Comparison of prognostic value of different metabolic response criteria determined by PET/CT in patients with metastatic breast cancer under CDK 4/6 inhibitor treatment.

PURPOSE: This study evaluates the prognostic role of different [18F]FDG PET/CT metabolic response criteria in metastatic breast cancer (MBC) patients treated with cyclin-dependent kinase 4/6 inhibitors (CDK 4/6). MATERIALS AND METHODS: We retrospectively evaluated the data of MBC patients treated with CDK 4/6 inhibitors who underwent an [18F]FDG PET/CT scan before starting and during treatment. [18F]FDG PET/CT response was assessed with the European Organization for Research and Treatment of Cancer (EORTC), PET Response Criteria in Solid Tumors (PERCIST), and whole-body total lesion glycolysis (WBTLG) criteria. Fleiss kappa was computed to assess the agreement between metabolic response criteria. The endpoint of the study was progression-free survival (PFS). PFS data were analyzed by the Kaplan-Meier method and compared using the log-rank test. RESULTS: The study included sixteen MBC patients who received CDK 4/6 inhibitors therapy. According to PERCIST, partial metabolic response (PMR) was found in seven patients, stable metabolic disease (SMD) in seven patients, and progressive metabolic disease (PMD) in two patients. According to EORTC, PMR was detected in eight patients, SMD in seven patients, and PMD in one patient. According to WBTLG, PMR was found in 10 patients, SMD in four patients, and PMD in two patients. There was a fair agreement between the three criteria. While progression was detected in seven of the patients during follow-up, no progression was detected in nine of them. Kaplan-Meier analysis revealed that the responders according to WBTLG showed significantly longer PFS than non-responders. CONCLUSION: Treatment response according to WBTLG criteria during treatment appears to be associated with prolonged PFS in patients treated with CDK 4/6 inhibitors for MBC.

Characteristics of Radiopharmaceutical Uptake in Primary Tumor and Metastatic Lesions of Prostate Carcinoma: Comparison of Oligometastatic with Multimetastatic Disease.

Objectives: Oligometastases may generate secondary to indolent tumor biology. In this study, we investigated whether semiquantitative measures of 18F-fluorodeoxyglucose (FDG) and gallium-68 (68Ga) prostate-specific membrane antigen (PSMA) uptake of metastatic lesions and prostatic sites are different between oligometastatic (OM) and multimetastatic (MM) disease of prostate carcinoma (PC). Methods: Patients with PC, who underwent positron emission tomography/computed tomography (PET/CT) from October 2012 to February 2020 were retrospectively reviewed. Patients, whose reports were consistent with metastatic diseases were selected. Patients classified as with MM or OM disease. Maximum standardized uptake values (SUVmax) were calculated from metastatic lesions and the prostatic site. The median of the SUVmax results between patients with OM and MM disease were compared. Results: A totally 145 patients with a mean age of 71.46±9.26, were evaluated. In 59 of 145 patients, 18F-FDG PET/CT was performed;86 patients had gone through 68Ga PSMA PET/CT. Thirty-seven of 145 patients were OM, whereas 108 patients were MM. The median of the SUVmax of metastatic lesions in patients with OM and MM disease in the 18F-FDG group were 5.60 and 9.51, respectively. The results of the calculated median SUVmax values in OM and MM disease in the Ga-68 PSMA group were 13.44 and 29.84, respectively. A significant difference was observed in the median SUVmax results of metastatic lesions between OM and MM disease (p<0.05). Median values of SUVmax calculated from the prostatic site in OM and MM disease were 7.83 and 12.29 respectively in 18F-FDG; 26.23 and 26.74 in the 68Ga PSMA group. No significant difference was found in the SUVmax results of the prostatic site between OM and MM disease (p>0.05). Conclusion: SUVmax results of metastatic lesions are significantly higher in patients with MM than in patients with OM disease in patients with PC, which may be secondary to their different biological contents in terms of aggressiveness.

Isolated Liver Metastasis Detected by 68 Ga-PSMA PET/CT in Newly Diagnosed Prostate Cancer.

ABSTRACT: Lymph nodes, bones, and liver are the most typical metastatic sites for prostate cancer. However, isolated liver metastasis from prostate cancer is extremely rare. Here, we report a 75-year-old man with newly diagnosed prostate adenocarcinoma, with isolated liver metastasis detected by 68 Ga-PSMA ( 68 Ga-prostate-specific membrane antigen) PET/CT. There was no sign of regional or distant metastases elsewhere. This case highlights the value of 68 Ga-PSMA PET/CT in detecting a very uncommon solitary liver metastasis from prostate cancer.

