As scarce literature on the topic is available, we aimed to compare diagnostic utility of semi-quantitative versus visual analysis in labelled white blood cell scintigraphy (WBCS) for osteoarticular ...infection. One-day and two-day protocols were assessed, particularly in orthopaedic devices.
Prospective study of 79 consecutive patients with suspected osteoarticular infection. In all patients, WBCS were performed at 30min, 4h, 8h and 24h. Images were analysed by grouping in two protocols: one-day-protocol (experts evaluated 30min, 4h and 8h planar images) and two-day-protocol (experts evaluated 30min, 4h and 24h planar images). Planar images were interpreted qualitative and semiquantitatively and also were compared grouping patients with and without orthopaedic devices. To find which cut-off value of the percentage variation could predict of osteoarticular infection, multiple cut-off values were calculated in both protocols from the Youden index. Three blinded readers analysed the images.
Comparing final diagnosis visual analysis of the one-day-protocol provided better results with sensitivity of 95.5%, specificity of 93% and diagnostic accuracy of 93.7% (P<.01) than the two-day-protocol with values of 86.4%, 94.7% and 92.4%, respectively (P<.01). For semi-quantitative analysis, the one-day-protocol also obtained better results with sensitivity of 72.7%, specificity of 78.9% and accuracy of 77.2% (P<.01) than two-day-protocol (no significant results; P=.14), especially in the group of patients with orthopaedic devices (sensitivity of 100%, specificity of 79.5% and accuracy of 82.7%; P<.01).
Most accurate approach in the diagnosis of osteoarticular infection corresponded to visual analysis in one-day-protocol that showed greater sensitivity and specificity than semi-quantitative analysis. Semi-quantitative analysis only could be useful when visual analysis is doubtful. In patients with joint prostheses, an increase in percentage variation above 9% obtained maximum sensitivity and negative predictive value.
Acral lentiginous melanoma (ALM) arises in areas that are not generally exposed to UV radiation. Chronic trauma has been hypothesized to play a role in the development of this tumor. The aim of this ...study was to analyze the association between the presence and characteristics of ALM and location in stress- and non–stress-bearing areas.
Observational, descriptive analysis. For 95 patients with ALM evaluated at Fundación Clínica Vida in Medellin, Colombia between January 2016 and August 2020 we collected demographic, histologic and clinical variables and assigned the patients to 2 groups depending on whether their tumor was located in a stress-bearing area or not.
Ninety-five patients (36 men and 59 women) with a median age of 59 years were studied. ALMs were more common in stress-bearing areas than in non–stress-bearing areas (58 61% vs. 17 17.8%). A history of direct trauma at the site of the tumor was reported in 18.9% of the cases (p = .025) and was most common in patients with nail lesions. Invasive ALMs in stress-bearing areas had a greater Breslow thickness (p = .006) and higher ulceration rates than those in non–stress-bearing areas (p = .018).
ALM on both the feet and hands is more common in stress-bearing areas. Our findings support the hypothesis that mechanical stress may have a pathogenic role in ALM.
El melanoma lentiginoso acral (MLA) se presenta en zonas con poca exposición a la radiación ultravioleta. Se ha planteado que el trauma crónico puede predisponer a su desarrollo. El objetivo del presente estudio fue relacionar la presencia del MLA y sus características con las zonas acrales que se consideran de presión y de no presión.
Se realizó un estudio observacional, descriptivo, con intención analítica. Se recogieron los datos de 95 pacientes con diagnóstico de MLA evaluados en la Fundación Clínica Vida en Medellín, Colombia, entre enero de 2016 y agosto de 2020. Se recolectaron variables demográficas, histológicas y clínicas del tumor, las cuales se analizaron en dos grupos, según si estaba sometida a fuerzas de presión o no.
Se incluyeron 95 pacientes con MLA (36 hombres y 59 mujeres), con una mediana de edad de 59 años. Se presentaron más melanomas en las zonas de presión que de no presión (58 61% vs. 17 17,8%). Se refirió la existencia de un trauma directo previo en 18,9% de los casos, el cual fue más frecuente en las lesiones de las uñas (p = 0,025). Los melanomas invasores tuvieron un mayor Breslow (p = 0,006) y presencia de ulceración (p = 0,018) en las zonas de presión y en las uñas que en las zonas de no presión.
