Intra-operative lymphatic mapping and sentinel node biopsy in laryngeal carcinoma using radiotracer injection.

OBJECTIVE: The purpose of this study was to determine the value of sentinel lymph node biopsy (SLNB) in the laryngeal SCC, using intra-operative peri-tumoral injection of Tc-99m-phytate. METHODS: Patients with biopsy-proven squamous cell carcinoma of the larynx were included. On the day of surgery, after anesthesia induction, suspension laryngoscopy was performed to inject 74 MBq/0.4 ml Tc-99m-phytate in four aliquots into the sub-mucosal peri-tumoral location. After a 10-min wait, a portable gamma probe was used to locate sentinel nodes. Subsequently, all patients underwent laryngectomy and neck dissection. Both sentinel nodes and non-sentinel nodes were examined using hematoxylin and eosin (H&E) staining. RESULTS: Twenty-six patients with a diagnosis of laryngeal carcinoma were included in the study. The SLN detection rate was 65.4%, with a 100% detection rate in the supraglottic region and a 52.6% detection rate for glottis/transglottic patients. Permanent pathology results showed lymph node involvement in four patients, but only one patient had a negative result in the SLNB, resulting in an overall false negative rate of 25%. The sensitivity of the SLN technique was 75% overall, 100% in the supraglottic region, and 67% in the glottis/transglottic region. CONCLUSION: The accuracy and feasibility of SLNB may be related to the location of the tumors in the larynx. For supraglottic tumors, the technique seems to be feasible with a low false negative rate. For glottis/transglottic tumors, both the detection rate and false negative rate seem to be suboptimal. Further studies are needed to validate our results.

Omental Hernia as a Potential Cause of False-Positive GI Bleeding on 99mTc-RBC Scintigraphy.

ABSTRACT: Gastrointestinal bleeding scintigraphy is a noninvasive study used to determine the presence of active bleeding, localize the bleeding site, and estimate the bleeding volume for prognostic purposes in patients with suspected gastrointestinal bleeding. However, it is important to note that false-positive results can occur due to various reasons. In this case, we present the scenario of a middle-aged woman who exhibited symptoms of gastrointestinal bleeding and underwent 99mTc-RBC scintigraphy. The imaging revealed an accumulation of radiotracer in the hypogastric region, which was later determined to be caused by an omental hernia on SPECT/CT images. The herniated structure caused congestion in the mesenteric vessels, leading to the accumulation of 99mTc-RBC. This case highlights the significance of considering anatomical anomalies and nonbleeding pathologies when interpreting the 99mTc-RBC scintigraphy results for gastrointestinal bleeding.

Reappraising the role of thyroid scintigraphy in the era of TIRADS: A clinically-oriented viewpoint.

Thyroid nodules (TNs) are a common entity, with the majority being benign. Therefore, employing an accurate rule-out strategy in clinical practice is essential. In the thyroid field, the current era is significantly marked by the worldwide diffusion of ultrasound (US)-based malignancy risk stratification systems of TN, usually reported as Thyroid Imaging Reporting And Data System (TIRADS). With the advent of US (and later TIRADS), the role of thyroid scintigraphy (TS) in clinical practice has gradually diminished. The authors of the present paper believe that the role of TS should be reappraised, also considering its essential role in detecting autonomously functioning thyroid nodules and its limited contribution to detecting thyroid cancers. Thus, this document aims to furnish endocrinologists, radiologists, surgeons, and nuclear medicine physicians with practical information to appropriately use TS.

Sentinel Node Mapping in Ovarian Tumors: A Study Using Lymphoscintigraphy and SPECT/CT.

