18F-FET PET/CT as a Diagnostic Tool for Brain Abscess.

ABSTRACT: A 49-year-old man presented with sudden right-sided weakness and seizure. Brain MRI identified a lobulated mass with diffusion restriction and irregular wall enhancement in the left parietal lobe. 18F-FET (O-(2-[18F]fluoroethyl)-l-tyrosine) PET/CT was performed, which identified a cystic mass in the left parietal lobe accompanied by FET uptake. Compartmentalized uptake was also confirmed throughout the left parietal lobe. Considering the relatively low target-to-background ratio and uptake observed in the entire left parietal lobe, the lesion was more likely to be a brain abscess than a tumor. The pathologic diagnosis after mass removal was acute and chronic inflammation with abscess.

Bacterial extracellular vesicles affect endocrine therapy in MCF7 cells.

BACKGROUND: : The microbiome is important in the development and progression of breast cancer. This study investigated the effects of microbiome derived from Klebsiella on endocrine therapy of breast cancer using MCF7 cells. The bacterial extracellular vesicles (EVs) that affect endocrine therapy were established through experiments focused on tamoxifen efficacy. METHODS: : The microbiomes of breast cancer patients and healthy controls were analyzed using next-generation sequencing. Among microbiome, Klebsiella was selected as the experimental material for the effect on endocrine therapy in MCF7 cells. MCF7 cells were incubated with tamoxifen in the absence/presence of bacterial EVs derived from Klebsiella pneumoniae and analyzed by quantitative real-time polymerase chain reaction and Western blot. RESULTS: : Microbiome derived from Klebsiella is abundant in breast cancer patients especially luminal A subtype compared to healthy controls. The addition of EVs derived from K pneumoniae enhances the anti-hormonal effects of tamoxifen in MCF7 cells. The increased efficacy of tamoxifen is mediated via Cyclin E2 and p-ERK. CONCLUSION: : Based on experiments, the EVs derived from K pneumoniae are important in hormone therapy on MCF7 cells. This result provides new insight into breast cancer mechanisms and hormone therapy using Klebsiella found in the microbiome.

Lymphoscintigraphic Findings as Indicators of Lymphaticovenous Anastomosis Outcome in Patients With Extremity Lymphedema: A Retrospective Cohort Study.

PURPOSE: This study was performed to evaluate the usefulness of lymphoscintigraphy in predicting the surgical outcomes of lymphaticovenous anastomosis (LVA) in a patient with extremity lymphedema. PATIENTS AND METHODS: We retrospectively evaluated 133 patients with extremity lymphedema who underwent lymphoscintigraphy followed by LVA surgery from February 2018 to March 2020. Lymphoscintigraphic findings were evaluated on the following parameters: the extent of dermal backflow (small/large), lymphatic flow patterns (trunk flow pattern/proximal-restricted pattern/distal-restricted pattern), visualization of lymph nodes, and collateral lymphatic vessels. The mean circumferential difference change before and after surgery, circumferential reduction (CR) rate (%), was used as the clinical outcome variables. RESULTS: A decrease in circumference was observed in 93 (69.9%) of 133 patients after LVA. The extent of dermal backflow and lymphatic flow patterns was significantly correlated with improved clinical outcomes after LVA. The large extent of the dermal backflow group showed a more significant CR rate than the small extent (19.27% vs 1.24%, P = 0.005). The TP group showed the most significantly decreased CR rate to 21.46%, and the proximal-restricted pattern and distal-restricted pattern groups were -2.49% and -5.33%, respectively (P < 0.001). Multivariate analysis revealed that dermal backflow and lymphatic flow patterns were independent predictors of therapeutic outcome (P < 0.001). CONCLUSIONS: Our study demonstrates that pretreatment lymphoscintigraphy may help predict the therapeutic effect of LVA in patients with extremity lymphedema. Furthermore, dermal backflow and lymphatic flow patterns are independent predictors of CR rate after LVA surgery for extremity lymphedema.

Non-Polar Myxococcus fulvus KYC4048 Metabolites Exert Anti-Proliferative Effects via Inhibition of Wnt/ß-Catenin Signaling in MCF-7 Breast Cancer Cells.

