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Summary Background Several de-escalation approaches are under investigation in patients with HER2-positive, early-stage breast cancer. We assessed early metabolic responses to neoadjuvant trastuzumab and pertuzumab using 18F-fluorodeoxyglucose (18F-FDG)-PET (18F-FDG-PET) and the possibility of chemotherapy de-escalation using a pathological response-adapted strategy. Methods We did a multicentre, randomised, open-label, non-comparative, phase 2 trial in 45 hospitals in Spain, France, Belgium, Germany, the UK, Italy, and Portugal. Eligible participants were women aged 18 years or older with centrally confirmed, HER2-positive, stage I–IIIA, invasive, operable breast cancer (≥1·5 cm tumour size) with at least one breast lesion evaluable by 18F-FDG-PET, an Eastern Cooperative Oncology Group performance status of 0 or 1, and a baseline left ventricular ejection fraction of at least 55%. We randomly assigned participants (1:4), via an interactive response system using central block randomisation with block sizes of five, stratified by hormone receptor status, to either docetaxel (75 mg/m2 intravenous), carboplatin (area under the concentration–time curve 6 mg/mL per min intravenous), trastuzumab (subcutaneous 600 mg fixed dose), and pertuzumab (intravenous 840 mg loading dose, 420 mg maintenance doses; group A); or trastuzumab and pertuzumab (group B). Hormone receptor-positive patients allocated to group B were additionally given letrozole if postmenopausal (2·5 mg/day orally) or tamoxifen if premenopausal (20 mg/day orally). Centrally reviewed 18F-FDG-PET scans were done before randomisation and after two treatment cycles. Patients assigned to group A completed six cycles of treatment (every 3 weeks) regardless of 18F-FDG-PET results. All patients assigned to group B initially received two cycles of trastuzumab and pertuzumab. 18F-FDG-PET responders in group B continued this treatment for six further cycles; 18F-FDG-PET non-responders in this group were switched to six cycles of docetaxel, carboplatin, trastuzumab, and pertuzumab. Surgery was done 2–6 weeks after the last dose of study treatment. Adjuvant treatment was selected according to the neoadjuvant treatment administered, pathological response, hormone receptor status, and clinical stage at diagnosis. The coprimary endpoints were the proportion of 18F-FDG-PET responders in group B with a pathological complete response in the breast and axilla (ypT0/is ypN0) as determined by a local pathologist after surgery after eight cycles of treatment, and 3-year invasive disease-free survival of patients in group B, both assessed by intention to treat. The definitive assessment of pathological complete response was done at this primary analysis; follow-up to assess invasive disease-free survival is continuing, hence these data are not included in this Article. Safety was assessed in all participants who received at least one dose of study drug. Health-related quality-of-life was assessed with EORTC QLQ-C30 and QLQ-BR23 questionnaires at baseline, after two cycles of treatment, and before surgery. This trial is registered with EudraCT (2016-002676-27) and ClinicalTrials.gov ( NCT03161353 ), and is ongoing. Findings Between June 26, 2017, and April 24, 2019, we randomly assigned 71 patients to group A and 285 to group B. Median follow-up was 5·7 months (IQR 5·3–6·0). 227 (80%) of 285 patients in group B were 18F-FDG-PET responders, of whom 86 (37·9%, 95% CI 31·6–44·5; p Interpretation 18F-FDG-PET identified patients with HER2-positive, early-stage breast cancer who were likely to benefit from chemotherapy-free dual HER2 blockade with trastuzumab and pertuzumab, and a reduced impact on global health status. Depending on the forthcoming results for the 3-year invasive disease-free survival endpoint, this strategy might be a valid approach to select patients not requiring chemotherapy. Funding F Hoffmann-La Roche.

Objectives Immunohistochemistry (IHC) is considered as a screening method for ALK rearrangement thanks to its excellent sensitivity. Strong marking on immunohistochemistry give the go-ahead to start ALK tyrosine kinase inhibitors (ALK TKI). Lack of therapeutic response may then lead to the suspicion of molecular alterations other than ALK rearrangements. Methods We present a patient with strong ALK and PD-L1 positive IHC expression lung sarcomatoid carcinoma with initial life-threatening disease progression after beginning ALK TKI. We also review the literature to summarize ALK amplification clinical features and therapeutic management in lung cancers. Results Fluorescence in situ Hybridization (FISH) revealed ALK amplification on the initial anatomopathological samples. Lack of ALK rearrangement and strong PD-L1 positive IHC expression led to the initiation of immune checkpoint inhibitor (ICI) as a second line of treatment, with an excellent response. Conclusion We demonstrated that IHC positive test, in these cases, must be interpreted with caution. FISH analysis has to be recommended to confirm IHC results in case of unusual phenotype, such as smoker or lung cancer other than adenocarcinoma. Although lung carcinoma with ALK rearrangement seems to be not sensitive to ICI, further investigations should be conducted on other types of ALK molecular alterations. ALK amplifications, as observed in the present case, should not be an impediment to taking into account the PD-L1 marking for the initiation of treatment by immunotherapy.

Resume Pendant la grossesse et l’allaitement, l’echographie mammaire est l’examen de premiere intention. En cas de pathologie suspecte, la strategie diagnostique est difficile car necessite la realisation d’imageries avancees a risque pour le fœtus. L’etat actuel de la litterature ne permet pas de donner de recommandations claires quant au bilan d’extension du cancer du sein lie a la grossesse et celui-ci doit etre adapte au rapport benefice–risque maternofœtal selon le type histologique et le risque metastatique du cancer. Les imageries necessaires devront etre discutees et validees en comite multidisciplinaire d’experts. L’objectif de cet article est de sensibiliser les radiologues aux risques et a la securite des examens d’imagerie mammaire pendant la grossesse et l’allaitement.

