Correction to: Nuclear medicine services after COVID-19: gearing up back to normality.

The authors P. Orellana and N. El-Haj were inadvertently deleted in the original paper.

Technetium-99m-MIBI uptake in small cell lung cancer.

UNLABELLED: Patients with small cell lung cancer (SCLC) often fail to respond to chemotherapy due to multidrug resistance (MDR). Technetium-99m-MIBI was reported to be a suitable transport substrate of P-glycoprotein, which is a cytoplasmic membrane protein encoded by the MDR gene. The purpose of this study was to evaluate whether or not the degree of MIBI uptake in SCLC or its retention on delayed imaging correlated with response to chemotherapy. METHODS: Twenty-five patients (19 men, 6 women; mean age 59 +/- 10 yr) with biopsy-proven SCLC had MIBI SPECT 3-7 days before starting chemotherapy. Imaging was acquired 1 and 4 hr after injection of 740 MBq MIBI using a single-head rotating gamma camera. Tumor-to-normal lung uptake ratio (T/NL) was measured. Percent retention (%R) was measured as: %R = 100 x (T/NL at 4 hr)/(T/NL at 1 hr). All patients received VAP chemotherapy (VP-16 100 mg/m2, adriamycin 40 mg/m2, cisplatin 25 mg/m2) every 4 wk for at least three times. Response to chemotherapy was grouped as complete remission, partial remission and no remission according to the change of tumor size on chest radiograph and CT images. Differences in T/NL and %R among the three groups were analyzed using ANOVA. RESULTS: T/NL of patients with complete remission (n = 7) and partial remission (n = 10) were significantly higher than that of no remission (n = 8) in 1 hr and 4 hr. T/NL at 1 hr in three groups were 2.75 +/- 0.78, 2.35 +/- 0.31 and 1.65 +/- 0.36, respectively. T/NL at 4 hr in three groups was 2.61 +/- 0.94, 2.48 +/- 0.50 and 1.66 +/- 0.42, respectively. However, %R was not different among three groups. Percent retention in three groups was 109.40 +/- 22.10, 96.71 +/- 14.25 and 103.59 +/- 28.43, respectively. CONCLUSION: SCLC with a higher MIBI uptake was more likely to respond to chemotherapy than that with a lower uptake. However, there was a considerable overlap of MIBI uptake among subjects. No significant correlation between the MIBI retention between 1 hr and 4 hr, and the response to chemotherapy was noted.

Different cutoff values of Cyfra 21-1 for cavitary and noncavitary lung cancers.

STUDY OBJECTIVES: Cell lysis and tumor necrosis release cytokeratin, a tumor marker of lung cancer, into the serum. The serum cytokeratin level can also be elevated in benign cavitary lung diseases. The purpose of this study was to evaluate whether Cyfra 21-1 can differentiate malignant lung diseases from benign diseases with cavitary lesions. DESIGN: This study is a retrospective review of the case records of patients with lung lesions seen during a 4-year period from January 1993 to May 1996. SETTING AND PATIENTS: Serum Cyfra 21-1 levels were measured in 306 patients with lung cancer (n = 143) or benign lung disease (n = 163). The patients were grouped according to radiologic evidence of cavitary lung lesions. Lung cancer included both non-small cell (n = 123) and small cell (n = 20) lung cancers, and the benign diseases include tuberculosis (n = 87), abscess (n = 26), pneumonia (n = 4), and others (n = 46). MEASUREMENTS AND RESULTS: Although Cyfra 21-1 clearly differentiated cavitary lung cancer (15.0, 9.1-29.8 ng/ml, median and interquartile range, n = 39) from benign cavitary disease (P < 0.001), and noncavitary lung cancer from benign noncavitary disease (1.7, 0.9-2.6 ng/ml, n = 108, P < 0.001), it could not differentiate noncavitary lung cancer (5.0, 2.1-12.4 ng/ml, n = 104) from benign cavitary diseases (3.3, 1.4-8.3 ng/ml, n = 55, P = 0.45). CONCLUSIONS: Serum Cyfra 21-1 is a useful tumor marker for differentiating benign from malignant lung diseases. However, different cutoff values are needed, depending on the presence of cavitary lesions. We recommend cutoff values of 30 ng/ml for cavitary lung diseases and 6 ng/ml for noncavitary lung diseases. If there are no radiologic data, a cutoff value of 15 ng/ml is recommended.

Comparison of Tc-99m sestamibi, serum neuron-specific enolase and lactate dehydrogenase as predictors of response to chemotherapy in small cell lung cancer.

