Cancer Treatment Today » PET

PET in cervical cancer – pro

M Levin, MD — Tue, 04 Sep 2012 13:17:41 +0000

Lay Summary: PET has become an accepted tool for determining the extent of newly diagnosed cervical cancer and for following effects of treatment

NCCN recently (8/07) revised its staging recomendations and lists PET as a recommended staging modlity. Positron-emission tomography (PET) scan is no longer optional for ≥ stage IB2 disease and is now recommended as part of the workup. Whole-body positron emission tomography (PET) completed after cervical cancer treatment predicts outcome in a recent study.

Grigsby PW, Siegel BA, Dehdashti F. Lymph node staging by positron emission tomography in patients with carcinoma of the cervix. Journal of Clinical Oncology. 19(17), 3745-3749, Sept. 1, 2001

http://www.nccn.org/professionals/physician_gls/PDF/cervical.pdf

Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma. JAMA. 2007 Nov 21;298(19):2289-95.

JHuang KG, Ng KK, Tang SG, Chang YC, Hsueh S, Tsai CS, Hong JH, Lin CT, Chao A, Ma SY, Lin WJ, Fu YK, Fan CC, Lai CH. Defining the priority of using 18F-FDG PET for recurrent cervical cancer.Yen TC, See LC, Chang TC, Nucl Med. 2004 Oct;45(10):1632-9.Comment in:
J Nucl Med. 2004 Oct;45(10):1602-4.

PET and other imaging in Langerhans Histiocytosis – pro

M Levin, MD — Thu, 30 Aug 2012 17:40:30 +0000

Histiocytosis is a rare disease that involves histiocytes. The disease can range from limited involvement that spontaneously regresses to progressive multiorgan involvement that can be chronic and debilitating. In some cases, the disease can be life-threatening. It is approximated that histiocytosis affects 1 in 200,000 children born each year in the United States. The disease is rare and not much is known securely about how to treat it. Because of its rarity, prospective studies are not possible.Unfortinately the only evidence that is available regarding PET is from case reports. The same is true of treatment ; this is rare disease.
With that caveat, there are a number of reports of PET being useful in this condition. A 2007 report by Kaste et al is representative. It concludes: “We conclude that PET-CT information is clinically useful to evaluate disease activity and response to therapy and provides information that cannot be obtained from technetium 99m methylene diphosphonate bone scans or radiographs.”
We conclude that PET-CT information is clinically useful to evaluate disease activity and response to therapy and provides information that cannot be obtained from technetium 99m methylene diphosphonate bone scans or radiographs.”

PDQ incldues PET in its recommendations. This is what it says in its section on Langerhans:
“Radiologic tests for the first level of screening include skeletal survey, skull series, positron emission tomography (PET), or bone scans, and chest x-ray. Computed tomographic (CT) scan of the head is indicated if orbital or mastoid involvement is suspected. Imaging tests may include magnetic resonance imaging (MRI) scan with gadolinium contrast of the brain for patients with DI or suspected brain or vertebral involvement.A CT scan of the lungs is indicated for patients with abnormal chest x-rays or pulmonary symptoms. High-resolution CT scans may show evidence of pulmonary Langerhans cell histiocytosis (LCH) when the chest x-ray is normal, thus in infants and toddlers with normal chest x-rays, a CT scan may be considered.[2] LCH causes fatty changes in the liver or hypodense areas along the portal tract, which can be identified by CT scans. Newer diagnostic imaging modalities, such as somatostatin analogue scintigraphy or fludeoxyglucose F 18 (18F-FDG) PET scans, which augment these standard methods may prove useful.[4-8] PET scans may be helpful in following the response to therapy since the intensity of the PET image diminishes with healing of a bone or other lesion.

Kaste SC, Rodriguez-Galindo C, McCarville ME, Shulkin BL.

PET-CT in pediatric Langerhans cell histiocytosis.Pediatr Radiol. 2007 Jul;37(7):615-22.