The Wnt/ß-catenin signaling pathway is involved in breast cancer and Myxococcus fulvus KYC4048 is a myxobacterial strain that can produce a variety of bioactive secondary metabolites. Although a previous study revealed that KYC4048 metabolites exhibit anti-proliferative effects on breast cancer, the biochemical mechanism involved in their effects remains unclear. In the present study, KYC4048 metabolites were separated into polar and non-polar (ethyl acetate and n-hexane) fractions via liquid-liquid extraction. The effects of these polar and non-polar KYC4048 metabolites on the viability of breast cancer cells were then determined by MTT assay. Expression levels of Wnt/ß-catenin pathway proteins were determined by Western blot analysis. Cell cycle and apoptosis were measured via fluorescence-activated cell sorting (FACS). The results revealed that non-polar KYC4048 metabolites induced cell death of breast cancer cells and decreased expression levels of WNT2B, ß-catenin, and Wnt target genes (c-Myc and cyclin D1). Moreover, the n-hexane fraction of non-polar KYC4048 metabolites was found most effective in inducing apoptosis, necrosis, and cell cycle arrest, leading us to conclude that it can induce apoptosis of breast cancer cells through the Wnt/ß-catenin pathway. These findings provide evidence that the n-hexane fraction of non-polar KYC4048 metabolites can be developed as a potential therapeutic agent for breast cancer via inhibition of the Wnt/ß-catenin pathway.

Radioactive Iodine Treatment for Children and Young Adults with Thyroid Cancer in South Korea: A Population-based Study.

PURPOSE: This study investigated radioactive iodine treatment (RAIT) patterns and the secondary cancer incidence among children and young adults receiving RAIT after thyroidectomy for thyroid cancer. METHODS: This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 18 617 children and young adults (0-29 years) who underwent thyroidectomy for thyroid cancer between 2008 and 2018. We recorded age at surgery, sex, the interval from surgery to RAIT, the doses of RAI, the number of RAIT sessions, and secondary cancer incidence. RESULTS: A total of 9548 (51.3%) children and young adults underwent 1 or more RAIT sessions. The initial dose of RAIT was 4.35 ±â€…2.19 GBq. The overall RAIT frequency fell from 60.9% to 38.5%, and the frequency of high-dose RAIT (>3.7 GBq) fell from 64.2% to 36.5% during the observational period. A total of 124 cases of secondary cancer developed during 120 474 person-years of follow-up; 43 (0.5%) in the surgery cohort and 81 (0.8%) in the RAIT cohort. Thus, the RAIT cohort was at an increased risk of secondary cancer (adjusted hazard ratio 1.52 [95% confidence interval 1.03-2.24], P = 0.035). CONCLUSION: The proportion of children and young adults receiving RAIT, and the RAI dose, fell significantly over the observational period. RAIT was associated with secondary cancers. This is of major concern in the context of child and young adult thyroid cancer survivors.

The impact of data-driven respiratory gating in clinical F-18 FDG PET/CT: comparison of free breathing and deep-expiration breath-hold CT protocol.

BACKGROUND: Respiratory motion can diminish PET image quality and lead to inaccurate lesion quantifications. Data-driven gating (DDG) was recently introduced as an effective respiratory gating technique for PET. In the current study, we investigated the clinical impact of DDG on respiratory movement in 18F-FDG PET/CT. METHOD: PET list-mode data were collected for each subject and DDG software was utilized for extracting respiratory waveforms. PET images was reconstructed using Q.clear and Q.clear + DDG, respectively. We evaluated SUVmax, SUVmean, the coefficient of variance (CoV), metabolic tumor volume (MTV), and tumor heterogeneity using the area under the curve of cumulative SUV histogram (AUC-CSH). Metabolic parameter changes were compared between each reconstruction method. The Deep-Expiration Breath Hold (DEBH) protocol was introduced for CT scans to correct spatial misalignment between PET and CT and compared with conventional free breathing. The DEBH and free breathing (FB) protocol comparison was made in a separate matching cohort using propensity core matching rather than the same patient. RESULTS: Total 147 PET/CT scans with excessive respiratory movements were used to study DDG-mediated correction. After DDG application, SUVmax (P < 0.0001; 8.15 ± 4.77 vs. 9.03 ± 5.02) and SUVmean (P < 0.0001; 4.91 ± 2.44 vs. 5.49 ± 2.68) of lung and upper abdomen lesions increased, while MTV significantly decreased (P < 0.0001; 7.07 ± 15.46 vs. 6.58 ± 15.14). In addition, the percent change of SUVs was greater in lower lung lesions compared to upper lobe lesions. Likewise, the MTV reduction was significantly greater in lower lobe lesions. No significant difference dependent on location was observed in liver lesions. DEBH-mediated CT breathing correction did not make a significant difference in lesion metabolic parameters compared to conventional free breathing. CONCLUSIONS: These results suggest that DDG correction enables more corrected quantification from respiratory movements for lesions located in the lung and upper abdomen. Therefore, we suggest that DDG is worth using as a standard protocol during 18F-FDG PET/CT imaging.