Neuron-specific enolase (NSE) and lactate dehydrogenase (LDH) are tumor markers of small cell lung cancer (SCLC) which were reported to predict outcome of patients with SCLC. We previously reported that dipyridamole-modulated Tc-99m sestamibi (dipyridamole-MIBI) single photon emission computed tomography (SPECT) could predict the response to chemotherapy in SCLC patients. The purpose of this study was to compare dipyridamole-MIBI and pretreatment serum levels of NSE and LDH for the prediction of response to chemotherapy in SCLC. Twenty-eight SCLC patients underwent dipyridamole-MIBI SPECT 3 to 7 days before starting chemotherapy (80 mg/m2 etoposide and 80 mg/m2 cisplatin every 3 or 4 weeks for at lease two cycles). Serum levels of NSE and LDH were also measured at the same day of the imaging. Tomographic images before and after 0.84 mg/kg dipyridamole infusion were acquired 1 hour after injection of 370 (10 mCi) and 1,110 (30 mCi) MBq MIBI, respectively. The response to chemotherapy was grouped as specified as complete (CR), partial response (PR), no change (NC), and progressive disease (PD), according to the change in tumor size on chest roentgenography and CT. Patients showing CR and PR were classified as responders, and those who showed NC and PD were considered nonresponders. Among the 28 patients, 15 were responders (2 CR, 13 PR) and 13 were nonresponders (11 NC, 2 PD). The change of tumor-to-normal lung ratio (T:NL) after infusion of dipyridamole was significantly higher in responders as compared with nonresponders (0.38 +/- 0.64 vs. -0.38 +/- 0.50, respectively, p = 0.002). However, pretreatment serum NSE and LDH levels did not correlate with the response to chemotherapy. Increase of T:NL after dipyridamole infusion was a strong negative predictor of chemotherapeutic response in SCLC patients, while NSE and LDH could not predict it.

Adjuvant internal hepatic radiotherapy using colloidal 32P chromic phosphate in colorectal cancer.

The purpose of the study is to investigate the value of adjuvant radiotherapy given in the form of colloidal chromic phosphate 32P suspension administered via portal vein, in preventing the growth of occult metastases in the liver. Twenty two patients (10 patients of treated group with 12 controls) were followed 12 months after operation. There was no significant change in the CBC and liver functions after administration of 32P labeled colloidal chromic phosphate. Although local recurrence rates were very similar in both groups of colorectal cancer (3/12 in the control group and 4/10 in the treated group), liver metastasis rates were quite different: 4/12 in the control group and none (0/10) in the treated group. In conclusion, 32P labeled colloidal chromic phosphate is expected to prevent liver metastases of completely resected colorectal cancer.

Double-phase Tc-99m sestamibi scintimammography to assess angiogenesis and P-glycoprotein expression in patients with untreated breast cancer.

This study evaluated the relation of Tc-99m sestamibi (MIBI) uptake and washout in untreated breast cancer with immunohistochemically determined angiogenesis and P-glycoprotein expression. Thirty-one patients with untreated breast cancer were studied prospectively. Tc-99m MIBI scintigraphy and immunohistochemical analyses of angiogenesis and P-glycoprotein expression were used to evaluate surgically removed tumor tissues. Anterior and both lateral planar images were acquired 10 and 180 minutes after intravenous injection of 740 MBq (20 mCi) Tc-99m MIBI. The tumor-to-normal breast ratio (T:N) and washout index (early T:N - late T:N divided by early T:N) were calculated. A significant correlation was found between angiogenesis and T:N at early and late images. Pearson's correlation coefficients and probability values were r = 0.54, P = 0.002 at early images and r = 0.47, P = 0.008 at late images. The T:N of both early and late images were not different among different groups of P-glycoprotein expression (P = 0.367 and P = 0.113, respectively), although the washout index was significantly different among the groups (P = 0.001). A strong correlation was found between the washout index and P-glycoprotein expression (r = 0.67, P < 0.01). Double-phase scintimammography to assess the early tumoral uptake and washout of Tc-99m MIBI can be used as a simple functional test for in vivo imaging of tumoral angiogenesis and P-glycoprotein expression in patients with untreated breast cancer.

Tc-99m MIBI uptake in simultaneous thyroid and lung cancers.

The authors present a patient with simultaneous follicular thyroid and small-cell lung cancers, both of which showed Tc-99m MIBI uptake. CT scans showed two masses: one involving the right lower neck including the right supraclavicular area and the right superior mediastinum, and the other involving the peripheral portion of the right upper lobe of the lung. I-131 imaging showed increased uptake in the right neck mass only. Tc-99m MIBI imaging, which was performed for evaluation of chest pain, showed intense uptake in the neck mass (tumor to heart ratios in planar and tomographic images were 0.92 and 0.96, respectively), and less uptake in the lung mass (tumor to heart ratios in planar and tomographic images were 0.53 and 0.40, respectively). Biopsy of the right supraclavicular mass revealed a follicular carcinoma, and a bronchoscopic biopsy of the right upper lobe mass revealed a small cell carcinoma.