Purpose To test the hypothesis that a simple machine learning algorithm could improve pathological complete response (pCR) prediction in breast cancer patients treated with neoadjuvant chemotherapy (NAC) using an integrative approach based on clinico-pathological and metabolic factors. Methods A total of 311 patients with non-metastatic breast cancer were included. Baseline clinico-pathologic features were evaluated before NAC and tumor uptake of FDG was evaluated before and after one course of NAC. The predictive value of clinico-pathologic and metabolic parameters on pCR was calculated by means of logistic regression analysis and a simple machine learning algorithm generating a hierarchical predictive model using a classification and regression tree (CART). Results: The CART model performed better than all the clinico-pathological and metabolic parameters that were predictive of pCR after univariate analysis. The CART model identified five different groups (G): G1 (luminal cancer with Ki67≤30%), G2 (luminal cancer with Ki67>30% and baseline SUVmax≤10.1), G3 (luminal cancer with Ki67 10.1), G4 (Her2 positive or triple negative cancer with ΔSUVmax ≤50%) and G5 (Her2 positive or triple negative cancer with ΔSUVmax >50%). The pCR rates predicted by the model for each of the identified groups were G1: 7.2%, G2: 16.7%, G3: 54.6%, G4: 35% and G5: 85% Conclusion This study showed that CART, a simple machine learning algorithm, integrating clinico-pathological and metabolic parameters easily obtainable in routine clinical practice, can improve pCR prediction in early breast cancer and identify subgroups that will not benefit from NAC Baseline patient characteristics of the entire cohort and according to the tumor subtypeCharacteristicsGlobalLumALumBHER2THN311321198476Age (median)4950.249.351.143.3Histological type NST/Other290/2127/5107/1281/375/1Grade 14%22%4%1%0%Grade 237%56%46%32%19%Grade 357%22%47%62%80%Grade missing2%0%3%5%1%ER+58%100%89%45%0%PgR+48%88%75%37%0%ER and PgR neg36%0%0%43%0%HER2 positif27%0%0%100%0%Nodal status negative32%13%32%35%33%Nodal status positive64%50%63%63%61%Nodal status missing data4%37%5%2%6%Stage 11%0%0%0%1%Stage 2A25%28%24%11%28%Stage 2B26%34%24%31%17%Stage 3A16%9%17%13%18%Stage 3B21%22%23%25%17%Stage 3C7%3%7%5%11%Missing stage5%3%5%4%8%mean SUV max (PET-FDG)8.94.859.28.411.7 Univariate and multivariate analyses for pCR predictionVariablepCR (%)OR (95% CI)Univariate analysisp valueOR (95% CI)Multivariate analysisp valueMolecular subtypeLum A1 (3.1)0.15 (0.01-0.076)30%60 (41.4)3.01 (1.77-5.23)AJCC TNM Stage0.36nodal statusN033 (33)0.53N+58 (29)Body surface area1.73143 (47.2)1Baseline SUV max10.139 (47.6)3.22 (1.77-5.98)2.24 (1.04-4.67)Delta SUV max=50%22 (66.7)6.82 (2.83-17.41) Citation Format: Marc-Antoine Benderra, Martine Antoine, Sonia Zilberman, Sandrine Richard, Fatima Kebir, Sofiane Bendifallah, Jean-Pierre Lotz, Emile Darai, Joseph Gligorov, Khaldoun Kerrou. Can we improve pCR prediction in early breast cancers treated with neoadjuvant chemotherapy using a simple machine learning algorithm based on 18-FDG and clinico-pathological parameters? [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-22.

The incidence of pregnancy-associated cancers has been increasing for decades. (18F)-FDG Positron Emission Tomography (PET)/Computed Tomography (CT) imaging has become a golden standard in the staging of many malignant diseases. The aims of the current study were to evaluate the feasibility, safety and impact of (18F)-FDG PET/CT performed during pregnancy. A retrospective analysis from the prospective database of the Cancer Associ�� �� La Grossesse (CALG) network (Tenon Hospital, France) including patients who underwent (18F)-FDG PET/CT during their pregnancy between 2015 and 2020. Of the 536 patients for whom advice from the CALG network was requested during the study period, 359 were diagnosed with cancer during pregnancy. Study population was composed of 63 (17.5%) patients who underwent (18F)-FDG PET/CT. Most cancers were diagnosed during the second trimester. Seventy-five percent were diagnosed with breast cancer, mostly locally advanced invasive ductal carcinomas. Median term of pregnancy at PET/CT was 24.8 weeks of gestation. Twelve (19%), 24 (38.1%) and 22 (34.9%) patients underwent the exam during the 1st, 2nd and 3rd trimester, respectively. (18F)-FDG PET/CT resulted in stage modification for 38 (60.3%) of the patients (28 with more extensive lymph node involvement and 10 with metastatic disease) with subsequently/accordingly modified first-line medical treatment. Fifty patients gave birth to healthy newborns. Two patients had a medical termination of pregnancy, five had a medical abortion, one neonatal death occurred in a patient with severe preeclampsia (unrelated to (18F)-FDG PET/CT). The data of 46 children were available at 6 months, 29 at 12 months, and 15 at 24 months. No cases of mental retardation, childhood cancer, or malformation were reported within 2 years. (18F)-FDG PET/CT has a major impact on the management of pregnancy-associated cancers and does not appear to cause fetal side effects suggesting that the exam is feasible during pregnancy as maternal benefits outweigh fetal risks.

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a new virus that has never been identified in humans before. COVID-19 caused at the time of writing of this article, 2.5 million cases of infections in 193 countries with 165,000 deaths, including two-third in Europe. In this context, Oncology Departments of the affected countries had to adapt quickly their health system care and establish new organizations and priorities. Thus, numerous recommendations and therapeutic options have been reported to optimize therapy delivery to patients with chronic disease and cancer. Obviously, while these cancer care recommendations are immediately applicable in Europe, they may not be applicable in certain emerging and low- and middle-income countries (LMICs). In this review, we aimed to summarize these international guidelines in accordance with cancer types, making a synthesis for daily practice to protect patients, staff and tailor anti-cancer therapy delivery taking into account patients/tumour criteria and tools availability. Thus, we will discuss their applicability in the LMICs with different organizations, limited means and different constraints., Highlights • The first recommendations concerned mainly staff and patients with cancer protection. • More than half of the worldwide cancers are diagnosed in low- and middle-income countries (LMICs). • Organization in accordance with available means: main key for anti-cancer strategy in LMICs. • European recommendations applicability for coronavirus disease 2019 (COVID-19) pandemic is questioned in LMICs. • Amplification of pandemic effects on both COVID and cancer is to be feared in LMICs.