El MLA es más frecuente en zonas de presión que de no presión, tanto en la mano como en el pie. Esto apoya la hipótesis de que el estrés mecánico puede jugar un papel en la patogénesis de este tipo de tumor.
Abstract
Aim: To investigate the use of 18F-FDG PET/CT at diagnosis and after end-of-treatment in the prediction of response to neoadjuvant chemotherapy (NAC) and its role in the prognosis of ...patients with locally advanced breast cancer (LABC).
Materials and Methods: One hundred thirty-two patients underwent a baseline FDG PET/ CT (PET-1) after the second course of chemotherapy (PET-2) and after the last course (PET-3).
Breast tumors were classified into molecular phenotypes and grouped into risk categories according to the biological prognostic factors obtained by immunohistochemistry.
PET/CT scans were semiquantitatively evaluated, obtaining the Δ% SUV1-2 and SUV1-3 in primary tumor and axillary lymph nodes to establish response groups attending to EORTC criteria. Moreover, a binary assessment was obtained classifying the studies as positive or negative.
Pathological response was determined both in breast and axillary lymph node specimens.
Overall survival (OS) and disease-free survival (DFS) were obtained during the follow-up.
ROC analysis was performed to determine a cutoff value of Δ% SUV1-2 and SUV1-3 for the prediction of response and prognosis.
Relations between molecular phenotypes, metabolic behavior, final pathological response, OS, and DFS were evaluated.
This prospective and multicenter study was approved by the local ethics committee of our institution and included 7 hospitals of our region.
Results: In binary analysis, only PET-3 was able to predict pathological response in lymph nodes. The cutoff values of %Δ SUV1-2 and %Δ SUV1-3 with the best sensitivity and specificity in the prediction of response in breast tumor were 62% (Se: 70% and Sp: 69%) and 84% (Se: 70%and Sp: 88%). A%ΔSUV1-3 of 74% in breast tumor was a predictor of DFS (AUC = 0.647; P = 0.037, Se: 52% and Sp: 66%). Kaplan- Meier analysis revealed significant relations between the binary lymph node assessment of PET-3 with OS (P = 0.016, χ2 = 5.78) and DFS (P = 0.003, χ2 = 9.10).
Conclusions: Among the multiple metabolic response variables in breast tumor and lymph nodes, end-of-treatment 18F-FDG PET/CT was a significant predictor of breast and lymph node response and patient prognosis. The molecular phenotypes and pathological lymph node response rate were independent predictors of OS and DFS. This stresses the potential of the biological influence over metabolic variables in the prognosis of patients. Metabolic response variables work better in their predictive and prognostic value in high-risk tumors.
Citation Format: Muñoz-Sánchez MdM, Molina-Garrido MJ, García Vicente AM, Soriano Rodríguez MdC, Amo Salas M, Olaverri Hernández A, Chacón Muñiz JI, Álvarez Cabellos R, Espinosa Aunión R, Ortega Ruipérez C, Martín Ordóñez F, Pena Pardo FJ, Jiménez Londoño GA, Val Pérez E, Santiago Crespo JA, Soriano Castrejón A. Determining the prognostic role of early and end-of-neoadjuvant chemotherapy 18F-FDG PET/CT in patients with locally advanced breast cancer abstract. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD3-03.
