20Jan 2017

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.


  1. Amthauer, H., Furth, C., Denecke, T., Hundsdoerfer, P., Voelker, T., Seeger, K., St?ver, B. andHenze, G.(2005):FDG-PET in 10 children with non-Hodgkin?s lymphoma: initial experience in staging and follow-up. KlinPadiatr., 217(6):327?333.
  2. Antoch, G., Saoudi, N., Kuehl, H., Dahmen, G., Mueller, S.P., Beyer, T., Bockisch, A., Debatin, J.F. and Freudenberg, L.S.(2005):Accuracy ofWhole-body dual-modality fluorine-18-2-fluo-2-deoxy-d-glucose positron emission tomography and computed tomography (FDG-PET-CT) for tumor staging in solid tumor: comparison with CT and PET. J ClinOncol.,22:4357?4368.
  3. Bakhshi, S., Radhakrishnan, V., Sharma, P., Kumar, R., Thulkar, S., Vishnubhatla, S., Dhawan, D. andMalhotra, A. (2012):Pediatric non-lymphoblastic non-Hodgkin lymphoma: baseline, interim, and posttreatment PET/CT versus contrast- enhanced CT for evaluation?a prospective study. Radiology, 262 (3): 956?968.
  4. Cheng, G., Servaes, S. and Zhuang, H. (2013): Value of 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography scan versus diagnostic contrast computed tomography in initial staging of pediatric patients with lymphoma. Leuk Lymphoma., 54:737?742.
  5. Choi, Y.J., Hwang, H.S., Kim, H.J., Jeong, Y.H., Cho, A, Lee, J.H., Yun, M., Lee, J.D. andKang, W.J. (2014):18F-FDG PET as a single imaging modality in pediatric neuroblastoma: comparison with abdomen CT and bone scintigraphy. Ann Nucl Med., 28(4):301?313.Erratum inAnn Nucl Med.2014;28(3):293.
  6. Cohade, C., Osman, M., Leal, J. and Wahl, R.L. (2003): Direct comparison of 18F-FDG PET and PET/CT in patients with colorectal carcinoma. J Nucl Med., 44:1797?1803.
  7. Depas, G., De Barsy, C., Jerusalem, G., Hoyoux, C., Dresse, M.F., Fassotte, M.F., Paquet, N., Foidart, J., Rigo, P. andHustinx, R. (2005):18F-FDG PET in children with lymphomas. Eur J Nucl Med MolImaging,32(1):31?38.
  8. Freudenberg, L.S., Rosenbaum, S.J., Beyer, T., Bockisch, A. andAntoch, G.(2007):PET versus PET/CT dual-modality imaging in evaluation of lung cancer.RadiolClin North Am., 45:639?644.
  9. Hernandez-Pampaloni, M., Takalkar, A., Yu, J.Q., Zhuang, H. andAlavi, A. (2006): F-18 FDGPET imaging and correlation with CT in staging and follow-up of pediatric lymphomas. PediatrRadiol., 36:524?531.
  10. Furth C., Denecke T., Steffen I., Ruf J., Voelker T., Misch D., Vondran F., Plotkin M., St?ver B., Henze G., Lemke A.J. andAmthauer H.(2006):Correlative imaging strategies implementing CT, MRI, and PET for staging of childhood Hodgkin disease. J PediatrHematolOncol., 28(8):501?512.
  11. Furth C., Steffen I.G., Amthauer H., Ruf J., Misch D., Sch?nberger S., Kobe C., Denecke T., St?ver B., Hautzel H., Henze G. andHundsdoerfer P.(2009):Early and late therapy response assessment with [18F]fluorodeoxyglucose positron emission tomography in pediatric Hodgkin?s lymphoma: analysis of a prospective multicenter trial. J ClinOncol., 27(26):4385?4391.
  12. Fuster D., Duck J., Paredes P., Velasco M., Mu?oz M., Santamar?a G., FontanillasM. and Pons F.(2008):Preoperative staging of large primary breast cancer with [18F] fluorodeoxyglucose positron emission tomography/computed tomography compared with conventional imaging procedures. J ClinOncol.,26(29):4746?4751.
  13. ny.gov.(2015): \'Basic Statistics: About Incidence, Prevalence, Morbidity, and Mortality - Statistics Teaching Tools - New York State Department of Health\'. N.p., 1999. Web. 7 Apr. 2015.
