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Restaging Clear Cell Renal Carcinoma With 18F-FDG PET/CT

Fuccio, Chiara, MD*; Ceci, Francesco, MD; Castellucci, Paolo, MD; Spinapolice, Elena Giulia, MD*; Palumbo, Raffaella, MD; D’Ambrosio, Daniela, MD*; Bernardo, Antonio, MD; Brunocilla, Eugenio, MD§; Schiavina, Riccardo, MD§; Maffione, Anna Margherita, MD; Chondrogiannis, Sotirios, MD; Grassetto, Gaia, MD; Colletti, Patrick M., MD; Rubello, Domenico, MD; Fanti, Stefano, MD; Trifirò, Giuseppe, MD*

doi: 10.1097/RLU.0000000000000382
Original Articles

Aim The aim of our retrospective study was to assess the usefulness of 18F-FDG PET/CT in the restaging of clear cell renal cell carcinoma (RCC) patients.

Patients and Methods Sixty-nine patients (median age = 62 years; range = 36–86 years) affected by clear cell RCC (TNM at staging: T1, 42 patients; T2, 13 patients; T3, 11 patients; T4, 3 patients; Fuhrman grade: G2, 47 patients; G3, 20 patients; G4, 2 patients) underwent whole-body 18F-FDG PET/CT to restage the disease after nephrectomy for clinical or radiological suspicion of metastases. Areas of abnormal uptake at PET/CT were classified, taking the liver uptake as reference, as follows: 1 = faint uptake, lower than liver; 2 = moderate uptake, equal to liver; and 3 = high uptake, higher than liver. Validation of 18F-FDG PET/CT results was established by (1) biopsy (23 patients) and (2) other imaging modalities (addressed BS; c.e.CT; MRI; 18F-fluoride PET/CT; subsequent 18F-FDG PET/CT), and/or clinical and radiological follow-up of 12 months (46 patients).

Results 18F-FDG PET/CT was positive in 42 patients and negative in 27 patients. Sixteen patients presented single lesions and 26 patients presented multiple localizations of the disease. On a patient basis, 40 patients resulted true positive, 2 patient false positive, 23 patients true negative, and 4 patients false negative. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 90%, 92%, 91%, 95%, and 85%, respectively. On a lesion basis, PET/CT detected 114 areas of abnormal uptake in 42 positive patients of which 112 resulted to be true positive. FDG uptake of the true positive lesions resulted to be high in 83 cases, moderate in 17 lesions, and finally faint in 12 lesions.

Conclusions 18F-FDG PET/CT demonstrated a good sensitivity in the restaging of clear cell RCC. Most of the lesions showed intense activity. According to our results, it seems that the use of 18F-FDG PET/CT in the restaging of RCC is feasible because the number of false-negative cases is limited.

From the *Nuclear Medicine & Physics Unit, Fondazione Salvatore Maugeri, Pavia, Italy; †Service of Nuclear Medicine, Policlinico Sant’Orsola-Malpighi, University of Bologna, Bologna, Italy; ‡Oncology Unit, Fondazione Salvatore Maugeri, Pavia, Italy; §Department of Urology, Policlinico Sant’ Orsola-Malpighi, University of Bologna, Italy; ¶Department of Nuclear Medicine & PET/CT Centre, Santa Maria della Misericordia Hospital Rovigo, Italy; and ∥Radiology Department, University of Southern California, Los Angeles, CA.

Received for publication October 28, 2013; and revision accepted December 28, 2013.

Conflicts of interest and sources of funding: none declared.

Reprints: Chiara Fuccio, MD, Nuclear Medicine Unit, Via Salvatore Maugeri 10, 27100 Pavia, Italy. E-mail:

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