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Purpose: To evaluate the added value of additional 68Ga-FAPI PET/CT following CT for primary staging, detection of postoperative recurrence, and management of gastric cancer patients. Methods: We retrospectively included patients with gastric cancers who underwent contrast-enhanced computed tomography (ceCT), followed by 68Ga-FAPI PET/CT within 30 days. 68Ga-FAPI PET/CT was performed for initial staging or detection of postoperative recurrence. Two nuclear medicine physicians and a radiologist independently decided on imaging-based staging. Pre-68Ga-FAPI PET/CT treatment decisions were made by a simulated tumor board and post-68Ga-FAPI PET/CT decisions were extracted from medical records. We evaluated the impact of 68Ga-FAPI PET/CT with inconsistent new findings based on the initial findings from ceCT and the resulting changes in treatment strategies. Results: We included 112 patients, 84 for initial staging and 28 for detection of postoperative recurrence. Compared to CT, 29 new findings in 24 patients were diagnosed as, or ruled out, cancer involvement on 68Ga-FAPI PET/CT. Among the 112 patients, 21 patients (18.8%) experienced changes in stage or postoperative recurrence. Among patients for initial staging, 14 had stage changes, with 10 being upstaged and 4 being downstaged. Among patients for detection of postoperative recurrence, 7 more patients were diagnosed with tumor recurrence. New findings of 68Ga-FAPI PET/CT led to treatment change in 20/112 (17.9%) patients, which was deemed of major change in 19 patients and minor change in 1 patient. Conclusions: 68Ga-FAPI PET/CT is valuable for precise staging and detection of postoperative recurrence of gastric cancers, and has the potential to influence management. [ABSTRACT FROM AUTHOR]

Background: We present retrospective data of patients with nonmuscle invasive bladder cancer (NMIBC) who underwent restaging transurethral resection of bladder tumor (Re-TURBT) at a tertiary care center. Materials and Methods: Records of all NMIBC patients undergoing Re-TURBT between March 2021 and September 2023 were retrospectively analyzed. Patients were risk stratified based on TURBT pathology. Re-TURBT was performed between 4 and 6 weeks. Adverse features such as number, size, and appearance were noted. Patients with persistent disease at Re-TURBT were counseled for early cystectomy with urinary diversion or intravesical Bacillus Calmette–Guerin (BCG). In case of disease upstaging, patients were counseled for radical cystectomy. Results: Thirty-eight NMIBC patients (30 males and 8 females) underwent Re-TURBT. Six patients had residual/persistent disease at 6 weeks, all high risk and high grade (HG, P value not significant, P = 0.31). There was no association with number and appearance of tumors with residual/persistence at 6 weeks. The mean lesion size on imaging in cases with and without residual disease was 3.32 ± 0.86 versus 3.39 ± 0.92 cm, respectively, P value not significant (0.868). There was no residual disease in the low-grade (LG) pT1 group, but HG pTa and pT1 (n = 3) had residual disease. Four HG pT1 patients opted for early cystectomy. Two patients each had pT0 and two pT2. At 3 months of follow-up, urethral strictures were seen both in high risk and intermediate risk. Among four patients who had stricture, meatal stenosis was common (50%, n = 2). Two patients had long-segment stricture requiring perineal urethrostomy with stage I Johannsen repair. All HG pT1 lesion patients eventually underwent cystectomy (3 were under staged and two treated completely with TURBT, one with TURBT + BCG and one patient progressed to metastasis). Conclusion: Re-TURBT is essential for the management of HG pTa and HG pT1 lesions for accurate staging and treatment of residual disease. However, LG pT1 patients can safely be excluded from Re-TURBT.

Background: The role of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) validated with video-assisted mediastinoscopic lymphadenectomy (VAMLA) for mediastinal restaging of patients with non-small cell lung cancer (NSCLC) after induction therapy has never been described. Objective: To report on our experience in this clinical setting. Design: Retrospective analysis of a prospectively built database. Methods: Patients with stage IIIA (N2) NSCLC who underwent EBUS-TBNA for mediastinal restaging after induction therapy were included. The sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and diagnostic accuracy of EBUS-TBNA and VAMLA for mediastinal restaging were calculated. The number of patients needed to undergo confirmatory VAMLA (NNT) after a negative EBUS-TBNA for mediastinal restaging to avoid a case of pathologic (p) N2 disease after resection was also calculated. Results: Forty-six patients underwent EBUS-TBNA which was positive in 12 patients and negative in 34. Patients with a negative EBUS-TBNA underwent VAMLA which was positive in seven cases. Of the other 27 patients with a negative VAMLA, 26 underwent resection that did not show N2 disease. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of EBUS-TBNA for restaging were 63.1%, 100%, 79.4%, 100%, and 84.7%, respectively. The sensitivity, specificity, NPV, PPV, and diagnostic accuracy of confirmatory VAMLA after EBUS-TBNA was 100%. The NNT confirmatory VAMLA after a negative EBUS-TBNA to avoid a case of pN2 disease at resection was five patients. Conclusion: EBUS-TBNA must remain as the first-choice test for invasive mediastinal restaging. However, the results of our study in terms of sensitivity and NPV, even considering the small size of our population, suggest that negative results of EBUS-TBNA should be interpreted with caution and surgical exploration of the mediastinum (specially VAMLA, if available) should be considered in these patients. [ABSTRACT FROM AUTHOR]

