(18)F-fluorodeoxyglucose positron-emission tomography-computed tomography to diagnose recurrent cancer.
BACKGROUND
Sometimes the diagnosis of recurrent cancer in patients with a previous malignancy can be challenging. This prospective cohort study assessed the clinical utility of (18)F-fluorodeoxyglucose positron-emission tomography-computed tomography ((18)F-FDG PET-CT) in the diagnosis of clinically suspected recurrence of cancer.


METHODS
Patients were eligible if cancer recurrence (non-small-cell lung (NSCL), breast, head and neck, ovarian, oesophageal, Hodgkin's or non-Hodgkin's lymphoma) was suspected clinically, and if conventional imaging was non-diagnostic. Clinicians were asked to indicate their management plan before and after (18)F-FDG PET-CT scanning. The primary outcome was change in planned management after (18)F-FDG PET-CT.


RESULTS
Between April 2009 and June 2011, 101 patients (age, median 65 years; 55% female) were enroled from four cancer centres in Ontario, Canada. Distribution by primary tumour type was: NSCL (55%), breast (19%), ovarian (10%), oesophageal (6%), lymphoma (6%), and head and neck (4%). Of the 99 subjects who underwent (18)F-FDG PET-CT, planned management changed after (18)F-FDG PET-CT in 52 subjects (53%, 95% confidence interval (CI), 42-63%); a major change in plan from no treatment to treatment was observed in 38 subjects (38%, 95% CI, 29-49%), and was typically associated with (18)F-FDG PET-CT findings that were positive for recurrent cancer (37 subjects). After 3 months, the stated post-(18)F-FDG PET-CT management plan was actually completed in 88 subjects (89%, 95% CI, 81-94%).


CONCLUSIONS
In patients with suspected cancer recurrence and conventional imaging that is non-diagnostic, (18)F-FDG PET-CT often provides new information that leads to important changes in patient management.
1] Department of Medicine, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario L8S 4K1, Canada [2] Department of Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Room HSC-2C8, Hamilton, Ontario L8S 4K1, Canada.
J J
JJ
You
Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada.
K J
KJ
Cline
Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada.
C-S
CS
Gu
Sunnybrook Odette Cancer Centre, Department of Medicine, University of Toronto, T2-107, 2075 Bayview Avenue, Toronto, Ontario M4N 3M5, Canada.
K I
KI
Pritchard
Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada.
I S
IS
Dayes
Department of Nuclear Medicine & Molecular Imaging, Hamilton Health Sciences & St Joseph's Healthcare Hamilton, McMaster University, 1200 Main Street West, Room HSC-1P15, Hamilton, Ontario L8N 3Z5, Canada.
K Y
KY
Gulenchyn
Department of Surgery, Division of Thoracic Surgery, London Health Sciences Centre, University of Western Ontario, 800 Commissioners Road East, Suite E2-122, London, Ontario N6A 5W9, Canada.
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RI
Inculet
Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada.
S K
SK
Dhesy-Thind
Department of Medical Imaging, University of Toronto, University Health Network, Eaton Wing, 1-ES-416, 200 Elizabeth Street, Toronto, Ontario M5G 2C4, Canada.
M A
MA
Freeman
Department of Oncology, Thunder Bay Regional Health Sciences Centre, 980 Oliver Road, Thunder Bay, Ontario P7B 6V4, Canada.
A M
AM
Chan
Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada.
J A
JA
Julian
1] Ontario Clinical Oncology Group, Department of Oncology, McMaster University, 711 Concession Street, G Wing, Hamilton, Ontario L8V 1C3, Canada [2] Department of Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, 699 Concession Street, Hamilton, Ontario L8V 5C3, Canada.
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Levine
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging* / Q000473:pathology; D009369:Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D049268:Positron-Emission Tomography / Q000379:methods*; D011859:Radiography
D019788:Fluorodeoxyglucose F18