Currently, Nuclear Medicine has a clearly defined role in clinical practice due to its usefulness in many medical disciplines. It provides relevant diagnostic and therapeutic options leading to ...patients' healthcare and quality of life improvement. During the first two decades of the 21st
century, the number of Nuclear Medicine procedures increased considerably.Clinical and research advances in Nuclear Medicine and Molecular Imaging have been based on developments in radiopharmaceuticals and equipment, namely, the introduction of multimodality imaging. In addition, new therapeutic applications of radiopharmaceuticals, mainly in oncology, are underway.This review will focus on radiopharmaceuticals for positron emission tomography (PET), in particular, those labeled with Fluorine-18 and Gallium-68. Multimodality as a key player in clinical practice led to the development of new detector technology and combined efforts to improve resolution. The concept of dual probe (a single molecule labeled with a radionuclide for single photon emission computed tomography)/positron emission tomography and a light emitter for optical imaging) is gaining increasing acceptance, especially in minimally invasive radioguided surgery. The expansion of theranostics, using the same molecule for diagnosis (γ or positron emitter) and therapy (β minus or α emitter) is reshaping personalized medicine.Upcoming research and development efforts will lead to an even wider array of indications for Nuclear Medicine both in diagnosis and treatment.
Complete pathological response to neoadjuvant systemic treatment (NAST) in some subtypes of breast cancer (BC) has been used as a surrogate of long-term outcome. The possibility of predicting BC ...pathological response to NAST based on the baseline 18F-Fluorodeoxyglucose positron emission tomography (FDG PET), without the need of an interim study, is a focus of recent discussion. This review summarises the characteristics and results of the available studies regarding the potential impact of heterogeneity features of the primary tumour burden on baseline FDG PET in predicting pathological response to NAST in BC patients. Literature search was conducted on PubMed database and relevant data from each selected study were collected. A total of 13 studies were eligible for inclusion, all of them published over the last 5 years. Eight out of 13 analysed studies indicated an association between FDG PET-based tumour uptake heterogeneity features and prediction of response to NAST. When features associated with predicting response to NAST were derived, these varied between studies. Therefore, definitive reproducible findings across series were difficult to establish. This lack of consensus may reflect the heterogeneity and low number of included series. The clinical relevance of this topic justifies further investigation about the predictive role of baseline FDG PET.
In “Joint EANM/SNMMI/ESTRO Practice Recommendations for the Use of 2-18FFDG-PET/CT External Beam Radiation Treatment Planning in Lung Cancer V1.0” clinical indications for PET-CT in (non-)small cell ...lung cancer are highlighted and selective nodal irradiation is discussed. Additionally, concepts about target definition, target delineation and treatment evaluation are reviewed.
Purpose
2-
18
FFDG PET/CT is of utmost importance for radiation treatment (RT) planning and response monitoring in lung cancer patients, in both non-small and small cell lung cancer (NSCLC and SCLC). ...This topic has been addressed in guidelines composed by experts within the field of radiation oncology. However, up to present, there is no procedural guideline on this subject, with involvement of the nuclear medicine societies.
Methods
A literature review was performed, followed by a discussion between a multidisciplinary team of experts in the different fields involved in the RT planning of lung cancer, in order to guide clinical management. The project was led by experts of the two nuclear medicine societies (EANM and SNMMI) and radiation oncology (ESTRO).
Results and conclusion
This guideline results from a joint and dynamic collaboration between the relevant disciplines for this topic. It provides a worldwide, state of the art, and multidisciplinary guide to 2-
18
FFDG PET/CT RT planning in NSCLC and SCLC. These practical recommendations describe applicable updates for existing clinical practices, highlight potential flaws, and provide solutions to overcome these as well. Finally, the recent developments considered for future application are also reviewed.
A patient with moderately differentiated pancreatic neuroendocrine tumor with synchronous multifocal liver metastases was referred for further staging with PET/CT. The examinations were performed on ...2 consecutive days and showed mild 68Ga-DOTANOC and intense 18F-FDG uptake in an incidental right parotid nodule. Differential diagnoses include primary or metastatic neuroendocrine tumor, malignant or benign primary parotid tumor, and intraparotid lymph node. Histology revealed characteristics of a Warthin tumor. While focal FDG uptake in Warthin tumor is frequently described, the somatostatin expression was rarely reported. This clinical case describes 68Ga-DOTANOC and 18F-FDG uptake in a parotid Warthin tumor histologically confirmed.
Significant advances in breast cancer (BC) treatment have been made in the last decade, including the use of immunotherapy and, in particular, immune checkpoint inhibitors that have been shown to ...improve the survival of patients with triple negative BC. This narrative review summarizes the studies supporting the use of immunotherapy in BC. Furthermore, the usefulness of 2-deoxy-2-
Ffluoro-D-glucose (2-
FFDG) positron emission/computerized tomography (PET/CT) to image the tumor heterogeneity and to assess treatment response is explored, including the different criteria to interpret 2-
FFDG PET/CT imaging. The concept of immuno-PET is also described, by explaining the advantages of mapping treatment targets with a non-invasive and whole-body tool. Several radiopharmaceuticals in the preclinical phase are referred too, and, considering their promising results, translation to human studies is needed to support their use in clinical practice. Overall, this is an evolving field in BC treatment, despite PET imaging developments, the future trends also include expanding immunotherapy to early-stage BC and using other biomarkers.
PDF