  14. Huang, B., Law, M.W. andKhong, P.L.(2009):Whole-body PET/CT scanning: estimation of radiation dose and cancer risk. Radiology,251:166?174.
  15. Ilivitzki, A., Radan, L., Ben-Arush, M., Israel, O. and Ben-Barak,A.(2013):Early interim FDG PET/CT prediction of treatment response and prognosis in pediatric Hodgkin disease: added value of low-dose CT. PediatrRadiol., 43:86?92.
  16. Kabickova, E., Sumerauer, D., Cumlivska, E., Drahokoupilova, E., Nekolna, M., Chanova, M., Hladikova, M., Kodet, R. andBelohlavek, O.(2006):Comparison of 18F-FDG-PET and standard procedures for the pretreatment staging of children and adolescents with Hodgkin?s disease. Eur J Nucl Med Mol Imaging, 33(9):1025?1031.
  17. L. and Goldsmith. S.J.(2003):18F-FDG PET evaluation of the response to therapy for lymphoma and for breast, lung, and colorectal carcinoma. J Nucl Med.,44:224?239.
  18. la Foug?re, C., Hundt, W., Brockel, N., Pfluger, T., Haug, A., Scher, B., Hacker, M., Hahn, K., Reiser, M. and Tiling, R.(2006):Value of PET/CT versus PET and CT performed as separate investigations in patients with Hodgkin?s disease and non-Hodgkin?s lymphoma.Eur J Nucl Med Mol Imaging,33(12):1417?1425.
  19. J.M., Weiner. M. and Kelly. K.M.(2006): Routine use of PET scans after completion of therapy in pediatric Hodgkin disease results in a high false positive rate. J PediatrHematolOncol., 28:711?714
  20. Longo D.L.(2013):Treatment of advanced Hodgkin lymphoma: the more thingschange, the more they stay the same. J ClinOncol.,31:660?662.
  21. Mandrekar, J.N. and Mandrekar, S.J.(2005):Statistical Methods in Diagnostic Medicine using SAS? Software.SUGI 30. Statistics and Data Analysis. Proceedings of the Thirtieth Annual SAS? Users Group International Conference, 2005 by SAS Institute Inc., Cary, NC, USA. Paper 211-30; 1-8
  22. Meany, H.J., Gidvani, V.K. andMinniti, C.P. (2007):Utility of PET scans to predict disease relapse in pediatric patients with Hodgkin lymphoma. Pediatr Blood Cancer, 48:399?402.
  23. Meta, J., Seltzer, M., Schiepers, C., Silverman, D.H., Ariannejad, M., Gambhir, S.S., Phelps, M.E., Valk, P. andCzernin, J.(2001):Impact of 18F-FDG PET on managing patients with colorectal cancer: the referring physician?s perspective. J Nucl Med.,42(4):586?590.
  24. Miller, E., Metser, U., Avrahami, G., Dvir, R., Valdman, D., Sira, L.B., Sayar, D., Burstein, Y., Toren, A., Yaniv, I. and Even-Sapir, E.(2006):Role of 18F-FDG PET/CT in staging and follow-up of lymphoma in pediatric and young adult patients. J Comput Assist Tomogr., 30(4):689?694.
  25. Ng, S.H., Chan, S.C., Yen, T.C, Chang, J.T., Liao, C.T., Ko, S.F., Liu, F.Y., Chin, S.C., Fan, K.H. and Hsu, C.L.(2009):Staging of untreated nasopharyngeal carcinoma with PET/CT: comparison with conventional imaging work-up. Eur J Nucl Med MolImaging,36(1):12?22. Erratum in: Eur J Nucl Med Mol Imaging. 2009;36(3):538.
  26. Nievelstein, R.A., Quarles, van Ufford, H.M., Kwee, T.C., Bierings, M.B., Ludwig, I., Beek, F.J., de Klerk, J.M., Mali, W.P., de Bruin, P.W. and Geleijns, J.(2012):Radiation exposure and mortality risk from CT and PET imaging of patients with malignant lymphoma. EurRadiol., 22(9):1946?1954.
  27. Nyari, T.(2011): Mathematical and Statistical Modelling in Medicine, Diagnostic Study: Conditional probability. model.u-szeged.hu/data/.../Nyari_HU_SRB_03.pd
  28. Patel., Hadar. N., Lee. J., ?Siegel. B.A., Bruce. E. Hillner. B.E. and ?Lau. J.(2013):The Lack of Evidence for PET or PET/CT Surveillance of Patients with Treated Lymphoma, Colorectal Cancer, and Head and Neck Cancer: A Systematic Review. J Nucl Med., 54 (9) 1518-1527 doi: 10.2967/jnumed.112.119362Copyright ? 2015 by AlphaMed Press