Resume Le bilan initial doit repondre a quatre imperatifs : apprecier l’etat clinique, obtenir une preuve diagnostique, definir le stade cTNM et, en cas de resecabilite, l'operabilite du patient. Les modalites du bilan locoregional basees sur les recommandations nationales et internationales sont resumees. L'examen clinique reste essentiel. Le scanner thoracique avec injection de produit de contraste iode est systematique, sauf contre-indication. La taille de la tumeur, son extension pleurale, parietale, endobronchique et mediastinale directe doivent etre precisees. Les performances du scanner pour predire l'envahissement ganglionnaire mediastinal sont mediocres (sensibilite [Se] = 61 % et specificite [Sp] = 79 %). La tomographie par emission de positons-tomodensitometrie (TEP-TDM) n'est pas indiquee en 1re intention, mais elle est indispensable chez un patient potentiellement eligible a un traitement curatif. Ses performances pour definir le statut mediastinal sont meilleures (Se = 80 % et Sp = 80-90 %). En l'absence d'un envahissement mediastinal massif, des explorations invasives sont indiquees en cas de ganglion ≥ 10 mm ou infracentimetrique fixant le fluorodesoxyglucose (FDG) ou devant la presence d'une adenopathie hilaire, d'une tumeur centrale ou > 3 cm. L’echoendoscopie bronchique et/ou œsophagienne est realisee en 1re intention, avant la mediastinoscopie. Les stades III doivent etre classes en potentiellement resecables, non resecables, potentiellement resecables avec risque de resection incomplete. Le respect des recommandations et une organisation adequate optimisent la prise en charge.

Splenic metastasis from cancers is extremely rare. They usually occur and are detected simultaneously with metastasis to other organs. We present a case of splenic metastasis from carcinoma of the breast occurring 5 years after initial treatment. The metastatic recurrence was an oligometastic form made from the association of a unique bone metastasis to a rib and the metastasis to the spleen. Treatment of the metastatic recurrence was a second line hormonotherapy as the primitive tumor was estrogen receptors positive and gave a 2 year’s long control of the disease. A clinical progression occurred then, the patient complained from pain in the left hypochondrium and was objective on [18F]-FDG PET which leaded to splenectomy. This case is being reported because of the rarity of the lesion and its originality is the first reported case with use of an in vivo demonstration of estrogen receptors expression in the spleen metastasis using PET/CT with 16α-[18F]-Fluoroestradiol.

Context:Preoperative ultrasonography and scintigraphy using 99mTc-sestamibi are commonly used to localize abnormal parathyroid glands. In cases of discrepant results between scintigraphy and ultrasonography, it is important to rely on another diagnostic imaging modality. 18F-fluorodeoxyglucose (FDG) and 11C-methionine positron emission tomography (PET) have been studied, but are imperfect to detect abnormal parathyroid glands. Recently, first cases of abnormal parathyroid glands taking-up radiolabelled choline were discovered incidentally in men referred to 11C-choline or 18F-fluorocholine (FCH)-PET/CT for prostate cancer. We checked if FCH uptake was a general feature of adenomatous or hyperplastic parathyroid glands.Methods:FCH-PET/CT was performed in 12 patients with primary (n = 8) or secondary hyperparathyroidism (1 dialyzed, 3 grafted) and with discordant or equivocal results on preoperative ultrasonography (US) and/or 123I/99mTc-sestamibi dual-phase scintigraphy. The results of the FCH-PET/CT were evaluated, with surgical exploration and histopathologic examination as the standard of truth.Results:On a per-patient level, the detection rate of FCH-PET/CT (at least one FCH focus corresponding to an abnormal parathyroid gland in a given patient) was 11/12 = 92%. FCH-PET/CT detected 18 foci interpreted as parathyroid glands and correctly localized 17 abnormal parathyroid glands (7 adenomas and 10 hyperplasias). On a per-lesion level, FCH-PET/CT results were 17 TP, 2 false negative ie, a lesion-based sensitivity of 89%, and 1 false positive.Conclusion:As the main result of this pilot study, we show that in patients with hyperparathyroidism and with discordant or equivocal results on scintigraphy or on ultrasonography, adenomatous or hyperplastic parathyroid glands can be localized by FCH-PET/CT with good accuracy. Furthermore, FCH-PET/CT can solve discrepant results between preoperative ultrasonography and scintigraphy and has thus a potential as a functional imaging modality in the detection of abnormal parathyroid glands. Our preliminary results are encouraging and prompt us to further evaluate FCH-PET/CT as a functional imaging agent in patients with biochemical hyperparathyroidism.

Resume Le FDG n’est pas adapte a la detection du cancer de la prostate. Cependant, une hyperfixation prostatique mise en evidence de facon inattendue lors de la TEP/TDM au FDG demandee pour une autre indication peut etre l’element revelateur d’un cancer de la prostate, meme si une origine benigne est plus frequente. Nous rapportons 4 cas d’incidentalome prostatique decele sur une hyperfixation du FDG, correspondant a 4 images et circonstances typiques : fixation diffuse, fixation focale avec divers niveaux de SUVmax et de concentration serique du PSA dosee au vu de la TEP/TDM. Nous presentons une meta-analyse des 6 series actuellement rapportees dans la litterature sur un total de 47 935 TEP au FDG : la frequence moyenne de cet incidentalome est de 1,5 % ; il a ete caracterise dans 68 % des cas, correspondant a un cancer dans 16 % des cas caracterises, un adenocarcinome dans 75 cas/78. Il n’y avait pas de correlation entre le score de Gleason et le SUVmax ; des adenocarcinomes Gleason = 6 peuvent etre deceles avec le FDG. Parmi les facteurs de risque pour une origine maligne, on trouve un SUVmax > 3, une localisation peripherique au sein de la prostate et l’absence de calcification dans la zone hyperfixante. La biopsie prostatique est utile dans la mesure ou on envisage de modifier la prise en charge du patient si le cancer de la prostate est confirme ; elle est alors indiquee en cas d’elevation franche de la concentration serique du PSA mais aussi lorsque cette valeur est normale s’il existe un ou plusieurs facteurs de risque sur la TEP/TDM au FDG.

18fluorine-fluorodihydroxyphenylalanine (FDOPA) PET/CT is currently the first-line imaging technique to distinguish between focal and diffuse forms of congenital hyperinsulinism (CHI) and to accurately localize focal forms. However, this technique has a number of limitations, mainly the very small size of focal forms or inversely a very large focal form mimicking a diffuse form, and misinterpretation of physiologic uptake masking hot spots or inversely mimicking focal forms. The other limitation is the limited availability of the radiopharmaceutical. FDOPA PET/CT has no recognized competitor to date among the available morphologic and functional imaging techniques. Other potential approaches using specific tracers for positron emission tomography (PET) are discussed, using radiopharmaceuticals specific for β cell mass or targeting somatostatin receptors. These radiopharmaceuticals can be labeled with gallium-68, a PET emitter readily available in PET centers equipped with 68Ge/68Ga generators.