PET for pancreatic cancer – pro

M Levin, MD — Tue, 28 Aug 2012 01:10:31 +0000

Pancreatic carcinoma is common in the United States, with approximately 30,000 patients each year diagnosed with pancreatic adenocarcinomas. Patients with inflammatory processes in the pancreas (pancreatitis) but no cancer can sometimes have high FDG uptake that is indistinguishable from cancers and, thus, must be differentiated from patients with cancer. FDG PET is being applied increasingly in pancreatic cancer diagnosis.
A recent literature review of all available studies found this:
For diagnosis: An estimated 50% change was noted in management effect, based on 26 patient studies. For diagnosis/staging: An estimated 43% change was noted in management effect, based on 65 patient studies. For staging: An estimated 36% change was noted in management effect, based on 33 patient studies. For recurrence: An estimated 53% change was noted in management effect, based on 19 patient studies. For monitoring response: An estimated 16% change was noted in management effect, based on 19 patient studies.

Considering the very poor prognosis of pancreatic carcinomas, PET´s greatest role may prove to be in helping to characterize masses appearing in the pancreas, as opposed to more general tumor staging. This is an active area of current investigation.

In terms of distinguishing between benign and malignant disease, the gold standard is percutaneous or open biopsy. If PET were to be used to allow patients with scans suggesting benign masses to avoid biopsy, a very high negative predictive value would be required. The key statistic underlying the negative predictive value is the false negative rate. Patients with false negative results are incorrectly assumed to have benign disease, and are thus not promptly treated for pancreatic cancer. Based on the literature review, the negative predictive value ranged between 75% and 92%, depending on an underlying prevalence of disease ranging from 50%-75%. This level of diagnostic performance may not be adequate to recommend against biopsy. The gold standard is endoscopic ultrasound.NCCN does not recommend PET in the initial workup. On p. PANC-A(2011) it says: “The role of PET/CT remains unclear. PET/CT may be considered after formal pancreatic protocol in high risk patients to detect extra-pancreatic massess. It is not a substitute for high quality contrast enchanced CT”.
The use to diagnose should be considered investigational. Special care is needed to avoid false positives that are common from infection and inflammatioin in this area.

A 2009 guideline says: ” At this time, there are insufficient treatment options that improve the outlook in patients who recur after surgical resection that would allow PET to contribute to management. PET imaging in recurrent disease should be restricted to clinical trials.”

NCCN PANC-2020 says: ” PET/CTcan be considered after formal pancreatic CT protocol in high-risk patient. It isn’t a substitute for high-quality, contrast-ecnchanced CT”.

Recurrence/Restaging

PET is not recommended for clinical management of suspected recurrence, nor for restaging at the time of recurrence, due to insufficient evidence and lack of effective therapeutic options.

Surveillance

NCCN advises suveillance 3-6 months for 2 years, then annually, but with CT and not PET.

http://www.petscaninfo.com/zportal/portals/phys/clinical/jnmpetlit/index_html/JNM_OncoApps

Matchar DB, Kulasingam SL, Havrilesky L, et al. and the Duke Center for Clinical Health Policy Research and Evidence Practice Center. Positron emission testing for six cancers (brain, cervical, small cell lung, ovarian, pancreatic and testicular). Technology Assessment. Prepared for the Agency for Healthcare Research and Quality (AHRQ). Rockville, MD: AHRQ; February 12, 2004.

Kanjeekal S, Biagi J, Walker-Dilks C. PET imaging in pancreatic cancer: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 20 p. (Recommendation report – PET; no. 5). [34 references]

Ana Beatriz Kinupe Abrahao, Yee Ung, Yoo-Joung Ko, Scott R. Berry; FDG PET/CT in pancreatic cancer staging and management: A retrospective study. Journal of Clinical Oncology 35, no. 4_suppl (February 2017) 464-464.

M. Ducreux et al, Cancer of the pancreas: ESMO Clinical Practice, Guidelines for diagnosis, treatment and follow-up. Annals of Oncology
26 (Supplement 5): v56

PET for GIST – pro

M Levin, MD — Tue, 28 Aug 2012 01:06:19 +0000

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract (GIT). About 5000 to 6000 new cases of GISTs are diagnosed in the United States annually. Response to conventional chemotherapeutic agents and radiation therapy is disappointing. Early experience with the tyrosine kinase inhibitor, STI-571 (Gleevec, imatinib mesylate), has been extremely encouraging and it is now an FDA approved treatment.