Introduction: Neoadjuvant therapy has become standard of care for locally advanced rectal cancer patients. It is correlated with improved clinical and pathological outcomes, including significant tumor downstaging and organ preservation in certain patients. Magnetic resonance imaging (MRI), which has become the standard for pre-operative staging, is also used for clinical and pre-operative restaging following pre-operative treatment. In this meta-analysis, we aimed to evaluate the concordance between restaging MRI (following the completion of neoadjuvant therapy) and postoperative pathology result. Methods: We conducted a meta-analysis following the PRISMA 2020 guidelines. Two independent reviewers searched PubMed and Google Scholar for studies reporting restaging MRI results compared to pathological outcomes. Outcomes included tumor and nodal staging, circumferential resection margin (CRM) and pathological complete response (pCR). Results: Out of 25,000 studies found on the initial search; 33 studies were included. The studies were published between 2005 and 2023 and included 4100 patients (57.14% males). The median age was 62.45 years. The median interval between the conclusion of neoadjuvant treatment and the subsequent restaging MRI was 6 weeks (range 4.14–8.8 weeks). The pooled concordance rates between the restaging MRI and the pathological outcomes for ypT stage and ypN stage were 63.9% (54.5%–73.3%, I2 = 96.02%) and 60.9% (42.9%–78.9%, I2 = 98.96%), respectively. The pooled concordance for predicting pathological complete response was 70.4% (53.6%–87.1%, I2 = 98.21%). As for the circumferential resection margin (CRM), the pooled concordance was 78.2.% (71.6%–84.8%, I2 = 83.76%). Conclusions: Our findings suggest that the concordance rates between restaging MRI and pathological outcomes in rectal cancer patients following neoadjuvant therapy are limited. Caregivers should take these results into consideration when making clinical decisions about these patients. More data should be gathered about the predictive value of MRI after total neoadjuvant therapy as well as immunotherapy in rectal cancer patients. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusion In the assessment of breast cancer using 18‐F FDG PET/CT, the incremental clinical benefit in performing a true whole‐body PET/CT (with a field of view (FOV) from the vertex to the toes) over a limited whole‐body PET/CT (with a FOV from the base of skull to the mid‐thighs) is uncertain.Two hundred and one studies of 120 patients who underwent staging or restaging true whole body 18F‐FDG PET/CT for breast cancer were retrospectively identified. Any abnormal hypermetabolic or structural focus outside the limited FOV was recorded and characterised, and referenced with the patient's known disease status and any symptomatology.A total of 18 (9.0%) studies had FDG avid and/or structural abnormalities detected outside the limited whole‐body FOV which were identified as malignant. Seventeen out of 18 (94.4%) were skeletal and of these, 15/17 (88.2%) were located within the lower limbs. In three cases, there were de novo findings but identified in the presence of interval progression of other metastases within the limited whole‐body FOV. None of these additional findings is known to have resulted in a change to staging or clinical management.In the assessment of breast cancer, a true whole‐body PET/CT can reveal metastases outside the limited whole‐body FOV, but these are unlikely to be encountered in isolation and therefore may have little bearing on clinical stage or management. Ultimately, while the choice of FOV should still be based on the individual patient situation, routine utilisation of the true whole‐body FOV in the asymptomatic patient may not be necessary. [ABSTRACT FROM AUTHOR]

Background: We present retrospective data of patients with nonmuscle invasive bladder cancer (NMIBC) who underwent restaging transurethral resection of bladder tumor (Re-TURBT) at a tertiary care center. Materials and Methods: Records of all NMIBC patients undergoing Re-TURBT between March 2021 and September 2023 were retrospectively analyzed. Patients were risk stratified based on TURBT pathology. Re-TURBT was performed between 4 and 6 weeks. Adverse features such as number, size, and appearance were noted. Patients with persistent disease at Re-TURBT were counseled for early cystectomy with urinary diversion or intravesical Bacillus Calmette–Guerin (BCG). In case of disease upstaging, patients were counseled for radical cystectomy. Results: Thirty-eight NMIBC patients (30 males and 8 females) underwent Re-TURBT. Six patients had residual/persistent disease at 6 weeks, all high risk and high grade (HG, P value not significant, P = 0.31). There was no association with number and appearance of tumors with residual/persistence at 6 weeks. The mean lesion size on imaging in cases with and without residual disease was 3.32 ± 0.86 versus 3.39 ± 0.92 cm, respectively, P value not significant (0.868). There was no residual disease in the low-grade (LG) pT1 group, but HG pTa and pT1 (n = 3) had residual disease. Four HG pT1 patients opted for early cystectomy. Two patients each had pT0 and two pT2. At 3 months of follow-up, urethral strictures were seen both in high risk and intermediate risk. Among four patients who had stricture, meatal stenosis was common (50%, n = 2). Two patients had long-segment stricture requiring perineal urethrostomy with stage I Johannsen repair. All HG pT1 lesion patients eventually underwent cystectomy (3 were under staged and two treated completely with TURBT, one with TURBT + BCG and one patient progressed to metastasis). Conclusion: Re-TURBT is essential for the management of HG pTa and HG pT1 lesions for accurate staging and treatment of residual disease. However, LG pT1 patients can safely be excluded from Re-TURBT. [ABSTRACT FROM AUTHOR]

Here we aim to provide updated guidance and standards for the indication, acquisition, and interpretation of PSMA PET/CT for prostate cancer imaging. Procedures and characteristics are reported for a variety of available PSMA small radioligands. Different scenarios for the clinical use of PSMA-ligand PET/CT are discussed. This document provides clinicians and technicians with the best available evidence, to support the implementation of PSMA PET/CT imaging in research and routine practice.

Purpose: To assess prognostic significance of residual tumor at repeat transurethral resection (reTUR) in contemporary non-muscle-invasive bladder cancer (NMIBC) patients. Methods: Patients were identified retrospectively from eight referral centers in France, Italy and Spain. The cohort included consecutive patients with high or very-high risk NMIBC who underwent reTUR and subsequent adjuvant BCG therapy. Results: A total of 440 high-risk NMIBC patients were screened, 29 (6%) were upstaged ≥ T2 at reTUR and 411 were analyzed (T1 stage: n = 275, 67%). Residual tumor was found in 191 cases (46%). In patients with T1 tumor on initial TURBT, persistent T1 tumor was found in 18% of reTUR (n = 49/275). In patients with high-grade Ta tumor on initial TURBT, T1 tumor was found in 6% of reTUR (n = 9/136). In multivariable logistic regression analysis, we found no statistical association between the use of photodynamic diagnosis (PDD, p = 0.4) or type of resection (conventional vs. en bloc, p = 0.6) and the risk of residual tumor. The estimated 5-yr recurrence and progression-free survival were 56% and 94%, respectively. Residual tumor was significantly associated with a higher risk of recurrence (p < 0.001) but not progression (p = 0.11). Only residual T1 tumor was associated with a higher risk of progression (p < 0.001) with an estimated 5-yr progression-free survival rate of 76%. Conclusions: ReTUR should remain a standard for T1 tumors, irrespective of the use of en bloc resection or PDD and could be safely omitted in high-grade Ta tumors. Persistent T1 tumor at reTUR should not exclude these patients from conservative management, and further studies are needed to explore the benefit of a third resection in this subgroup. [ABSTRACT FROM AUTHOR]

FDG PET/CT provides complementary metabolic information with greater sensitivity and specificity than conventional imaging modalities for evaluating local recurrence, nodal, and distant metastases in patients with cervical cancer. PET/CT can also be used in radiation treatment planning, which is the mainstay of treatment. With the implementation of various oncological guidelines, FDG PET/CT has been utilized more frequently in patient management and prognostication. Newer PET tracers targeting the tumor microenvironment offer valuable biologic insights to elucidate the mechanism of treatment resistance and tumor aggressiveness and identify the high-risk patients. Artificial intelligence and machine learning approaches have been utilized more recently in metastatic disease detection, response assessment, and prognostication of cervical cancer.