Focal pulmonary uptake during Tc-99m myocardial perfusion SPECT imaging.

PURPOSE: To evaluate the incidence and origin of abnormal focal pulmonary uptake during myocardial perfusion SPECT imaging (MSPECT). METHODS: For evaluation of chest pain, 790 men and 581 women (mean age, 56 +/- 13 years) underwent MSPECT. All of them received adenosine for pharmacologic stress and Tc-99m tetrofosmin (TF, n = 817) or Tc-99m sestamibi (MIBI, n = 554) for myocardial perfusion imaging. RESULTS: Review of chest radiography with or without computed tomography revealed 111 (8.1%) focal pulmonary diseases. Among them, 38 (34.2%) showed focal pulmonary uptake (TF, 22; MIBI, 16); 27 (30.7%) of 88 showed previous pulmonary tuberculosis; 2 of 10 (20%) benign pulmonary nodules; 4 of 5 (80%) metastatic lung cancers; 2 of 4 (50%) primary lung cancers; and 3 of 4 (75%) pneumonias. No difference in uptake was noted for the two imaging agents. Intensity of uptake did not vary with origin of the uptake. Focal abnormal pulmonary uptake was found in 2.8% of patients undergoing MSPECT and in 34.2% of patients in whom radiological examinations showed regional pulmonary disease. In patients with abnormal pulmonary uptake on MSPECT, 16% had a malignant lesion, whereas 75% of patients with a pulmonary nodule shown on radiography and focal pulmonary uptake on MSPECT had a malignant lesion. CONCLUSIONS: Although the incidence of abnormal pulmonary uptake during MSPECT was very low, the incidence of malignant lesions in the patients with nodular pulmonary uptake was relatively high.

Dipyridamole modulated Tc-99m sestamibi lung SPECT in small cell lung cancer.

PURPOSE: In this study, the authors wanted to determine whether dipyridamole-modulated MIBI (dipyridamole-MIBI) could enhance the prediction of the response to chemotherapy in patients with small cell lung cancer. METHODS: Twenty-seven patients with biopsy-proved small cell lung cancer (25 men, 2 women; mean age, 61 +/- 7 years) underwent dipyridamole-MIBI SPECT 3 to 7 days before starting chemotherapy (80 mg/m2 etoposide and 80 mg/m2 cisplatin every 3 or 4 weeks for at least two cycles). Tomographic images before and after dipyridamole (0.84 mg/kg) were acquired 1 hour after injection of 370 (10 mCi) and 1,110 (30 mCi) MBq MIBI, respectively. The response to chemotherapy was grouped as specified as complete response (CR), partial (PR), no change (NC), or progressive disease (PD), according to the change in tumor size on chest roentgenography and CT. Patients showing CR and PR were classified as responders, and those who showed NC and PD were considered nonresponders. RESULTS: Among the 27 patients, 22 were responders (3 CR, 19 PR) and 5 were nonresponders (3 NC, 2 PD). The tumor-to-normal lung ratio (T:NL) of responders was significantly higher than that of nonresponders. The diagnostic accuracy of the T:NL ratio to differentiate responders and nonresponders was 33.3%, with a cutoff value of 2.5, which was significantly improved to 77.8% when an increased T:NL ratio after dipyridamole was assigned to a nonresponder. Furthermore, all patients with CR showed diminished T:NL ratios after dipyridamole, and all patients with NR showed an increased T:NL ratio after dipyridamole. CONCLUSION: Dipyridamole-MIBI SPECT could enhance the prediction of response to chemotherapy in patients with small cell lung cancer.

Sero-epidemiology of hepatitis A virus infection among healthcare workers in Korean hospitals.

Hepatitis A virus (HAV) has been increasingly reported in Korea as has an outbreak in Korean healthcare workers (HCWs). This 2008 study evaluated the sero-epidemiology of HAV infections among 3696 HCWs in four Korean hospitals. HCWs were tested for immunoglobulin G anti-HAV antibodies using commercially available kits. Data including demographic characteristics, occupation, workplace and serological status for other hepatitis viruses were collected. Statistical analyses were conducted to identify variables related to HAV seropositivity. Among the 3696 participants, 2742 (74%) were women and the majority (96%) were aged 20-39 years (median: 28; range: 19-68). Eighteen percent were physicians, 46% nurses, 10% nurses' aides, 11% paramedical technicians and 15% administrative staff. Seropositivity for HAV significantly increased with age (P<0.001): 1.8% for < or =24 years, 14.7% for 25-29 years, 41.8% for 30-34 years, 75.5% for 35-39 years, and 93.7% for > or =40 years. Among those aged 20-39 years, age-specific HAV seroprevalence was significantly lower in physicians than in the other occupational groups (P<0.001). In Korea, mass vaccination to HCWs aged < or =29 years or screening for seropositivity and vaccinating non-immune subjects aged 30-39 years should be considered, especially in physicians.