The role pf PET is udner investigation. Positron emission tomographic scanning with the radiotracer 18F-FDG can reveal early functional changes in tumor glucose metabolism that appear to correlate closely with metabolic response to imatinib mesylate. When compared with CT alone, PET with FDG and PET/CT provided valuable additional information about the extent and metabolic activity of the disease process. The response to drug therapy could be shown as early as 24 hours after completion of a therapeutic regimen.Though very promising, the number of reporteds and the number of published papers is too small to definitely assess sensitivity of PET and PET/CT in evaluating GIST response, as this malignancy is rare. A larger, multicenter study is required.

Antoch G, Kanja J, Bauer S, et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med.2004;45:357-365.

Van den Abbeele AD, for the GIST Collaborative PET Study Group. F18-FDG-PET provides early evidence of biological response to STI571 in patients with malignant gastrointestinal stromal tumors [abstract]. Proc Am Soc Clin Oncol. 2001;20:362a; Abstract 1444.

PET scan for GIST – pro

M Levin, MD — Tue, 28 Aug 2012 00:51:24 +0000

PET is often used for staging and monitoring of response for GIST tumors. A recent consensus statement says: “The panelists agreed that currently available imaging techniques to evaluate GIST include computed tomography (CT), magnetic resonance imaging (MRI) and fluorine-18-fluorodeoxyglucose (FDG) positron emission tomography (PET). ”

The journal Applied Radiology (vol. 34, no. 6, 2005), in an article titled ‘Role of Positron Emission Tomographic Imaging in Gastrointestinal Stromal Tumors,’ cited case studies where PET ‘helped in accurate re-staging by indicating the malignant nature of the hepatic and subhepatic masses and excluding pelvic spread.’ The article also noted that, ‘when compared with CT alone, PET with FDG and PET/CT provided valuable additional information about the extent and metabolic activity of the disease process. … The advantage of PET lies in its ability to differentiate active tumor from a nonviable necrotic tumor mass, malignant from benign tissue, and recurrent tumor from scar tissue.’ Unfortunately, however, there is little support for PET in GIST beyond case reports and studies.

The aforementioned consensus statement concluded: ” Evaluation of FDG uptake using PET scanning is recommended when an early detection of tumor response to imatinib treatment is required, e.g. for consideration of surgery after imatinib cytoreduction in rectal tumors (SOR expert opinion, NCCN level 2A). PET scan may also be useful in case of equivocal images suspected to be metastatic. Aside from these cases, PET scan is not mandatory in all GIST patients after complete resection (SOR expert agreement, NCCN level 2A). ”

A 2010 review (Reishardt et al) says: :

“Contrast-enhanced abdominal and pelvic CT scan is the technique of choice for staging and follow-up. A chest x-ray can complement staging and work-up. MRI should be used in rectal GIST as it provides better preoperative staging information. PET or PET–CT/MRI is not routinely required but may be useful for early detection of tumor response during neoadjuvant treatment.uld approve CT or PET for staging”.

Peter Reichardt, Jean-Yves Blay, Margaret von Mehren,Towards Global Consensus in the Treatment of Gastrointestinal Stromal TumorExpert Rev Anticancer Ther. 2010;10(2):221-32.

Van den Abbeele AD, Badawi RD, Cliche JP et al. 18F-FDG-PET predicts response to imatinib mesylate (Gleevec) in patients with advanced gastrointestinal stromal tumors (GIST). Proc Am Soc Clin Oncol 2002; 21: 403a (Abstr 1610).

Stroobants S, Goeminne J, Seegers M et al. 18FDG-Positron emission tomography for the early prediction of response in advanced soft tissue sarcoma treated with imatinib mesylate (Imatinib). Eur J Cancer 2003; 39: 2012–2020.

Antoch G, Kanja J, Bauer S et al. Comparison of PET, CT, and dual-modality PET/CT imaging for monitoring of imatinib (STI571) therapy in patients with gastrointestinal stromal tumors. J Nucl Med 2004; 45: 357–365.

Choi H, Macapinlac H, Burgess M et al. Correlation of computerized tomography (CT) and proton emission tomography (PET) in patients with metastatic GIST treated at a single institution with imatinib mesylate. Proc Am Soc Clin Oncol 2003; 22: 819.

