Are contrast enhanced mammography and digital breast tomosynthesis equally effective in diagnosing patients recalled from breast cancer screening?

Purpose: Full-field digital mammography (FFDM) is widely used in breast cancer screening. However, to improve cancer detection rates, new diagnostic tools have been introduced. Contrast enhanced mammography (CEM) and digital breast tomosynthesis (DBT) are used in the diagnostic setting, however their accuracies need to be compared.The aim of the study was to evaluate the diagnostic performance of CEM and DBT in women recalled from breast cancer screening program. Methods: The study included 402 consecutive patients recalled from breast cancer screening program, who were randomized into two groups, to undergo either CEM (202 patients) or DBT (200 patients). All visible lesions were evaluated and each suspicious lesion was histopathologically verified. Results: CEM detected 230 lesions; 119 were classified as benign and 111 as suspicious or malignant, whereas DBT identified 209 lesions; 105 were classified as benign and 104 as suspicious or malignant. In comparison to histopathology, CEM correctly detected cancer in 43 out of 44 cases, and DBT in all 33 cases, while FFDM identified 15 and 18 neoplastic lesions in two groups, respectively. CEM presented with 97% sensitivity, 63% specificity, 70% accuracy, 38% PPV and 99% NPV, while DBT showed 100% sensitivity, 60% specificity, 32%, PPV, 100% NPV and 66% accuracy. The CEM's AUC was 0.97 and DBT's 0.99. The ROC curve analysis proved a significant (p<0.000001) advantage of both CEM and DBT over FFDM, however, there was no significant difference between CEM and DBT diagnostic accuracies (p=0.23). Conclusions: In this randomized, prospective study CEM and DBT show similar diagnostic accuracy.

Immunotherapy in Ovarian Cancer.

Despite advances in surgery and chemotherapy, ovarian cancer remains one of the most lethal malignancies. Hence, the implementation of novel treatment approaches is required to improve the outcomes of the disease. Immunotherapy has been proven to be effective in many tumors and has already been incorporated into clinical practice. In this review, we describe key strategies in immunotherapy of ovarian cancer and summarize data from clinical studies assessing immunological prospects which could improve ovarian cancer treatment approaches in the future. The most notable current strategies include checkpoint blockade agents, the use of vaccines, adoptive cell transfer, as well as various combinations of these methods. While several of these options are promising, large controlled randomized studies are still needed to implement new immunotherapeutic options into clinical practice.

Impact of the Q.Clear reconstruction algorithm on the interpretation of PET/CT images in patients with lymphoma.

BACKGROUND: Q.Clear is a new Bayesian penalized-likelihood PET reconstruction algorithm. It has been documented that Q.Clear increases the SUVmax values of different malignant lesions. PURPOSE: SUVmax values are crucial for the interpretation of PET/CT images in patients with lymphoma, particularly when the early and final responses to treatment are evaluated. The aim of the study was to systematically analyse the impact of the use of Q.Clear on the interpretation of PET/CT in patients with lymphoma. METHODS: A total of 280 18F-FDG PET/CT scans in patients with lymphoma were performed for staging (sPET), for early treatment response (iPET), after the end of treatment (ePET) and when a relapse of lymphoma was suspected (rPET). Scans were separately reconstructed with two algorithms, Q.Clear and OSEM, and further compared. RESULTS: The stage of lymphoma was concordantly diagnosed in 69/70 patients with both algorithms on sPET. Discordant assessment of the Deauville score (p < 0.001) was found in 11 cases (15.7%) of 70 iPET scans and in 11 cases of 70 ePET scans. An upgrade from a negative to a positive scan by Q.Clear occurred in 3 cases (4.3%) of iPET scans and 7 cases (10.0%) of ePET scans. The results of all 70 rPET scans were concordant. The SUVmax values of the target lymphoma lesions measured with Q.Clear were higher than those measured with OSEM in 88.8% of scans. CONCLUSION: Although the Q.Clear algorithm may alter the interpretations of PET/CT in only a small proportion of patients, we recommend using standard OSEM reconstruction for the assessment of treatment response.

18F-choline positron emission tomography/computed tomography for the detection of prostate cancer relapse: assessment of maximum standardized uptake value correlation with prostate-specific antigen levels.

OBJECTIVE: Patients with prostate cancer are monitored by prostate-specific antigen (PSA) evaluation and PET [PET/computed tomography (CT)]. The aim of our study was to evaluate correlations between PSA levels and standardized uptake values (SUV) in patients with recurrent prostate cancer. METHODS: We analyzed 282 prostate cancer patients undergoing PET-CT due to suspicion of recurrence. Levels of PSA and PSA change per month were analyzed, together with maximum standardized uptake value (SUVmax). RESULTS: PET/CT results were positive in 175 patients (62.1%) and negative in 107 patients (37.9%). In the positive group, PSA levels were significantly higher. The ROC curve analysis indicated PSA level of 1.70 ng/ml and PSA level change in time of 0.12 ng/ml are the optimal cut-off values. Patients were divided into subgroups: with metastases (M), local relapse (L), and local relapse and metastases (M + L). The latest PSA levels, were similar in subgroups L and M: 5.00 (2.98-10.30) ng/ml and 3.90 (1.27-14.08) ng/ml, but lower than in subgroup M + L: 12.43 (6.08-49.36) ng/ml. PSA level change in time was similar in the subgroups L and M: 0.63 (0.09-1.00) ng/ml/month and 0.33 (0.02-1.73) ng/ml/month, but lower in subgroup M + L: 2.21 (0.22-10.34) ng/ml/month, P < 0.05. SUVmax was significantly (P < 0.05) lower in subgroup L than in M and L + M: 3.00 (2.30-4.00), 4.60 (2.70-7.40), and 4.90 (3.80-8.00), respectively. PSA level significantly correlated with SUVmax in patients from subgroups L (R = 0.424; P < 0.05) and M (R = 0.314; P < 0.01). Positive correlation between PSA change and SUVmax was observed in subgroup M + L (R = 0.561; P < 0.01) and M (R = 0.270; P < 0.05). CONCLUSION: The study confirmed that patients with high PSA level and fast PSA increase are likely to be diagnosed with both, local relapse and metastases. Moreover, SUVmax values in metastatic lesions are usually higher.