Purpose: Ovarian cancer in the early stage requires a complete surgical staging, including radical lymphadenectomy, implying subsequent risk of morbidity and complications. Sentinel lymph node (SLN) mapping is a procedure that attempts to reduce radical lymphadenectomy-related complications and morbidities. Our study evaluates the feasibility of SLN mapping in patients with ovarian tumors by the use of intraoperative Technetium-99m-Phytate (Tc-99m-Phytate) and postoperative lymphoscintigraphy using tomographic (single-photon emission computed tomography/computed tomography (SPECT/CT)) acquisition. Materials and Methods: Thirty-two patients with ovarian mass participated in this study. Intraoperative injection of the radiopharmaceutical was performed just after laparotomy and before the removal of tumor in utero-ovarian and suspensory ligaments of the ovary just beneath the peritoneum. Subsequently, pelvic and para-aortic lymphadenectomy was performed for malignant masses, and the presence of tumor in the lymph nodes was assessed through histopathological examination. Conversely, lymphadenectomy was not performed in patients with benign lesions or borderline ovarian tumors. Lymphoscintigraphy was performed within 24 hr using tomographic acquisition (SPECT/CT) of the abdomen and pelvis. Results: Final pathological examination showed 19 patients with benign pathology, 5 with borderline tumors, and 6 with malignant ovarian tumors. SPECT/CT identified SLNs in para-aortic-only areas in 6 (20%), pelvic/para-aortic areas in 14 (47%), and pelvic-only areas in 7 (23%) cases. Notably, additional unusual SLN locations were revealed in perirenal, intergluteal, and posterior to psoas muscle regions in three patients. We were not able to calculate the false negative rate due to the absence of patients with involved lymph nodes. Conclusion: SLN mapping using intraoperative injection of radiotracers is safe and feasible. Larger studies with more malignant cases are needed to better evaluate the sensitivity of this method for lymphatic staging of ovarian malignancies.

Accuracy of sentinel node mapping in Marjolin ulcer: Comparison of three different injection techniques.

BACKGROUND: Marjolin ulcer is a specific type of squamous cell cancer that can benefit from the use of lymphoscintigraphy.The purpose of this study was to evaluate 3 different injection techniques for sentinel node biopsy in patients with Marjolin ulcer. METHODS: Forty-eight patients with Marjolin ulcer (27 male and 21 female) ranging in age from 24 to 85 years were included in our study. Intratumoral (IT), peritumoral (PT) and periscar (PS) tissue injections of radiotracer were done in 9, 10, and 29 patients respectively. Injections were done 2-4 h before surgery. Lymphoscintigraphy was done for mapping the lymphatic drainage. During surgery, lymphatic mapping and sentinel node biopsy was performed using a handheld gamma probe. After harvesting sentinel nodes, regional lymph node dissection was done. RESULT: Sentinel node detection rate was higher in the PS group as compared to the IT and PT groups (89.6% vs. 50% and 22.2%) respectively. False negative rate was 0%. Pathologically involved sentinel nodes were detected in 16% of the included patients of our study which led to management change. None of the patients with pathologically non-involved sentinel nodes developed regional lymph node recurrence. CONCLUSION: Lymphatic mapping and sentinel node biopsy is feasible in Marjolin ulcer with high detection rate and low false negative cases which by detection of regional lymph node involvement can potentially change the management of patients. Injection site may be an important factor influencing the success of the procedure and injection of the mapping material in the peri-scar normal skin proximal to the lesion is the best technique.

Nonmalignant 68 Ga-FAPI-46 Uptake in 2 Cases of TENIS Syndrome : Comparison With 18 F-FDG.

ABSTRACT: The cancer specificity of fibroblast activation protein inhibitor (FAPI) uptake remains understudied topic, and several cases of false-positive FAPI PET/CT findings have been reported. We present 2 patients of differentiated thyroid cancer with thyroglobulin elevation and negative iodine scintigraphy syndrome who underwent 68 Ga-FAPI PET/CT and 18 F-FDG PET/CT for evaluation of any possible sites for metastatic disease. Although no focus of metastatic disease was found in these patients, remarkable findings were noticed instead. Nonmalignant FAPI uptake was evident in the gallbladder, uterus, and degenerative changes, whereas these uptake were discordant or partially concordant with those in FDG's, also CT images showed no underlying abnormality.

Evaluation of the diagnostic value of Sentinel Lymph Node in patients with gastric adenocarcinoma.

