UNASSIGNED: The aim of this study was to evaluate the prognostic value of imaging-based variables and tumor marker in predicting the progression-free survival (PFS) in treatment-naïve pancreatic cancer (PC) using baseline 18-fluorodeoxyglucose (18FDG) positron emission tomography/computed tomography (PET/CT).
UNASSIGNED: This retro-prospective study was conducted at PET/CT imaging facility of JCIA health-care facility of Pakistan. Total 68 patients with PCs were retrospectively included who had 18FDG PET/CT for staging from March 2017 to December 2020. Thirty-two patients had unresectable Stage IV disease on baseline imaging while the remaining 36 underwent Whipple\'s procedure and both categories were followed by chemotherapy with/without immunotherapy. These patients were followed for a median period of 18 months (1-62 months) for PFS. Logistic regression analysis and receiver operating characteristic (ROC) analysis were used for independent predictors of patients\' demographics, tumor characteristics, CA 19-9, and maximum standardized uptake value (SUVmax) in PFS. Kaplan-Meier\'s survival curves were analyzed to measure PFS using ROC-derived significant cutoff values of CA 19-9 and SUVmax.
UNASSIGNED: Median PFS was 18 months (11-45) with 60% (41/68) patients were either died or labelled having metabolic progressive disease (MPD. Using logistic regression analysis, significant correlations were found for Stage IV disease and pancreatic body/tail tumor with disease progression (odd ratio: 7.535 and 4.803, respectively; P < 0.05). Gender, obesity, histological tumor type, and 18FDG-avid regional nodes did not show a significant impact on PFS. On ROC analysis, SUVmax >5.3 of primary tumor and baseline CA 19-9 >197 U/ml were found to have a significant negative correlation with PFS (area under the curve: 0.827 and 0.911, respectively; P < 0.0001) and no association of age and primary tumor size in PFS. Significantly, shorter PFS was found using ROC-derived cutoff values of SUVmax >5.3 versus ≤5.3 of primary tumor (mean and 95% confidence interval [CI]: 16.7 vs. 48.5 and 10-23 vs. 41-56; log-rank = 25.014; P < 0.0001) and baseline CA 19-9 >197 versus ≤197 U/ml (mean and 95% CI: 11.8 vs. 46.9 and 7-16 vs. 39-55; log-rank = 38.217; P < 0.0001).
UNASSIGNED: SUVmax >5.3 of primary tumor and baseline CA 19-9 >197 U/ml were found to have a significant negative correlation with PFS in treatment-naïve PC patients. Among demographics, only Stage IV disease and pancreatic tail and body tumors were found to have a negative association with disease progression.

BACKGROUND: Extranodal (EN) lymphomas involve sites other than lymph nodes (LNs), spleen, thymus, and the pharyngeal lymphatic ring. The highest standardized uptake value (SUV) max of the LN can aid in the diagnosis of EN site lymphomatous infiltrations over inflammation or infection especially when there are no contrast-enhanced computed tomography (CT) changes.
OBJECTIVE: The purpose of this study was to find the significance of correlation between absolute SUVmax and mediastinal blood pool (mbSUVmax) and liver (lvSUVmax) normalized SUVmax of EN sites and the most fluorodeoxyglucose (FDG) avid LN in patients with primary and secondary EN involvement in Non-Hodgkin\'s and Hodgkin\'s Lymphoma.
METHODS: This was a retrospective study of 70 patients with histopathologically proven lymphoma in whom 18F-FDG positron emission tomography CT was performed for pretherapy staging.
METHODS: Images were used to detect EN sites of disease and SUVmax of mediastinal blood pool, liver, highest SUVmax LN, and highest SUVmax EN site were calculated.
METHODS: Karl Pearson\'s coefficient of correlation (r) was used to correlate the highest SUV max of LN and EN site and corresponding highest blood pool corrected and liver corrected SUV max. In view of small sample size, t-test for paired samples at 5% and 10% significance was conducted to validate the findings. Two-tailed t-test for independent samples was also used to compare means of SUVmax values between data grouped according to gender and lymphoma subtype (Non-Hodgkin lymphoma and Hodgkin lymphoma).
RESULTS: r = 0.54 for the highest LN SUVmax-highest EN SUVmax values and on further validation by one- and two-tailed paired t-test at significance levels of 5% and 10%, P = 0.00052 and 0.00103 respectively which denoted significant positive and moderate correlation. r = 0.59 for highest LN lvSUVmax-highest EN vSUVmax and P = 0.00032 and 0.00065 showing positive and moderate correlation. r = 0 0.82 for highest LN mbSUVmax-highest EN mbSUVmax values and P = 0.00034 and 0.00068 revealing positive and strong correlation.
CONCLUSIONS: Significant positive and strong correlation exists between nodal and EN mbsUVmax. This is stronger than the correlation between nodal and EN absolute SUVmax and lvSUVmax. Since normalization of lesion SUVmax to reference tissues reduces the variability of SUV, this can be a useful adjunct to determine whether high SUVmax of the EN site is due to lymphomatous infiltration.