AIMOur aim was two-fold, to study the interobserver agreement in tumour segmentation and to search for a reliable methodology to segment gliomas using 18F-fluorocholine PET/CT. METHODS25 patients ...with glioma, from a prospective and non-randomized study (Functional and Metabolic Glioma Analysis), were included.Interobserver variability in tumour segmentation was assessed using fixed thresholds. Different strategies were used to segment the tumours. First, a semi-automatic tumour segmentation was performed, selecting the best SUVmax-% threshold for each lesion. Next we determined a variable SUVmax-% depending on the SUVmax. Finally a segmentation using a fixed SUVmax threshold was performed. To do so, a sampling of 10 regions of interest (ROI of 2.8cm2) located in the normal brain was performed. The upper value of the sample mean SUVmax±3 SD was used as cut-off. All procedures were tested and classified as effective or not for tumour segmentation by two observer's consensus. RESULTSIn the pilot segmentation, the mean±SD of SUVmax, SUVmean and optimal SUVmax-% threshold were: 3.64±1.77, 1.32±0.57 and 21.32±8.39, respectively. Optimal SUVmax-% threshold showed a significant association with the SUVmax (Pearson=-0.653, p=.002). However, the linear regression model for the total sample was not good, that supported the division in two homogeneous groups, defining two formulas for predicting the optimal SUVmax-% threshold. As to the third procedure, the obtained value for the mean SUVmax background+3 SD was 0.33. This value allowed segmenting correctly a significant fraction of tumours, although not all. CONCLUSIONA great interobserver variability in the tumour segmentation was found. None of the methods was able to segment correctly all the gliomas, probably explained by the wide tumour heterogeneity on 18F-fluorocholine PET/CT.
Our objective was to analyze all the rejected PET/CT-request forms (rf), its primary question to be answered and the impact of not performing the PET/CT studies for the management of the patients.
We ...retrospectively reviewed all the cancelled PET/CT-rf received in our department from January 2007 to June 2011. The reasons for cancelling were patient clinical status, request from referring physician, patient request and criteria of nuclear medicine physician. PET/CT-rf were classified according to the primary question to be answered. The clinical evolution of patients was followed up for 6 months after PET/CT was requested.
Thirty-nine studies were cancelled due to the patient clinical situation (mainly advanced state of neoplastic disease), 46 due to request from referring physician, 18 by patient request and 74 PET/CT-rf were rejected due to nuclear medicine physician criteria. Thirty-four patients with a rejected PET/CT had known neoplastic history. The more prevalent primary questions to be answered were: evaluation of pulmonary (20) and bone lesions (13). Regarding pulmonary nodules, only 4 patients had previous neoplastic disease and their size was less than 5mm. The rejection of PET/CT studies did not cause any impact in the natural evolution of the disease of the patients.
This procedure avoided unnecessary PET/CT scans reducing expenses and radiation without any detriment in the patients.
AIMTo analyze the relationship between measurements of global heterogeneity, obtained from 18F-FDG PET/CT, with biological variables, and their predictive and prognostic role in patients with locally ...advanced breast cancer (LABC). MATERIAL AND METHODS68 patients from a multicenter and prospective study, with LABC and a baseline 18F-FDG PET/CT were included. Immunohistochemical profile estrogen receptors (ER) and progesterone receptors (PR), expression of the HER-2 oncogene, Ki-67 proliferation index and tumor histological grade, response to neoadjuvant chemotherapy (NC), overall survival (OS) and disease-free survival (DFS) were obtained as clinical variables. Three-dimensional segmentation of the lesions, providing SUV, volumetric metabolic tumor volume (MTV) and total lesion glycolysis (TLG) and global heterogeneity variables coefficient of variation (COV) and SUVmean/SUVmax ratio, as well as sphericity was performed. The correlation between the results obtained with the immunohistochemical profile, the response to NC and survival was also analyzed. RESULTSOf the patients included, 62 received NC. Only 18 responded. 13 patients relapsed and 11 died during follow-up. ER negative tumors had a lower COV (p=0.018) as well as those with high Ki-67 (p=0.001) and high risk phenotype (p=0.033) compared to the rest. No PET variable showed association with the response to NC nor OS. There was an inverse relationship between sphericity with DFS (p=0.041), so, for every tenth that sphericity increases, the risk of recurrence decreases by 37%. CONCLUSIONSBreast tumors in our LABC dataset behaved as homogeneous and spherical lesions. Larger volumes were associated with a lower sphericity. Global heterogeneity variables and sphericity do not seem to have a predictive role in response to NC nor in OS. More spherical tumors with less variation in gray intensity between voxels showed a lower risk of recurrence.
