Prognostic value of 18F-FDG PET/CT tumor metabolic parameters and Ki-67 in pre-treatment diffuse large B-cell lymphoma.

Background: Diffuse large B-cell lymphoma (DLBCL) is a highly aggressive lymphoma. Rituximab-based conventional chemotherapy still leads to drug resistance or relapse in 30-40% of patients. Therefore, early identification of high-risk patients and accurate assessment of prognosis are very important for clinical decision-making. The aim of this study is to investigate the value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) of tumor metabolic, clinical and biological parameters in the prognostic risk stratification of DLBCL before treatment. Methods: We retrospectively collected clinical data on 63 patients with newly diagnosed DLBCL admitted to Shanxi Bethune Hospital during the period from November 2016 to April 2020 who underwent 18F-FDG PET/CT prior to treatment in a cohort study. Metabolic, clinical, and biological parameters were analyzed by Cox regression. Kaplan-Meier curves of patient survival were compared by the log-rank test. Results: The median follow-up was 21 months. The 2-year progression-free survival (PFS) was 47.62%, and the overall survival (OS) was 53.97%. The subtype, double expression, Ann Abor stage, NCCN-IPI score, Ki-67, maximum standardized uptake value (SUVmax), bulk volume glycolysis (BVG), total lesion glycolysis (TLG), total metabolic tumor volume (TMTV) were the influencing factors for PFS and OS (P<0.050) in univariate analysis. BVG (PFS: HR =6.62, P<0.001; OS: HR =3.53, P=0.029), TLG (PFS: HR =8.56, P<0.001; OS: HR =5.20, P=0.004), TMTV (PFS: HR =12.02, P=0.001; OS: HR =5.05, P=0.033) and Ki-67 were found to be independent prognostic risk stratification parameters affecting PFS and OS by multivariate regression analysis. The 2-year PFS and OS rates for patients with high BVG (≥288.00 cm3), TLG (≥1,854.00 cm3), TMTV (≥103.00 cm3), and Ki-67 (≥85%) were 20% and 28.57%, 9.68% and 22.58%, 20.51%, and 30.77%, and 25% and 33.33%, respectively; and the 2-year PFS and OS rates for patients with low BVG (<288.00 cm3), TLG (<1,854.00 cm3), TMTV (<103.00 cm3), and Ki-67 (<85%) patients were 82.14% and 85.71%, 84.37% and 84.37%, 91.67% and 91.67%, and 61.54% and 66.67%, respectively. Patients with high BVG, TLG, TMTV, and Ki-67 had a worse 2-year PFS as well as OS rate (Ki-67: P=0.0018/P=0.0025; P<0.0001 for the rest of the groups). Conclusions: Our findings suggest that BVG, TLG, TMTV, and Ki-67 are independent prognostic indicators for survival in patients with pre-treatment DLBCL, especially BVG, which is a novel prognostic indicator that has to be validated in future research.

Sufficiency of a Single Negative Thyroglobulin Standard for Judging the Success of Ablation in Low- and Intermediate-risk Differentiated Thyroid Cancer: A Retrospective Study.

BACKGROUND: We investigated how reduced successful ablation criteria may be used to evaluate radioiodine remnant ablation in patients with low- and intermediate-differentiated thyroid carcinoma (DTC). METHODS: Overall, 254 low- and intermediate-risk patients with DTC were categorized into three groups (positive, weak, positive, and negative) on the basis of a visual study of thyroid imaging performed before postoperative iodine treatment. Semi-quantitative analysis parameters were incorporated into the positive Tc-99m pertechnetate scanning to further examine the clinical use of thyroid imaging. We investigated the value of successful judgment criteria and the influencing factors of radioiodine ablation. At the same time, the predictive value of thyroglobulin (Tg) for radioiodine treatment and the overall clinical efficacy were assessed. RESULTS: A total of 250 (98.43%) patients were identified as having functional thyroid tissue residue on the Tx-whole-body scan, and 137 (53.94%) patients had positive Tc-99m pertechnetate scans using semi-quantitative analysis. The single Tg standard could not substitute the double standard (χ! !=22.042, p<0.001) for patients with residual thyroid weight by a semiquantitative analysis. However, the semi-quantitative analysis revealed no association between 99mTcO4-thyroid scan and ablation treatment using semi-quantitative analysis; only preablation sTg levels were related with success in the multivariate logistic regression analysis, with a cut-off value of 2.88 ng/mL. The pre-ablation stimulated Tg level was also the primary factor of satisfactory response following follow-up with an optimal cut-off of 6.506 ng/mL. CONCLUSION: Even in low- and intermediate-risk patients with DTC, a single negative Tg standard also requires receiving some restrictions in the evaluation of ablation success and is inadequate. Conventional 99mTcO4 thyroid imaging combined with a quantitative analysis program can improve the clinical practice of single negative Tg standard.