PET for gastric cancer – pro

M Levin, MD — Tue, 28 Aug 2012 00:47:31 +0000

Positron emission tomography using 2-deoxy-2-[18F] fluorodeoxyglucose (FDG-PET) has been used to detect malignancies associated with certain kinds of tumors. Data regarding the use of FDG-PET scan for evaluating gastric cancer are scarce. A recent review of studies showed that PET produced an estimated 14% change was noted in management effect, based on 109 patient studies for diagnosis/staging in gastric cancer; however, this is no randomized data.
Several Western guidelines state that PET is not routinely indicated for gastric cancer. This refers to both staging and restaging. Japanese literature (where this cancer is very common) is more suggestive that it may be useful in preoperative staging of lymph nodes (in Japan a wider lymph node dissection is performed than in the West) but it does not contain the same recommendations for PET for restaging. A recent review paper says: “POSITRON-EMISSION TOMOGRAPHY (PET) for these assessments may be useful although currently available data are limited.” NCCN says that PET is optional for staging.

Table of studies: http://www.petscaninfo.com/zportal/portals/phys/clinical/jnmpetlit/index_html/JNM_OncoApps/JNM_Table10/article_elements_view

http://www.nccn.org/professionals/physician_gls/PDF/gastric.pdf, p.5

Analysis Ken Herrmann, Katja Ott, Andreas K. Buck, Florian Lordick, Dirk Wilhelm, Michael Souvatzoglou, Karen Becker, Tibor Schuster, Hans-Jürgen Wester, Jörg R. Siewert, Markus Schwaiger, and Bernd J. KrauseImaging Gastric Cancer with PET and the Radiotracers 18F-FLT and 18F-FDG: A Comparative J Nucl Med 48: 1945-1950; First published on November 15, 2007;

Kota Mukai et al Usefulness of preoperative FDG-PET for detection of gastric cancer
Journal Gastric Cancer Volume 9, Number 3 / August, 2006

Chen, J, Cheong, JH, Yun, MJ, Kim, J, Lim, JS, Hyung, WJ et al. (2005) “Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography” Cancer 103: 2383-90

Scottish Intercollegiate Guidelines Network (SIGN). Management of oesophageal and gastric cancer. A national clinical guideline. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN); 2006 Jun. 69 p. (SIGN publication; no. 87). [393 references]

Dimitrios H Roukos and Angelos M Kappas Perspectives in the treatment of gastric cancerNature Clinical Practice Oncology (2005) 2, 98-107

PET for cervical cancer – pro

M Levin, MD — Mon, 27 Aug 2012 16:05:30 +0000

For a initial staging, PET scan is of limited utility. While it can well assess known lymphadenopathy, it is not a sensitive staging tool. Many studies have reported low sensitivities for the detection of nodal metastases, ranging from 25–73%. Chao et al. concluded that PET/CT has a limited role in staging for patients with early-stage disease and should not replace lymphadenectomy for the detection of lymph node metastases. Many studies have reported low sensitivities for the detection of nodal metastases, ranging from 25–73%. Chao et al. concluded that PET/CT has a limited role in staging for patients with early-stage disease and should not replace lymphadenectomy for the detection of lymph node metastases.

In 2016, NCCN removed PET and MRI form its general algorithm to be explained in the section on imaging. There it says: “:Consider PET in in FIGO stage IB2.

Whole-body FDG-PET is a sensitive and specific tool for the detection of recurrent cervical cancer in patients who have clinical findings suspicious for recurrence. In one study, 11 patients with cervical carcinoma were investigated. Combined PET/CT identified additional lesions missed by CT and ultrasound alone in five patients (45%), all of whom had their treatment changed to address the additional areas of involvement.The sensitivity and specificity of FDG-PET for detecting recurrent cervical cancer are 85.7 and 86.7%, respectively. The positive and negative predictive values are 85.7 and 86.7%, respectively.InJanuary2005 the Center forMedicareservices(CMS) approved coverage of FDG-PETforstagingofcervical cancer patients.