Objectives: Sentinel lymph node biopsy (SLNB) has been proven as a safe and efficient procedure in some cancers like breast cancer and melanoma with a reduction of complications and side effects of unnecessary lymphadenectomy in many patients. However, the diagnostic value of SLNB in gastric cancer is a point of debate. This study evaluated the diagnostic value of SLNB using radiotracer and isosulphan blue dye injection in patients with Gastric Adenocarcinomas (GA). Methods: This descriptive study was performed at Imam-Reza HOSPITAL on 39 patients diagnosed with GA with no lymphatic metastasis using two methods: the combination of radionuclide with isosulphan together (R&I) method compared with the isosulphan alone method. Lymphatic dissection was performed in all patients. The pathological results were compared between the sentinel lymph nodes (SLN) and other lymph nodes and their accordance rate was calculated. Results: In the T1 group, the sentinel lymph node biopsy detection rate was 100% for the combination of the R&I method and 60% for the isosulphan method and the false negative rate was zero. These values respectively were 88.8% and 88.8% in the T2 group with a false negative rate of 75%. In the T3 group, the values were 100% for the combination of the R&I method and 93.7% for the isosulphan method with a false negative rate of 40%. In the combination of the R&I method, the sensitivity, specificity, and positive and negative predictive values were 57.9, 100, 100, and 69.2 percent respectively. Conclusion: Based on the false negative rate (47.4%), SLNB by injection of isosulphan blue dye alone is not a diagnostic enough value for predicting lymph node metastasis in GA. Although, SLNB by combination of the R&I had better accuracy compared to the isosulphan alone, more studies with larger samples are needed to prove this result.

High-Protein Diets during either Resistance or Concurrent Training Have No Detrimental Effect on Bone Parameters in Resistance-Trained Males.

BACKGROUND: The effects of combining resistance training (RT) and concurrent training (CT; resistance + endurance training) with varied protein doses on bone measures remain poorly understood. Hence, we conducted a comparison of the impacts of two high-protein diets (1.6 or 3.2 g kg-1 d-1) over 16 weeks in resistance-trained males, either with CT or RT alone. METHODS: A total of forty-eight males, all of whom were resistance-trained, had the following demographics: 26.6 ± 6 years, body mass index: 25.6 ± 2.9 kg m-2 administered either 3.2 g kg-1 d-1 protein (CT2; n = 12; RT2; n = 12) or 1.6 g kg-1 d-1 protein (CT1; n = 12; RT1; n = 12) during 16 weeks (four sessions·w-1). Bone parameters were assessed pre- and post-intervention. RESULTS: There was no significant interaction between the intervention group and time for the legs, arms, ribs, or pelvis area BMC and BMD (p > 0.05). For the BMD of the pelvis and the BMC of the right ribs, however, there were significant time effects noted (p < 0.05). Furthermore, there was a significant interaction between the intervention group and time in the lumbar and thoracic spines, with a particular time effect noted for the thoracic spine region (p < 0.05). The regional differences in skeletal responses to the intervention are highlighted by these data. CONCLUSION: Our findings show that the intake of two high-protein diets combined with RT and CT during 16 weeks had no adverse effects on bone tissue parameters. While these findings indicate that protein intake between 2 and 3 times the current RDI does not promote bone demineralization when consumed in conjunction with exercise, future studies investigating the long-term effects of chronic high protein intake on bone tissue health are warranted.

Initial Staging and Response Evaluation With 18 F-FDG PET/CT in a Rare Case of Nested Variant Urothelial Urethral Cancer.

ABSTRACT: Primary urothelial urethral cancer is a relatively infrequent but serious form of cancer in the urinary tract, and nested variant is extremely rare. Until now, no studies have been published regarding 18 F-FDG PET/CT in patients with primary urothelial urethral cancer. In this study, we discussed the role of 18 F-FDG PET/CT in the initial staging, treatment response evaluation, and recurrence assessment of a 53-year-old woman with nested variant urothelial urethral cancer, which could lead to timely diagnosis and evaluation of the extent of involvement, thus achieving the best treatment plan for this group of patients.

Unilateral Chronic Parotitis With 68 Ga-DOTA-FAPI-04 PET/CT and 18 F-FDG PET/CT Imaging in a Case of a Patient With Papillary Thyroid Carcinoma.

