Letters to Editor
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Figure 1: Maximum intensity projection PET image (a) showing abnormal 18F-FDG accumulation in left hypochondrium (arrows), mid abdomen (broken arrow), and left lower neck (arrowhead). No local recurrent disease was seen (b-d). Axial contrast CT (e), PET (f), and PET/CT (g) images reveal massive solid cystic splenomegaly (arrows) with heterogeneous enhancement and irregularly increased 18F-FDG uptake (SUVmax-7.9). The splenic lesion is also infiltrating the tail of pancreas. Another enhancing 18F-FDG avid (SUVmax-4.1) mass at junction of head and body of pancreas (h-j, broken arrow) was seen. Also noted was enlarged 18F-FDG avid (SUVmax-3.1) left supraclavicular lymphadenopathy (k-m, arrowhead) PET = positron emission tomography, 18F-FDG = 18F-fluorodeoxyglucose, CT = Computed tomography, SUV = Standardized uptake value.
REFERENCES 1. 2. 3. 4. 5. 6.
Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res 2009;130:219‑21. Long HJ 3rd. Management of metastatic cervical cancer: Review of the literature. J Clin Oncol 2007;25:2966‑74. Piura E, Piura B. Splenic metastases from female genital tract malignancies. Harefuah 2010;149:315‑20, 335, 334. Goktolga U, Dede M, Deveci G, Yenen MC, Deveci MS, Dilek S. Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: A case report and review of the literature. Eur J Gynaecol Oncol 2004;25:742‑4. Pang LC. Solitary recurrent metastasis of squamous cell carcinoma of the uterine cervix in the spleen: Case report. South Med J 2004;97:301‑4. Campagnutta E, Zarrelli A, Stefanutti V, Cimitan M, Querin F, Scarabelli C.
7.
Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case. Minerva Ginecol 1992;44:667‑70. Klein B, Stein M, Kuten A, Steiner M, Barshalom D, Robinson E, et al. Splenomegaly and solitary spleen metastasis in solid tumors. Cancer 1987;60:100‑2. Access this article online Quick Response Code: Website: www.ijnm.in
DOI: 10.4103/0972-3919.136608
F‑18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of recurrence carcinoma cervix Sir, The recent report on F‑18 fluorodeoxyglucose (F‑18‑FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of recurrence carcinoma cervix is very interesting.[1] Bhoil et al. concluded that “PET/CT appears to have an important role in detecting recurrence following primary treatment of cervical cancer.”[1] It is no doubt that the tool can be useful in investigative medicine for searching malignancy. However, there are some concerns on the F‑18‑FDG PET/CT. Errors can be seen in some cases. The good examples are the errors that can be seen in the case with existed atherosclerotic plaques[2] and lymphadenopathy due to infectious etiologies.[3] To diagnose, the careful interpretation on investigation result accompanied with available history and clinical features of the patients is required.
Viroj Wiwanitkit1,2,3 2
1 Hainan Medical University, China, Faculty of Medicine, University of Nis, Serbia, 3 Joseph Ayobabalola University, Nigeria
Address for correspondence: Prof. Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok, Thailand. E‑mail: [email protected]
REFERENCES 1.
Indian Journal of Nuclear Medicine | Vol. 29: Issue 3 | July-September, 2014
Bhoil A, Mittal BR, Bhattacharya A, Santhosh S, Patel F. Role of F‑18 fluorodeoxyglucose positron emission tomography/computed tomography 201
Letters to Editor
2. 3.
in the detection of recurrence in patients with cervical cancer. Indian J Nucl Med 2013;28:216‑20. Hanif MZ, Ghesani M, Shah AA, Kasai T. F‑18 fluorodeoxyglucose uptake in atherosclerotic plaque in the mediastinum mimicking malignancy: Another potential for error. Clin Nucl Med 2004;29:93‑5. Jacene HA, Stearns V, Wahl RL. Lymphadenopathy resulting from acute hepatitis C infection mimicking metastatic breast carcinoma on FDG PET/ CT. Clin Nucl Med 2006;31:379‑81.