Diagnostic compatibility of V/Q SPECT and CTPA, which are non-invasive diagnostic methods, for the detection of CTEPH, which is a treatable cause of pulmonary hypertension.

OBJECTIVE: To evaluate the compatibility between ventilation/perfusion (V/Q) single photon emission computed tomography (SPECT) scintigraphy and computed tomography pulmonary angiography (CTPA) in diagnosing chronic thromboembolic pulmonary hypertension (CTEPH). SUBJECT AND METHODS: Twenty cases of CTEPH, out of 98 patients with pre-diagnosis of pulmonary hypertension (PH), who was diagnosed with CTEPH with a multidisciplinary approach and a council decision, were included in the study retrospectively. The diagnostic performances of V/Q SPECT and CTPA, which are used as noninvasive methods in diagnosing CTEPH, and the compatibility between them were calculated statistically. RESULTS: Of 20 patients diagnosed with CTEPH, 12 were female, and 8 were male; the mean age was 59.1 (range: 36-79). The sensitivity of V/Q SPECT scintigraphy of imaging methods used to diagnose CTEPH was 90%, CTPA was 80%, specificities were 88% and 92%, respectively, and accuracy was 88% in both cases methods. According to the reference standard, the kappa value for V/Q scintigraphy was calculated as 0.765 and 0.678 for CTPA. These values were statistically significant (P<0.01), and there was a substantial concordance between them. CONCLUSION: There is significant compatibility between V/Q SPECT scintigraphy and CTPA in diagnosing CTEPH, whose differential diagnosis is essential because of its high cure potential due to PH causes.

Characterization of bone metastases detected on 68Ga-PSMA PET/CT in newly diagnosed prostate cancer.

OBJECTIVE: This study sought to investigate the characteristics of bone metastasis (BM) and the association of BM with clinicopathological factors in prostate cancer (PCa) patients presenting with BM on the initial staging gallium-68-prostate-specific membrane antigen (68Ga-PSMA) positron emission tomography/computed tomography (PET/CT). MATERIALS AND METHODS: Patients with at least one BM in the initial staging 68Ga-PSMA PET/CT between January 2018 and December 2021 were reviewed retrospectively. Types of BM were classified according to 68Ga-PSMA PET/CT findings as osteoblastic (OB), osteolytic (OL), intramedullary (IM) and coexistence of these types. Patients were divided into two groups according to the number of BM: Oligo-BM for those with five or fewer BMs and poly-BM for those with more than five BM. Receiver-operating characteristic (ROC) curves were generated for serum bone-specific alkaline phosphatase (ALP) and prostate-specific antigen (PSA) levels to discriminate between oligo-BM and poly-BM groups. Univariate and multivariate logistic regression tests were performed to find independent predictors of poly-BM. RESULTS: A total of 53 patients with a median age of 70 (range: 49-88) were included in the study. The median Gleason score of the patients was 8 (range: 6-10). Among the patients, 23 had solely OB-type; 10 had solely IM type; 12 had OB and IM type; four had IM and OL type, two had OB and OL type; one had solely OL type, and one had IM and OB and OL type BM. Oligo-BM was detected in 25 patients (47.2%) and poly-BM was detected in 28 patients (52.8%). In multivariate analyses, serum ALP levels ≥122U/L and PSA levels ≥85.4ng/mL were found to be independent predictors of poly-BM. CONCLUSION: In characterizing BM of PCa, we found that OB-type metastases were the most common type, followed by IM-type and OL-type metastases, respectively. High ALP and PSA levels were found to be independent predictors of poly-BM.

A rare involvement of diffuse large B-cell lymphoma: Peritoneal lymphomatosis with a peritoneal super-scan appearance on 18F-FDG PET/CT.

Peritoneal lymphomatosis (PL) is a rare extranodal involvement of non-Hodgkin's lymphoma (NHL) and is associated with a poor prognosis. It is confused with the more common peritoneal carcinomatosis and may be misdiagnosed. Early diagnosis is the most important step of effective treatment. In patients with NHL, fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) is a valuable imaging modality in guiding biopsy, determining extent of the disease, and evaluating metabolic response to therapy. It also provides important information in the differential diagnosis. We report a case of a 40-year-old male patient who presented with abdominal distention and pain, with diffuse thickening of the peritoneum suggestive of peritoneal carcinomatosis on a computed tomography scan. Biopsy from the thickened peritoneum confirmed the diagnosis of diffuse large B cell lymphoma (DLBCL). Fluorine-18-FDG PET/CT performed for staging showed thickening and increased 18F-FDG uptake in almost the entire peritoneum as well as lymph node involvement in supra- and infra-diaphragmatic areas, and a mass in the spleen. Post-treatment 18F-FDG PET/CT revealed a complete metabolic response.