Resume La synovite villonodulaire (SVN) est une pathologie benigne potentiellement agressive siegeant le plus souvent dans les grosses articulations. Cet article rapporte un cas rare d’une SVN extra-articulaire du muscle psoas gauche. Cette lesion a ete decouverte fortuitement lors d’un examen de suivi par TEP/TDM au FDG. La patiente etait asymptomatique et n’a pas ete operee. Cet article montre un interet de la TEP/TDM au FDG dans le suivi de la SVN.

We describe the potentiality of a new liposomal formulation enabling positron emission tomography (PET) and magnetic resonance MR() imaging. The bimodality is achieved by coupling a 68Ga-based radiotracer on the bilayer of magnetic liposomes. In order to enhance the targeting properties obtained under a permanent magnetic field, a sugar moiety was added in the lipid formulation. Two new phospholipids were synthesized, one with a specific chelator of 68Ga (DSPE-PEG-NODAGA) and one with a glucose moiety (DSPE-PEG-glucose). The liposomes were produced according to a fast and safe process, with a high radiolabeling yield. MR and PET imaging were performed on mice bearing human glioblastoma tumors (U87MG) after iv injection. The accumulation of the liposomes in solid tumor is evidenced by MR imaging and the amount is evaluated in vivo and ex vivo according to PET imaging. An efficient magnetic targeting is achieved with these new magnetic liposomes.

A 59-year-old transexual (male to female) patient presented with a squamous cell carcinoma of the larynx. She underwent an F-FDG PET/CT for initial staging. The examination showed high F-FDG uptake of the primary lesion and a homolateral lymphadenopathy. Incidental heterogeneous uptake of round hyperdense lesions in the gluteal muscles and subcutaneous fat was visualized. The medical history revealed secondly that the patient had had free liquid silicone injections 30 years before the examination. Although the injection of free silicone is not practised since the 1980s, this incidental finding should prompt to check the patient's medical history over several decades.

Hybrid positron emission tomography/computed tomography (PET/CT) has now become available, as well as whole-body, low-dose multidetector row computed tomography (MDCT) or magnetic resonance imaging (MRI). The radioactive glucose analogue 18F-fluorodeoxyglucose (FDG) is the most widely used tracer but has a relatively low sensitivity in detecting multiple myeloma (MM). We compared FDG with a more recent metabolic tracer, 18F-fluorocholine (FCH), for the detection of MM lesions at time of disease relapse or progression. We analyzed the results of FDG and FCH imaging in 21 MM patients undergoing PET/CT for suspected relapsing or progressive MM. For each patient and each tracer, an on-site reader and a masked reader independently determined the number of intraosseous and extraosseous foci of tracer and the intensity of uptake as measured by their SUVmax and the corresponding target/non-target ratio (T/NT). In the skeleton of 21 patients, no foci were found for two cases, uncountable foci were observed in four patients, including some mismatched FCH/FDG foci. In the 15 patients with countable bone foci, the on-site reader detected 72 FDG foci vs. 127 FCH foci (+76 %), whereas the masked reader detected 69 FDG foci vs. 121 FCH foci (+75 %), both differences being significant. Interobserver agreement on the total number of bone foci was very high, with a kappa coefficient of 0.81 for FDG and 0.89 for FCH. Measurement of uptake in the matched foci that took up both tracers revealed a significantly higher median SUVmax and T/NT for FCH vs. FDG. Almost all unmatched foci were FCH-positive FDG-negative (57/59 = 97 % on-site and 56/60 = 93 % on masked reading); they were more frequently observed than matched foci in the head and neck region. These findings suggest that PET/CT performed for suspected relapsing or progressive MM would reveal more lesions when using FCH rather than FDG.

Purpose To detect the presence of hypoxic tissue, which is known to increase the radioresistant phenotype, by its uptake of fluoromisonidazole (18F) (FMISO) using hybrid positron emission tomography/computed tomography (PET/CT) imaging, and to compare it with the glucose-avid tumor tissue imaged with fluorodeoxyglucose (18F) (FDG), in residual postsurgical skull base chordoma scheduled for radiotherapy. Patients and Methods Seven patients with incompletely resected skull base chordomas were planned for high-dose radiotherapy (dose ≥70 Gy). All 7 patients underwent FDG and FMISO PET/CT. Images were analyzed qualitatively by visual examination and semiquantitatively by computing the ratio of the maximal standardized uptake value (SUVmax) of the tumor and cerebellum (T/C R), with delineation of lesions on conventional imaging. Results Of the eight lesion sites imaged with FDG PET/CT, only one was visible, whereas seven of nine lesions were visible on FMISO PET/CT. The median SUVmax in the tumor area was 2.8 g/mL (minimum 2.1; maximum 3.5) for FDG and 0.83 g/mL (minimum 0.3; maximum 1.2) for FMISO. The T/C R values ranged between 0.30 and 0.63 for FDG (median, 0.41) and between 0.75 and 2.20 for FMISO (median,1.59). FMISO T/C R >1 in six lesions suggested the presence of hypoxic tissue. There was no correlation between FMISO and FDG uptake in individual chordomas ( r = 0.18, p = 0.7). Conclusion FMISO PET/CT enables imaging of the hypoxic component in residual chordomas. In the future, it could help to better define boosted volumes for irradiation and to overcome the radioresistance of these lesions. No relationship was founded between hypoxia and glucose metabolism in these tumors after initial surgery.

Resume Le but de cette observation est d’illustrer le role de la TEP/TDM au FDG dans la prise en charge diagnostique d’un lymphome folliculaire atypique de decouverte fortuite. Nous rapportons le cas d’un patient âge de 75 ans, asymptomatique, suivi annuellement par echographie abdomino-pelvienne pour surveillance d’un traumatisme renal ancien complique d’infections renales, ayant permis la decouverte fortuite d’une volumineuse masse mesenterique, mesurant 23 cm, semblant envahir le pancreas et englobant les vaisseaux mesenteriques. La TEP/TDM au FDG a permis la caracterisation tissulaire comme tres probablement maligne, la stadification, l’elimination du diagnostic differentiel de tumeur stromale gastro-intestinale, et la determination d’une voie d’abord peu invasive pour la cytoponction a l’aiguille fine par voie endoscopique transduodenale, afin d’aboutir au diagnostic cytologique de lymphome malin non hodgkinien centro-folliculaire de stade IV de Ann Arbor. Le traitement par chimiotherapie (R-CHOP rituximab) a ete debute.