Camphene Attenuates Skeletal Muscle Atrophy by Regulating Oxidative Stress and Lipid Metabolism in Rats.

Sarcopenia- or cachexia-related muscle atrophy is due to imbalanced energy metabolism and oxidative stress-induced muscle dysfunction. Monoterpenes play biological and pharmacological reactive oxygen species (ROS) scavenging roles. Hence, we explored the effects of camphene, a bicyclic monoterpene, on skeletal muscle atrophy in vitro and in vivo. We treated L6 myoblast cells with camphene and then examined the ROS-related oxidative stress using Mito TrackerTM Red FM and anti-8-oxoguanine antibody staining. To investigate lipid metabolism, we performed real-time polymerase chain reactions, holotomographic microscopy, and respiratory gas analysis. Rat muscle atrophy in in vivo models was observed using 18F-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography and immunocytochemistry. Camphene reversed the aberrant cell size and muscle morphology of L6 myoblasts under starvation and in in vivo models. Camphene also attenuated E3 ubiquitin ligase muscle RING-finger protein-1, mitochondrial fission, and 8-oxoguanine nuclear expression in starved myotubes and hydrogen peroxide (H2O2)-treated cells. Moreover, camphene significantly regulated lipid metabolism in H2O2-treated cells and in vivo models. These findings suggest that camphene may potentially affect skeletal muscle atrophy by regulating oxidative stress and lipid metabolism.

Metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging according to primary tumor uptake and background parenchymal enhancement.

OBJECTIVE: This study was aimed at investigating metabolic changes in breast cancer on dual-time-point 18F-FDG PET/CT imaging (DTPI) according to primary tumor uptake and determining whether this technique is affected by background parenchymal enhancement (BPE). METHODS: A total of 189 patients with newly diagnosed breast cancer who underwent DTPI examination were retrospectively evaluated. DTPI was performed using a standard FDG/PET protocol followed by delayed image acquisition at 120 min after injection. Patients were divided into two groups according to primary tumor uptake as breast cancer with low maximum standard uptake value (SUVmax) (< 2.5) and high SUVmax (≥ 2.5). The maximal SUV of the primary breast tumor (T-SUVmax), contralateral breast parenchyma uptake (B-SUVmax) according to different BPE grades, tumor to background ratio (T/B-SUVmax), and their percentage changes between early and delayed images (retention index, RI) were calculated. RESULTS: For primary tumor uptake, tumors with high SUV had a significant increase in mean T-SUVmax between early and delayed images (8.17 vs. 9.16, P < 0.001), and %RI T-SUVmax was 10.52%. Conversely, mean T-SUVmax did not change between early and delayed images for tumors with low SUV (1.96 vs. 1.94, P = 0.610), and %RI T-SUVmax was - 1.41%. The mean %RI B-SUVmax was - 12.43% for minimal BPE, - 14.19% for mild BPE, - 19.49% for moderate BPE, and - 21.25% for marked BPE grade, indicating that higher BPE grades undergo better washouts on delayed imaging (ß = - 3.220, P < 0.001 for trend). The %RI T/B-SUVmax of both breast cancer groups with low SUV and high SUV was 18.86% and 32.47%, respectively. CONCLUSIONS: Breast cancer with low SUV undergoes no significant change in SUV on DTPI; however, washing of background parenchymal activity was evident over time, resulting in significantly increased tumor contrast in delayed images, which leads to increased sensitivity. Breast parenchymal washout was more significant with increased BPE level. Therefore, DTPI is expected to be more useful for evaluating breast lesions in regions with marked BPE on MRI.

