JULIANO JULIO CERCI
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bookPart Tomografia por Emissão de Pósitrons e Tomografia Computadorizada em Cardiologia(2013) VITOLA, João Vicente; CERCI, Juliano Julio; DELBEKE, Dominique- Investigation Route of the Coronary Patient in the Public Health System in Curitiba, Sao Paulo and in Incor - IMPACT Study(2014) CERCI, Juliano J.; TRINDADE, Evelinda; PRETO, Daniel; CERCI, Rodrigo Julio; LEMOS, Pedro A.; CESAR, Luiz Antonio Machado; PRETO, Luis; STINGHEN, Luiz; MARTINEZ, Catia; MENEGHETTI, Jose ClaudioBackground: The investigation of stable coronary artery disease (CAD) and its treatment depend on risk stratification for decision-making on the need for cardiac catheterization and revascularization. Objective: To analyze the procedures used in the diagnosis and invasive treatment of patients with CAD, at the Brazilian Unified Health System (SUS) in the cities of Curitiba, Sao Paulo and at InCor-FMUSP. Methods: Retrospective, descriptive, observational study of the diagnostic and therapeutic itineraries of the Brazilian public health care system patient, between groups submitted or not to prior noninvasive tests to invasive cardiac catheterization. Stress testing, stress echocardiography, perfusion scintigraphy, catheterization and percutaneous or surgical revascularization treatment procedures were quantified and the economic impact of the used strategies. Results: There are significant differences in the assessment of patients with suspected or known CAD in the metropolitan region in the three scenarios. Although functional testing procedures are most often used the direct costs of these procedures differ significantly (6.1% in Curitiba, 20% in Sao Paulo and 27% in InCor-FMUSP). Costs related to the procedures and invasive treatments represent 59.7% of the direct costs of SUS in Sao Paulo and 87.2% in Curitiba. In InCor-FMUSP, only 24.3% of patients with stable CAD submitted to CABG underwent a noninvasive test before the procedure. Conclusion: Although noninvasive functional tests are the ones most often requested for the assessment of patients with suspected or known CAD most of the costs are related to invasive procedures/treatments. In most revascularized patients, the documentation of ischemic burden was not performed by SUS.
conferenceObject Incidence of post-treatment PET-positivity and relapse in Hodgkin lymphoma patients with a negative interim FDG-PET(2012) ZANONI, L.; CERCI, J.; LOPCI, E.; BIANCHI, A.; HUTCHINGS, M.; LEE, S. Ting; DELBEKE, D.; CELLI, M.; CHITI, A.; FANTI, S.Background: 18F-fluorodeoxyglucose positron emission tomography (FDG-PET), used for assessment of early response in Hodgkin’s lymphoma (HL) patients, is an accurate predictor of progression-free survival. Is has been suggested that end-treatment PET (PETe) is unnecessary if interim PET (PETi) results are negative. The purpose of this study was to evaluate the incidence and clinical characteristics of HL patients with PETi-negative and PETe-positive scans. Material and Methods: For this purpose we retrospectively analyzed data from HL patients enrolled in seven different nuclear medicine centers worldwide. Scans were read by at least one board certified nuclear physician. PETi-negative was defined as no pathologic FDG uptake at any site, including all sites of previously increased pathologic uptake. PETi minimal residual uptake (MRU) was defined as low-grade FDG uptake, although PETi-MRU scans were considered as PETi-negative scan for the purpose of the analysis. A study was considered PETi-positive in case of focal FDG uptake that could not be attributed to physiological distribution. There was no modification in treatment based on PETi results. The incidence of a PETi-negative scan in combination with a PETe-positive scan was calculated. Results: A total of 868 patients were analysed and after two or three cycles of chemotherapy, 643/868 (74.1%) patients were PETi-negative, and 225/868 (25.9%) were PETi-positive. Of the 643 PETi-negative patients, 7.2% (46/643) showed PETe-positive scans. HL was confirmed in 5.1% (33/643) patients, while 2.2% (14/643) were false positive results. Four of those patients died during follow-up, due to HL complications, with a median follow up of 47 (±24.1) months. Clinical characteristics of the 33 early relapsed patients were investigated (sex; age; pathological subtype; B symptoms; Bulky diseae; Clinical stage; International Prognostic Score). Of those patients, 81.8% (27/33) were treated with ABVD. Radiotherapy was administrated in 12 (33.6%) patients. Of the 13 patients with early stage disease, six (46.1%) were submitted to combined therapy. Of the 14 patients with advanced disease, six (42.8%) were submitted to combined therapy. Conclusion: We conclude that, although a rare occurrence, a small number of HL patients will show recurrent signs of disease at the end of treatment, despite a negative PETi. Thus, there is at present not evidence for the omission of PETe. PETe should still be performed as part of the patient's management plan , in order to identify these patients who need additional therapy.- A tomografia por emissão de pósitrons com 2-[18F]-fluoro-2-desoxi-D-glicose é custo-efetiva em pacientes com câncer de pulmão não pequenas células no Brasil(2012) CERCI, Juliano Julio; TAKAGAKI, Teresa Yae; TRINDADE, Evelinda; MORGADO, Roberta; MORABITO, Fausto; MUSOLINO, Rafael Silva; SOARES JUNIOR, José; MENEGHETTI, José CláudioOBJECTIVE: To evaluate the accuracy and cost-effectiveness of metabolic staging (MS) with FDG-PET as compared with the conventional staging (CS) strategy in the preoperative staging of non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: A total of 95 patients with initial diagnosis of NSCLC were staged before undergoing treatment. The MS and CS results were compared with regard to treatment definition and incidence of futile thoracotomies with both strategies. RESULTS: Metabolic staging with FDG-PET upstaged 48.4% and downstaged 5.3% of the patients, and would lead to change in the treatment of 41% of cases. Thoracotomy was considered as futile in 47% of the patients with CS, and in 19% of the patients with MS. The cost of futile thoracotomies in eight patients with MS was R$ 79,720, while in 31 patients with CS it would be R$ 308,915. Just such saving in costs would be more than enough to cover the costs of all FDG-PETs (R$ 126,350) or FDG-PET/CTs (R$ 193,515) for the 95 patients. CONCLUSION: The metabolic staging with FDG-PET is more accurate than CS in patients with NSCLC. Both FDG-PET and FDG-PET/CT are cost-effective methods and their utilization is economically justifiable in the Brazilian public health system.