Resume Ce patient, presentant une recidive occulte de cancer de la prostate (PSA = 1,56 ng/mL) prostatectomise 15 ans auparavant, a beneficie de deux TEP/TDM, au fluorure (18F) de sodium, puis a la fluorocholine (18F) (FCH). Avec le fluorure (18F), seul un foyer de la crete iliaque gauche etait douteux mais la biopsie, negative, d’une osteocondensation avait ete pratiquee cinq mois avant. Avec la FCH, on retrouvait une hyperfixation diffuse de la moelle osseuse et un foyer ganglionnaire iliaque externe droit deja visualise sur la precedente TEP/TDM a la FCH et qui avait donne lieu a la resection endoscopique de trois ganglions non envahis. La fixation medullaire diffuse a ete rattachee a un traitement tout recent par facteur de croissance granulocytaire humain recombinant, le pegfilgrastim (G-CSF), un agent simulant l’hematopoiese de la lignee blanche. Il a ete conclu que la recidive etait electivement ganglionnaire droite et une irradiation avec modulation d’intensite (IMRT) a ete pratiquee, qui a entraine la diminution de la concentration de PSA d’un facteur 4. Cette observation illustre le risque, jusque la non rapporte, de resultat faux-positif quant a l’invasion osteomedullaire en cas de traitement par G-CSF. Elle permet egalement de confirmer l’interet de la TEP/TDM a la FCH en cas de recidive occulte de cancer de la prostate, y compris pour verifier que le curage a bien emporte un ganglion juge douteux sur la TEP/TDM FCH precedente, et sa capacite a guider l’IMRT.

The aim of this study was to determine whether early acquisition of F-fluorodihydroxyphenylalanine (F-FDOPA) PET/CT could improve the detection of medullary thyroid cancer (MTC). We retrospectively compared early (median time: 15 min) and delayed (median time: 94 min) acquisitions, positive on at least one of the two phases, in 15 dual-phase F-FDOPA PET/CT examinations performed on 14 patients referred for initial staging (one examination), suspected recurrence (eight examinations) or restaging of MTC (six examinations). Among the 14 true-positive (TP) examinations, more lesions (51 vs. 43) or more intense uptake (mean SUVmax=4 vs. 2.4, P

Presurgical identification of patients at high risk for early recurrence of hepatocellular carcinoma (HCC) after resection could warrant additional therapies. F-fluorodeoxyglucose (FDG) uptake by the tumour on preoperative PET can predict HCC recurrence after resection as effectively as poor differentiation or presence of microvascular invasion (MVI) on postsurgical histology. A better sensitivity for the detection of HCC nodules has been reported with F-fluorocholine (FCH), a PET tracer of lipid metabolism. This pilot study aimed to compare preoperative FDG and FCH PET/CT for predicting early recurrence of unifocal HCC, occurring within 6 months after surgical resection.FDG and FCH tumour uptakes were assessed on preoperative PET/CT by two masked readers. On FCH PET/CT, a photopenic lesion and a hot focus were considered as indicative of malignancy. During postoperative follow-up, recurrence was searched for by regularly performing CT and MRI.In 11 consecutive HCC patients, the detection rate was greater with FCH (80%) than with FDG (27%). After resection, the overall recurrence rate was 55%. Early recurrence occurred in four patients, who were the only ones with an FDG-positive and FCH-photopenic tumour, with a significant reduction in disease-free survival. On postsurgical histology, those four patients also presented with MVI and satellite nodules. Histological differentiation and capsule disruption appeared less accurate than PET/CT or MVI in predicting early recurrence.In unifocal HCC, the FCH photopenic pattern was associated with MVI and predicted early HCC recurrence after surgical resection as accurately as did an FDG uptake. Larger studies with FCH are warranted.

Resume L’autorisation de mise sur le marche d’un nouveau radiopharmaceutique pour la TEP par les agences du medicament n’est pas si frequente et il a semble interessant d’en suivre les consequences sur la demande des autres examens de medecine nucleaire par les correspondants cliniciens. La fluorocholine (18F) ou FCH a ete enregistree en France le 2 avril 2010 avec parmi les indications la localisation des metastases osseuses dans le cancer de la prostate (CP). Methodes Une analyse de la demande des examens de medecine nucleaire (MN) en cas de CP a ete effectuee a l’hopital Tenon, couvrant huit trimestres depuis avril 2010. Resultats Durant ces deux ans, 721 examens de MN ont ete effectues chez des patients atteints de CP. La demande en TEP/TDM a la FCH a augmente rapidement, de 11 % des examens de MN au premier trimestre a 37 % au deuxieme trimestre et a 56 % au huitieme trimestre. Le nombre total d’examens de MN demandes pour CP a lui aussi augmente durant ces deux ans. Globalement, la part de la TEP/TDM a la FCH a ete de 42 %, celle de la TEP/TDM au fluorure (18F) de sodium (F Na) de 27 %, celle de la scintigraphie osseuse (SO) de 25 %. La demande en TEP/TDM au FDG (6 % des examens de MN) a ete limitee a quelques cas de PC hormono-resistant ou multimetastatique. Les examens limites a la detection des metastases osseuses (TEP/TDM au F Na et SO) ont ete demandes de facon tres predominante lors de la stadification initiale, alors que la FCH a ete preferee pour la detection des recidives occultes, a des concentrations bien plus faibles de PSA. Le suivi therapeutique et l’evaluation d’un traitement peu apres qu’il est termine est une indication prometteuse qui necessite une evaluation des radiopharmaceutiques ; elle a represente 19 % des examens, tout comme la restadification avant reprise d’un traitement. Conclusion La disponibilite de la TEP/TDM a la FCH aboutit a une augmentation rapide de sa demande, en particulier en cas de recidive occulte, avec une augmentation globale de la demande pour les examens de MN dans le CP, de + 11 % d’une annee sur l’autre.