Clinical Evaluation of (4S)-4-(3-[18F]Fluoropropyl)-L-glutamate (18F-FSPG) for PET/CT Imaging in Patients with Newly Diagnosed and Recurrent Prostate Cancer.

PURPOSE: (4S)-4-(3-[18F]Fluoropropyl)-L-glutamic acid (18F-FSPG) is a radiopharmaceutical for PET imaging of system xC - activity, which can be upregulated in prostate cancer. We present data on the first evaluation of patients with newly diagnosed or recurrent prostate cancer with this radiopharmaceutical. EXPERIMENTAL DESIGN: Ten patients with primary and 10 patients with recurrent prostate cancer were enrolled in this prospective multicenter study. After injection of 300 MBq of 18F-FSPG, three whole-body PET/CT scans were obtained. Visual analysis was compared with step-section histopathology when available as well as other imaging studies and clinical outcomes. Metabolic parameters were measured semiquantitatively. Expression levels of xCT and CD44 were evaluated by IHC for patients with available tissue samples. RESULTS: 18F-FSPG PET showed high tumor-to-background ratios with a relatively high tumor detection rate on a per-patient (89%) and per-lobe (87%) basis. The sensitivity was slightly higher with imaging at 105 minutes in comparison with 60 minutes. The maximum standardized uptake values (SUVmax) for cancer was significantly higher than both normal (P < 0.005) and benign pathology (P = 0.011), while there was no significant difference between normal and benign pathology (P = 0.120). In the setting of recurrence, agreement with standard imaging was demonstrated in 7 of 9 patients (78%) and 13 of 18 lesions (72%), and revealed true local recurrence in a discordant case. 18F-FSPG accumulation showed moderate correlation with CD44 expression. CONCLUSIONS: 18F-FSPG is a promising tumor imaging agent for PET that seems to have favorable biodistribution and high cancer detection rate in patients with prostate cancer. Further studies are warranted to determine the diagnostic value for both initial staging and recurrence, and how it compares with other investigational radiotracers and conventional imaging modalities.

99mTc-RBC SPECT/CT for Duodenal Bleeding Point Detection.

This is a case of a 63-year-old man who presented with acute melena and low hemoglobin. Upper and lower gastrointestinal evaluations failed to localize the bleeding focus. Tc-RBC planar scintigraphy identified 2 sites of suspected bleeding in the lower abdomen area. Subsequent SPECT/CT was performed and identified the precise main focus of active bleeding, the second and third parts of the duodenum, and also described the blood accumulation in the jejunum. Esophagogastroduodenoscopy was immediately performed, and results confirmed spurting blood from the small vessel with multiple ulcers in the second part of the duodenum.

Clinicopathological characteristics of primary central nervous system lymphoma with low 18F-fludeoxyglucose uptake on brain positron emission tomography.

Primary central nervous system lymphoma (PCNSL) typically shows a strong uptake of F-fludeoxyglucose (FDG) imaged by positron emission tomography (PET). Uncommonly, PCNSL demonstrates a low uptake on FDG PET. We investigated the clinicopathological characteristics of the unusual cases of PCNSL with low FDG uptake.We retrospectively enrolled 104 consecutive patients with newly diagnosed PCNSL who underwent baseline brain FDG PET. The degree of FDG uptake of PCNSL was visually scored by 4 grades (0, ≤contralateral white matter; 1, >contralateral white matter and contralateral gray matter). Grades 0-2 were considered as PCNSL with low uptake. We investigated association of low uptake of PCNSL with the following clinicopathological factors: age, sex, steroid treatment, lactate dehydrogenase level, cerebrospinal fluid protein level, condition of PET scanning, immunohistochemical markers (cluster of differentiation 10 [CD10], B-cell lymphoma 6 [BCL-6], B-cell lymphoma 2 [BCL-2], multiple myeloma oncogene 1 [MUM1], Epstein-Barr virus [EBV] protein, and Ki67), location of lesions, tumor size, multiplicity of lesions, involvement of deep brain structures, and cystic or necrotic appearance of lesions.Of the 104 patients with PCNSL, 14 patients (13.5%) showed PCNSL with low FDG uptake on PET. Among various clinicopathological factors, MUM1 negativity was the only factor associated with low FDG uptake PCNSL by univariate (P = .002) and multivariate analysis (P = .007).This study suggests that the different clinicopathological characteristics between patients with high uptake and low uptake of PCNSL on FDG PET is closely associated with lack of MUM1, a protein known to be a crucial regulator of B-cell development and tumorigenesis.