Comparison of 18F-FDG PET/CT and conventional methods in diagnosing extranodal natural killer/T-cell lymphoma.

Background: The utility of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in natural killer (NK)/T-cell lymphoma patients is yet to be established. The aim of this study was to investigate the role of PET/CT scanning in detecting NK/T-cell lymphoma. Methods: We analyzed the PET/CT imaging characteristics of 38 patients with a primary diagnosis of NK/T-cell lymphoma and also compared the ability of PET/CT to detect tumor lesions with conventional methods (CMs) (physical examination, computed tomography (CT) with intravenous contrast, magnetic resonance imaging (MRI), biopsies from primary sites, and bone marrow examinations)and their impact on staging and treatment options. Biopsy and clinical follow-up (including imaging) are the gold standard for diagnosis. Results: We analyzed PET/CT images of NK/T-cell lymphomas. We found that most of the primary lesions were located in the nasal cavity, with the sinuses and the posterior pharyngeal wall being the most common sites of adjacent invasion. The majority of cases involved cervical lymph nodes, and the distribution of affected lymph nodes between the cervical and extra-cervical regions was random. There was no discernible pattern to the locations of affected tissues and organs across the body. In total, 219 lesions (including 81 nodal lesions and 138 extranodal lesions) tested positive for malignancy. The number of positive lymph node lesions detected by PET/CT and CMs was 79 (97.5 %) and 62 (76.5 %), respectively (P = 0.004). There were 53 (96.4 %) and 46 (83.6 %) cervical lymph nodes detected (P = 0.008), 26 (100 %) and 16 (61.5 %) other lymph nodes detected (P = 0.041)), respectively. The number of positive extranodal lesions detected by PET/CT and CMs was 137 (99.3 %) and 98 (71.0 %), respectively (P = 0.01), and there were no discernible differences in the upper respiratory tract. PET/CT outperformed CMs in the detection of malignant lesions by a significant margin, detecting 79 (98.8 %) extranodal lesions compared to 45 (56.3 %) by CMs (P = 0.034). PET/CT results changed the initial staging in 15.8 % of cases and the treatment plan in 10.5 % of patients. Conclusion: Our findings indicate that 18F-FDG PET/CT scanning is crucial in identifying tumor lesions, determining staging, and devising treatment strategies for individuals diagnosed with NK/T-cell lymphoma.

Advancements in theranostic applications: exploring the role of fibroblast activation protein inhibition tracers in enhancing thyroid health assessment.

BACKGROUND: The diagnostic accuracy of [18F]-fluorodeoxyglucose ([18F]-FDG) positron emission tomography imaging in accurately identifying thyroid lesions is limited, primarily due to the physiological uptake of normal head and neck tissues and inflammatory uptake in lymph nodes. Since fibroblast activating protein is highly expressed in tumors and largely unexpressed in normal tissues, quinoline-based fibroblast activating protein inhibitors (FAPI) have emerged as promising tools in the diagnosis of cancer and other medical conditions. Several studies have reported on the feasibility and value of FAPI in thyroid cancer. MAIN BODY: In this narrative review, we summarize the current literature on state-of-the-art FAPI positron emission tomography imaging for thyroid cancer and fibroblast activating protein-targeted radionuclide therapy. We provide an overview of FAPI uptake in normal thyroid tissue, thyroid cancer and its metastases. Additionally, we highlight the difference between FAPI uptake and [18F]-FDG uptake in thyroid lesions. Furthermore, we discuss the therapeutic value of FAPI in iodine-refractory thyroid cancer. CONCLUSION: The utilization of fibroblast activating protein inhibitors in thyroid cancer holds significant promise, offering clinicians valuable insights for more precise diagnose choices and treatments strategies in the future.