AIMTo assess the diagnostic accuracy of 18F-FDG PET/contrast enhanced computed tomography (ceCT) in the detection of asymptomatic recurrences in patients with lymphoma. MATERIAL AND METHODSPatients ...with lymphoma and clinical complete remission underwent 18F-FDG PET/ceCT for standard follow-up.18F-FDG PET and ceCT were evaluated blindly by two independent observers, and classified as positive or negative for recurrence. Additionally a combined evaluation of both techniques was performed. The final diagnosis was established by histopathological analysis or a clinical follow-up longer than 6 months. Statistical diagnostic parameters and concordance levels between both diagnostic techniques were calculated. RESULTSA total of 114 explorations on 90 patients were analyzed. Only 4 patients were diagnosed as asymptomatic recurrence during the follow-up. 18F-FDG PET/ceCT, 18F-FDG PET and ceCT showed an association with the final diagnosis (p=0.002 and χ2=11.96; p<0.001 and χ2=15.60; p=0.001 and χ2=11.96, respectively). The concordance between 18F-FDG PET and ceCT was moderate/high and significant (kappa=0.672; p<0.001). A sensitivity and specificity of 50% and 88% was obtained for the 18F-FDG PET/ceCT civ, 50% and 93% for the 18F-FDG PET, and 50% and 91% for the ceCT. CONCLUSIONThe combined use of 18F-FDG PET/ceCT did not offer any advantage compared to any isolated diagnostic technique in the detection of asymptomatic lymphoma recurrence.
Background
The early identification of patients at high risk of severe post liver transplant hepatitis C recurrence is relevant, as these patients may be treated using interferon (IFN)‐free regimens.
...Methods
In a retrospective study with prospectively collected data, we investigated whether the use of several non‐invasive methods (fibrosis 4 index FIB‐4, AST‐to‐platelets ratio index APRI, enhanced liver fibrosis test ELF, IFN‐γ‐inducible protein 10 IP‐10, and transient elastography by Fibroscan) and their combinations 6 months after transplantation could identify those recipients at higher risk of severe recurrence, defined by the presence of significant fibrosis (F ≥2) and/or portal hypertension (hepatic venous pressure gradient ≥6 mmHg) 12 months after transplant. Seventy‐two hepatitis C virus (HCV)‐infected liver transplant patients and 10 recipients in whom HCV was eradicated before transplantation were included in the study.
Results
The levels of all biomarkers were significantly higher in HCV‐infected recipients than in controls. Among HCV recipients, levels of biomarkers were significantly higher in patients with severe recurrence. Although there were no statistically significant differences between biomarkers, APRI, ELF, and FIB‐4 obtained the highest area under the ROC curve values. The combination of serum biomarkers with Fibroscan increased the negative and positive predictive values, although diagnostic accuracy of individual tests was not significantly improved.
Conclusions
Patients at higher risk of severe HCV recurrence can be identified early, 6 months after transplantation, using readily available non‐invasive methods.
Acral lentiginous melanoma (ALM) arises in areas that are not generally exposed to UV radiation. Chronic trauma has been hypothesized to play a role in the development of this tumor. The aim of this ...study was to analyze the association between the presence and characteristics of ALM and location in stress- and non-stress-bearing areas.
Observational, descriptive analysis. For 95 patients with ALM evaluated at Fundación Clínica Vida in Medellin, Colombia between January 2016 and August 2020 we collected demographic, histologic and clinical variables and assigned the patients to 2 groups depending on whether their tumor was located in a stress-bearing area or not.
Ninety-five patients (36 men and 59 women) with a median age of 59 years were studied. ALMs were more common in stress-bearing areas than in non-stress-bearing areas (58 61% vs. 17 17.8%). A history of direct trauma at the site of the tumor was reported in 18.9% of the cases (p = .025) and was most common in patients with nail lesions. Invasive ALMs in stress-bearing areas had a greater Breslow thickness (p = .006) and higher ulceration rates than those in non-stress-bearing areas (p = .018).
ALM on both the feet and hands is more common in stress-bearing areas. Our findings support the hypothesis that mechanical stress may have a pathogenic role in ALM.
![[Translated article] Charac...](http://api.summon.serialssolutions.com/2.0.0/image/issn/XR4PS5YY4K/0001-7310_1578-2190_1695-4734/small "[Translated article] Characteristics of Acral Lentiginous Melanoma According to Location in Stress- or Non–Stress-Bearing Areas: A Retrospective Study of 95 Patients")
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