Association Between Pregnancy Outcomes and Radioactive Iodine Treatment After Thyroidectomy Among Women With Thyroid Cancer.

Importance: Current guidelines recommend that women delay pregnancy for 6 to 12 months after the receipt of radioactive iodine treatment (RAIT) following thyroidectomy for differentiated thyroid carcinoma. Although concerns exist regarding the risks associated with pregnancy after RAIT, no large-scale study, to date, has investigated the association between RAIT and pregnancy outcomes. Objective: To investigate whether RAIT was associated with increases in adverse pregnancy outcomes among South Korean women who received RAIT after thyroidectomy for thyroid cancer and to evaluate the appropriate interval between RAIT and conception. Design, Setting, and Participants: This population-based cohort study used the Health Insurance Review and Assessment database of South Korea to identify a total of 111 459 women of childbearing age (20-49 years) who underwent thyroidectomy for the treatment of differentiated thyroid carcinoma between January 1, 2008, and December 31, 2015. Participants were allocated to 2 cohorts: those who underwent surgery alone (n = 59 483 [53.4%]) and those who underwent surgery followed by RAIT (n = 51 976 [46.6%]). The pregnancy outcomes data were collected from January 1, 2008, to December 31, 2017. Main Outcomes and Measures: The rates of abortion (both spontaneous and induced), preterm delivery, and congenital malformation were assessed. Multivariate logistic regression models were used to control for confounding variables. Results: Among the 111 459 women of childbearing age who underwent thyroidectomy with or without RAIT for the treatment of thyroid cancer, the mean (SD) age at surgery or RAIT was 39.8 (6.7) years. Of those, 10 842 women (9.7%) became pregnant, and the mean (SD) age at conception was 33.3 (4.4) years. The rates of abortion, preterm delivery, and congenital malformation among patients who underwent surgery alone compared with patients who underwent surgery followed by RAIT were 30.7% vs 32.1% for abortion, 12.8% vs 12.9% for preterm delivery, and 8.9% vs 9.0% for congenital malformation, respectively (P > .05). A subgroup analysis based on the interval between RAIT and conception indicated congenital malformation rates of 13.3% for the interval of 0 to 5 months, 7.9% for 6 to 11 months, 8.3% for 12 to 23 months, and 9.6% for 24 months or more. The adjusted odds ratio of congenital malformation was 1.74 (95% CI, 1.01-2.97; P = .04) in conceptions that occurred 0 to 5 months after RAIT compared with conceptions that occurred 12 to 23 months after RAIT. The abortion rates based on the interval between RAIT and conception were 60.6% for the interval of 0 to 5 months, 30.1% for 6 to 11 months, 27.4% for 12 to 23 months, and 31.9% for 24 months or more. Conclusions and Relevance: These large-scale real-world data indicate that receipt of RAIT before pregnancy does not appear to be associated with increases in adverse pregnancy outcomes when conception occurs 6 months or more after treatment.

Incidence, comorbidities, and treatment patterns of nontuberculous mycobacterial infection in South Korea.