Early gastric cancer in Korea.

We reviewed the 639 cases of early gastric cancer from nation-wide 16 medical centers. The proportion of early gastric cancer among surgically resected gastric carcinoma comprised 6 to 12 percent. Male to female ratio was 1.7 to 1 with male preponderance. Mean ages of the early gastric cancer was 49.0 years and most prevalent ages was 5th decade. Macroscopically type IIc was most prevalent, reaching 59.9 percent. Depressed type lesions was more frequent than elevated type lesions by four folds. The size of lesions less than 4 cm accounted for more than 80 percent. Most frequent site of lesions were lower third by the CMA classification and lesser curvature transectionally. Lymph node metastasis was observed in 10.9 percent of all cases and it was more frequent in large tumor size more than 4 cm, elevated type, and undifferentiated carcinoma. 5-year survival rate was 91.6 percent. Gastrofiberscopic examination was superior to that of radiological examination in the diagnosis of early gastric cancer.

Autoradiographic and immunohistochemical study on the proliferative kinetics of intestinal metaplasia.

In order to elucidate the proliferative behavior of the intestinal metaplasia around gastric cancer, the authors used both in vitro tritiated thymidine (3H-thymidine) autoradiography and in vivo bromodeoxyuridine (BrdUrd) immunohistochemistry for labeling the proliferative cells of the normal pyloric glands and metaplastic gastric glands. The results of the methods were comparable: The labeling pattern and the rate of labeling were very similar. In the normal pyloric mucosa, the labeled cells were confined to the isthmus region, indicating that pyloric glandular cells are normally renewed from the isthmus region. On the other hand, a zone of the labeled cells was found in the lower half of the intestinalized mucosa, indicating that cell proliferation took place deep in the mucosa, just like the case of normal intestinal glands. The labeling indices of the pyloric mucosa were 19.4% by autoradiography and 18.0% by immunohistochemistry, and that of the intestinalized gastric glands were 25.2% by autoradiography and 24.2% by immunohistochemistry. In conclusion, both 3H-thymidine autoradiography and BrdUrd immunohistochemistry showed that the proliferative kinetics of the intestinalized gastric glands was similar to that of the normal intestinal glands rather than the pyloric glands, i.e. a lower level of proliferative zone and higher labeling index were present.

Differentiation of malignant from benign pancreatic mass by Tl-201 abdominal SPECT.

The aim of the present study was to evaluate the ability of Tl-201 abdominal SPECT to differentiate between chronic focal pancreatitis and pancreatic malignancy. Seventeen patients (12 men, 5 women; mean age, 56 years; 9 pancreatic cancer, 8 chronic pancreatitis) with pancreatic mass were prospectively investigated with Tl-201 abdominal SPECT. In all patients, CT and/or US could not clarify the nature of the pancreatic mass. Focal hot uptake was present in 8 of 9 patients with pancreatic cancer, while it was present in 2 of 8 patients with chronic pancreatitis. Therefore, the sensitivity and specificity of the present study were 89% and 75%, respectively. A significant difference of Tl-201 uptakes was noted between benign and malignant masses (p < 0.05). Therefore, we concluded that Tl-201 abdominal SPECT was a useful test in differentiation of malignant from benign pancreatic mass, especially when the differentiation could not be made by other imaging modalities.

A comparison of serum CYFRA 21-1 and SCC Ag in the diagnosis of squamous cell lung carcinoma.

To evaluate the usefulness of CYFRA 21-1 and SCC Ag in the diagnosis of squamous cell carcinoma (SQC) of the lung, we tested sera from 124 patients with lung cancers (squamous cell ca 72, adenoca 22, large cell ca 4, small cell ca 18 and undetermined 8) and 78 patients with inflammatory lung diseases (bronchitis 24, bronchiectasis 29, tuberculosis 19 and others 6) using immunoradiometric assay kit for cytokeratin fragment 19 (CYFRA 21-1) and radioimmunoassay kit for SCC Ag. The serum CYFRA 21-1 and SCC Ag were significantly higher in lung cancer patients compared with control subjects. However, the significant difference was restricted only to SQC. In patients with SQC, CYFRA 21-1 and SCC Ag showed significantly higher levels according to the advanced anatomic stages (stage I-IIIa vs. stage IIIb, IV, p < 0.05). There was a good correlation between CYFRA 21-1 and SCC Ag (r = 0.41, p < 0.001). Receiver operating characteristic (ROC) curves were generated from results of both tumor markers and areas under the curves (AUC) were calculated. AUC of CYFRA 21-1 (0.93) were significantly larger than that of SCC Ag (0.77) for the diagnosis of SQC (p < 0.05). Therefore, we conclude that CYFRA 21-1 is superior to SCC Ag in the diagnosis of squamous cell carcinoma of the lung.