Resume L’hibernome est une tumeur benigne rare des parties molles, generalement asymptomatique, survenant habituellement chez l’adulte jeune. Il s’agit d’un lipome de la graisse brune. Son diagnostic est essentiellement anatomopathologique. Ses principaux diagnostics differentiels sont le lipome et le liposarcome. Son aspect en TEP/TDM au FDG n’a ete rapporte que dans un petit nombre de cas. Nous rapportons le cas d’un homme de 68 ans atteint d’un cancer ORL chez qui une tumeur graisseuse axillaire gauche avait ete decouverte fortuitement sur la tomodensitometrie (TDM) de stadification. Le diagnostic d’hibernome a ete suspecte en TEP/TDM au FDG, avec des arguments concordants sur les differents examens d’imagerie realises. En imagerie par resonance magnetique (IRM) la lesion etait atypique pour un simple lipome car elle se rehaussait apres injection de gadolinium. En TEP/TDM, la lesion fixait intensement le FDG (SUVmax = 16), ce qui est l’une caracteristiques de l’hibernome, tumeur developpee aux depens de la graisse brune. Les examens d’imagerie n’ont pas permis de faire la distinction entre hibernome et liposarcome, et le diagnostic d’hibernome–lipome mixte benin a ete obtenu par histologie apres resection complete de la tumeur. Nous retrouvons des elements quantitatifs qui distinguent hibernome et liposarcome : le caractere hautement metabolique de l’hibernome (SUVmax > 10) et la fluctuation de l’intensite de la fixation du FDG d’un examen a l’autre, le SUVmax passant de 16 a 48 en 16 mois dans le cas presente. Devant une tumeur de densite graisseuse en TDM, une valeur elevee de SUVmax au FDG semble plaider davantage en faveur d’une tumeur benigne, l’hibernome, que de la tumeur maligne apparentee, le liposarcome.

Resume Cas clinique Un patient est adresse pour TEP/TDM a la fluorocholine (18F) du fait d’une recidive biologique de cancer de la prostate, avec un doute sur une recidive locale et pauciganglionnaire en IRM. Resultat Cet examen montre plusieurs foyers pelviens evoquant une recidive locale et ganglionnaire plus etendue que ce qui etait visible en IRM pelvienne, sans localisation osseuse ; le patient est traite par hormonotherapie. Un foyer cerebral gauche est egalement decouvert sur la TEP/TDM. Celui-ci est alors explore en IRM cerebrale qui est evocatrice d’une lesion de grade II. Conclusion Cette observation a pour but de souligner l’importance des images du corps entier en TEP/TDM a la fluorocholine (18F), tete inclue, en cas de cancer de la prostate, meme quand des foyers evocateurs sont detectes dans le pelvis. Plusieurs cancers accumulent la fluorocholine (18F) : en cas de foyer visceral a distance chez un patient atteint d’un cancer de la prostate, il faut garder presente a l’esprit l’hypothese d’un second cancer primitif.

Resume Cas clinique Pour la stadification d’un carcinome hepatocellulaire (CHC), on demande une TEP/TDM au fluorodesoxyglucose(18F) (FDG) et, si necessaire, a la fluorocholine(18F) (FCH). Le CHC a ete prouve lors de la seconde biopsie d’une masse hepatique decouverte sur une TDM abdominale realisee du fait d’une recidive biologique de cancer de la prostate. Resultat La TEP/TDM au FDG ne montre aucune anomalie. La TEP/TDM a la FCH est donc realisee et montre plusieurs foyers : au niveau de la masse hepatique, d’une volumineuse adenomegalie retroportale et d’un nodule pulmonaire infracentimetrique. La discussion diagnostique porte surtout sur cette derniere lesion qui est biopsiee et correspond a une metastase du cancer de la prostate. La prise en charge du patient a ete modifiee, du fait des deux cancers actifs et metastatiques, avec une chimiotherapie pour le CHC et une hormonotherapie pour le cancer de la prostate. Conclusion Plusieurs cancers accumulent la FCH, qui est un outil puissant de detection metastatique, en particulier lorsqu’il existe une anomalie biologique et que la TEP/TDM au FDG est negative. Meme en cas de positivite de celle-ci, la TEP/TDM a la FCH peut reveler des foyers inattendus de caracteristique metabolique differente. Tout comme le FDG, elle n’est pas specifique d’un cancer primitif. Pour stadifier un CHC, nous recommandons donc la TEP/TDM pratiquee successivement avec les deux radiopharmaceutiques.

Resume L’utilite de la scintigraphie preoperatoire des parathyroides en cas d’hyperparathyroidie secondaire est parfois mise en doute. Un examen permettant de mettre en evidence par leurs caracteristiques fonctionnelles toutes les glandes hyperplasiques, y compris en position ectopique, est surement utile chez ces patients a l’etat general fragile. Cependant, la scintigraphie a dans certains cas une sensibilite limitee. Nous avons recherche si l’un des facteurs suivants permettait d’identifier un groupe de patients ou le taux de detection serait meilleur : âge, sexe, dialyse en cours, anciennete de la dialyse et concentration plasmatique de parathyrine (PTH). Methodes Etude retrospective de 38 patients adresses pour une scintigraphie des parathyroides du fait d’une hyperparathyroidie secondaire non operee et qui ont eu ensuite une parathyroidectomie. La scintigraphie a ete pratiquee 20 minutes puis trois heures apres injection de 8 MBq/kg de sestamibi (99mTc) precedee trois heures avant par l’ingestion de 0,1 MBq/kg d’iode-123. Resultat Aucune correlation n’a ete observee entre le nombre de glandes decelees et confirmees a l’histologie postoperatoire et la PTHemie avant l’examen (r = −0,17). Une faible correlation positive non significative (r = +0,34) a ete notee dans le groupe de six patients non hemodialyses. Aucune relation significative entre ce nombre de glandes decelees et les parametres cliniques n’a ete relevee. Conclusion Dans notre experience, les parametres etudies ne permettent pas de selectionner, parmi les patients atteints d’hyperparathyroidie secondaire, ceux qui devraient beneficier d’une scintigraphie avant parathyroidectomie.

