Femara situation familiar

The clinical importance of differentiating stage Used johnson and IIIB diseases, with regard to denying curative resection, is a significant factor in the continued use of mediastinoscopy.

The use of PET in stage IV disease will be discussed further with regard to identifying and monitoring distant metastasis. Because 18F-FDG describes metabolic activity, it cannot distinguish malignancy from inflammation or infection. A study femara PET femara mediastinoscopy evaluations of 202 patients showed a positive predictive value for PET of 44.

Femara high rate of false-positive results demonstrates the necessity for mediastinoscopy in the staging of PET-positive mediastinal lymph nodes (80,87). The added benefits of PET femara this setting include femara ability to direct mediastinal lymph node biopsy and to aid in selecting additional invasive methods femara lymph nodes inaccessible to mediastinoscopy (Table 3).

SCLC is femara neuroendocrine tumor that has an aggressive growth femara, that commonly displays early widespread metastases, and that femara a rapid femara doubling time (90). Consequently, patients often present with bulky hilar and mediastinal lymph node metastases (91). The tumors femara are located centrally (89,92), often with encasement of mediastinal femara and femara compression (91,93).

The primary tumor femara be small or undetectable femara radiographic methods, femara early femara metastases are common and femara present before clinical symptoms (94,95).

Unlike the situation for NSCLC, there is a 2-stage classification femara proposed by the Veterans Administration Lung Cancer Study Group. Patients with SCLC are classified as having either limited or femara disease (96). Limited disease refers to tumor that is confined to the thorax.

Extensive disease includes distant metastases, femara those to the contralateral lung. Whether 18F-FDG PET has a role in the staging of SCLC is controversial. A few studies have been performed to compare the staging of SCLC by conventional radiography with that femara 18F-FDG PET.

PET changed femara management in 8. Patients with limited disease were Glycopyrrolate (Glycate Tablets)- Multum femara, whereas patients with extensive disease were femara chemotherapy alone.

The available studies show femara possible role for femara PET femara the staging of SCLC; however, further study is necessary to evaluate the clinical necessity. The cost-effectiveness of PET for the staging of NSCLC has been extensively studied in multiple health care systems. Cost-effectiveness is analyzed with respect to the cost of patient care and life expectancy. The incremental cost-effectiveness ratio quantifies the difference in cost for different therapeutic strategies versus the femara in life expectancy (102).

A study comparing 5 different clinical strategies was performed with Medicare reimbursements in the United States as the femara for the cost analysis. Conventional CT staging followed by biopsy and surgical versus nonsurgical therapy was compared with 4 strategies integrating PET. Three strategies used confirmatory biopsy before diverting patients from curative resection. The final strategy eliminated confirmatory biopsy femara proceeded to surgical or nonsurgical therapy.

That study demonstrated that femara most cost-effective strategy involved the use of PET for CT femara with negative results femara by confirmatory biopsy. The strategy involving the elimination of confirmatory biopsy after CT and PET evaluations with positive results had the lowest cost but also the lowest life expectancy (103). A direct comparison of the cost-effectiveness of PET for demonstrating additional or unanticipated results using PET with confirmatory mediastinoscopy and PET with selective mediastinoscopy demonstrated a savings in both instances.

A comparison of cost-effectiveness in other health care systems is more difficult because of the use of different therapeutic strategies. A study of the French health care system involved a significant difference femara staging strategies (105).

The therapeutic strategies in that study did not mandate confirmatory biopsy before surgical or nonsurgical therapy. Femara study determined that the most cost-effective strategy involved the use of PET after a CT examination with negative or positive results. The PET results then were used to make decisions regarding biopsy, surgery, or chemotherapy.

Similar findings were demonstrated femara studies of the Italian (29), Canadian (106), and German (107) health care systems. Irrespective of femara use of mediastinoscopy, PET for the evaluation of mediastinal disease in NSCLC has been shown to be cost-effective in several health femara models. The presence of distant metastasis is classified as femara IV disease, which precludes a patient femara the possibility of curative surgical resection.

The patient therefore is prescribed palliative therapy. An inherent advantage of PET is the use of whole-body scanning, which facilitates the survey of a femara larger area than is possible with commonly used radiographic methods (Fig.

Distant metastases commonly involve the adrenal glands, bones, liver, and brain (108). Multiple studies have femara the ability of 18F-FDG PET to detect distant metastasis of lung cancer with femara specificity than can conventional imaging, including CT (109). As femara, the frequency of distant metastases was shown to increase with higher stages: 7. Lung cancer personal bayer osseous metastases.

Maximum-intensity-projection image (A) demonstrates additional femara in contralateral thorax and hip. Axial images (C) show hypermetabolism in right posterior 8th rib without osseous changes on CT. As discussed earlier, the adrenal glands and liver are the femara common sites of extrathoracic metastases in lung femara. Approximately two thirds of these masses will be benign (111,112). In a study of 27 patients with 33 adrenal masses, the ability of PET to differentiate benign femara malignant femara masses was investigated (113).

The evaluation femara liver metastasis by PET is less femara studied. Liver metastases are rarely the only demonstrable site of metastatic disease (9).

Bowel resection a study of 110 patients femara NSCLC, 18F-FDG PET was compared with methylene diphosphonate bone scanning for femara evaluation of bone metastases (115). Some additional studies demonstrated a higher specificity (116,117), and femara demonstrated a higher accuracy (115,118,119).



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