Cost-utility analysis of sacituzumab govitecan versus chemotherapy for the treatment of metastatic triple-negative breast cancer in Singapore.

OBJECTIVE: To assess the cost-effectiveness of sacituzumab govitecan for treating relapsed or refractory metastatic triple-negative breast cancer (TNBC) in Singapore. METHODS: A three-state partitioned survival model was developed to evaluate the cost-effectiveness of sacituzumab govitecan from a healthcare system perspective over 5 years. Clinical inputs were obtained from the ASCENT trial. Health state utilities were retrieved from the literature and direct costs were sourced from public healthcare institutions in Singapore. Sensitivity and scenario analyses were conducted to explore the impact of uncertainties and assumptions on cost-effectiveness results. RESULTS: Compared with single-agent chemotherapy, sacituzumab govitecan was associated with a base-case incremental cost-effectiveness ratio (ICER) of S$328,000 (US$237,816) per quality-adjusted life year (QALY) gained. One-way sensitivity analyses showed that the ICER was most sensitive to the cost of sacituzumab govitecan and progression-free utility values. Regardless of variation in these parameters, the ICER remained high, and a substantial price reduction was required to reduce the ICER. CONCLUSION: At its current price, sacituzumab govitecan does not represent a cost-effective treatment for relapsed or refractory metastatic TNBC in Singapore. Our findings will be useful to inform funding decisions alongside other factors including clinical effectiveness, safety, and budget impact considerations.

MRI signs of intrauterine fetal demise.

Intrauterine fetal demise (IUFD) is an uncommon but serious event that may occasionally be encountered on fetal MRI. Compared to the more florid signs of fetal demise which has occurred some time ago, recent IUFD is associated with more subtle findings that may be missed or misinterpreted. The two main MRI sequences used in imaging the fetus are T2-like two-dimensional balanced steady-state free-precession (SSFP), a white blood sequence, or T2-weighted single-shot fast spin-echo (SSFSE), a black blood sequence. The most reliable and specific signs of a recent IUFD are a constricted heart with poorly delineated cardiac chambers and signal abnormality in the heart and aorta, which will have different features depending on the MRI sequence used. Secondary signs of IUFD include global brain ischemia, abnormal globes, effusions, body wall edema and umbilical cord thrombosis. Unlike fetal ultrasound examinations where cardiac activity is routinely assessed, fetal MRI requires careful scrutiny of the fetal heart for assessment of fetal life.

Methadone-induced Toxic Encephalopathy In Pediatric Patients: Two Case Reports.

Toxic encephalopathy is a wide spectrum of encephalopathy secondary to insult from toxic substances, with variable clinical presentations from minor cognitive impairment to severe neurological dysfunction and death. Methadone-induced toxic encephalopathy is an extremely rare form of toxic encephalopathy which typically demonstrates abnormal imaging findings in the dentate nuclei or cerebellum. This is a report of methadone-induced toxic encephalopathy in two toddlers secondary to accidental ingestion. They were brought in unconscious to the emergency department of a tertiary hospital and were found to be cyanotic and pulseless, requiring cardiopulmonary resuscitation and mechanical ventilation. Magnetic resonance imaging (MRI) of the brain of both patients showed similar findings of symmetrical hyperintense foci in bilateral cerebellar hemispheres on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. These areas also demonstrated diffusion restriction on diffusion weighted imaging (DWI). Blood and urine toxicology results confirmed the presence of methadone in both patients. As the exact substance of accidental ingestion may not be known at the time of presentation, early radiological diagnosis of methadone-induced encephalopathy may prompt early initiation of treatment to prevent further life-threatening complications, particularly in vulnerable pediatric population.

Radiological features of a rare case of pancreatic panniculitis presenting in bilateral lower extremities.

Pancreatic panniculitis is a rare cutaneous presentation in patients with pancreatic pathology. While it presents as cutaneous inflammation with painful and erythematous nodules which demonstrate ulceration, imaging features of this pathology are seldom described. The common sites of involvement are the extremities. It demonstrates characteristic histological features of lobular panniculitis with ghost cells. MR imaging with its excellent soft tissue contrast can be helpful in confirming the diagnosis, demonstrating imaging features of fat necrosis with surrounding inflammation as demonstrated in our patient.

Periampullary Diverticula Misdiagnosed as Cystic Pancreatic Lesions: A Review of 3 Cases.

BACKGROUND: Cystic lesions on the pancreatic head can mimic fluid-filled duodenal or periampullary diverticula. We reviewed a series of cases in which periampullary diverticula were misdiagnosed as cystic pancreatic lesions. CASE REPORT: Case 1. A Chinese woman presented to the surgical outpatient clinic for intermittent upper abdominal discomfort. Contrast-enhanced MRI of the abdomen revealed a cystic-appearing lesion in the region of the pancreatic head, which was reported as a cystic pancreatic lesion. A follow-up scan showed this lesion to be filled with fluid, gas, and debris, suggestive of a periampullary diverticulum. Review of a prior CT scan confirmed a periampullary diverticulum. Case 2. A Chinese man with a history of chronic hepatitis B infection underwent an MRI of the liver, which revealed a cystic-appearing lesion in the region of the pancreatic head, reported as a cystadenoma or pseudocyst. The patient underwent an endoscopic ultrasound. A large periampullary diverticulum was discovered but there was no pancreatic head lesion. Case 3. A Chinese woman with a history total hysterectomy and bilateral salpingo-oophorectomy for ovarian malignancy underwent an MRI of the abdomen and pelvis. A cystic-appearing lesion was found in the region of the pancreatic head, which was reported as a cystadenoma or intraductal papillary mucinous neoplasm. Follow-up magnetic resonance cholangiopancreatography showed a signal void within, suggestive of gas within a periampullary diverticulum. Review of a prior CT scan showed a periampullary diverticulum. CONCLUSIONS: Periampullary diverticula, when fluid-filled, can be confused with cystic lesions in the pancreatic head. Radiologists should be aware of this potential pitfall.