Nontuberculous mycobacteria (NTM) are important pathogens in humans, and hospital-based studies have shown an increased incidence of NTM infection. However, little is known about the treatment pattern of NTM infection with respect to the number of cases per population in South Korea. This study evaluated the trends in the incidence of NTM infection, respiratory comorbidities, and treatment patterns in South Korea.National claims data from the Health Insurance Review and Assessment service database for the years 2009 to 2015 were reviewed, and codes related to NTM infection, respiratory comorbidities occurring from one year before NTM infection and associated treatments were identified.In total, 52,551 patients were included in the study and the average annual incidence per 100,000 person-years was 12.8. The annual incidence was found to have increased from 6.6 to 26.6 per 100,000 persons. Accompanied comorbidities were tuberculosis (33.7%), followed by bronchial asthma (33.2%), chronic obstructive pulmonary disease (25.6%), and lung cancer (5.8%). A total of 76.6% of patients did not receive any combination treatment within one year after the diagnosis of NTM infection. Macrolide-based treatment was administered to 18.8% of patients.A dramatic increase in the incidence of NTM infection was noted in the population of South Korea. Approximately three-fourth of the patients with NTM infection were clinically observed without treatment for at least 1 year after the identification of NTM infection and most patients who treated NTM infection received macrolide-based combination therapy.

Real-world treatment patterns for patients 80 years and older with early lung cancer: a nationwide claims study.

BACKGROUND: Old age is an important factor that could affect the treatment of early-stage lung cancer. In this study, we evaluated the treatment patterns and outcomes of patients over the age of 80 years who had been diagnosed with early-stage lung cancer in real-world practice. METHODS: Elderly patients who were diagnosed with early-stage lung cancer between 2008 and 2016 were identified using claims data provided by the Health Insurance Review and Assessment Service. The proportion of patients who underwent surgical resection or stereotactic body radiation therapy (SBRT), practice pattern trends, and overall survival (OS) were analyzed from the population-based data. RESULTS: Over 9 years, 1,684 patients underwent surgical resection (74.9%) or SBRT (25.1%) as a localized treatment. From 2008 to 2016, the treatment modality changed: the percentage of patients who underwent surgical resection decreased from 90.6 to 71.4%, and those who underwent SBRT increased from 9.4 to 28.6%. The percentage of patients treated with SBRT increased over time (p < 0.001). The median OS was 56.4 months in the surgery group and 35.5 months in the SBRT group. The SBRT group showed worse OS compared with the surgery group (Adjusted hazard ratio, 1.44; 95% confidence interval, 1.21-1.72; p < 0.001). CONCLUSION: Changes in local treatment patterns in elderly lung cancer patients were observed and SBRT increased its role in this population. Surgical resection or SBRT should be considered the treatment of choice in elderly patients with localized lung cancer. Further prospective studies are required to elucidate the benefits of surgery and SBRT.

The Value of Preoperative Positron Emission Tomography/Computed Tomography in Node-Negative Endometrial Cancer on Magnetic Resonance Imaging.

OBJECTIVE: The aim of this study was to investigate the value of [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) in predicting lymph node status in node-negative endometrial cancer on preoperative magnetic resonance imaging (MRI). METHODS: Patients with endometrial cancer who underwent both preoperative MRI and FDG-PET/CT followed by hysterectomy and lymphadenectomy were initially included. We then enrolled patients with MRI-defined node-negative disease (lymph nodes <1 cm in the short-axis diameter, or no visible lymph node). Histologic examination was the gold standard for lymph node metastasis diagnosis. The diagnostic performance of FDG-PET/CT in predicting lymph node metastasis was calculated in patient-by-patient and lymph node station-by-station analyses. RESULTS: On preoperative MRI, 362 patients had no lymph node metastasis. All patients underwent pelvic lymph node dissection and 118 patients underwent further para-aortic lymph node dissection. From 2099 lymph node stations, 10,238 lymph nodes were retrieved. Twenty-seven patients (7.5%) had lymph node metastasis in 49 lymph node stations (2.3%) on pathologic examination. FDG-PET/CT identified lymph node metastasis in five patients (18.5%) and eight lymph node stations (16.3%). The median diameter of false-negative metastatic lymph nodes was 6 mm (range 1-22) in the long axis and 3 mm (range 1-11) in the short axis. For para-aortic lymph nodes, FDG-PET/CT diagnosed 2 of 11 patients (18.1%) with para-aortic lymph node metastasis, and 3 of 12 para-aortic lymph node stations (25%) with metastasis. CONCLUSION: Preoperative FDG-PET/CT has low value in predicting lymph node metastasis in node-negative endometrial cancer on preoperative MRI.