ABSTRACT: The 68 Ga-FAPI (fibroblast activation protein inhibitor) radiotracer is a novel and versatile tool in nuclear medicine, exhibiting potential for use in various conditions due to its significant upregulation in cancerous and inflammatory conditions, particularly those involving fibrotic and infectious processes. In this report, we present the case of a patient with papillary thyroid carcinoma who underwent total thyroidectomy and iodine therapy. He was referred because of high thyroglobulin despite negative diagnostic radioiodine imaging (TENIS syndrome). The patient underwent 18 F-FDG and 68 Ga-DOTA-FAPI-46 PET/CT imaging for metastatic workup and treatment planning. FAPI uptake was observed in the right parotid gland (with no FDG uptake), prompting a 99m TcO 4- salivary scintigraphy. Subsequently, a diagnosis of chronic sialadenitis was made.

Effects of 16 weeks of two different high-protein diets with either resistance or concurrent training on body composition, muscular strength and performance, and markers of liver and kidney function in resistance-trained males.

PURPOSE: It is unclear whether resistance (RT) and concurrent training (CT; resistance plus endurance training) combined with different protein intakes have differential effects on muscle hypertrophy, strength, and performance. Therefore, we compared the effects of two high-protein diets (1.6 or 3.2 g.kg-1.d-1) during 16 weeks of either CT or RT alone in resistance-trained males. METHODS: Forty-eight resistance-trained males (age: 26 ± 6 yr, body mass index: 25.6 ± 2.9 kg.m-2) performed 16 weeks (four sessions·w-1) of CT or RT with either 1.6 g.kg-1.d-1 protein (CT1; n = 12; RT1; n = 12) or 3.2 g.kg-1.d-1 protein (CT2; n = 12; RT2; n = 12). Training adaptations were assessed pre-, mid-, and post-intervention. RESULTS: All measures of performance (endurance, vertical jump, and pull-up), lean mass, muscle strength, and power significantly increased post-intervention in all groups, but peak power gains were greater in RT2 compared with RT1 and CT1 (p < .05). VO2max significantly increased in both CT groups (p < .001). Select biochemical markers of kidney and liver function significantly increased within the RT2 and CT2 groups (p < .05), however, no between-group differences were apparent (p > .05). CONCLUSIONS: With the exception of peak power, intake of 1.6 g.kg-1.d-1 of protein appears sufficient to maximize gains in lean mass, muscle strength, performance, and aerobic capacity during both RT and CT without influencing markers of kidney and liver function, indicating this daily protein amount is effective and safely tolerated in young, healthy adults.

[68Ga] Ga-Pentixafor diffuse bilateral Adrenal & Breast uptake in a patient with High-grade Glioma: A note of caution on normal variants.

[68Ga] Ga-labeled C-X-C motif receptor4 as a novel radio-ligand using PET/CT has been investigated for tracing various kinds of solid and hematopoietic malignancies in recent years. High-grade Glioma (WHO classification 2016 grade III and IV) shows elevated levels of CXCR4 ligand expression in the affected tumoral cells. Healthy and non-affected organ cells express low-level CXCR4 ligands density. We performed [68Ga] Ga-Pentixafor (Pars-Cixafor™) PET/CT in a patient with high-grade Glioma (anaplastic oligodendroglioma WHO grade III) with no other documented medical condition and history. In addition to the Pentixafor-avid tumor remnant in the PET/CT images, we observed mild symmetrical bilateral uptake in the fibro glandular tissue of the breasts and moderate CXCR4(Pentixafor) avidity in both adrenal glands without any discernable pathology and abnormal density changes in the CT component of the study. Attention should be paid to the interpreting [68Ga] Ga-Pentixafor PET/CT examination and its normal uptakes and variants.

Diagnostic importance of lung perfusion/ventilation scans in the evaluation of pulmonary embolism in COVID-19 patients: systematic review of the literature.