Clinical application of real-time PET/CT guided targeted retroperitoneal masses biopsy in diagnosing malignant tumors.

OBJECTIVE: To explore the feasibility, safety, and clinical application value based on the fusion image of 18 F-FDG PET/CT, for guiding retroperitoneal puncture biopsy technology and to determine the diagnosis of retroperitoneal masses in diagnosing malignant tumors. METHODS: From March 2019 to January 2023, 42 patients underwent 18 F-FDG PET/CT imaging and were found to have retroperitoneal lesions that required definite diagnosis; 22 were male, 20 were female, and the average age was(59.17 ± 13.23) years. According to the fused 18 F-FDG PET/CT tomographic image, the target point with the highest metabolic activity, the safest, and expected maximum sample size was selected. CT scans were acquired with the same machine and fused with 18 F-FDG PET, guiding the puncture biopsy needle to approach the expected target zone, enabling timely delivery of pathological and immunohistochemical examination of the biopsy. Success rate, total examination time, biopsy operation time, complications, CT radiation dose, pathological, and immunohistochemical results were recorded. RESULTS: All 42 patients were sampled successfully with the successful rate being 100%. The site of sampling of 42 patients accurately targeted the highest metabolic activity, the safest, and the expected maximum sample size. All 42 patients received clear diagnosis (25 cases of malignant tumors and cases of 17 benign tissues). 15 cases of patients had a change in clinical diagnosis, accounting for 35.7% of all patients, and affecting subsequent treatment plans. The average total examination time for patients was (41.3 ± 7.3) minutes, and the biopsy operation time was (29.1 ± 8.7) minutes. The effective radiation dose generated by the entire examination generated by CT guidance was (2.0 ± 0.5) mSv; no severe complications occurred in the patients. CONCLUSION: Real-time-guided retroperitoneal puncture biopsy based on 18 F-FDG PET/CT fusion image is safe, accurate, and feasible, and can provide patients of retroperitoneal mass with clear pathological diagnosis and immunohistochemical evaluation.

Comparison of biochemical markers and technetium 99m methoxyisobutylisonitrile imaging in primary and secondary hyperparathyroidism.

Objective: To investigate the differences in biochemical marker levels and the extent of lesion visualization on technetium 99m methoxyisobutylisonitrile (99mTc-MIBI) imaging between primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT). Methods: Nineteen patients with PHPT and 14 patients with SHPT were enrolled in the study, all of whom underwent routine 99mTc-MIBI dual-phase planar imaging, single-photon emission computed tomography combined with computed tomography (SPECT/CT fusion) imaging, and serum biochemical and hormonal investigations prior to surgery. The target-to-non-target (T/NT) ratios were calculated based on images from the early and delayed phases of 99mTc-MIBI planar imaging and also based on SPECT/CT fusion imaging. The volume of the parathyroid glands was measured following their excision. Results: A total of 62 parathyroid glands were removed: 14 parathyroid adenomas and five parathyroid carcinomas in PHPT patients; and 18 parathyroid adenomas, 17 parathyroid hyperplasia lesions, and eight instances of nodular hyperplasia with adenoma in SHPT patients. The median volume of the lesions in PHPT and SHPT was 1.69 cm3 and 0.52 cm3 respectively, and the difference between them was statistically significant (P = 0.001). The median T/NT ratios calculated at the early phase of 99mTc-MIBI planar imaging, the delayed phase of 99mTc-MIBI planar imaging, and the subsequent SPECT/CT fusion imaging were 1.51, 1.34, and 2.75, respectively, in PHPT, and 1.46, 1.30, and 1.38, in SHPT, respectively. The T/NT ratio difference between PHPT and SHPT on the SPECT/CT fusion imaging was statistically significant (P = 0.002). The histopathology subtypes of the lesions were associated with significant differences in two areas: the T/NT ratios on the SPECT/CT fusion imaging and the volume of the lesions (P=0.002, P<0.001). Conclusion: The proportion of positive findings on 99mTc-MIBI dual-phase planar imaging and the T/NT ratios of 99mTc-MIBI SPECT/CT fusion imaging were higher in PHPT than in SHPT. The volume of parathyroid lesions in SHPT was smaller than in PHPT.

