Letter to the Editor
Is 18FDG PET/CT evaluation really useful in the diagnosis of elastofibroma dorsi?
¿Es útil realizar una 18FDG-PET/TAC en la sospecha diagnóstica de elastofibroma dorsi?
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"tieneTextoCompleto" => true "saludo" => "<span class="elsevierStyleItalic">Dear Sirs</span>," "paginas" => array:1 [ 0 => array:1 [ "paginaInicial" => "62" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "F. Lococo, A. Cesario, S. de Franco, T. Ricchetti, G. Sgarbi, G. Treglia" "autores" => array:6 [ 0 => array:4 [ "nombre" => "F." "apellidos" => "Lococo" "email" => array:1 [ 0 => "filippo_lococo@yahoo.it" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "A." "apellidos" => "Cesario" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "S." "apellidos" => "de Franco" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "T." "apellidos" => "Ricchetti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "G." "apellidos" => "Sgarbi" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "G." "apellidos" => "Treglia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Unit of Thoracic Surgery, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Deputy Scientific Director, IRCCS San Raffaele Pisana, Rome, Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Department of Nuclear Medicine and PET Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "¿Es útil realizar una <span class="elsevierStyleSup">18</span>FDG-PET/TAC en la sospecha diagnóstica de elastofibroma dorsi?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Blumenkrantz and co-workers<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> have reported an interesting retrospective analysis on a relative large series of elastofibroma dorsi (ED) incidentally imaged with <span class="elsevierStyleSup">18</span>FDG PET/CT that prompted us a series of reflections, discussed herein.</p><p id="par0010" class="elsevierStylePara elsevierViewall">As correctly remarked by the Authors<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>, “although it is not necessary to perform a PET study to diagnose such lesions, it is important to identify them in order to avoid misdiagnosis”. In fact, this entity being identified more and more frequently during <span class="elsevierStyleSup">18</span>FDG PET/CT scans performed for other purposes, the exact characterization of <span class="elsevierStyleSup">18</span>FDG PET/CT findings could be helpful for the physicians.</p><p id="par0015" class="elsevierStylePara elsevierViewall">In this setting, there is a body of evidence<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2,3</span></a> supporting that <span class="elsevierStyleSup">18</span>FDG PET/CT could actually help in discriminating among benign and eventually malignant tumor. However, the answer concerning if the <span class="elsevierStyleSup">18</span>FDG PET/CT is really useful in the diagnosis and treatment planning of patients with ED is still unanswered and, in this context, the results reported by Blumenkrantz and coll.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> are very interesting and stimulate such debate.</p><p id="par0020" class="elsevierStylePara elsevierViewall">As already reported<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>, in such patients we deem the diagnostic use of <span class="elsevierStyleSup">18</span>FDG PET/CT not yet fully supported by evidences strong enough to include it in the routine clinical practice.</p><p id="par0025" class="elsevierStylePara elsevierViewall">In fact, the metabolic findings of such neoplasms may be variable (SUVmax ranging from 1.4 to 3.2 in the study of Blumenkrantz) and sometimes a moderate up to intense uptake (SUVmax up to 5<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>) have been reported in few studies<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a>; this could potentially mislead the final diagnosis. Indeed, Onishi and co-workers<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> reported a 40% of ED with a <span class="elsevierStyleSup">18</span>FDG uptake comparable or greater than the liver and concluded their study remarking as these findings “<span class="elsevierStyleItalic">…should not be misinterpreted as abnormal accumulation observed in malignant lesions…”.</span></p><p id="par0030" class="elsevierStylePara elsevierViewall">In this regard, we have recently observed a patient with a right subscapular lesion with radiological features not clearly consistent with the diagnosis of ED; with the aim of discerning from ED and a malignant tumor (sarcoma or other more rare malignant chest wall tumors) we have planned and performed a <span class="elsevierStyleSup">18</span>FDG PET/CT scan that revealed a moderate uptake of the radio-tracer (SUVmax up to 3.5) at the level of subscapular lesion, this theoretically suggesting its malignant nature. The tumor was surgically removed and the definitive pathology was indicative for ED (with no peculiar pathological findings).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Therefore, we completely agree with the Authors<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> concerning the inadequacy of <span class="elsevierStyleSup">18</span>FDG PET/CT evaluation when planning the best strategy of care. Furthermore, we would like to emphasize that the diagnosis of ED is substantially based on clinical even more than radiological findings. In fact, the localization in the infra-scapular region is substantially a pathognomonic sign in the diagnosis of ED. Even in case of <span class="elsevierStyleSup">18</span>FDG PET/CT “incidental positivity” in correspondence of a subscapular soft tissue lesion, the diagnostic hypothesis of ED is more plausible than a soft tissue metastasis and a bioptic confirmation mandatory.</p><p id="par0040" class="elsevierStylePara elsevierViewall">We would greatly appreciate the Authors’ reflections and reactions of the points raised.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-09-07" "fechaAceptado" => "2013-09-13" "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Characterization of elastofibroma dorsi with (18)FDG PET/CT: a retrospective study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Y. 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