George Segall, M.D. Stanford University PET/CT in Oncology Slide
2 Evolution of Technology CT PET 1973 2000 PET/CT 2001 Slide 3
Slide 4 CT - Topogram (scout) - CT scan (1 min) PET - Brain (10
min) - Heart (10 min) - Body (20 min) Diagnosis, Staging, and
Restaging (unless otherwise indicated) Head & Neck Thyroid
Breast Lung Esophagus Colon & Rectum Cervix Lymphoma Melanoma
Other Cancers Medicare Approved Indications for PET-CT follicular:
I -131 neg, Tg >10 ng/dL not breast masses or regional nodes
CT/MRI neg for extra-pelvic mets not regional nodes only non-small
cell when enrolled in NOPR Slide 15 National Oncologic PET Registry
http://www.cancerpetregistry.org Sponsored by AMI and managed by
ACR for CMS April 15, 2008 1,728 facilities - 74,541 scans since
May 2006 Slide 16 http://www.cancerpetregistry.org Pre PET/CT Form
Indication for PET/CT Cancer type and extent Management plan Post
PET/CT Form Change in assessment of extent of disease Change in
management plan National Oncologic PET Registry Slide 17 National
Comprehensive Cancer Network www.nccn.org Slide 18 Acute Myeloid
Leukemia Bladder Cancer Bone Cancer Breast Cancer Central Nervous
System Tumors Cervical Cancer Chronic Myelogenous Leukemia
Colorectal Cancer Esophageal Cancer Gastric Cancer Head and Neck
Cancer Hepatobiliary Cancer Hodgkins Disease Kidney Cancer Melanoma
Practice Guidelines in Oncology Myelodysplastic Syndromes Multiple
Myeloma Neuroendocrine Tumors Non Hodgkins Lymphoma Non-Small Cell
Lung Cancer Occult Primary Cancer Ovarian Cancer Pancreatic Cancer
Prostate Cancer Soft Tissue Sarcoma Skin Cancer (except Melanoma)
Small Cell Lung Cancer Testicular Cancer Thyroid Cancer Uterine
Cancer National Comprehensive Cancer Network Slide 19 Bone Cancer
Breast Cancer Cervical Cancer Colorectal Cancer Esophageal Cancer
Head and Neck Cancer Hodgkins Disease Melanoma Practice Guidelines
in Oncology Multiple Myeloma Non Hodgkins Lymphoma Non-Small Cell
Lung Cancer Occult Primary Cancer Ovarian Cancer Soft Tissue
Sarcoma Small Cell Lung Cancer Testicular Cancer Thyroid Cancer
National Comprehensive Cancer Network Slide 20 47 year old man with
multiple trauma from a MVA who was incidentally discovered to have
a pulmonary nodule Lesion Characterization Slide 21 84 year old man
with chronic cough found to have a 13 mm nodule on CXR Lesion
Characterization Slide 22 73 year old woman s/p resection for colon
cancer, rising CEA level and negative CT Enhanced Detection Slide
23 Slide 24 70 y/o male with H&N cancer Enhanced Detection
Slide 25 FDG PETI-131 47 year old man with biopsy proven recurrent
thyroid cancer 3 months after thyroidectomy Enhanced Detection
Slide 26 Unknown Primary 68 year old man who presented with right
neck mass Slide 27 49 year old man with new lung cancer Staging
Slide 28 Recurrent Disease 64 year old man s/p laryngectomy, now
has dysphagia Slide 29 Monitoring Response 63 year old man stage 3A
lung cancer, has received 4 cycles of chemotherapy Slide 30 CT +
PET/CT vs PET/ CT MOST CASES Standard CT followed by PET/CT if
needed SOME CASES PET/CT CT component can be low resolution or
optimized Slide 31 Problems and Pitfalls False positive findings
Normal physiology Granulomas and other infections Adenomas Tumor
histology Lesions smaller than 8 mm Diabetes/Non-fasting patients
False negative findings Slide 32 56 year man with HCV, end stage
liver disease, and presumed hepatoma Standard CT PET/CT Slide 33
Physiologic Uptake: Brown Fat Slide 34 Infection 68 year old man
with solitary lung nodule. Biopsy: aspergillosis Slide 35
Granulomatous Disease 62 year old man with hilar and mediastinal
adenopathy. Biopsy: sarcoidosis Slide 36 Adenoma 82 year old man
with wt loss and liver masses Slide 37 Adenoma 82 year old man with
wt loss and liver masses Slide 38 Clinical Impact of PET/CT More
accurate diagnosis Avoidance of unnecessary tests, and
(potentially) harmful procedures Better treatment or management
Slide 39 http://www.cancerpetregistry.org National Oncologic PET
Registry 36.5% change in decision to treat or not treat Slide 40
Conclusions 1. CT is the first imaging test of choice in most cases
2. PET - CT is more accurate than CT alone Characterizing lesions
difficult to biopsy Detecting occult cancer Determining extent of
cancer and response to therapy 3. PET - CT changes management 36%
Slide 41 Why PET-CT?