Prostate cancer (PC) is the most widespread malignancy in men worldwide and the third leading cause of cancer-related death. Accurate diagnostic and staging procedures are key for therapy success and personalized treatment in all stages of PC. Prostate cancer-specific positron emission tomography-computed tomography (PET/CT) is able to detect disease sites in both localized and recurrent PC, at serum levels of prostate specific antigen (PSA) that are lower compared with those detected by conventional imaging. Currently, the backbone of nuclear medicine staging in PC is based on prostate-specific membrane antigen (PSMA) PET/CT, given the numerous advantages of PSMA over other tracers used for PC molecular imaging. In this free-style narrative review, the historic perspective, literature, clinical utility, and practice patterns of PSMA PET/CT in PC are discussed and key points summarized for busy oncologists with an interest in PC.

Background: Computed diffusion‐weighted images (cDWI) of random b value could be derived from acquired DWI (aDWI) with at least two different b values. However, its comparison between aDWI and cDWI images in locally advanced rectal cancer (LARC) patients after neoadjuvant therapy (NT) is needed. Purpose: To compare the cDWI and aDWI in image quality, restaging, and treatment response of LARC after NT. Study Type: Retrospective. Population: Eighty‐seven consecutive patients. Field Strength/Sequence: 3.0 T/DWI. Assessment: All patients underwent two DWI sequences, including conventional acquisition with b = 0 and 1000 s/mm2 (aDWIb1000) and another with b = 0 and 700 s/mm2 on a 3.0‐T MR scanner. The images of the latter were used to compute the diffusion images with b = 1000 s/mm2 (cDWIb1000). Four radiologists with 3, 4, 14, and 25 years of experience evaluated the images to compare the image quality, TN restaging performance, and treatment response between aDWIb1000 and cDWIb1000. Statistical Tests: Interclass correlation coefficients, weighted κ coefficient, paired Wilcoxon, and McNemar or Fisher test were used. A significance level of 0.05 was used. Results: The cDWIb1000 images were superior to the aDWIb1000 ones in both subjective and objective image quality. In T restaging, the overall diagnostic accuracy of cDWIb1000 images was higher than that of aDWIb1000 images (57.47% vs. 49.43%, P = 0.289 for the inexperienced radiologist; 77.01% vs. 63.22%, significant for the experienced radiologist), with better sensitivity in determining ypT0‐Tis tumors. Additionally, it increased the sensitivity in detecting ypT2 tumors for the inexperienced radiologist and ypT3 tumors for the experienced radiologist. N restaging and treatment response were found to be similar between two sequences for both radiologists. Data Conclusion: Compared to aDWIb1000 images, the computed ones might serve as a wise approach, providing comparable or better image quality, restaging performance, and treatment response assessment for LARC after NT. Level of Evidence: 3 Technical Efficacy Stage: 2 [ABSTRACT FROM AUTHOR]

Background Transurethral resection of the bladder tumor (TURBT) is the treatment of choice and gold standard for the treatment of clinical non-muscle invasive bladder cancer. Incomplete resection, tumor cell re-implantation, presence of subclinical tumors lead to recur rence of bladder cancer. According to guideline recommendations, restage TURBT is indicated 2-6 weeks after the initial TURBT in high-risk patients. The objective of the present study was undertaken to evaluate role of restage TURBT in high risk nonmuscle invasive bladder cancer (NMIBC). Objective To identify the category of patients with high risk non-muscle invasive bladder cancer who may benefit from a routine restage TURBT procedure. Materials and Methods In this prospective observational study, biopsy proven NMIBC patients with gross total painless hematuria secondary to urinary bladder mass from October 2017 to June 2019 were enrolled. Patients with high risk disease on primary TURBT underwent re-TURBT within 2-6 weeks of primary procedure. Residual/recurrent disease and tumor upstaging were recorded. Logistic regression analysis were used to explore risk factors associated with residual/recurrent disease and tumor upstaging during re-TURBT. Results A total of 250 patients (deep muscle involvement, n=237 and no muscle involvement, n=13) with histopathologically confirmed high risk disease following re-TURBT were included in the final analysis. During re-TURBT, 18% patients had residua or recurrent tumor. Presence of upper tract changes, presence of perivesical fat stranding and tumor size > 3cm, high grade histopathology and positive urine for malignant cytology were significantly associated with risk of residual or recurrent disease. Absence of muscle in primary TURBT specimen, presence of recurrent/residual growth in re-TURBT specimen, bladder tumor antigen increased the risk of upstaging. Conclusion Despite the low recurrence rate of tumor in re-TURBT, reTURBT within 2-6 weeks of primary TURBT is an essential step for the accurate diagnosis among NMIBC patients. This further aids in deciding the subsequent treatment step in patients with upstaging and recurrent/residual tumor. [ABSTRACT FROM AUTHOR]

Background: The objective was to retrospectively evaluate the contribution of fluorodeoxyglucose [18F] positron emission tomography/computed tomography (18FDG-PET/CT) to the re-staging of adrenocortical carcinoma (ACC). Materials and methods: A total of 16 patients (10 males and 6 females), who underwent adrenalectomy due to adrenocortical carcinoma and 18FDG-PET/CT scan to re-stage the tumor between July 2007 and April 2013, were included in the present study. The mean age was 53.37 ± 13.91 years (min: 30, max: 74) The patients were required to fast for six hours prior to scanning, and whole-body PET scanning from the skull base to the upper thighs was performed approximately 1 h after the intravenous injection of 555 MBq of F-18 FDG. Whole body CT scanning was performed in the cranio-caudal direction. FDG-PET images were reconstructed using CT data for attenuation correction. Suspicious recurrent or metastatic lesions were confirmed by histopathology or clinical follow-up. Results: Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 18FDG-PET/CT were 100%, 83.3%, 90.9%, 83.3%, and 93.7%, respectively. Conclusion: 18FDG-PET/CT detects local recurrence and/or distant metastases with high accuracy in the re-staging of operated adrenocortical carcinoma. It is considered that the procedure could play an important role in treatment decision after the operation and post-operative follow-up and could influence the entire decision-making process. [ABSTRACT FROM AUTHOR]

