their aneurysm, only one had recent non-aortic surgery, none of them required urgent surgery, only two had a rapidly expanding AAA, and in only one patient, PET-imaging revealed an unknown lung cancer. Conclusion: these data suggest a possible association between increased 18-FDG uptake and AAA expansion and rupture. [less ▲]

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See detailGamma-probe-directed lymphatic mapping and sentinel lymphadenectomy in primary cutaneous melanoma.
Belhocine, T.; Pierard, Gérald ULg; Gielen, Jean-Louis ULg et al

in Dermatology : International Journal for Clinical & Investigative Dermatology (2002), 204(4), 355-61

BACKGROUND: Radiotracer and blue-dye lymphatic mapping is a recommended combined method to guide sentinel lymphadenectomy and full regional lymph node dissection in selected patients with cutaneous ... [more ▼]

BACKGROUND: Radiotracer and blue-dye lymphatic mapping is a recommended combined method to guide sentinel lymphadenectomy and full regional lymph node dissection in selected patients with cutaneous melanoma. OBJECTIVE: To evaluate the diagnostic accuracy and the prognostic value of gamma-probe-directed lymphatic mapping in cutaneous melanomas. METHODS: Sixty-five stage I and II melanoma patients underwent gamma-probe-directed lymphatic mapping. Sentinel lymph nodes were studied by both conventional and immunohistochemical stainings. The median follow-up was 11 months. RESULTS: Sensitivities of preoperative and intraoperative sentinel lymph node detection were 100 and 98%, respectively. Only 1 failure of detection and 1 missed same-basin metastasis were experienced in the axillary and cervical areas, respectively. Eleven patients (16.9%) had sentinel node metastases leading to adjuvant therapy. CONCLUSION: Gamma-probe-directed lymphatic mapping is useful for staging melanoma. However, in the expectation of a more specific identification of the sentinel lymph node, the standard protocol remains recommended for exploring the axillary and cervical areas. The histological examination supported in some cases by immunohistochemistry remains mandatory in all cases. [less ▲]

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See detailStaging of regional nodes in AJCC stage I and II melanoma: 18FDG PET imaging versus sentinel node detection.
Belhocine, Tarik; Pierard, Gérald ULg; De Labrassinne, Michel et al

in Oncologist (2002), 7(4), 271-8

PRIMARY PURPOSE: The staging of regional nodes by means of sentinel node detection has been shown to accurately detect subclinical nodal metastases from cutaneous melanoma. On the other hand, the ... [more ▼]

PRIMARY PURPOSE: The staging of regional nodes by means of sentinel node detection has been shown to accurately detect subclinical nodal metastases from cutaneous melanoma. On the other hand, the oncological applications of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (18FDG PET) are, nowadays, firmly established. However, the sensitivity of such metabolic imaging for staging the regional nodes in primary melanoma remains debatable. We prospectively assessed the actual value of PET for detecting sentinel node metastases in 21 consecutive patients presenting with early-stage melanoma. MATERIALS AND METHODS: Twenty-one melanoma patients scheduled for lymphatic mapping and sentinel lymphadenectomy underwent fully corrected whole-body PET using 18FDG. In all cases, the disease was initially classified as either stage I or II, from the latest version of the American Joint Committee on Cancer staging system. The sentinel node detection was systematically performed within the week following the PET scan. Serial sections of the sentinel nodes were analyzed by both conventional pathology and immunohistochemical staining. Metastatic sentinel nodes were also assessed for the size of tumor deposits and the degree of nodal involvement (focal, partial, or massive). The median follow-up time was 12 months. RESULTS: Six of the 21 patients (28.5%) had an involved sentinel node. PET was positive in only one case with a sentinel node >1 cm. In the five other cases, the sentinel nodes missed by PET were <1 cm with focal and/or partial involvements. One patient, free of regional nodal metastases in both sentinel node detection and PET imaging, had, however, a same-basin recurrence 3 months later. In another case, PET had one false positive result. Overall, the sentinel detection of subclinical nodal metastases had a sensitivity of 86%. PET detected only 14% of sentinel node metastases. CONCLUSIONS: Sentinel node detection remains the procedure of choice for detecting subclinical lymph node involvement from primary cutaneous melanoma. Owing to its limited spatial resolution, PET appears insufficiently sensitive to identify microscopic nodal metastases. As a practical consequence, metabolic imaging is not recommended as a first-line imaging strategy for staging regional lymph nodes in patients with stage I or II melanoma. [less ▲]

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