Clinical characteristics of nasolacrimal duct obstruction after iodine therapy in differentiated thyroid cancer patients.

OBJECTIVE: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) patients with nasolacrimal duct obstruction (NLDO) after Iodine-131 (131I) therapy and provide guidance for clinical decision-making. METHODS: Thirty-one DTC patients with NLDO were retrospectively enrolled from the Nuclear Medicine Department of Shanxi Bethune Hospital during follow-up of 131I therapy between June 2018 and March 2021. Eight hundred and seventy-one thyroid cancer patients during this period without NLDO after 131I therapy were enrolled as the control group. Clinical characteristics, including sex, age, dose, anti-thyroglobulin antibodies (TGAb), and metastatic lesions, were analyzed by χ2 test and logistic multifactor regression. RESULTS: In the NLDO group and without NLDO group, there were statistically significant differences in gender, age, dose, and whether there was metastasis. Among the NLDO group, the proportion of women, age >55 years old, dose >5.55 GBq, and the presence of metastasis was higher, and the difference was statistically significant; There was no significant difference in the proportion of TGAb positive and negative patients based on 131I therapy (χ2 = 0.27, P = .782).Multivariate logistic regression analysis showed that sex (2.59), age (1.45), dose (2.36), and metastatic lesions (1.93) were all statistically significant influential factors of NLDO after iodine therapy. Significant differences were found in the incidence of NLDO between the number of treatment courses (χ2 = 23.541, P < .001). Prevalence rate of repeat radioiodine therapy (2 times or 3 times and more) is higher than 1 time. CONCLUSION: Women patients over 55 who had metastatic lesions, and received a dose >5.55 GBq, were more likely to have NLDO. When determining therapeutic doses of 131I, doctors should weigh multiple factors and then give appropriate dosage and suggest that high risk populations be referred for appropriate ophthalmic surgical consultation, for timely diagnosis and therapy.

Developing a predictive model for clinically significant prostate cancer by combining age, PSA density, and mpMRI.

PURPOSE: The study aimed to construct a predictive model for clinically significant prostate cancer (csPCa) and investigate its clinical efficacy to reduce unnecessary prostate biopsies. METHODS: A total of 847 patients from institute 1 were included in cohort 1 for model development. Cohort 2 included a total of 208 patients from institute 2 for external validation of the model. The data obtained were used for retrospective analysis. The results of magnetic resonance imaging were obtained using Prostate Imaging Reporting and Data System version 2.1 (PI-RADS v2.1). Univariate and multivariate analyses were performed to determine significant predictors of csPCa. The diagnostic performances were compared using the receiver operating characteristic (ROC) curve and decision curve analyses. RESULTS: Age, prostate-specific antigen density (PSAD), and PI-RADS v2.1 scores were used as predictors of the model. In the development cohort, the areas under the ROC curve (AUC) for csPCa about age, PSAD, PI-RADS v2.1 scores, and the model were 0.675, 0.823, 0.875, and 0.938, respectively. In the external validation cohort, the AUC values predicted by the four were 0.619, 0.811, 0.863, and 0.914, respectively. Decision curve analysis revealed that the clear net benefit of the model was higher than PI-RADS v2.1 scores and PSAD. The model significantly reduced unnecessary prostate biopsies within the risk threshold of > 10%. CONCLUSIONS: In both internal and external validation, the model constructed by combining age, PSAD, and PI-RADS v2.1 scores exhibited excellent clinical efficacy and can be utilized to reduce unnecessary prostate biopsies.

Three-dimensional genome landscape comprehensively reveals patterns of spatial gene regulation in papillary and anaplastic thyroid cancers: a study using representative cell lines for each cancer type.