Can shear wave elastography determine remnant thyroid tissue in the early postoperative period in patients with differentiated thyroid carcinoma?

PURPOSE: This study aims to investigate the usability of ultrasonography (US) and shear wave elastography (SWE) in detecting remnant thyroid tissue (RTT) within the first three postoperative months in patients who underwent total thyroidectomy (TT) for differentiated thyroid cancer (DTC) and who were scheduled for radioiodine (RAI) ablation therapy. METHODS: Sixty-nine patients who underwent a TT operation due to DTC were included in the study. The participant's thyroid surgical bed was first evaluated by thyroid scintigraphy and then by greyscale US and SWE to investigate RTT. The participants were divided into two groups, those with and those without RTT. SWE quantitative data were compared between the two groups. Receiver operating characteristic (ROC) curve analysis was performed to determine the best cut-off values for stiffness and velocity in distinguishing RTT. RESULTS: A total of 149 regions were analysed in 69 participants (43 females, 26 males). The average time elapsed after the operation was 65.2 ± 24.1 days. RTT was determined by scintigraphy and US-SWE in 38 (55%) patients. The stiffness and velocity values were significantly higher in the group with RTT than in the group without RTT. To distinguish RTT from the thyroid bed, the best cut-off values for stiffness and velocity were 15.7 kPa and 2.12 m/s, respectively. CONCLUSIONS: US with SWE can detect RTT in the early postoperative period in patients who have undergone TT due to DTC and who are scheduled for RAI treatment. The use of US and SWE will be particularly beneficial in patients with RTT but who have false-negative Tg levels and RTT that is not I-131 avid.

Using 2-dimensional color superb microvascular imaging vascularization index technique in the assessment of thyroid surgical bed.

AIM: The purpose of this study was to investigate the effectiveness of the vascularization index (VI) obtained using color superb microvascular imaging (cSMI) technique in the assessment of thyroid surgical bed for remnant thyroid tissue (RTT). MATERIAL AND METHODS: We evaluated the thyroid surgical bed of 65 patients who had underwent total thyroidectomy (TT) due to papillary carcinoma (PC) using thyroid scintigraphy and cSMI. Color SMI was also performed for the examination of the thyroid parenchyma of 39 healthy asymptomatic participants. VI measurements were performed by manually drawing the contours of the RTT in those with remnant thyroid, the thyroid surgical bed in the patients' group without remnant thyroid, and normal thyroid parenchyma in the control group, using the free region of interest (ROI) with 2-dimensional color SMI VI (2DcSMIVI) mode. The volume of ROI was measured and echogenicity was evaluated. The quantitative 2DcSMIVI values of the surgical bed with RTT (Group A), the surgical bed without RTT (Group B) and normal thyroid of healthy asymptomatic participants (Group C) were compared. RESULTS: The mean 2DcSMIVI values of Group A was significantly higher than Group B and C (p=0.001). The presence of RTT can be diagnosed with 89.1% sensitivity and 87.5% specificity when 1.75 2DcSMIVI is designated as the cut-off value. CONCLUSION: The 2DcSMIVI is an effective imaging technique that can be used for the diagnosis of RTT.

Bone mineral density in emphysema and chronic bronchitis phenotypes in hospitalized male chronic obstructive pulmonary disease patients.