  29. Paulino, A.C., Margolin, J., Dreyer, Z., The, B.S. and Chiang, S.(2012): Impact of PET-CT on involved field radiotherapy design for pediatric Hodgkin lymphoma. Pediatr Blood Cancer, 58:860?864.
  30. Peacock, J. ‏and Peacock, P.(2011):Oxford Handbook of Medical Statistics.Oxford Medical Handbooks. Chapter 9, pp. 342 Oxford University Press.United Kingdom.
  31. Podoloff, D.A., Advani, R.H., Allred, C., Benson, A.B. 3rd, Brown, E., Burstein, H.J., Carlson, R.W., Coleman, R.E., Czuczman, M.S., Delbeke, D., Edge, S.B., Ettinger, D.S., Grannis, F.W. Jr., Hillner, B.E., Hoffman, J.M., Kiel, K., Komaki, R., Larson, S.M., Mankoff, D.A., Rosenzweig, K.E., Skibber, J.M., Yahalom, J., Yu, J.M. andZelenetz, A.D.(2007):NCCN task force report: positron emission tomography (PET)/computed tomography (CT) scanning in cancer. J Natl ComprCancNetw., 5(suppl 1):S1?S22.
  32. Podoloff, D.A., Ball, D.W., Ben-Josef, E., Benson, A.B. 3rd., Cohen, S.J., Coleman, R.E., Delbeke, D., Ho, M., Ilson, D.H., Kalemkerian, G.P., Lee, R.J., Loeffler, J.S., Macapinlac, H.A., Morgan, R.J. Jr., Siegel, B.A., Singhal, S., Tyler, D.S. and Wong, R.J.(2009):NCCN task force: clinical utility of PET in a variety of tumor types. J Natl ComprCancNetw.,7(suppl 2):S1?S26.
  33. Punwani, S., Taylor, S.A., Bainbridge, A., Prakash, V., Bandula, S., De Vita, E., Olsen, O.E., Hain, S.F., Stevens, N., Daw, S., Shankar, A., Bomanji, J.B. and Humphries, P.D.(2010):Pediatric and adolescent lymphoma: comparison of whole-body STIR half-Fourier RARE MR imaging with an enhanced PET/CT reference for initial staging. Radiology, 255(1):182?190.
  34. Rathore, N., Eissa, H.M., Margolin, J.F., Liu, H., Wu, M.F., Horton, T., Kamdar, K., Dreyer, Z., Steuber, P., Rabin, K.R., Redel,l M., Allen, C.E., McClain, K.L., Guillerman, R.P. and Bollard, C.M.(2012):Pediatric Hodgkin lymphoma: are we over-scanning our patients? J PediatrHematolOncol., 29(5):415?423.
  35. Rhodes, M.M., Delbeke, D., Whitlock, J.A., Martin, W., Kuttesch, J.F., Frangoul, H.A. and Shankar, S.(2006):Utility of FDG-PET/CT in follow up of children treated for Hodgkin and non-Hodgkin lymphoma. J PediatrHematolOncol., 28(5):300?306.
  36. Riad, R., Omar, W., Kotb, M., Hafez, M., Sidhom, I., Zamzam, M., Zaky, I. and Abdel-Dayem, H.(2010):Role of PET/CT in malignant pediatric lymphoma. Eur J Nucl Med Mol Imaging, 37(2):319?329.
  37. Rohren, E.M., Turkington, T.G. and Coleman, R.E.(2004): Clinical applications of PET in oncology. Radiology, 231:305?332.
  38. Schaefer, N.G., Hany, T.F., Taverna, C., Seifert, B., Stumpe, K.D., von Schulthess, G.K. andGoerres, G.W.(2004):Non-Hodgkin lymphoma and Hodgkin disease: coregistered FDG PET and CT at staging and restaging?Do we need contrast-enhanced CT? Radiology, 232(3):823?829.
  39. Sher, D.J., Mauch, P.M., Van Den Abbeele, A., LaCasce, A.S., Czerminski, J. and Ng, A.K. (2009):Prognostic significance of mid- and post-ABVD PET imaging in Hodgkin?s lymphoma: the importance of involved-field radiotherapy. Ann Oncol.,20:1848?1853.
  40. Sherriff, J.M., Ogunremi,B., Colley, S., ?Sanghera, P., and ?Hartley, A.(2015): The role of positron emission tomography/CT imaging in head and neck cancer patients after radical chemo-radiotherapy? DOI: http://dx.doi.org/10.1259/bjr/20976707., Print ISSN: 0161-5505. Online ISSN: 2159-662X. Copyright ? 2015Society of Nuclear Medicine and Molecular Imaging.