N a recent study byElittet al, a randomized clinical trial, 44 of 112 patients receiving PET-CT compared with 14 of 56 patients receiving CT alone received more extensive chemotherapy and radiotherapy or palliative treatment, a nonsignificant difference. Five percent of patients in each group were treated with palliative intent. In this trial among women with locally advanced carcinoma of the cervix, there was no significant difference between PET-CT plus CT vs CT alone, possibly because the trial was underpowered. However, NCC now appears to accept it: “all body PET/CT preferred…”

Lorraine M. Elit et al, Effect of Positron Emission Tomography Imaging in Women With Locally Advanced Cervical CancerA Randomized Clinical Trial. JAMA Netw Open. 2018;1(5):e182081

Findings In a randomized clinical trial, 44 of 112 patients receiving PET-CT compared with 14 of 56 patients receiving CT alone received more extensive chemotherapy and radiotherapy or palliative treatment, a nonsignificant difference. Five percent of patients in each group were treated with palliative intent.

Meaning In this trial among women with locally advanced carcinoma of the cervix, there was no significant difference between PET-CT plus CT vs CT alone, possibly because the trial was underpowered.

Loft A, Berthelsen AK, Roed H et al.: The diagnostic value of PET/CT scanning in patients with cervical cancer: a prospective study. Gynecol. Oncol. 106(1),29–34 (2007).

Chao A, Ho KC, Wang CC et al.: Positron emission tomography in evaluating the feasibility of curative intent in cervical cancer patients with limited distant lymph node metastases. Gynecol. Oncol. 110(2),172–178 (2008).

Schwarz JK, Siegel BA, Dehdashti F, Grigsby PW. Association of posttherapy positron emission tomography with tumor response and survival in cervical carcinoma.JAMA. 2007 Nov 21;298(19):2289-95.

nccn.org, cervical, CERV-B, 1, 2019

PET for glioblastoma – pro

M Levin, MD — Fri, 24 Aug 2012 18:05:03 +0000

PET is not medically appropriate to follow glioblastoma because it not supported by credible scientific evidence published in peer-reviewed medical literature generally and recognized by the relevant medical community. PET for brain cancer is not included in the NCCN guidelines and CMS does not cover PET for this diagnosis. Occasionally, PET can provide information to differentiate tumor necrosis from tumor progression. The sensitivity of PET for differentiating necrosis and tumor progression is 80%–90% and the specificity is 50%–90%. Causes of false-negative PET results include recent radiation therapy, low histologic grade, and small tumor volume. FDG PET may be false positive in nonmalignant inflammatory processes and subclinical seizure activity. The question of hypermetabolic foci of radiation injury as a cause of false-positive scans requires further investigation. Other issues requiring further study are the optimal timing of FDG PET after radiation and chemotherapy and the accuracy of FDG PET in tumors other than high-grade gliomas.

A 2010 guideline by Laperrier says: Positron emission tomography (PET) is not recommended for the determination of diagnosis or grading in gliomas. A recommendation cannot be made for or against the use of PET or positron emission tomography/computed tomography (PET/CT) in the assessment of patients with recurrent gliomas because of insufficient evidence. Positron emission tomography (PET) is not recommended for the determination of diagnosis or grading in gliomas. A recommendation cannot be made for or against the use of PET for the assessment of treatment response in gliomas because of insufficient evidence. A recommendation cannot be made for or against the use of PET or positron emission tomography/computed tomography (PET/CT) in the assessment of patients with recurrent gliomas because of insufficient evidence. Positron emission tomography (PET) is not recommended for the determination of diagnosis or grading in gliomas. A recommendation cannot be made for or against the use of PET for the assessment of treatment response in gliomas because of insufficient evidence. A recommendation cannot be made for or against the use of PET or positron emission tomography/computed tomography (PET/CT) in the assessment of patients with recurrent gliomas because of insufficient evidence.
The situation is different if pseudoprogression or radiation necrosis ii being considered. There, NCCN GLIO-4 recommends MR Spectroscopy, PET or MR Perfusion, footnote S.

D. A. Podoloff PET/CT and Occult Primary Tumors J Natl Compr Canc Netw, March 1, 2009; 7(3): 239 – 244.

Laperriere N, Walker-Dilks C. PET imaging in brain cancer: recommendations. Toronto (ON): Cancer Care Ontario (CCO); 2009 Jan 19. 13 p. (Recommendation report – PET; no. 10). [14 references]

nccn, brain cancers, 2012

Read the Layperson version here.