Reply by the author
Website: www.ijnm.in
DOI: 10.4103/0972-3919.136609
uptake. A correctly fused PET/CT helps not only in attenuation correction, but also in proper localization thus reducing the chances of false positive.
Dear Prof. Viroj, Thank you very much for showing your interest in our paper on F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of recurrence carcinoma cervix.[1] I fully agree with your views that interpretation of PET/CT data with relation to the history, clinical features and investigative findings can never underestimate while reporting. However, with regard to false positive results due to atherosclerotic plaque, Hanif et al.[2] did not made use of hybrid imaging (PET/CT). Data were interpreted using only the PET images, hence probably the false positive. A hybrid imaging enables correct fusion of data from two modalities performed sequentially in a single session. CT attenuation correction or respiratory motion may create reconstruction artifacts leading to false positive F-18-FDG
202
Access this article online Quick Response Code:
False positive FDG avid lymphadenopathy due to infectious etiologies[3] is a well-known fact. It applies to all malignancies irrespective of the site of primary. However, A follow-up PET/ CT imaging or if needed histopathological correlation can be done. Even in our study, we had four false positive cases of which two patient with suspected local recurrence and lung metastasis had normal study on follow-up scan. In another two cases showed inflammatory pathology on histopathological examination. PET/CT helps the treating doctor to be more vigilant on such lymph nodes. Amit Bhoil Department of Nuchlear Medicine, PGIMER, Chandigarh, India
Indian Journal of Nuclear Medicine | Vol. 29: Issue 3 | July-September, 2014
Copyright of Indian Journal of Nuclear Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
a
b
e
c
f
d
g
l
h
k
i
l
j
m
Figure 1: Maximum intensity projection PET image (a) showing abnormal 18F-FDG accumulation in left hypochondrium (arrows), mid abdomen (broken arrow), and left lower neck (arrowhead). No local recurrent disease was seen (b-d). Axial contrast CT (e), PET (f), and PET/CT (g) images reveal massive solid cystic splenomegaly (arrows) with heterogeneous enhancement and irregularly increased 18F-FDG uptake (SUVmax-7.9). The splenic lesion is also infiltrating the tail of pancreas. Another enhancing 18F-FDG avid (SUVmax-4.1) mass at junction of head and body of pancreas (h-j, broken arrow) was seen. Also noted was enlarged 18F-FDG avid (SUVmax-3.1) left supraclavicular lymphadenopathy (k-m, arrowhead) PET = positron emission tomography, 18F-FDG = 18F-fluorodeoxyglucose, CT = Computed tomography, SUV = Standardized uptake value.
REFERENCES 1. 2. 3. 4. 5. 6.
Nandakumar A, Ramnath T, Chaturvedi M. The magnitude of cancer cervix in India. Indian J Med Res 2009;130:219‑21. Long HJ 3rd. Management of metastatic cervical cancer: Review of the literature. J Clin Oncol 2007;25:2966‑74. Piura E, Piura B. Splenic metastases from female genital tract malignancies. Harefuah 2010;149:315‑20, 335, 334. Goktolga U, Dede M, Deveci G, Yenen MC, Deveci MS, Dilek S. Solitary splenic metastasis of squamous cell carcinoma of the uterine cervix: A case report and review of the literature. Eur J Gynaecol Oncol 2004;25:742‑4. Pang LC. Solitary recurrent metastasis of squamous cell carcinoma of the uterine cervix in the spleen: Case report. South Med J 2004;97:301‑4. Campagnutta E, Zarrelli A, Stefanutti V, Cimitan M, Querin F, Scarabelli C.
7.