  41. Special report: positron emission tomography for the indication of post-treatment surveillance of cancer. BlueCross BlueShield Association Web site. http://www.bcbs.com/blueresources/tec/vols/25/25_03.pdf. Published November 2010. Accessed May 29, 2013.
  42. Strobel, K., Skalsky, J., Kalff, V., Baumann, K., Seifert, B., Joller-Jemelka, H., Dummer, R. andSteinert, H.C.(2007):Tumour assessment in advanced melanoma: value of FDG PET/CT in patients with elevated serum S-100B.Eur J Nucl Med Mol Imaging,34(9):1366?1375.
  43. Tatsumi, M., Miller, J.H. andWahl, R.L.(2007):18F-FDG PET/CT in evaluating non-CNS pediatric malignancies.J Nucl Med., 48(12):1923-31.
  44. Troost,E.G.C.,Schinagl,A.X., Bussink, J. , Boerman, O.C., van der Kogel, A.J. , Oyen, W.J.G. andKaanders,J.H.A.M.(2015):Innovations in Radiotherapy Planning of Head and Neck Cancers: Role of PET. Journal of Nuclear Medicine Print ISSN: 1540-1405. Online ISSN: 1540-1413. Copyright ? 2015 by Journal of the National Comprehensive Cancer Network
  45. Uslu, L., Doing, J., Link, M., Rosenberg, J., Quon, A., and Daldrup-Link, H.E.(2015): Value of 18F-FDG PET and PET/CT for Evaluation of Pediatric Malignancies. J Nucl Med., 56:274?286. DOI: 10.2967/jnumed.114.146290.
  46. Veit-Haibach, P., Vogt, F.M., Jablonka, R., Kuehl, H., Bockisch, A., Beyer, T., Dahmen, G., Rosenbaum, S. andAntoch, G.(2009):Diagnostic accuracy of contrast-enhanced FDG PET/CT in primary staging of cutaneous malignant melanoma.Eur J Nucl Med Mol Imaging,36(6):910?918.
  47. vonSchulthess, G.K., Steinert, H.C. and Hany, T.F.(2006): Integrated PET/CT: current applications and future directions. Radiology, 238:405?422.
  48. Wagner-Johnston, N.D. and Bartlett, N.L.(2011):Role of routine imaging in lymphoma. J Natl ComprCancNetw., 9:575?584.
  49. Walker, H.K., Hall, W.D. and Hurst, J.W.(1990):Clinical Methods. The History, Physical, and Laboratory Examinations. 3rd edition. Chapter 6, Butter Worth publishers. Boston
  50. Weber, W.A.(2005):Use of PET for monitoring cancer therapy and for predicting outcome. J Nucl Med., 46:983?995.
  51. Wickmann, L., Luders, H. andDorffel, W.(2003):18-FDG-PET-findings in children and adolescents with Hodgkin?s disease: retrospective evaluation of the correlation to other imaging procedures in initial staging and to the predictive value of follow up examinations [in German]. KlinPadiatr., 215:146?150.
  52. Xu, G., Zhao, L., and He, Z. (2012/2015):Performance of Whole-Body PET/CT for the Detection of Distant Malignancies in Various Cancers: A Systematic Review and Meta-Analysis.J Nucl Med., 53(12):1847-54. doi: 10.2967/jnumed.112.105049. Epub 2012 Oct 16.Journal of Nuclear Medicine Print ISSN: 0161-5505. Online ISSN: 2159-662X Copyright ? 2015 Society of Nuclear Medicine and Molecular Imaging
  53. Yang, D.H., Min, J.J., Jeong, Y.Y., Ahn, J.S., Kim, Y.K., Cho, S.H., Chung, I.J., Bom, H.S., Kim, H.J. and Lee, J.J.(2009):The combined evaluation of interim contrast enhanced computerized tomography (CT) and FDG-PET/CT predicts the clinical outcomes and may impact on the therapeutic plans in patients with aggressive non-Hodgkin?s lymphoma. Ann Hematol., 88(5):425?432.

[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


Abaza A
Assistant Prof. of Safety and Prevention of Oncology in Radiation Protection Department, Nuclear and Radiological Regulatory Authority, Cairo, Egypt. PhD, M.D in Childhood Studies & Pediatric Oncology, Ain-Shams University, Cairo, Egypt.

DOI:


Article DOI: 10.21474/IJAR01/2761       DOI URL: http://dx.doi.org/10.21474/IJAR01/2761


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