PET for bladder cancer – pro

M Levin, MD — Thu, 23 Aug 2012 17:52:43 +0000

Conventional PET using FDG is unsuitable for imaging bladder tumors because of its high urinary excretion. However, it is 67% sensitive, 86% specific and 80% accurate in detecting pathologic lymph nodes in patients with bladder cancer, which exceeds both CT and MRI. Although PET scans are being used as part of research projects in bladder cancer, it is not yet certain how valuable they are in helping to manage the care of patients with bladder cancer. According to a recent review article. “PET demonstrates limited utility in diagnosis and staging of bladder cancer”. A recent guideline says: “PET studies to date are not proven to enhance pretreatment staging and are not indicated until further validation and studies are completed.”
However, a more recent guideline says: “Therefore, “fluorine-18 fluorodeoxyglucose (FDG-PET) might be useful in detecting perivesical tumor growth or distant metastasis in patients with advanced bladder cancer, and for the early detection of recurrent cancer following therapy, although a major remaining pitfall is the intense FDG accumulation due to excretion in the urine…. A study correlating 18F-FDG-PET and CT results in the same patients reported sensitivity, specificity, and accuracy of 60%, 88%, and 78%, respectively, in nodal and metastasis staging, suggesting improved distant metastatic and locoregional node staging. ”

The 2009 ACR guideline rates PET as 2/10, which is “not recommended”. NCCN does not recommend PET.

Jafri SZ, Shetty M, Choyke PL, Bluth EI, Bush WH Jr, Casalino DD, Francis IR, Kawashima A, Papanicolaou N, Rosenfield AT, Sandler CM, Segal AJ, Tempany C, Resnick MI, Expert Panel on Urologic Imaging. Pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2005. 8 p. [51 references]

http://www.moffitt.org/moffittapps/ccj/v9n4/pdf/335

Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH Jr., Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer Leyendecker JR, Francis IR, Casalino DD, Arellano RS, Baumgarten DA, Curry NS, Dighe M, Israel GM, Papanicolaou N, Prasad S, Ramchandani P, Remer EM, Sheth S, Fulgham P, Expert Panel on Urologic Imaging. ACR Appropriateness Criteria® pretreatment staging of invasive bladder cancer. [online publication]. Reston (VA): American College of Radiology (ACR); 2009. 9 p. [82 references

Jafri SZ, Dinan D, Francis IR, Baumgarten DA, Bluth EI, Bush WH JR, Casalino DD, Curry NS, Israel GM, Kawashima A, Papanicolaou N, Remer EM, Sandler CM, Spring DB, Fulgham P, Expert Panel on Urologic Imaging. Follow-up imaging of bladder carcinoma. [online publication]. Reston (VA): American College of Radiology (ACR); 2007. 9 p. [71 references]

nccn bladder 2018

Anaplastic Thyroid Cancer and PET – pro

M Levin, MD — Mon, 02 Jul 2012 16:13:41 +0000

FDG-PET has not been studied for surveillance in patients with ATC. A limited number of reports of FDG-PET studies in patients with ATC are available. Jadvar et al described that FDG-PET correctly detected anaplastic thyroid cancer along with other rare tumors evaluation. Conti et al found positive findings in a patient with anaplastic carcinoma in a study of thyroid cancer by FDG-PET. McDougall et al also reported positive FDG-PET findings in the evaluation of patients with recurrent anaplastic thyroid cancer. Thus, FDG-PET may have a positive impact in the follow-up of patients with ATC after initial resection for the detection of residual or metastatic disease and also in patients with advanced disease who underwent chemotherapy (to prolong survival) for assessing therapeutic response. NCCN in ANAP-1 in its Thyroid Cancer guideline says: “Consider PET scan”, although it speaks about general diagnostic use.

REFERENCES:

Jadvar H, Fischman AJ. Evaluation of rare tumors with [F-18]fluorodeoxyglucose positron emission tomography. Clin Positron Imaging. 1999; 2:153-158.

McDougall IR, Jadvar H, Segall G. PET scan in patients with suspected recurrent thyroid cancer. Presented at Thyroid One. Thyroid Cancer Pathogenesis, Diagnosis including PET, and Treatment. International Symposium. October 7-10, 1998, Linz, Austria. Thyroid. 1998;8:1222. Abstract.

Nccn.org, thyroid cancer