Virtual Library
Start Your Search
O. Evbuomwan
Author of
-
+
P1.06 - Poster Session/ Screening and Early Detection (ID 218)
- Event: WCLC 2015
- Type: Poster
- Track: Screening and Early Detection
- Presentations: 2
- Moderators:
- Coordinates: 9/07/2015, 09:30 - 17:00, Exhibit Hall (Hall B+C)
-
+
P1.06-024 - Patterns of <sup>18</sup>F FDG-PET/CT Studies in Patients with Suspected or Confirmed Lung Cancer - A Johannesburg Academic Hospital Perspective (ID 527)
09:30 - 09:30 | Author(s): O. Evbuomwan
- Abstract
Background:
Lung cancer incidence has increased rapidly in developing countries over the last few decades. It is estimated to account for nearly one-fifth of cancer-related deaths in South Africa. Imaging plays an integral role in the evaluation of patients with lung cancer. 2-[[18]F] fluoro-2-deoxy-d- positron emission tomography ([18]F FDG-PET) is now an accepted part of the imaging assessment. Integrated FDG-PET/ CT imaging is recognised as being superior to PET alone and CT alone in the imaging of lung cancer especially for staging of untreated non-small cell lung cancer (NSCLC). An audit was conducted to describe the patterns of disease in our centre.
Methods:
Retrospective audit which included 89 studies performed for patients with suspected or histologically confirmed lung cancer referred to us for PET/CT from September 2008 to March 2015. PET/CT reports of the patients were retrieved together with relevant clinical information from the case files whenever necessary. Over two-third (71%) of patients were referred for diagnosis/staging, others for re-staging (19%) and response to therapy (10%). All of the studies were reported by qualified and experienced Nuclear Medicine Physicians and the CT components of these studies were also read in conjunction with qualified Radiologists.
Results:
There were 89 scans from 87 patients. Majority of the patients were males (60%) and the mean age was 61.0 ± 9.4 years. About 42% (n=37) of the studies were performed on patients with histologically confirmed lung cancer; of the remaining indications, 15% (n=13) were referred for solitary pulmonary nodule and 43% (n=39) for multiple pulmonary nodules and masses. More than two-thirds (71%) were referred for staging, about one fifth (19%) for re-staging and 10% to assess response to treatment. The vast majority (94%) of known lung cancer were NSCLC that included adenocarcinoma (40%), squamous cancer (29%) and NSCLC not otherwise specified [NOS] (26%). F-18 FDG PET/CT showed almost an equal number in the presence (37%) or absence of metastases (36%). No significant differences were noted on FDG PET uptake between the three subtypes mentioned above (p > 0.05, Chi square). However, there was a tendency for a difference between these histological subtypes [squamous, adenocarcinoma and NSCLC NOS] for the presence of metastases (p<0.09) and the sites of metastatic predilection (p<0.08). Just more than half (53%) of patients showed evidence of positive regional nodal involvement on PET. All SPN were visualised on PET (sensitivity 100%) with about 57% with high FDG uptake (mean SUV=7.71) and about 43% with low FDG uptake (mean SUV=1.05). Correlation with histology was available for 38% of all SPNs and FDG PET correctly identified all of them as malignant or benign (100% specificity).
Conclusion:
[18]F FDG-PET/CT is useful in characterising solitary pulmonary nodules (SPNs) and staging as well as monitoring treatment response in lung cancer. Although it cannot replace histological confirmation of nodal and metastatic involvement, it serves as a roadmap to identify areas for tissue diagnosis. The detection of metastases may alter the therapeutic decision of NSCLC.
-
+
P1.06-026 - 18F-FDG PET/CT Evaluation of Non-Small Cell Lung Cancer - Initial Experience from Johannesburg (ID 63)
09:30 - 09:30 | Author(s): O. Evbuomwan
- Abstract
Background:
Lung cancer is the most common cause of cancer-related mortality, with an overall five year survival of 16.6%. It is most likely to recur in the first four years after therapy. The overall five year survival for newly diagnosed lung cancer is poor in both developed and developing countries. In South Africa, statistics show that lung cancer caused 52,217 deaths between 1995 and 2006. The 2009 data from South Africa showed that the number of male and female cases of lung cancer was 1440 and 685, respectively. [18]F-FDG PET/CT allows non-invasive imaging of non-small cell lung cancer (NSCLC) based on the increased glucose metabolism by the cancer cells. [18]F-FDG PET/CT imaging of NSCLC has been found to be useful in staging, early detection of recurrence, detection of residual disease and monitoring of treatment response. Our study was carried out to evaluate its role in histologically proven NSCLC in our center.
Methods:
We retrospectively reviewed data of 34 patients with histologically confirmed NSCLC. A total of 51 scans were reviewed, of which 17 were follow-up PET/CT scans. Eleven patients had 1 follow up (FU) scan, 5 patients had 2 FU scans and one patient had 3 FU scans. FDG-PET/CT findings were reported as positive or negative for disease. Sites for distant and nodal metastases were noted. Follow up scans were also compared with previous or base line scans to assess for treatment response, early detection of recurrence and detection of residual disease. Of the total number of patients, only 24 patients have had follow up to see how PET/CT influenced their management.
Results:
Data were analysed from 20 males (59%) and 14 females (41%) of which majority (83%) were aged between 61 to 80 years old. A total of 51 scans were done, 37 (72.5%) were positive and 14 (27.5%) were negative. Almost a quarter of PET/CT scans were referred for staging (25.3%), about half for detection of residual disease (47.1%) and the remaining for the detection of recurrence (13.8%) and assessment of treatment response (13.8%). At initial imaging, metastases were visualized in 44% of patients; two-thirds of the metastases being in the adrenal, bone and contralateral lung. Nodal disease on the initial scans was noted in 56% of patients. We compared the findings in patients with FU studies. The changes from the initial studies and the first FU showed a tendency towards a significant difference (p=0.05; Pearson Chi-square). When the rest of FU scans were compared, there was no significant difference (p=0.66 for FU1 Vs FU2) and (p=0.71 for FU2 Vs FU3). PET/CT correctly up staged 29.4% and down stage 5.9% of patients and at the same time falsely down staged 5.9% and upstaged 2.9% of patients.
Conclusion:
[18]F-FDG PET/CT is useful in staging, early detection of recurrence, detection of residual disease and monitoring of treatment response in patients with non-small cell cancer. The tendency noted in comparing the initial and FU scans is due to lower power of this study.