The impact of prostate-specific membrane antigen (PSMA) PET/CT on management of prostate cancer (PCa) patients with biochemical recurrence (BCR) is well established. However, whether and how PSMA PET/CT affects the management of patients undergoing scans for other clinical indications remains unknown. The goal of this study was to determine the impact of 68Ga-PSMA-11 PET/CT on initial and subsequent management decisions in a cohort of PCa patients referred for various indications (i.e., a basket trial) excluding the 2 main classic indications: BCR and presurgical staging. Methods: This was a prospective study of 197 patients that aimed to determine the impact of 68Ga-PSMA-11 PET/CT on PCa stage and management. The indications for PSMA PET/CT were initial staging of nonsurgical candidates (30 patients) and restaging after definitive treatment (167 patients). The restaging cohort comprised patients restaged with known advanced metastatic disease (n = 103), after androgen deprivation therapy only (n = 16), after surgery and with serum prostate-specific antigen levels lower than 0.2 ng/mL (n = 13), after radiation therapy and not meeting the Phoenix criteria (n = 22), and after other primary local treatments (i.e., high-intensity focused ultrasound, focal laser ablation, cryoablation, hyperthermia, or irreversible electroporation) (n = 13). Patients with BCR and candidates for curative surgery were excluded. Impact on management was assessed using pre- and post-PET questionnaires completed by referring physicians, electronic chart review, or patient telephone calls. Results: PSMA PET/CT changed the disease stage in 135 of 197 (69%) patients (upstaging in 38%, downstaging in 30%, and no change in stage in 32%). Management was affected in 104 of 182 (57%) patients. Specifically, PSMA PET/CT impacted the management of patients who were restaged after radiation therapy without meeting the Phoenix criteria for BCR, after other definitive local treatments, and with advanced metastatic disease in 13 of 18 (72%), 8 of 12 (67%), and 59 of 96 (61%), respectively. Conclusion: PSMA PET/CT has a profound impact on stage and management of PCa patients outside the 2 main classic indications (BCR and presurgical staging) across all examined clinical scenarios.

Abstract Background Incidental gallbladder carcinoma (IGBC) is identified after cholecystectomy being performed for a presumed to be benign disease, and histopathology turns out as malignant disease. For optimal management planning, it is crucial to know the actual disease status. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) provides local, regional as well as distant disease, i.e., restaging and identifying true burden of disease for optimal treatment planning. The aim of this study was to restage the IGBC patients on 18F FDG PET/CT and find out any change in treatment plan. Methods This retrospective descriptive study was performed between November 2021 and February 2023. All PET/CT scans were analyzed which came for restaging in IGBC. Results PET/CT was performed at a median time of 9 weeks (range 6–12 weeks) from the date of surgery. This study included 17 patients (6 males and 11 females), with a median age of 55 years (range 38–76 years). From total of 17 PET/CT scans, 10 (58.8%) patients were positive and 7 (41.1%) patients were negative on PET/CT. Among the PET/CT positive patients, disease pattern was seen in the form of local/residual disease/liver infiltration, regional lymph nodes and distant metastases. Among the 17 patients, treatment plan in 5 patients (having PET/CT negative) was changed from surgical intervention to no treatment, and in 2 patients (having PET/CT positive), treatment plan was changed to chemotherapy, i.e., total 7 (5 + 2, 41% of total 17 patients) patients’ treatment plans were changed. By reducing the number of patients undergoing re-resection, we can say that it reduces the burden on already overburdened health infrastructure, especially in developing countries like India where incident is high. Conclusions PET/CT provides the actual stage of IGBC. It changes treatment plan and reduces the number of patients undergoing re-resection. It also decreases burden on overburdened health infrastructure.

The oeuvre of Constança Capdeville (1937–1992) includes a significant body of music theatre works that represent a challenge for restaging. The lack of systematic information makes it necessary for those who have worked with her to bequeath a living testimony of her work, whose conceptual approach represents an enrichment of the Portuguese musical panorama. ‘Ce désert est faux’—Constança Capdeville in memoriam (2012) is a music theatre performance based entirely on Capdeville’s music theatre works, proposing a stage production enacted in her spirit. In fact, from the choice of works and excerpts to be included in the performance to their distribution and staging, the main objective guiding this project aims to establish a context that would allow for Capdeville’s music theatre works to be experienced just as they were conceived. The strategies respecting Capdeville’s typical procedures are also discussed in this study. [ABSTRACT FROM AUTHOR]

Background: A biochemical recurrence (BCR) risk model was created based on pretest prostate specific antigen (PSA) and groupings by restaging prostate specific membrane antigen (PSMA) PET/CT. Methods: A cohort of 1216 BCR patients were analyzed for overall survival (OS) according to the PSA threshold and restaging PSMA PET/CT. A Cox regression analysis of OS was carried out to detect significant clinical characteristics. Results: In the cohort, 271 patients had a pretest PSA of <0.5 ng/mL and 945 patients had higher PSA values. The restaging PSMA PET/CT was positive for 834 patients and negative for 369. Of 1203 patients, 133 (11%) died, including 19 of the 369 (5%) patients without positive sites on the restaging PSMA PET/CT, 82 of the 711 (12%) with 1–5 positive sites, and 32 of the 123 (26%) with >5 positive sites. In the Cox regression analysis, four variables significantly predicted OS: treatment center, International Society of Urologic Pathology (ISUP) grade, pretest PSA threshold, and the grouping of positive sites on the restaging PSMA PET/CT. Conclusions: The pretest PSA and PSMA PET/CT were important for the OS of the BCR patients. The findings argue for the new BCR risk model and serve as framework for ongoing trials. [ABSTRACT FROM AUTHOR]

Background: Incidental gallbladder carcinoma (IGBC) is identified after cholecystectomy being performed for a presumed to be benign disease, and histopathology turns out as malignant disease. For optimal management planning, it is crucial to know the actual disease status. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) provides local, regional as well as distant disease, i.e., restaging and identifying true burden of disease for optimal treatment planning. The aim of this study was to restage the IGBC patients on 18F FDG PET/CT and find out any change in treatment plan. Methods: This retrospective descriptive study was performed between November 2021 and February 2023. All PET/CT scans were analyzed which came for restaging in IGBC. Results: PET/CT was performed at a median time of 9 weeks (range 6–12 weeks) from the date of surgery. This study included 17 patients (6 males and 11 females), with a median age of 55 years (range 38–76 years). From total of 17 PET/CT scans, 10 (58.8%) patients were positive and 7 (41.1%) patients were negative on PET/CT. Among the PET/CT positive patients, disease pattern was seen in the form of local/residual disease/liver infiltration, regional lymph nodes and distant metastases. Among the 17 patients, treatment plan in 5 patients (having PET/CT negative) was changed from surgical intervention to no treatment, and in 2 patients (having PET/CT positive), treatment plan was changed to chemotherapy, i.e., total 7 (5 + 2, 41% of total 17 patients) patients' treatment plans were changed. By reducing the number of patients undergoing re-resection, we can say that it reduces the burden on already overburdened health infrastructure, especially in developing countries like India where incident is high. Conclusions: PET/CT provides the actual stage of IGBC. It changes treatment plan and reduces the number of patients undergoing re-resection. It also decreases burden on overburdened health infrastructure. [ABSTRACT FROM AUTHOR]