INTRODUCTION: Risk of osteoporosis known to increase in chronic obstructive pulmonary disease (COPD), but is usually overlooked, especially in male patients. OBJECTIVES: The present study compares the bone mineral density (BMD) measurements of male COPD patients with emphysema and the chronic bronchitis phenotype, and evaluates the association between density of emphysema and osteoporosis. METHODS: Ninety-four patients with COPD, and with emphysema and the chronic bronchitis phenotype, were included in the prospective study. A high-resolution computed tomography (HRCT) was used for the diagnosis of emphysema, and a dual X-ray absorptiometry was used to measure the BMD of the lumbar vertebrae and neck of the femur. RESULTS: Emphysema phenotype 45.75% and chronic bronchitis phenotype 54.25%, based on their clinical findings and a quantitative volumetric analysis by HRCT. Osteoporosis was found 60.47% and 17.65% of patients with emphysema and bronchitis, while osteopenia was detected 27.91% and 41.18% of patients with emphysema and bronchitis, respectively. A negative correlation was found between HRCT emphysema density and the bone densitometer t-score in patients with osteoporosis. Among the patients with osteoporosis, a positive correlation was found between Body Mass Index (BMI) and the bone densitometer t-score. Only BMI and emphysema score were found to be independent risk factors for a low BMD. One unit drop in BMI increased the risk of osteoporosis by 28% (OR = 1.28, 95% CI 1.14-1.45) (P < 0.001). One unit increase in emphysema score increased the risk of osteoporosis by 6% (OR = 1.06, 95% CI 1.03-1.09) (P < 0.001). CONCLUSION: Especially male patients with emphysema, high dyspnea score, low BMI and frequent exacerbations should be evaluated for osteoporosis.

Evaluation of bone mineral density (BMD) and indicators of bone turnover in patients with hemophilia.

A decrease in bone mass is observed in hemophilic patients. The aim of this study was to evaluate bone mineral density (BMD), parathyroid hormone (PTH), 25-hydroxy vitamin D (vitamin D), and a bone formation and resorption marker, procollagen type I N-terminal propeptide (PINP) and urinary N-terminal telopeptide (uNTX) respectively, in hemophilic patients and healthy controls. Laboratory parameters related to the pathogenesis of bone loss such as neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) were also evaluated. Thirty-five men over 18 years of age, with severe hemophilia (A and B) and receiving secondary prophylaxis, were included in the study. The same number of age-, sex-, and ethnicity-matched healthy controls were evaluated. Anthropometric, biochemical, and hormonal parameters were determined in both groups. No significant difference in anthropometric parameters was found between the two groups. The BMD was low in 34% of hemophilic patients. Vitamin D, calcium, and free testosterone levels were significantly lower (p < 0.001, p = 0.011, p < 0.001, respectively), while PTH, PINP, and activated partial thromboplastin time (aPTT) levels were significantly higher (p < 0.014, p = 0.043, p < 0.001, respectively), in hemophilic patients compared to controls. There was no significant difference between the two groups in NLR, PLR, phosphorus, thyroid-stimulating hormone, and uNTX level. The reduction of bone mass in hemophilic patients may be evaluated using the markers of bone formation and resorption, enabling early detection and timely treatment.

Comparative Effectiveness of Laparoscopic Sleeve Gastrectomy on Morbidly Obese, Super-Obese, and Super-Super Obese Patients for the Treatment of Morbid Obesity.

BACKGROUNDS: The management of super-super obese patients is challenging for bariatric surgeons. Laparoscopic sleeve gastrectomy (LSG) is feasible as two-stage treatment for high-risk patients. However, its efficacy as a stand-alone procedure in super-super obese (SSO) patients is controversial. The study objective was to demonstrate the safety and efficacy of LSG in super-obese (SO) and SSO patients. METHODS: A retrospective analysis was performed of consecutive patients undergoing LSG. The patients were classified into three groups: morbidly obese (MO), SO, and SSO. The patients' data, including each patient's characteristics, body mass index (BMI), preoperative comorbidities, postoperative complications, the resolution of comorbidities, percentage of excess weight loss (%EWL), and total weight loss (%TWL) were compared between groups. RESULTS: Of the 186 patients, 163 (87.6%) were followed up for 41.2 ± 7.3 months (range 33-54 months). The mean BMI was 52.6 kg/m2. Eighty-three patients (50.9%) were MO, 52 (31.9%) were SO, and 28 (17.2%) were SSO. The groups were similar in terms of preoperative characteristics and postoperative complications. The mean %TWL were lower for the SSO group with no significant difference. The mean %TWL at 12, 24, 36, and 41.2 months postoperatively was 34.7, 34.4, 31.4, and 29.6% in SSO group, respectively. Also, the %EWL for the SSO group was significantly lower (48.3%) at the end of the follow-up period. However, the rate of significant improvement or complete resolution of comorbidities was similar in all groups. CONCLUSION: Although %EWL was lower in the SSO group, LSG was a feasible and safe stand-alone bariatric surgical procedure for the resolution of comorbidities in MO, SO, and SSO patients.