Isolated splenic metastasis in a case of adenocarcinoma of the uterine cervix. A clinical case. Minerva Ginecol 1992;44:667‑70. Klein B, Stein M, Kuten A, Steiner M, Barshalom D, Robinson E, et al. Splenomegaly and solitary spleen metastasis in solid tumors. Cancer 1987;60:100‑2. Access this article online Quick Response Code: Website: www.ijnm.in
DOI: 10.4103/0972-3919.136608
F‑18 fluorodeoxyglucose positron emission tomography/computed tomography in the detection of recurrence carcinoma cervix Sir, The recent report on F‑18 fluorodeoxyglucose (F‑18‑FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of recurrence carcinoma cervix is very interesting.[1] Bhoil et al. concluded that “PET/CT appears to have an important role in detecting recurrence following primary treatment of cervical cancer.”[1] It is no doubt that the tool can be useful in investigative medicine for searching malignancy. However, there are some concerns on the F‑18‑FDG PET/CT. Errors can be seen in some cases. The good examples are the errors that can be seen in the case with existed atherosclerotic plaques[2] and lymphadenopathy due to infectious etiologies.[3] To diagnose, the careful interpretation on investigation result accompanied with available history and clinical features of the patients is required.
Viroj Wiwanitkit1,2,3 2
1 Hainan Medical University, China, Faculty of Medicine, University of Nis, Serbia, 3 Joseph Ayobabalola University, Nigeria
Address for correspondence: Prof. Viroj Wiwanitkit, Wiwanitkit House, Bangkhae, Bangkok, Thailand. E‑mail: [email protected]
REFERENCES 1.
Indian Journal of Nuclear Medicine | Vol. 29: Issue 3 | July-September, 2014
Bhoil A, Mittal BR, Bhattacharya A, Santhosh S, Patel F. Role of F‑18 fluorodeoxyglucose positron emission tomography/computed tomography 201
Letters to Editor
2. 3.
in the detection of recurrence in patients with cervical cancer. Indian J Nucl Med 2013;28:216‑20. Hanif MZ, Ghesani M, Shah AA, Kasai T. F‑18 fluorodeoxyglucose uptake in atherosclerotic plaque in the mediastinum mimicking malignancy: Another potential for error. Clin Nucl Med 2004;29:93‑5. Jacene HA, Stearns V, Wahl RL. Lymphadenopathy resulting from acute hepatitis C infection mimicking metastatic breast carcinoma on FDG PET/ CT. Clin Nucl Med 2006;31:379‑81.
Reply by the author
Website: www.ijnm.in
DOI: 10.4103/0972-3919.136609
uptake. A correctly fused PET/CT helps not only in attenuation correction, but also in proper localization thus reducing the chances of false positive.
Dear Prof. Viroj, Thank you very much for showing your interest in our paper on F-18 fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET)/computed tomography (CT) in the detection of recurrence carcinoma cervix.[1] I fully agree with your views that interpretation of PET/CT data with relation to the history, clinical features and investigative findings can never underestimate while reporting. However, with regard to false positive results due to atherosclerotic plaque, Hanif et al.[2] did not made use of hybrid imaging (PET/CT). Data were interpreted using only the PET images, hence probably the false positive. A hybrid imaging enables correct fusion of data from two modalities performed sequentially in a single session. CT attenuation correction or respiratory motion may create reconstruction artifacts leading to false positive F-18-FDG
202
Access this article online Quick Response Code:
False positive FDG avid lymphadenopathy due to infectious etiologies[3] is a well-known fact. It applies to all malignancies irrespective of the site of primary. However, A follow-up PET/ CT imaging or if needed histopathological correlation can be done. Even in our study, we had four false positive cases of which two patient with suspected local recurrence and lung metastasis had normal study on follow-up scan. In another two cases showed inflammatory pathology on histopathological examination. PET/CT helps the treating doctor to be more vigilant on such lymph nodes. Amit Bhoil Department of Nuchlear Medicine, PGIMER, Chandigarh, India
Indian Journal of Nuclear Medicine | Vol. 29: Issue 3 | July-September, 2014
Copyright of Indian Journal of Nuclear Medicine is the property of Medknow Publications & Media Pvt. Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
