This is the Evaluation we should be piggy backing with. It would be awesome to provide a Recaf test and then perform a whole body scan. They complement eachother.

Journal of Clinical Oncology, Vol 27, No 11 (April 10), 2009: pp. 1767-1773
© 2009 American Society of Clinical Oncology.

Prospective Evaluation of Whole-Body Cancer Screening With Multiple Modalities Including [18F]Fluorodeoxyglucose Positron Emission Tomography in a Healthy Population: A Preliminary Report

Sadahiko Nishizawa, Shinsuke Kojima, Satoshi Teramukai, Masayuki Inubushi, Hironobu Kodama, Yoshiki Maeda, Hiroyuki Okada, Bin Zhou, Yoji Nagai, Masanori Fukushima

From the Hamamatsu Medical Imaging Center, Hamamatsu Medical Photonics Foundation; Development Bureau and Central Research Laboratory, Hamamatsu Photonics KK, Shizuoka; Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Hyogo; and the Translational Research Center, Kyoto University Hospital, Kyoto, Japan.

Corresponding author: Sadahiko Nishizawa, MD, PhD, Hamamatsu Medical Imaging Center, Hamamatsu Medical Photonics Foundation, 5000 Hirakuchi, Hamakita-ku, Hamamatsu, Shizuoka 434-0041, Japan; e-mail: sadahiko@hmp.or.jp .

Purpose To prospectively evaluate the utility of whole-body cancer screening with multiple modalities including [18F]fluorodeoxyglucose positron emission tomography (FDG-PET) in a healthy population. This report summarizes the results of the first three annual screenings.

Participants and Methods A total of 1,197 healthy volunteers 35 years old were enrolled between August 2003 and July 2004 and offered annual cancer screening for 5 years with subsequent long-term follow-up. Screening modalities included were whole-body FDG-PET, chest and abdominal computed tomography (CT), brain and pelvic magnetic resonance imaging, several tumor markers, and fecal occult blood testing.

Results As of the end of 2006, 22 primary cancers were pathologically confirmed. Nineteen of 22 were detected by the screening; 18 in the initial, one in the second, and none in the third. Three were diagnosed after development of symptoms. Of the 18 detected in the initial screening (six thyroid, four lung, three prostate, three breast, one endometrial, and one thymic), 12 were at stage I and 11 were PET positive. PET-negative cancers were detected by CT or the prostate-specific antigen (PSA) test. Sensitivity and specificity were 50.0% (11 of 22) and 93.2% (1,095 of 1,175), respectively, for FDG-PET alone and 81.8% (18 of 22) and 82.0% (963 of 1,175), respectively, for the combination of imaging modalities and PSA.

Conclusion While FDG-PET alone is insufficient, whole-body cancer screening with selected modalities including FDG-PET has initial performance supporting possible utility by detecting a wide variety of early-stage cancers with reasonable sensitivity. However, the detection of many indolent cancers and false positives necessitate continuing study for appropriate evaluation.

S.N. and S.K. contributed equally to this study.

Supported by the Hamamatsu Medical Photonics Foundation.

Presented in part in abstract format at 41st Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 13-17, 2005; and 42nd Annual Meeting of the American Society of Clinical Oncology, Atlanta, GA, June 2-6, 2006.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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