Resume La tomographie par emission de positons (TEP) a la fluoroethyltyrosine (FET), analogue de l’acide amine, a ete pratiquee depuis le debut de la decennie, en Allemagne, pour l’imagerie moleculaire metabolique des tumeurs cerebrales, car le fluorodesoxyglucose (FDG), analogue du glucose et traceur de reference en TEP clinique, presente l’inconvenient d’etre fixe intensement par le cortex cerebral sain. Dans cette etude preliminaire, notre equipe a compare les TEP/TDM a la FET et au FDG chez dix patients evaluables, presentant une lesion cerebrale, lors du diagnostic ou apres traitement. Pour tenter d’obtenir une specificite optimale, la TEP/TDM a la FET a ete acquise une heure apres injection, alors que la pratique rapportee est une acquisition dynamique sur 40 minutes commencant a l’injection de la FET. Dans ces conditions, les performances pour la FET sont : sensibilite = 88 % ; exactitude = 80, contre 13 % et 30 % respectivement pour le FDG. Conclusion La FET est un radiopharmaceutique utile pour le diagnostic, la determination d’extension et le suivi des tumeurs cerebrales. L’association avec le FDG permet de mieux definir les lesions ou contingents de haut grade, mais pourrait ne plus etre necessaire lorsque les conditions d’acquisition et de quantification de la TEP a la FET auront ete mieux optimisees et standardisees.

Resume But Evaluer l’impact de la TEP/TDM au FDG sur la prise en charge du patient adresse pour la stadification et/ou le suivi d’un cancer anal. Patients et methodes Nous avons inclus les patients adresses dans le service pour cancer du canal anal dont la prise en charge therapeutique etait evaluable grâce a un suivi d’au moins six mois. Resultats Les resultats de 44 patients ont ete analyses : 22 avaient eu un examen TEP/TDM pour la stadification initiale et 36 dans le suivi. La TEP/TDM a eu un impact chez neuf patients sur 44 (20 %) et il etait pertinent chez huit d’entre eux. Conclusion La TEP/TDM est une modalite d’imagerie fiable pour le cancer du canal anal, en particulier dans le suivi en cas de suspicion de persistance ou de recidive de la maladie ou son impact sur la prise en charge du patient a ete le plus net.

Resume Cette observation illustre l’interet de la tomographie par emission de positons/tomodensitometrie (TEP/TDM) au fluoro-desoxy-glucose (FDG) (18F) en cas de lâcher de ballons pulmonaire pour aider au diagnostic etiologique et guider la biopsie chirurgicale decouvrant une granulomatose sarcoidosique necrosante alors que la biopsie sous TDM n’est pas contributive.

Resume Le fluorodesoxyglucose ( 18 F) ou FDG, analogue radioactif du glucose et radiopharmaceutique de reference en TEP cancerologique, n’est pas adapte a la detection des metastases du cancer de la prostate dont le metabolisme glucidique n’est que peu augmente. Le fluorure ( 18 F) s’accumule dans l’os cortical, de facon franche et precoce en cas de reaction a une metastase. Il vient d’obtenir, en 2008, une autorisation de mise sur le marche (AMM) en France, incluant l’imagerie des metastases osseuses dans le cancer de la prostate. Nous presentons des cas cliniques originaux pour illustrer ses performances cliniques. L’imagerie par resonance magnetique (IRM) du « corps-entier » se developpe et a egalement la capacite de detecter les metastases osseuses. Recemment, l’IRM de diffusion a ete proposee pour ameliorer la detection des metastases du squelette axial qui sont largement predominantes dans le cancer de la prostate. Dans les deux cas, TEP couplee a la TDM ou IRM, on mobilise des moyens moins disponibles et plus couteux que la classique scintigraphie du squelette, afin d’obtenir des performances diagnostiques superieures. Le STIC qui vient d’etre accepte vise donc a preciser l’impact d’une detection plus precoce et plus exacte de la premiere metastase osseuse macroscopique sur la prise en charge du patient et l’efficacite des strategies diagnostiques incluant ces innovations, individuellement et associees. En cas de cancer de la prostate a haut risque metastatique, mais alors qu’aucune metastase osseuse n’est averee et que la scintigraphie du squelette n’est pas evocatrice de lesions secondaires, on ajoutera la TEP/TDM au fluorure ( 18 F) de sodium a l’IRM corps-entier. L’histologie et/ou un suivi de six mois serviront d’etalon de verite pour juger la pertinence de l’impact sur la prise en charge du patient et le rapport benefice/cout additionnel de ces examens. Nous esperons grâce a cette etude multicentrique prospective demontrer dans le monde reel la place de ce radiopharmaceutique qui date de plusieurs decennies mais dont les potentialites sont tres accrues grâce a l’essor recent de l’imagerie TEP/TDM.

Fluorodihydroxyphenylalanine-(18F) (FDOPA) positron emission tomography (PET) is a recent imaging modality used to localize endocrine tumors. This study was conducted to evaluate the impact of FDOPA-PET on the management of patients referred for carcinoid or noncarcinoid digestive tumors and the clinical relevance of the treatment decisions based on this examination.Between March 2002 and December 2006, 101 FDOPA-PET examinations were performed in 78 adult patients for follow-up of histologically documented carcinoid tumor of the ileum (23 patients) or noncarcinoid digestive tumor (26 patients) or to screen for occult digestive endocrine tumors (29 patients). More than one FDOPA-PET examination was performed in 12 patients. The impact of FDOPA PET was evaluated on a per-patient basis by means of a questionnaire completed by the referring physician, and the relevance of the treatment decision was assessed on the basis of follow-up data.The survey response rate was 91% (71 of 78). The overall impact rate of FDOPA-PET on patient management was 25% (18 of 71). The greatest impact was observed for carcinoid tumors (50%: 11 of 22) and was clinically relevant in every case, followed by occult endocrine tumors (16%: four of 25), and was clinically relevant in three of the four cases, and noncarcinoid tumors (13%: 3 of 22), clinically relevant in only one case.FDOPA-PET appears to be a major tool for the management of carcinoid tumors with excellent diagnostic performances and induced relevant changes in patient management. FDOPA-PET was less sensitive and less useful for the management of noncarcinoid tumors.

Resume Bien que la TEP/TDM au FDG soit un examen extremement sensible et performant pour nombre de cancers, le FDG n’est pas un traceur specifique et il peut se reveler peu sensible dans certaines pathologies neoplasiques, le plus souvent tres bien differenciees ou lentement evolutives. Il existe donc un interet de plus en plus important pour la mise au point de radiopharmaceutiques specifiques, complementaires du FDG. Nous rapportons quelques exemples de l’utilite clinique, demontree ou potentielle de ces radiopharmaceutiques dans plusieurs types de pathologie tumorale.