OBJECTIVE: To investigate the outcomes of ventilation/perfusion scintigraphy on the diagnosis of pulmonary embolism in coronavirus disease 2019 (COVID-19) patients, we performed a systematic review of the available literature. MATERIALS AND METHODS: PubMed and Scopus were systematically searched up to 4 June 2022, for relevant studies. We included studies on patients with COVID-19 who have performed ventilation/perfusion scintigraphy for diagnosis of pulmonary embolism to describe any diagnosis outcome. Irrelevant and non-English articles were excluded. RESULTS: Overall, 27 articles were included in our review. The database search yielded studies from PubMed, Scopus, and studies identified through reviewing the reference list of included studies. Extracted information from the included studies could be categorized into several aspects: Diagnosis of pulmonary embolism with Q single-photon emission computed tomography (SPECT) CT, Tracheobronchial uptake, Diagnostic value of V/Q rather than Q at diagnosis pulmonary embolism, Different characteristics (morphological alterations) of COVID-19 in ventilation orperfusion scan, the prevalence of pulmonary embolism with Q or V/Q criteria, and Design of radiotherapy planning in lung cancer patients with COVID-19. CONCLUSION: Different perfusion patterns in COVID-19 are challenging but can be alleviated by adding SPECT/computed tomography (CT) to lung perfusion scans. Although perfusion only SPECT/CT can rule out or rule in others in considerable number of patients, ventilation scan is still needed in certain patients.

Interesting Findings in 68 Ga-FAPI-46 PET/CT Imaging in a Patient With Glioblastoma Multiforme.

ABSTRACT: A 55-year-old disabled man with glioblastoma multiforme was referred to us for fibroblast activation protein inhibitor (FAPI) PET/CT imaging. 68 Ga-DOTA-FAPI-46 scan revealed uptake in the primary tumor and unexpected uptakes in soft tissue, especially in periarticular regions. These latter foci were compatible with calcifications on the CT. One in the breast was compatible with fibrotic tissue, but 2 other foci, in the rectus abdominis and gallbladder wall, could not be correlated with the CT findings. In Neurogenic heterotopic ossification, hypoxia-associated oxidative stress results in the metaplastic transformation of fibroblasts. Abnormal differentiation of fibroblasts in neurogenic heterotopic ossification before ossification could explain radiolabeled FAPI avidity in the mentioned areas.

Lung Ventilation-Perfusion Scan in COVID-19: Various Patterns of Perfusion Defects.

ABSTRACT: Although COVID-19 infection is associated with the increased risk of pulmonary thromboembolism (PTE), COVID-19 pulmonary lesions cause ventilation-perfusion (V/Q) patterns other than PTE. Although extensive research has been done to address different anatomical patterns of COVID-19, there is a knowledge gap in terms of V/Q lung scintigraphy in these patients. The purpose of this study is to demonstrate these patterns and to show how important it is to use SPECT/CT in addition to planar images to differentiate between these patterns from PTE. In the current collection, we presented various patterns of V/Q SPECT/CT abnormalities in COVID-19 patients.

A meta-analysis of prognostic factors in patients with left-sided pancreatic cancer.

Background: Patients with ductal adenocarcinoma of the body and tail of the pancreas usually remain asymptomatic until late in the course of the disease, and the survival of such patients depends on multiple factors, which may affect the therapeutic approach and patient survival. Hence, the aim of this study was to investigate such risk factors by pooling various available studies. Methods: A systematic review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines between January 1, 2007, and December 31, 2016, using the following databases: Medline, Scopus, the Cochrane Library, and Google Scholar. Studies were selected according to the predesigned eligibility criteria, and information was extracted for demographics, clinical features, and survival outcomes. Data were pooled using fixed- or random-effects models. Results: Sixteen studies were included (5,660 patients) with a median age of 64.8 years and a median survival of 28.5 (range 13-38) months. Identified significant factors for overall survival were higher age (hazard ratio [HR] = 1.211), men (HR = 1.182), presence of lymph node metastasis (HR = 1.964), multivisceral resection (HR = 1.947), N stage (1 versus 0; HR = 1.601), surgical margin (R0 versus No R0; HR = 0.519) and tumor size (>3 cm; HR = 1.890). Conclusion: The pooled results of this study revealed several risk factors for overall survival in patients with left-sided pancreatic cancer.