- Consistency of FDG-PET Accuracy and Cost-Effectiveness in Initial Staging of Patients With Hodgkin Lymphoma Across Jurisdictions(2011) CERCI, Juliano J.; TRINDADE, Evelinda; BUCCHERI, Valeria; FANTI, Stefano; COUTINHO, Artur M. N.; ZANONI, Lucia; LINARDI, Camila C. G.; CELLI, Monica; DELBEKE, Dominique; PRACCHIA, Luis F.; PITELA, Felipe A.; SOARES JR., Jose; ZINZANI, Pier Luigi; MENEGHETTI, Jose C.Introduction: Two hundred ten patients with newly diagnosed Hodgkin's lymphoma (HL) were consecutively enrolled in this prospective trial to evaluate the cost-effectiveness of fluorine-18 ((18)F)-fluoro-2-deoxy-D-glucose-positron emission tomography (FDG-PET) scan in initial staging of patients with HL. Methods: All 210 patients were staged with conventional clinical staging (CCS) methods, including computed tomography (CT), bone marrow biopsy (BMB), and laboratory tests. Patients were also submitted to metabolic staging (MS) with whole-body FDG-PET scan before the beginning of treatment. A standard of reference for staging was determined with all staging procedures, histologic examination, and follow-up examinations. The accuracy of the CCS was compared with the MS. Local unit costs of procedures and tests were evaluated. Incremental cost-effectiveness ratio (ICER) was calculated for both strategies. Results: In the 210 patients with HL, the sensitivity for initial staging of FDG-PET was higher than that of CT and BMB in initial staging (97.9% vs. 87.3%; P < .001 and 94.2% vs. 71.4%, P < 0.003, respectively). The incorporation of FDG-PET in the staging procedure upstaged disease in 50 (24%) patients and downstaged disease in 17 (8%) patients. Changes in treatment would be seen in 32 (15%) patients. Cumulative cost for staging procedures was $3751/patient for CCS compared to $5081 for CCS + PET and $4588 for PET/CT. The ICER of PET/CT strategy was $16,215 per patient with modified treatment. PET/CT costs at the beginning and end of treatment would increase total costs of HL staging and first-line treatment by only 2%. Conclusion: FDG-PET is more accurate than CT and BMB in HL staging. Given observed probabilities, FDG-PET is highly cost-effective in the public health care program in Brazil.
- Dealing with Bone Marrow Specimen in Staging of Classical Hodgkin Lymphoma: An Old Issue Revisited in the ""FDG PET Era""(2014) PAULA, H. M. de; GONCALVES, M. C.; LINARDI, C. C. G.; BUCCHERI, V.; CERCI, J. J.; SIQUEIRA, S. A. C.; ALDRED, V. L.; ZERBINI, M. C. N.
article 16 Citação(ões) na Scopus Use of PET/CT to evaluate response to therapy in lymphoma(2011) ZANONI, L.; CERCI, J. J.; FANTI, S.F-18-FDG-PET is a well established standard procedure for most lymphoma subtypes. In particular the advantage of metabolic imaging stands in its strong predictivity in response. Indeed PET scan has been incorporated into revised response criteria for aggressive lymphomas and recommended to be performed at baseline and after therapy. At the same time, several ongoing clinical trials are investigating the value of treatment adaptation based on interim PET (PETi) results for Hodgkin Lymphoma (HL) and aggressive Non-Hodgkin Lymphoma (NHL). On the other hand, scientific literature provides limited detailed information regarding the numerous non aggressive NHL subtypes. Usually indolent NHL are typically less FDG avid, furthermore their long natural history and high incidence of recurrence decreases the clinical impact of a potential risk-adapted or response-adapted approach. We reviewed, from a nuclear medicine point of view and a clinical point of interest, evidence for the use of FDG-PET in monitoring early and end treatment response.conferenceObject FDG-PET initial staging in Hodgkin lymphoma patients has impact on 5-year overall and event free survival(2012) CERCI, Juliano; LINARDI, Camila; PRACCHIA, Luis; SOARES, Jose; TRINDADE, Evelinda; CERCI, Rodrigo; DELBEKE, Dominique; MENEGHETTI, Jose- Dealing with Bone Marrow Specimen in Staging of Classical Hodgkin Lymphoma: An Old Issue Revisited in the ""FDG PET Era""(2014) PAULA, H. M. de; GONCALVES, M. C.; LINARDI, C. C. G.; BUCCHERI, V.; CERCI, J. J.; SIQUEIRA, S. A. C.; ALDRED, V. L.; ZERBINI, M. C. N.