Simple Summary: Lymph node involvement is a prognostic determinant in the diagnostic work-up and management of muscle-invasive bladder cancer. Thus, it is crucial to provide an accurate staging of the bladder tumor to better identify the best therapeutic strategies to improve the chances of survival and the quality of life of patients affected by bladder cancer. Positron Emission Tomography/Computed Tomography (PET/CT) has been increasingly used in bladder cancer staging to improve the accuracy of lymph node detection and to overcome the lack of sensitivity and the understaging showed by conventional imaging. The aim of this narrative literature review is to provide an overview of the current evidence on the use of 18F-FDG PET/CT in the diagnosis, staging, and restaging of bladder cancer, with a particular focus on its sensitivity and specificity for the detection of LN metastasis. We aim to provide clinicians with a better understanding of 18F-FDG PET/CT's potential benefits and limitations in clinical practice. Despite the heterogeneity of the studies in the literature and the lack of a consensus, 18F-FDG PET/CT provides important incremental staging and restaging information that can potentially influence the clinical management of patients affected by muscle-invasive bladder cancer. Introduction: Lymph node (LN) involvement is a crucial determinant of prognosis for patients with bladder cancer, and an accurate staging is of utmost importance to better identify timely and appropriate therapeutic strategies. To improve the accuracy of LN detection, as an alternative to traditional methods such as CT or MRI, 18F-FDG PET/CT has been increasingly used. 18F-FDG PET/CT is also used in post-treatment restaging after neoadjuvant chemotherapy. The aim of this narrative literature review is to provide an overview of the current evidence on the use of 18F-FDG PET/CT in the diagnosis, staging, and restaging of bladder cancer, with a particular focus on its sensitivity and specificity for the detection of LN metastasis. We aim to provide clinicians with a better understanding of 18F-FDG PET/CT's potential benefits and limitations in clinical practice. Materials and Methods: We designed a narrative review starting from a wide search in the PubMed/MEDLINE and Embase databases, selecting full-text English articles that have examined the sensibility and specificity of PET/CT for nodal staging or restaging after neoadjuvant therapy in patients with bladder cancer. The extracted data were analyzed and synthesized using a narrative synthesis approach. The results are presented in a tabular format, with a summary of the main findings of each study. Results: Twenty-three studies met the inclusion criteria: fourteen studies evaluated 18F-FDG PET/CT for nodal staging, six studies examined its accuracy for restaging after neoadjuvant therapy, and three studies evaluated both applications. To date, the use of F-18 FDG PET/TC for detection of LN metastasis in bladder cancer is controversial and uncertain: some studies showed low accuracy rates, but over the years other studies have reported evidence of high sensitivity and specificity. Conclusions: 18F-FDG PET/CT provides important incremental staging and restaging information that can potentially influence clinical management in MIBC patients. Standardization and development of a scoring system are necessary for its wider adoption. Well-designed randomized controlled trials in larger populations are necessary to provide consistent recommendations and consolidate the role of 18F-FDG PET/CT in the management of bladder cancer patients. [ABSTRACT FROM AUTHOR]

Introduction. Cutaneous melanoma (CM) has a high metastasizing potential and requires many imaging tests for accurate staging and restaging. As a hybrid imaging method, 18F-FDG PET/CT has the power to diagnose clinically undetected regional and distant metastatic disease with a better detection rate than conventional imaging. The aim of our study was to assess the value of 18F-FDG PET/CT in detecting different types of malignant lesions - local recurrences, regional lymph nodes (RLN), in-transit (ITM) and distant metastases (DM) after radical excision of the primary lesion or regional recurrence. Materials and methods. A retrospective analysis was performed of all patients with CM referred for 18F-FDG PET/CT for staging or after resection of locoregional recurrent disease. All patients had a combination of pre-PET/CT conventional imaging studies (CIS), including a whole body computed tomography (CT) and ultrasonography (US) of the RLN basin/s. The results from 18F-FDG PET/CT were compared with the CIS results. Results. 246 consecutive patients, aged 10-87 years were included with identification of 71 malignant lymph nodes, 4 local recurrences, 28 ITM, and 65 DM in total. The detection rate of 18F-FDG PET/CT for RLN was 84.5%, and in the diagnosis of ITM and DM, it reached a sensitivity of 100.0% with 0.7% of false positive results. Conclusions. 18F-FDG PET/CT has an invaluable role in the detection of small, clinically silent ITM and DM and has a smaller value in RLN detection. It may guide the process of selection of suspicious lesions, suitable for biopsy or further ultrasound follow-up. [ABSTRACT FROM AUTHOR]

Background: Reliable mediastinal restaging after neoadjuvant treatment to rule out persistent nodal disease is essential to select patients for resection. Main endpoints of this study are: to analyse the accuracy of video-assisted mediastinoscopic lymphadenectomy (VAMLA) and to determine the rate of persistent N2-3 in patients with clinical N2-3 (cN2-3) non-small cell lung cancer (NSCLC) after neoadjuvant treatment., Methods: Prospective observational single-centre study of patients with NSCLC and histologically proven mediastinal involvement (cN2-3), treated with neoadjuvant therapy who underwent VAMLA for restaging. Patients with negative VAMLA underwent lung resection. Systematic nodal dissection (SND) was considered the reference test to confirm negative VAMLAs. Staging values were calculated based on pathologic findings using the standard formulas., Results: From 2017 to 2023, 41 patients with cN2-3 NSCLC received neoadjuvant therapy and thereafter underwent VAMLA for restaging. Neoadjuvant treatments: concomitant cisplatin-based chemotherapy and radical radiotherapy (n=33), chemoradiotherapy and immunotherapy (n=2), chemotherapy (n=2), chemotherapy and immunotherapy (n=2), tyrosine kinase inhibitor and immunotherapy (n=1) and immunotherapy (n=1). VAMLA was feasible in all patients. Restaging values with VAMLA were: sensitivity, 1 [95% confidence interval (CI): 0.72-1]; negative predictive value (NPV), 1 (95% CI: 0.89-1); and diagnostic accuracy, 1 (95% CI: 0.91-1). Rate of persistent N2 of the whole series: 29% (12/41). Complication rate was 9.7%., Conclusions: This preliminary series of patients with cN2-3 NSCLC treated with neoadjuvant treatment and restaged by VAMLA demonstrated high accuracy and high rate of persistent N2. VAMLA should be included in restaging algorithms to select patients with potentially resectable cN2-3 NSCLC., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://tlcr.amegroups.com/article/view/10.21037/tlcr-24-841/coif). The authors have no conflicts of interest to declare., (Copyright © 2025 AME Publishing Company. All rights reserved.)