Serum anti-Müllerian hormone levels decrease after endometriosis surgery.

The purpose of this study was to evaluate and compare the post-operative decline in serum AMH levels in patients with endometriosis and other benign cysts. This study also attempts to clarify the factors of endometriosis that may influence the AMH level. A total of 75 were recruited prospectively between 2011 and 2012. Fifty-nine patients had endometriosis, while the other 16 had another kind of benign ovarian cyst. In the endometriosis group, the AMH level decreased significantly from pre- to postoperatively (4.3 ± 0.4 vs. 2.8 ± 0.2, p<.001). This significant decrement in AMH levels was present in the endometriosis group regardless of multiplicity (p=.028 vs. p<.001) and bilaterality (p=.003 vs. p<.001). The stage III-IV endometriosis group also demonstrated a significant decrease (p<.001). Laparoscopic ovarian cystectomy in patients with endometriosis may cause a decrease in serum AMH levels. We suggest that preoperative and postoperative AMH levels should be evaluated in reproductive-aged women with endometriosis for their future fertility.

A Randomized Feasibility Study of 18F-Fluoroestradiol PET to Predict Pathologic Response to Neoadjuvant Therapy in Estrogen Receptor-Rich Postmenopausal Breast Cancer.

The aim of this study was to explore the ability of 18F-fluoroestradiol (18F-FES) PET/CT imaging to predict pathologic response to neoadjuvant therapy in postmenopausal women with estrogen receptor (ER)-rich breast cancer. Methods: This was a prospective, single-center study conducted as a substudy of the neoadjuvant study of chemotherapy versus endocrine therapy in postmenopausal patients with primary breast cancer (NEOCENT) trial. Patients with ER-rich breast cancer were randomized to neoadjuvant chemotherapy (NC) or neoadjuvant endocrine therapy (NET). The baseline SUVmax of 18F-FES PET/CT was measured. The pathologic response was assessed by the Miller-Payne system as nonresponse (grades 1 and 2) and response (grades 3-5). Results: Twenty-six patients were enrolled, with pathologic response achieved in 25 (NC, 12; NET, 13). Two patients achieved pathologic complete response after NC, but the remaining 23 patients had residual disease after NC or NET. Eight of 12 patients responded to NC, and 4 of 13 to NET; the difference was marginally significant (P = 0.07). In the NC group, the 2 patients with 18F-FES-negative tumors and none of the 10 patients with 18F-FES-avid tumors achieved pathologic complete response (P = 0.02). No difference in the SUVmax between responders and nonresponders was observed in either group. However, 5 of 7 NC patients with a baseline SUVmax of less than 7.3 achieved pathologic response, whereas none of the 5 NET patients with an SUVmax of less than 7.3 were responders (P = 0.03). The SUVmax values of the NC group were negatively correlated with percentage reduction of tumor cellularity (r = -0.63, P = 0.03), whereas those of the NET group showed positive correlation (r = 0.62, P = 0.02). During the median follow-up of 74 mo (range, 44-85 mo), recurrence occurred in only 4 NET patients. In patients with an SUVmax of less than 7.3, recurrence occurred in none of the 8 NC patients and 2 of the 5 NET patients (P = 0.13). Conclusion: Postmenopausal women who are ER-positive, but 18F-FES-negative, may benefit from NC rather than NET. 18F-FES PET/CT has the potential to predict response to neoadjuvant therapy in postmenopausal women with ER-rich breast cancer.

Fertility of patients with polycystic ovary syndrome undergoing in vitro fertilization by age.

