We performed a multicenter study to validate the concept that a simple comprehensive geriatric assessment (CGA) can identify elderly, non-fit patients with diffuse large B-cell lymphoma (DLBCL) in whom curative treatment is not better then palliation, and to analyze potential benefits of treatment modulation after further subdividing the non-fit category by CGA criteria. One hundred and seventy-three patients aged > 69 treated with curative or palliative intent by clinical judgement only were grouped according to CGA into fit (46%), unfit (16%) and frail (38%) categories. Two-year overall survival (OS) was significantly better in fit than in non-fit patients (84% vs. 47%; p < 0.0001). Survival in unfit and frail patients was not significantly different. Curative treatment slightly improved 2-year OS in unfit (75% vs. 45%) but not in frail patients (44% vs. 39%). CGA was confirmed as very efficient in identifying elderly patients with DLBCL who can benefit from a curative approach. Further efforts are needed to better tailor therapies in non-fit patients.

Context: Thyroid incidentaloma diagnosed by 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography/computed tomography (F-18-FDG-PET/CT) is defined as a thyroid uptake incidentally and newly detected in a patient studied for nonthyroid purpose. In this review, we have comprehensively analyzed the diagnostic and clinical significance of F-18-FDG-PET/CT thyroid incidentalomas revealed during studies performed for an unrelated and nonthyroid purpose. Evidence Acquisition: A comprehensive literature research of the PubMed/MEDLINE databases was conducted to find relevant published articles about the F-18-FDG-PET or F-18-FDG-PET/CT thyroid incidentalomas. Evidence Synthesis: All studies considered in this review have investigated a very large number of patients, achieving overall about 147,505 units. The pooled incidence of thyroid incidentalomas detected by F-18-FDG-PET or PET/CT was 2.46% (95% confidence interval, 1.68–3.39%). The malignancy ratio was 34.6% (95% confidence interval, 29.3–40.2%). Conclusion: F-18-FDG-PET/CT thyroid incidentaloma is a relevant clinical finding; diffuse uptakes and most focal uptakes are commonly caused by benign diseases, whereas about one third of focal uptakes are malignant; the most frequent malignant histological type responsible for F-18-FDG-PET/CT thyroid incidentaloma is papillary thyroid carcinoma.

Background: Several meta-analyses reporting data on the diagnostic performance or prognostic value of positron emission tomography (PET) with different tracers in detecting brain tumors have been published so far. This review article was written to summarize the evidence-based data in these settings. Methods: We have performed a comprehensive literature search of meta-analyses published in the Cochrane library and PubMed/Medline databases (from inception through July 2019) about the diagnostic performance or prognostic value of PET with different tracers in patients with brain tumors. Results: We have summarized the results of 24 retrieved meta-analyses on the use of PET or PET/computed tomography (CT) with different tracers in brain tumors. The tracers included were: fluorine-18 fluorodeoxyglucose (¹⁸F-FDG), carbon-11 methionine (¹¹C-methionine), fluorine-18 fluoroethyltyrosine (¹⁸F-FET), fluorine-18 dihydroxyphenylalanine (¹⁸F-FDOPA), fluorine-18 fluorothymidine (¹⁸F-FLT), and carbon-11 choline (¹¹C-choline). Evidence-based data demonstrated good diagnostic performance of PET with different tracers in detecting brain tumors, in particular, radiolabelled amino acid tracers showed the highest diagnostic performance values. All the PET tracers evaluated had significant prognostic value in patients with glioma. Conclusions: Evidence-based data showed a good diagnostic performance for some PET tracers in specific indications and significant prognostic value in brain tumors.

Objective. To meta-analyze published data about the diagnostic performance of fluorine-18-Fluorodeoxyglucose (¹⁸F-FDG) positron emission tomography (PET) and PET/computed tomography (PET/CT) in the postchemotherapy management of patients with seminoma.Methods. A comprehensive literature search of studies published through January 2014 on this topic was performed. All retrieved studies were reviewed and qualitatively analyzed. Pooled sensitivity and specificity, positive and negative predictive values (PPV and NPV), accuracy, and area under the summary ROC curve (AUC) of¹⁸F-FDG-PET or PET/CT on a per examination-based analysis were calculated. Subgroup analyses considering the size of residual/recurrent lesions were carried out.Results. Nine studies including 375 scans were selected. The pooled analysis provided the following results: sensitivity 78% (95% confidence interval (95% CI): 67–87%), specificity 86% (95% CI: 81–89%), PPV 58% (95% CI: 48–68%), NPV 94% (95% CI: 90–96%), and accuracy 84% (95% CI: 80–88%). The AUC was 0.90. A better diagnostic accuracy of¹⁸F-FDG-PET or PET/CT in evaluating residual/recurrent lesions >3 cm compared to those <3 cm was found.Conclusions.¹⁸F-FDG-PET and PET/CT were demonstrated to be accurate imaging methods in the postchemotherapy management of patients with seminoma; nevertheless possible sources of false-negative and false-positive results should be considered. The literature focusing on this setting still remains limited and cost-effectiveness analyses are warranted.