Colorectal cancer (CRC) is among the most commonly diagnosed gastrointestinal malignancies worldwide. It is inadequate to handle in terms of staging and restaging only based on morphological imaging modalities and serum surrogate markers. And the correct and timely staging of CRC is imperative to prognosis and management. When compared to established sequential, multimodal conventional diagnostic methods, the molecular and functional imaging 18F-FDG PET/CT shows superiorities for tailoring appropriate treatment maneuvers to each patient. This review aims to summarize the utilities of 18F-FDG PET/CT in CRC, focusing on primary staging, follow-up assessment of tumor responses and diagnostic of recurrence. In addition, we also summarize the technical considerations of PET/CT and the conventional imaging modalities in those patients who are either newly diagnosed with CRC or has already been treated from this cancer. [ABSTRACT FROM AUTHOR]

Simple Summary: We undertook an individual patient data meta-analysis of the overall survival of 1216 patients with PSA-only recurrence of prostate cancer restaged with PSMA PET/CT before salvage treatment. Despite the patients having a low PSA at the recurrence, the restaging PSMA PET/CT markedly predicted the overall survival for the patients with a prescan PSA > 0.5 ng/mL. An individual patient meta-analysis followed 1216 patients with PSA-only recurrence (biochemical recurrence, BCR) restaged with [68Ga]Ga-PSMA-11 PET/CT before the salvage treatment for median 3.5 years and analyzed the overall survival (OS). A new risk model included a good risk group with a prescan PSA < 0.5 ng/mL (26%), an intermediate risk group with a prescan PSA > 0.5 ng/mL and a PSMA PET/CT with 1 to 5 positive sites (65%), and a poor risk group with a prescan PSA > 0.5 ng/mL and a PSA PET/CT with > 5 positive sites (9%) (p < 0.0001, log rank test). The poor risk group had a five-year OS > 60%. Adding a BCR risk score by the European Association of Urology did not significantly improve the prediction of OS (p = 0.64). In conclusion, the restaging PSMA PET/CT markedly predicted the 5-year OS. The new risk model for patients with PSA-only relapse requires a restaging PSMA PET/CT for patients with a prescan PSA > 0.5 ng/mL and has a potential use in new trials aiming to improve the outcome for patients with PSA-only recurrence who have polysites prostate cancer detected on PSMA PET/CT. [ABSTRACT FROM AUTHOR]

Background: Non-small-cell lung cancer (NSCLC) with additional nodule(s) located in the same lobe or ipsilateral different lobe were designated as T3 and T4, respectively, which was merely defined by anatomical location of additional nodule(s), regardless of other prognostic factors. Methods: A total of 4711 patients with T1-4, N0-2, M0 NSCLC undergoing complete resection were identified between 2009 and 2014, including 145 patients with additional nodule(s) in the same lobe (T3-Add) and 174 patients with additional tumor nodule(s) in ipsilateral different lobe (T4-Add). Overall survival (OS) was compared using multivariable Cox regression models and propensity score matching analysis (PSM). Results: T3-Add patients [T3-Add versus T3, hazard ratio (HR), 0.695; 95% confidence interval (CI), 0.528–0.915; p = 0.009] and comparable OS with T2b patients through multivariable Cox analysis, and further validated by PSM. T4-Add patients carried a wide spectrum of prognosis, and the largest diameter of single tumor was screened out as the most effective indicator for distinguishing prognosis. T4-Add (⩽3 cm) patients had better OS than T4 patients [T4-Add (⩽3 cm) versus T4, HR, 0.629; 95% CI, 0.455–0.869; p = 0.005] and comparable OS with T3 patients. And T4-Add (>3 cm) patients had comparable OS with T4 patients. Conclusion: NSCLC patients with additional nodule(s) in the same lobe and ipsilateral different lobe (maximum tumor diameter ⩽ 3 cm) should be further validated and considered restaging as T2b and T3 in the forthcoming 9th tumor, node, and metastasis staging system. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is among the most commonly diagnosed gastrointestinal malignancies worldwide. It is inadequate to handle in terms of staging and restaging only based on morphological imaging modalities and serum surrogate markers. And the correct and timely staging of CRC is imperative to prognosis and management. When compared to established sequential, multimodal conventional diagnostic methods, the molecular and functional imaging 18F-FDG PET/CT shows superiorities for tailoring appropriate treatment maneuvers to each patient. This review aims to summarize the utilities of 18F-FDG PET/CT in CRC, focusing on primary staging, follow-up assessment of tumor responses and diagnostic of recurrence. In addition, we also summarize the technical considerations of PET/CT and the conventional imaging modalities in those patients who are either newly diagnosed with CRC or has already been treated from this cancer.

Background: A biochemical recurrence (BCR) risk model was created based on pretest prostate specific antigen (PSA) and groupings by restaging prostate specific membrane antigen (PSMA) PET/CT. Methods: A cohort of 1216 BCR patients were analyzed for overall survival (OS) according to the PSA threshold and restaging PSMA PET/CT. A Cox regression analysis of OS was carried out to detect significant clinical characteristics. Results: In the cohort, 271 patients had a pretest PSA of 5 positive sites. In the Cox regression analysis, four variables significantly predicted OS: treatment center, International Society of Urologic Pathology (ISUP) grade, pretest PSA threshold, and the grouping of positive sites on the restaging PSMA PET/CT. Conclusions: The pretest PSA and PSMA PET/CT were important for the OS of the BCR patients. The findings argue for the new BCR risk model and serve as framework for ongoing trials.

Background: Preoperative determination of lymph node (LN) status is crucial in treatment planning for rectal cancer. This study prospectively evaluated the risk factors for lymph node metastasis (LNM) at staging and restaging based on a node-by-node pairing between MRI imaging findings and histopathology and constructed nomograms to evaluate its diagnostic value. Methods: From July 2021 to July 2022, patients with histopathologically verified rectal cancer who underwent MRI before surgery were prospectively enrolled. Histological examination of each LN status in the surgical specimens and anatomical matching with preoperative imaging. Taking histopathological results as the gold standard, federating clinical features from patients and LN imaging features on MRI-T2WI. Risk factors for LN metastasis were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomograms was assessed with calibration plots and bootstrapped-concordance index and validated using validation cohorts. Results: A total of 500 target LNs in 120 patients were successfully matched with node-by-node comparisons. A total of 353 LNs did not receive neoadjuvant therapy and 147 LNs received neoadjuvant chemoradiotherapy (neoCRT). Characterization of LNs not receiving neoadjuvant therapy and multivariate regression showed that the short diameter, preoperative CEA level, mrT-stage, border contour, and signal intensity were associated with a high risk of LN metastasis (P < 0.05). The nomogram predicted that the area under the curve was 0.855 (95% CI, 0.794–0.916) and 0.854 (95% CI, 0.727–0.980) in the training and validation cohorts, respectively. In the neoadjuvant therapy group, short diameter, ymrT-stage, internal signal, and MRI-EMVI were associated with LN positivity (P < 0.05), and the area under the curves using the nomogram was 0.912 (95% CI, 0.856–0.968) and 0.915 (95% CI, 0.817–1.000) in two cohorts. The calibration curves demonstrate good agreement between the predicted and actual probabilities for both the training and validation cohorts. Conclusion: Our nomograms combined with preoperative clinical and imaging biomarkers have the potential to improve the prediction of nodal involvement, which can be used as an essential reference for preoperative N staging and restaging of rectal cancer. [ABSTRACT FROM AUTHOR]