To evaluate the prognostic value of preoperative 18-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) in patients with potentially resectable pancreatic cancer.
The study included 103 consecutive patients with potentially resectable pancreatic cancer who underwent preoperative FDG-PET/CT. Age, sex, blood glucose level, tumor marker levels (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9)), PET-related parameters (maximum standardized uptake value (SUVmax)), and contrast-enhanced CT-related factors (tumor size, location, enhancement pattern, and CT-based T and N factors by tumor nodes metastasis (TNM) classification) were assessed for their ability to independently predict postoperative tumor recurrence using Cox proportional hazards model.
Median follow-up was 23.1 months. Univariate analyses revealed that SUVmax (P = 0.0004), tumor size (P = 0.0002), T factor (P = 0.0102), N factor (P = 0.0049), and CA19-9 levels (P = 0.0059) were significantly associated with disease-free survival (DFS). In multivariate analysis, SUVmax (P = 0.0163) and CA19-9 levels (P = 0.0364) independently predicted DFS. Kaplan-Meier analysis revealed that patients with low (< 2.5) SUVmax had a significantly better prognosis than those with higher SUVmax (P = 0.0006). The DFS in patients with SUVmax < 2.5 (n = 23) and SUVmax ≥ 2.5 (n = 80) was 61.9% and 9.7%, respectively, 3 years postoperatively.
SUVmax can predict DFS in patients with resectable pancreatic cancer. A SUVmax < 2.5 heralds a better prognosis.

Pancreatic schwannomas are uncommon. About 60% of pancreatic schwannomas develop cystic lesions, and the differential diagnosis from other cystic pancreatic tumors is difficult. A 43-year-old man presented for evaluation of liver dysfunction detected during a medical checkup. Blood testing detected obstructive jaundice. A computed tomography scan revealed a well-defined polycystic tumor of about 5 cm at the pancreatic head. We performed surgical resection to treat the patient\'s symptoms and facilitate long-term management. Histopathological examination revealed spindle-shaped cells. Immunohistochemical studies showed S100 protein expression and the absence of CD34 and c-kit protein expression. Finally, we diagnosed a schwannoma. Pancreatic schwannoma is usually asymptomatic. The present case presented with obstructive jaundice, which is reportedly a rare symptom. Pancreatic schwannomas should be considered as a differential diagnosis of pancreatic cystic tumors. Dilatation of the pancreatic duct and the 18-fluorodeoxyglucose positron emission tomography findings are important for the differential diagnosis.

BACKGROUND: Non-Hodgkin\'s lymphomas arising from the tissues other than primary lymphatic organs are named primary extranodal lymphoma. Most of the studies evaluated metabolic tumor parameters in different organs and histopathologic variants of this disease generally for treatment response. We aimed to evaluate the prognostic value of metabolic tumor parameters derived from initial FDG-PET/CT in patients with a medley of primary extranodal lymphoma in this study.
METHODS: There were 67 patients with primary extranodal lymphoma for whom FDG-PET/CT was requested for primary staging. Quantitative PET/CT parameters: maximum standardized uptake value (SUVmax), average standardized uptake value (SUVmean), metabolic tumor volume (MTV) and total lesion glycolysis (TLG) were used to estimate disease-free survival and overall survival.
RESULTS: SUVmean, MTV and TLG were found statistically significant after multivariate analysis. SUVmean remained significant after ROC curve analysis. Sensitivity and specificity were calculated as 88% and 64%, respectively, when the cut-off value of SUVmean was chosen as 5.15. After the investigation of primary presentation sites and histo-pathological variants according to recurrence, there is no difference amongst the variants. Primary site of extranodal lymphomas however, is statistically important (p = 0.014). Testis and central nervous system lymphomas have higher recurrence rate (62.5%, 73%, respectively).
CONCLUSIONS: High SUVmean, MTV and TLG values obtained from primary staging FDG-PET/CT are potential risk factors for both disease-free survival and overall survival in primary extranodal lymphoma. SUVmean is the most significant one amongst them for estimating recurrence/metastasis.

The aim of the current study was to determine the diagnostic accuracy of whole-body fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) in detecting carcinoma of unknown primary (CUP) with bone metastases. We evaluated 87 patients who were referred to FDG-PET/CT imaging and reported to have skeletal lesions with suspicion of malignancy. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. The median survival rate was measured to evaluate the prognostic value of the FDG-PET/CT findings. In the search for a primary, FDG-PET/CT findings correctly diagnosed lesions as the site of the primary true positive (TP) in 64 (73%) cases, 4 (5%) findings diagnosed no site of a primary, and none were subsequently proven to be true negative (TN); 14 (16%) diagnoses were false positive (FP) and 5 (6%) diagnoses were false negative (FN). Life expectancy was between 2 months and 25 months. Whole-body FDG-PET/CT imaging may be a useful method in assessing the bone lesions with suspicion of bone metastases.