Evaluation of PET/CTRole in Diagnosis and Management of Pediatric Malignancy
- Assistant Prof. of Safety and Prevention of Oncologyin Radiation Protection Department, Nuclear and Radiological Regulatory Authority, Cairo, Egypt. PhD, M.D in Childhood Studies & Pediatric Oncology, Ain-Shams University, Cairo, Egypt. Assistant Prof.of Applied Statisticin Radiation Safety Department,Nuclear and Radiological Regulatory Authority, Cairo, Egypt.PhD inApplied Statistic,Ain-Shams University, Cairo, Egypt.
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Background: Successful management of solid tumors in children requires imaging tests for accurate disease detection, characterization, and treatment monitoring. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is a highly sensitive and specific imaging modality for whole-body evaluation of pediatric malignancies.The study aimed to retrospectively evaluate the efficacy of FDG PET/CT imaging system in the management of some pediatric malignancy and to determine if it provided additional diagnostic information on disease status; during the last 4 years (y). Methodology: 180 pediatric patients (118 male and 62 female) were included in the study. Their ages ranged from 6 month to 19 y at their first PET/CT examination. 78.3% of the patients were below 10 years old. 100 patients had lymphoma (82 Hodgkin and 18 Non-Hodgkin), 26 had soft tissue sarcoma (STS), and 54 had neuroblastoma. The indication, purpose, and findings of each PET/CT examination were reviewed, in addition to other imaging findings as well as clinical information including follow-up results for >1 y from their last PET/CT examination. 720 scan was performed for whole body in all patients for initial diagnosis & staging and restaging of recurrent malignancy. It is also, performed to assess cancer response to therapy and after therapy as a routine follow-up procedure or for further evaluation of suspected recurrence or for secondary malignancy. 1080 suspicious sites were evaluated in the studied patients, and those whose reports indicated areas of increased FDG uptake were selected. PET/CT findings were compared with the results of other diagnostic procedures (including CT and ultrasound), biopsy findings and follow-up data. Results: The current study represents that the, 18F-FDG PET/CT may influence the treatment decision if distant metastases or second primary tumors are detected with regard to staging of the primary tumor. Post Chemo-radiotherapy (CRT) PET/CT does aid subsequent management decisions. The overall sensitivities, specificities & positive and negative predictive values of the imaging system for all the suspicious sites were 98.1%, 97.2%, 97.6% and 97.8% respectively. It was 94.60%, 97.50%, 92.10%, and 98.30% respectively for detecting the local recurrence at the end of treatment; and 96.20%, 98.30%, 92.60%, and 99.10% after 1y of treatment. The sensitivities and specificities of 18F-FDG PET/CT for initial staging of malignant lymphomas are83.3%-100% and 93.75%-100% respectively. It ranged 66.70%-100% and 91.30%-100% respectively in sarcoma and 86.70%-100% and 95.80%-100% respectively in Neuroblastoma. Conclusion: The study concluded that the 18F-FDG PET/CT is the gold standard for noninvasive functional imaging in oncology. Technical developments in PET scanning in cancer management may increase the precision of radiotherapy planning and thus improve tumor control and reduce treatment-related morbidity. Recommendation regarding the use of PET/CT in the management of pediatric malignancy to facilitates the sparing of normal structures and the escalation of dose.
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[Abaza A.and El- Shanshoury G. (2017); Evaluation of PET/CTRole in Diagnosis and Management of Pediatric Malignancy Int. J. of Adv. Res. 5 (1). 408-419] (ISSN 2320-5407). www.journalijar.com
Article DOI: 10.21474/IJAR01/2761 DOI URL: http://dx.doi.org/10.21474/IJAR01/2761
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