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There is no clear evidence regarding the benefit of restaging for distant metastases after neoadjuvant radiotherapy (RTX) in patients with soft tissue sarcoma (STS) of the extremities and trunk wall. This study aimed to determine how often restaging of the chest identified metastatic disease that altered management in these patients. We performed a single-centre retrospective study from 2010 to 2020. All patients with non-metastatic STS of the extremities and trunk wall who were treated with neoadjuvant RTX and received a staging and restaging chest CT scan or X-ray for distant metastasis were included. The outcome of interest was change in treatment strategy due to restaging after neoadjuvant RTX. Within the 144 patients who were staged and treated with neoadjuvant RTX, a restaging chest CT or X-ray was performed in 134 patients (93%). A change in treatment strategy due to new findings at restaging after RTX was observed in 26 out of 134 patients (19%). In 24 patients the scheduled resection of the primary STS was cancelled at restaging (24/134, 18%), given the findings at restaging. The other two patients did receive the intended local resection, but either with palliative intent, or as a part of a previously unplanned multimodality treatment. In approximately one in five patients restaging results in a change in treatment strategy. This underlines the added value of routine restaging for distant metastases with chest CT or X-ray after neoadjuvant RTX in patients with STS. [ABSTRACT FROM AUTHOR]

PurposeInvestigating the value of Ga-PSMA-PET/CT in biochemically recurring prostate cancer patients with negative F-choline-PET/CT.Patients and methodsOne hundred thirty-nine consecutive patients with biochemical recurrence after curative (surgery and/or radiotherapy) therapy were offered participation in this sequential clinical imaging approach. Patients first underwent an F-choline-PET/CT. If negative, an additional Ga-PSMA-PET/CT was offered. One hundred twenty-five of 139 eligible patients were included in the study; 32 patients underwent additional Ga-PSMA-PET/CT. Patients with equivocal findings (n = 5) on F-choline-PET/CT and those who declined the additional Ga-PSMA-PET/CT (n = 9) were excluded. Images were analyzed visually for the presence of suspicious lesions. Findings on PET/CT were correlated with PSA level, PSA doubling time (dt), and PSA velocity (vel).ResultsThe overall detection rates were 85.6% (107/125) for the sequential imaging approach and 74.4% (93/125) for F-choline-PET/CT alone. Ga-PSMA-PET/CT detected sites of recurrence in 43.8% (14/32) of the choline-negative patients. Detection rates of the sequential imaging approach and F-choline-PET/CT alone increased with higher serum PSA levels and PSA vel. Subgroup analysis of Ga-PSMA-PET/CT in F-choline negative patients revealed detection rates of 28.6%, 45.5%, and 71.4% for PSA levels of 0.2 or greater to less than 1 ng/mL, 1 to 2 ng/mL, and greater than 2 ng/mL, respectively.ConclusionsThe sequential imaging approach designed to limit Ga-PSMA imaging to patients with negative choline scans resulted in high detection rates. Ga-PSMA-PET/CT identified sites of recurrent disease in 43.8% of the patients with negative F-choline PET/CT scans.

Background. Evaluation of the therapeutic effect of neoadjuvant chemoradiotherapy (nCRT) for rectal cancer (RC) is of prognostic value and allows to individually plan the type and extent of further surgical intervention. One of the most promising methods of MRI evaluation is magnetic resonance tumour regression grade (mrTRG) system. However, the reliability and safety of this method must be confirmed by the results of clinical trials and practical application.Objective: to analyze our experience in the prospective use of mrTRG system and evaluate the additional contribution of diffusion-weighted images (DWI) to its diagnostic efficiency.Material and methods. The mrTRG values were determined in 125 (including 30 with DWI) patients with locally advanced RC who received combined treatment with nCRT in Tsyb Medical Radiological Research Centre from 2015 to 2019. The obtained data were compared with the modified pathologic response based on Lushnikov’s definition, and the diagnostic parameters of differentiation of patients responding and nonresponding to nCRT were calculated.Results. When the mrTRG system was used without DWI, the following sensitivity and specificity values as well as positive and negative predictive values were obtained: 75%, 60%, 70% and 67%, respectively, with DWI – 87%, 87%, 87% and 87%, respectively.Conclusion. A prospective evaluation of the result of nCRT using the mrTRG system has moderate accuracy for stratification of patients responding and non-responding to nCRT, which requires the use of additional criteria for MRI scores to select patients who may receive less aggressive surgical treatment. Despite the small number of patients with DWI, we obtained higher values of the diagnostic parameters. In this regard, we consider it appropriate to use DWI when assessing the treatment response.

Objective: To assess the surgical and oncological outcomes of laparoscopic restaging compared with laparotomy for apparent early-stage epithelial ovarian cancer. Methods: A retrospective chart review was undertaken of patients who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) restaging at the Peking Union Medical College Hospital, China, between January 2012 and December 2017. All patients had apparent stage I epithelial ovarian cancer that was incompletely staged at the initial surgery. Results: A total of 157 patients were included, with 50 in the laparoscopy group and 107 in the laparotomy group. Baseline characteristics were similar between the groups. No cases were converted from laparoscopy to laparotomy. The laparoscopy group had a significantly shorter operating time (p<0.001), less estimated blood loss (p<0.001), and a shorter postoperative hospitalization duration (p<0.001) than the laparotomy group. Transfusions were required in only eight laparotomy patients. No significant differences in postoperative complications were observed between the two groups (p=0.55). Eighteen (11.5%) patients were upstaged to stage II or stage III after surgery. A total of 123 (78.3%) patients received postoperative platinum-based chemotherapy. During the follow-up period, 15 (9.6%) patients experienced disease recurrence, and 3 patients died of disease progression. Five-year disease-free survival (p = 0.242, log-rank test) and overall survival (p = 0.236, log-rank test) were not affected by the surgical approach. Conclusions: Laparoscopic restaging showed more favorable operative outcomes than laparotomy. Surgical restaging via laparoscopy versus laparotomy was not associated with worse survival in women with apparent stage I epithelial ovarian cancer. [ABSTRACT FROM AUTHOR]