OBJECTIVE: To evaluate outcomes of in vitro fertilization (IVF) among patients with polycystic ovary syndrome (PCOS) by age. METHODS: In a retrospective study, data were retrieved for patients with PCOS (Rotterdam 2003 criteria) and individuals with tubal factor infertility who underwent IVF at a center in Seoul, South Korea, between January 2003 and August 2012. IVF outcomes were compared by age group (A: 30-32 years; B: 33-35 years; C: 36-38 years; D: 39-41 years). RESULTS: The analysis included 307 women with PCOS and 364 with tubal factor infertility. There was a significant difference between women with PCOS and those with tubal infertility factor in the live birth rate in group B (41.3% vs 28.6%, P=0.038) and in group C (40.4% vs 15.1%, P=0.002). Among women with PCOS, no significant differences in number of retrieved oocytes were observed between the age groups (18.8 ± 9.6, 19.1 ± 10.0, 17.7 ± 7.5, and 17.0 ± 13.8). However, the clinical pregnancy rate was significantly lower in group D than in group C (47.2% vs 18.8%, P=0.042). CONCLUSION: Fertility in patients with PCOS was maintained until age 38 years using IVF. Thereafter, the pregnancy rate decreased, although the number of oocytes retrieved by IVF remained stable.

Histogram Analysis of Apparent Diffusion Coefficients for Occult Tonsil Cancer in Patients with Cervical Nodal Metastasis from an Unknown Primary Site at Presentation.

PURPOSE: To explore the added value of histogram analysis of apparent diffusion coefficient (ADC) values over magnetic resonance (MR) imaging and fluorine 18 ((18)F) fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) for the detection of occult palatine tonsil squamous cell carcinoma (SCC) in patients with cervical nodal metastasis from a cancer of an unknown primary site. MATERIALS AND METHODS: The institutional review board approved this retrospective study, and the requirement for informed consent was waived. Differences in the bimodal histogram parameters of the ADC values were assessed among occult palatine tonsil SCC (n = 19), overt palatine tonsil SCC (n = 20), and normal palatine tonsils (n = 20). One-way analysis of variance was used to analyze differences among the three groups. Receiver operating characteristic curve analysis was used to determine the best differentiating parameters. The increased sensitivity of histogram analysis over MR imaging and (18)F-FDG PET/CT for the detection of occult palatine tonsil SCC was evaluated as added value. RESULTS: Histogram analysis showed statistically significant differences in the mean, standard deviation, and 50th and 90th percentile ADC values among the three groups (P < .0045). Occult palatine tonsil SCC had a significantly higher standard deviation for the overall curves, mean and standard deviation of the higher curves, and 90th percentile ADC value, compared with normal palatine tonsils (P < .0167). Receiver operating characteristic curve analysis showed that the standard deviation of the overall curve best delineated occult palatine tonsil SCC from normal palatine tonsils, with a sensitivity of 78.9% (15 of 19 patients) and a specificity of 60% (12 of 20 patients). The added value of ADC histogram analysis was 52.6% over MR imaging alone and 15.8% over combined conventional MR imaging and (18)F-FDG PET/CT. CONCLUSION: Adding ADC histogram analysis to conventional MR imaging can improve the detection sensitivity for occult palatine tonsil SCC in patients with a cervical nodal metastasis originating from a cancer of an unknown primary site.

18F-Fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography in mucosa-associated lymphoid tissue lymphoma: variation in 18F-FDG avidity according to site involvement.

The purpose of this study was to determine the 18F-FDG avidity of MALT lymphoma and the additional utility of 18F-FDG PET/CT in MALT lymphoma staging. Pretreatment 18F-FDG PET/CT scans of 222 patients with 227 MALT lymphoma lesions were retrospectively analyzed. 18F-FDG avidity of lesions was noted in 28%. The proportion was lower for gastric MALT lymphomas than for non-gastric lesions (9% vs. 60%, p<0.0001) and higher for mass-forming lesions than for superficial lesions (82% vs. 2%, p<0.0001). 18F-FDG PET/CT showed the presence of additional lesions in 23 patients: four of six true-positive lesions had 18F-FDG avid primary lesions, and 15 of 17 false-positive lesions had 18F-FDG-non avid lesions. 18F-FDG avidity differed according to the location and gross morphologic characteristics of the MALT lymphoma. Most gastric MALT lymphomas were superficial and had low 18F-FDG avidity. For staging, 18F-FDG PET/CT can be helpful mainly for 18F-FDG avid primary MALT lymphomas.