Lymph node status in endometrial cancer is a major prognostic factor. Sentinel lymph node (SLN) biopsy using radiocolloid and blue dye labeling has emerged as an alternative to systematic lymphadenectomy. This technique requires a preoperative lymphoscintigraphy. The aim of this study was to evaluate the limits of day-before preoperative lymphoscintigraphy to SLN biopsy.Between July 2002 and March 2007, 38 patients with endometrial cancer underwent laparoscopic SLN procedure using radiocolloid and blue dye. Those with early-stage I endometrial cancer (35 patients) underwent a SLN procedure followed by systematic pelvic lymphadenectomy and a hysterectomy with bilateral salpingo-oophorectomy while those with presumed stage IIB on MR imaging (3 patients) underwent a radical hysterectomy. Omentectomy and paraaortic lymphadenectomy were also performed for women with clear cell or serous papillary carcinoma (5 patients). The SLN identification rates and false-negative rates were studied.The detection rate of lymphoscintigraphy was 84.5% (32/38), with 1.9 nodes per patient. Eight of 17 patients (47%) with unilateral sentinel lymph node on lymphoscintigraphy had bilateral SLNs at surgery and three of 15 patients (20%) with bilateral SLN on lymphoscintigraphy had unilateral SLN at surgery. The correlation was poor (kappa=0.266). When categorized in2 andor =2 sentinel nodes, the correlation between lymphoscintigraphic and surgical SLN mapping was moderate (kappa=0.33).Our results demonstrated the low correlation between day-before lymphoscintigraphy and surgical SLN mapping raising issues of its usefulness and cost-effectiveness in routine practice.

Resume La tomographie par emission de positons (TEP) est devenue une modalite d’imagerie primordiale en oncologie. Cependant, la TEP au fluorodesoxyglucose (FDG) s’est revelee globalement decevante pour la mise en evidence du cancer de la prostate, aussi bien en stadification initiale que pour la recherche de recidive. Le developpement de nouveaux radiopharmaceutiques pourrait permettre d’ameliorer les performances de la TEP dans ces indications. Les traceurs du metabolisme lipidique, tels que la choline et ses analogues marques par le fluor 18, semblent particulierement prometteurs. L’impact therapeutique de ces examens reste a evaluer, en tenant compte des nouvelles strategies therapeutiques, notamment la possibilite de traitement cible en cas de recidive locale isolee.

The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. Twenty-seven patients (20 men and seven women, aged 48–76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p

Resume Le 68 Ga est un emetteur de positons obtenu a partir d’un generateur 68 Ge/ 68 Ga, qui peut servir a marquer des peptides d’interet clinique. Le DOTATOC-( 68 Ga) est un traceur de forte affinite pour les recepteurs de type 2 de la somatostatine et est utilise pour l’imagerie des tumeurs qui les expriment, dont les tumeurs endocrines digestives. Nous rapportons le cas d’un patient atteint d’une tumeur carcinoide du grele avec metastases hepatiques, traite par analogues de la somatostatine, chez qui la scintigraphie des recepteurs de la somatostatine (SRS) montrait trois lesions hepatiques, alors que la TEP/TDM au DOTATOC-( 68 Ga) permettait de visualiser davantage de lesions hepatiques. Deux etudes recentes concluent a la superiorite de la TEP au DOTATOC-( 68 Ga) sur la SRS et sa complementarite avec la TDM, en particulier en ce qui concerne la mise en evidence des metastases osseuses. La TEP/TDM au DOTATOC-( 68 Ga), qui associe la specificite de la detection scintigraphique des recepteurs de la somatostatine, la resolution spatiale de la TEP et la precision anatomique de la TDM, semble promise a un bel avenir, d’autant plus qu’elle offre de substantiels avantages pour le patient : un temps d’attente court, la realisation de l’examen en une seule acquisition et une dosimetrie satisfaisante.

Lymph node status in cervical cancer is a major prognostic factor. Sentinel lymph node (SN) biopsy using radiocolloid and blue dye labeling and preoperative lymphoscintigraphy has emerged as a potential alternative to systematic lymphadenectomy. The aim of this study was to evaluate the contribution of preoperative lymphoscintigraphy to SN biopsy.Between April 2001 and December 2005, 71 of 77 patients with cervical cancer (38 patients with stages IA or IB1, and 39 patients with stage IB2, IIA or IIB) underwent laparoscopic SN procedure using radiocolloid and blue dye with day-before lymphoscintigraphy. The SN identification rates and false-negative rates were studied.Seventy patients underwent a combined technique and the last patient a radiocolloid technique alone due to blue dye allergic reaction. Detection rate of lymphoscintigraphy was 84.5% (60/71), with 1.4 sentinel nodes per patient. Three of 11 patients (27.3%) with no SN on lymphoscintigraphy had at least one SN during surgery. Sixteen of 27 patients (59.3%) with solitary SN on lymphoscintigraphy had multiple SNs. Nine of 35 patients (25.7%) with unilateral SNs on lymphoscintigraphy had bilateral SNs at surgery (kappa = 0.44 [0.19-0.64]). When categorized into2 andor=2 sentinel nodes, the correlation between lymphoscintigraphic and surgical detection was poor (kappa = 0.05 [0.0-0.18]).SN biopsy is a feasible and accurate method to stage early cervical cancer. However, day-before lymphoscintigraphy is poorly correlated to surgical SN mapping.

Imaging and PET-CT of adultand childhood lymphoma Malignantlymphomas are lymphoproliferative disorders arising in both lymphoidtissue and non-lymphoid organ systems. Treatment rarely is surgical,and currently relies on a combination of chemotherapy and radiationtherapy. The role of imaging is to determine the spread of the disease,to identify targets and to assess therapeutic response. Imaging techniquesmainly use morphological criteria, and may underestimate infiltrativedisease, as observed in bones. The frequent presence of residualmasses after treatment usually prevents classification of patientsas complete response. Over time, positron emission tomography (PET) withF18-fluorodeoxyglucose (FDG) has become a prominent part of theworkup at diagnosis and during follow-up. Recently, PET has been integratedin the revised response criteria for malignant lymphoma.