Objectives: Positron Emission Tomography with Computed Tomography (PET/CT) is a valuable imaging method for the restaging of malignant diseases as well as the evaluation of treatment outcomes. As melanoma lesions are mostly FDG-avid, whole-body 18F-fluorodeoxyglucose (18F-FDG) PET/CT imaging modality can be used to determine the spread of the tumor. In the present study, we intended to share our clinical experience with FDG PET/CT in malignant melanoma patients under different kinds of treatment. Methods: In this retrospective study, the data sets of 122 patients who had surgical resection of known primary tumors, all of which were histopathology-proven malignant melanoma, were analyzed. All patients underwent baseline 18F-FDG PET/CT scan no sooner than 45 days and at least once after surgery. Clinical information, radiological imaging, histopathology, and treatment modalities were noted for all patients, and 18F-FDG PET/CT findings were examined. Results: All patients were histopathology-proven and 47 of them had acral lentiginous, 37 nodular, 23 amelanotic, and 15 atypical malignant melanoma. Local recurrence was detected by 18F-FDG PET/CT in 13 (10.6%; 3 male, 10 female) of the 122 patients, and the mean recurrence time after diagnosis was 3 ± 1.4 years. 10 patients with brain and bone metastases underwent radiotherapy. 19 patients with lung, bone, and hepatic metastases received chemotherapy and 22 patients immunotherapy. Conclusions: Malignant melanoma is a type of skin cancer that may involve any organ. In localized cases, complete surgical resection may be adequate for a cure. If diagnosed with the latter type, the whole body of the patient must be examined. [ABSTRACT FROM AUTHOR]

ObjectiveTo assess the surgical and oncological outcomes of laparoscopic restaging compared with laparotomy for apparent early-stage epithelial ovarian cancer.MethodsA retrospective chart review was undertaken of patients who underwent laparoscopic (laparoscopy group) or laparotomic (laparotomy group) restaging at the Peking Union Medical College Hospital, China, between January 2012 and December 2017. All patients had apparent stage I epithelial ovarian cancer that was incompletely staged at the initial surgery.ResultsA total of 157 patients were included, with 50 in the laparoscopy group and 107 in the laparotomy group. Baseline characteristics were similar between the groups. No cases were converted from laparoscopy to laparotomy. The laparoscopy group had a significantly shorter operating time (p

After prostate malignancy diagnosis, precise determination of disease extent are fundamental steps for tailored made therapy. The earlier the diagnosis of the burden of the disease, the longer the survival in many cases. National and international guidelines are based on “classic” imaging technics combining radiological and nuclear medicine scans like CT, MRI and bone scintigraphy (BS). The most recent nuclear medicine development is the prostate specific membrane antigen (PSMA) PET and is emerging as the most promising tool of medical imaging, gaining ground every day. Nevertheless, the different onset among multiple studies fails to establish a worldwide admission and incorporation of this technique in guidelines and its position in workaday medical algorithms. It seems that the medical community agrees not to utilize PSMA PET for low-risk patients; intense debate and research is ongoing for its utility in intermediate risk patients. Contrariwise, in high-risk patients PSMA PET is confirmed outperforming CT and BS combined. Additionally, irrespectively to their castration status, patients with biochemical failure should be referred for PSMA PET. Even though PSMA PET reveals more extended disease than expected or exonerates equivalent lesions, thus impacting treatment optimization. Studies being in progress and future trials with clarify whether PSMA PET will be the new gold standard technic for specific groups of patients.

BackgroundIt is well established that magnetic resonance imaging (MRI) is better than multi-slice computed tomography (MSCT) for the accurate diagnosis of pretreatment tumor (T) and node (N) staging of rectal cancer. However, the diagnostic value of MRI and MSCT in local restaging of rectal cancer after neoadjuvant chemoradiotherapy (NCRT) is controversial. The aim of this study is to investigate the performance of the two imaging exams in restaging of patients with rectal cancer.MethodsPatients with rectal cancer from April 2015 to April 2021 were analyzed retrospectively. The inclusion criteria are as follows: 1) diagnosis of rectal cancer through pathology; 2) NCRT had been performed; 3) all patients had undergone both MSCT and MRI examination before the surgery. Exclusion criteria are as follows: 1) incomplete clinical and imaging data; 2) previous history of pelvic surgery. Two radiologists performed T and N staging of patient images. Diagnostic accuracy, consistency analysis, and error restaging distribution of the two imaging exams for T and N restaging of rectal cancer were assessed using postoperative pathological staging as the gold standard.ResultsA total of 62 patients (49 men; mean age: 59 years; age range 29–83 years) were included in the study. The diagnostic accuracy of MSCT and MRI for T restaging was 51.6% (95% CI 39.3%–63.9%) and 41.9% (95% CI 29.6%–54.2%), respectively, and no statistical difference was found between them (p > 0.05). The diagnostic accuracy of MSCT and MRI for N restaging was 56.5% (95% CI 44.2%–68.8%) and 53.2% (95% CI 40.8%–65.6%), respectively, and no statistical difference was found between them (p > 0.05). The consistency analysis showed that T restaging (κ = 0.583, p < 0.001) and N restaging (κ = 0.644, p < 0.001) were similar between MSCT and MRI. There was no significant difference in the distribution of over, accurate, or low staging in T restaging (p > 0.05) and N restaging (p > 0.05) between MSCT and MRI.ConclusionsMSCT and MRI have similarly poor performance in the diagnosis of preoperative T and N restaging of rectal cancer after NCRT. Neither of them cannot effectively stage the ypT0-1 of rectal cancer. These findings may be of clinical relevance for planning less imaging exam.

Malignant melanoma is one of the more aggressive cancers in the skin, with an increasing incidence every year. Melanoma has a better prognosis if diagnosed early and survival tends to decrease once the disease has metastasized. Positron emission tomography (PET) with 2-[18F]fluoro-2-deoxy-D-glucose (18F-FDG) has been used extensively over the past two decades in staging and assessing responses to therapy in patients with melanoma. Metabolic PET parameters have been demonstrated to be independent prognostic factors for progression-free survival (PFS) and overall survival (OS) in different malignancies, melanoma included. In our study, we evaluated the metabolic parameters of 18F-FDG PET/CT (flourodeoxyglucose positron emission tomography/computed tomography) in predicting the overall survival in patients with malignant melanoma who presented for restaging. Metabolic PET parameters (maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV) and total lesion glycolysis (TLG)) of the primary tumor, as well as whole-body MTV and TLG of the metastatic disease, were measured. Survival curves for OS were constructed and mortality rates were determined using the different PET variables. Forty-nine patients who presented for a PET/CT restaging in melanoma were included in this study. We found that non-survivors had significantly higher median MTV (11.86 cm3 vs. 5.68 cm3; p-value = 0.022), TLG (3125 vs. 14; p-value = 0.0357), whole-body MTV (53.9 cm3 vs. 14.4 cm3; p-value = 0.0076) and whole-body TLG (963.4 vs. 114.6; p-value = 0.0056). This demonstrated that high MTV and TLG values of the primary tumor and whole-body TLG as quantified by 18F-FDG PET/CT were prognostic factors for overall survival. The findings may potentially guide clinicians in decision making and identifying patients with a poorer prognosis. [ABSTRACT FROM AUTHOR]