Midterm Clinical Outcomes of Antrum Resection Margin at Laparoscopic Sleeve Gastrectomy for Morbid Obesity.

BACKGROUND: Laparoscopic sleeve gastrectomy (LSG) is one of the most frequently performed procedures in obesity surgery. The benefits of minimally invasive surgery include rapid recovery. We evaluated the clinical outcomes of different resection margin lengths from the pylorus in LSG. METHODS: This retrospective study included 152 patients who underwent LSG from January 2011 to October 2014. The antrum was resected 2 cm from the pylorus in 84 patients (group A) and 6 cm from the pylorus in 68 patients (group B). The patients' demographics, staple line distance, complications, sex, age, body mass index loss, length of hospital stay, and comorbidities were retrospectively reviewed. RESULTS: The patients comprised 104 women (68.4 %) and 48 men (32.6 %) with a mean age of 41.2 years (range, 28-53 years). The percent total and excess weight loss were statistically significant in both groups at 6 and 12 months postoperatively. Weight loss was significantly greater in group A than that in B at 6 and 12 months, but the difference at 24 months was not statistically significant. The results of pH monitoring showed significantly lower scores in group A than those in B at 6 and 12 months, but no difference at 24 months. CONCLUSION: LSG is an effective procedure with good short-term outcomes. Both procedures described herein are equally effective with respect to the patient's return to daily activities. Increasing the distance from the resection line to the pylorus is associated with better weight loss but slightly increased symptoms of gastroesophageal reflux disease without a significant difference in complications.

Gastric Metastasis of Triple Negative Invasive Lobular Carcinoma.

Invasive lobular carcinomas are the second most common type (5% to 15%) of invasive breast carcinomas. The most frequent sites of breast cancer metastasis are the local and distant lymph nodes, brain, lung, liver, and bones; metastasis to the gastrointestinal system, especially to the stomach, is rare. When a mass is detected in an unusual place in a patient with invasive lobular carcinoma, it should be kept in mind that such a mass may be either a second primary carcinoma or the metastasis of an invasive lobular carcinoma. In this report, we present a case of gastric metastasis from triple-negative invasive lobular breast cancer. It is important to make an accurate diagnosis by distinguishing gastric metastasis from breast cancer in order to select the best initial treatment for systemic diseases of breast cancer. Considering our case, healthcare professionals should take into account that cases with invasive lobular breast cancer may experience unusual metastases.

Sensitivity of (18)F-FDG PET in evaluation of solitary pulmonary nodules.

INTRODUCTION: The solitary pulmonary nodule (SPN) may be an early sign of lung cancer. Due to the difficulties of radiological imaging techniques in differentiation of benign/malignant nodules, functional imaging techniques like PET-CT are required in patients diagnosed with SPN. The aim of this study was the evaluation of the role of PET-CT in differentiation of malignant/benign SPN by some characteristic findings in PET-CT. Moreover, among the nodules with histopathologically diagnosed as benign, malignant or metastatic, the SUVmax and Hounsfield Units (HU) of PET-CT imaging were also aimed to be compared to assess the role of PET-CT in discrimination of malignant/benign SPN. MATERIAL AND METHOD: Among the patients evaluated with PET-CT with the pre-diagnosis of pulmonary nodule or non-pulmonary malignancies, between July 2010 and January 2012, in Konya University Meram Medical School Nuclear Medicine Department, 241 patients (167 male, 74 female) diagnosed with pulmonary nodule were enrolled in the study. In visual evaluation of PET-CT of all patients, there was only one nodule in lung parenchyma. The diameter in cm, location as central or peripheral, regularity of borders, presence of calcification and HU and Maximum standardized uptake values (SUVmax) values with quantitative analysis of all nodules was recorded. The histopathological evaluation of nodules was available in 91 of those 241 patients and they were also recorded. RESULTS: In comparison of mean SUVmax values in regards to the characteristic findings of nodules in PET-CT, the mean SUVmax value of patients was statistically significantly higher in patients with the nodule diameter ≥1 cm, centrally located nodules, or nodules with irregular borders. CONCLUSION: In malignant/benign differentiation of solitary pulmonary nodules with the diameter of higher than 1 cm, PET-CT plays an essential role; however, for the nodules smaller than 1 cm in diameter, in small, single metastatic nodules and some benign nodules with high SUVmax values, PET-CT may be unsatisfactory. However, it is clear that, in especially undetermined nodules, PET-CT is an important complementary tool in diagnosis.