BACKGROUND: Spatial chromatin structure is intricately linked with somatic aberrations, and somatic mutations of various cancer-related genes, termed co-mutations (CoMuts), occur in certain patterns during cancer initiation and progression. The functional mechanisms underlying these genetic events remain largely unclear in thyroid cancer (TC). With discrepant differentiation, papillary thyroid cancer (PTC) and anaplastic thyroid cancer (ATC) differ greatly in characteristics and prognosis. We aimed to reveal the spatial gene alterations and regulations between the two TC subtypes. METHODS: We systematically investigated and compared the spatial co-mutations between ATC (8305C), PTC (BCPAP and TPC-1), and normal thyroid cells (Nthy-ori-3-1). We constructed a framework integrating whole-genome sequencing (WGS), high-throughput chromosome conformation capture (Hi-C), and transcriptome sequencing, to systematically detect the associations between the somatic co-mutations of cancer-related genes, structural variations (SVs), copy number variations (CNVs), and high-order chromatin conformation. RESULTS: Spatial co-mutation hotspots were enriched around topologically associating domains (TADs) in TC. A common set of 227 boundaries were identified in both ATC and PTC, with significant overlaps between them. The spatial proximities of the co-mutated gene pairs in the two TC types were significantly greater than in the gene-level and overall backgrounds, and ATC cells had higher TAD contact frequency with CoMuts > 10 compared with PTC cells. Compared with normal thyroid cells, in ATC the number of the created novel three-dimensional chromatin structural domains increased by 10%, and the number of shifted TADs decreased by 7%. We found five TAD blocks with CoMut genes/events specific to ATC with certain mutations in genes including MAST-NSUN4, AM129B/TRUB2, COL5A1/PPP1R26, PPP1R26/GPSM1/CCDC183, and PRAC2/DLX4. For the majority of ATC and PTC cells, the HOXA10 and HIF2α signals close to the transcription start sites of CoMut genes within TADs were significantly stronger than those at the background. CNV breakpoints significantly overlapped with TAD boundaries in both TC subtypes. ATCs had more CNV losses overlapping with TAD boundaries, and noncoding SVs involved in intrachromosomal SVs, amplified inversions, and tandem duplication differed between ATC and PTC. TADs with short range were more abundant in ATC than PTC. More switches of A/B compartment types existed in ATC cells compared with PTC. Gene expression was significantly synchronized, and orchestrated by complex epigenetics and regulatory elements. CONCLUSION: Chromatin interactions and gene alterations and regulations are largely heterogeneous in TC. CNVs and complex SVs may function in the TC genome by interplaying with TADs, and are largely different between ATC and PTC. Complexity of TC genomes, which are highly organized by 3D genome-wide interactions mediating mutational and structural variations and gene activation, may have been largely underappreciated. Our comprehensive analysis may provide key evidence and targets for more customized diagnosis and treatment of TC.

Optimal administration time of vitamin C after 131I therapy in differentiated thyroid cancer based on propensity score matching.

Objectives: This study aimed to investigate the protection of the salivary glands by vitamin C administration at 2 and 24 h after an initial treatment using iodine-131 (131I) in patients with differentiated thyroid cancer (DTC) and examined the optimal administration time of vitamin C to protect the salivary glands from radiation injury. Method: The clinical data of patients with differentiated thyroid carcinoma who had been treated with 131I in the Department of Nuclear Medicine in Shanxi Bethune Hospital from January 2014 to December 2020 were retrospectively analyzed. The propensity score matching method was adopted to match patients who received the administration of vitamin C at 2 h with those receiving administration at 24 h. A total of 230 pairs/460 patients were enrolled in the study. The chi-squared (χ 2) or Fisher's exact test was used to compare the indicators representing the incidence of salivary gland injury between the two groups. Results: The incidence of salivary gland injury (17.39%) with acidic substances at 2 h was lower compared with administration at 24 h (26.96%). The incidence of acute salivary gland injury (15.22%) and chronic salivary gland injury (26.09%) in the 24-h group were higher than those in the 2-h group (4.78% and 18.26%, respectively). The differences in the left submandibular gland concentrate index and right submandibular gland concentrate index were statistically significant before and after treatment in both the 2 and the 24-h groups; these functions had been impaired after treatment. Conclusions: Following treatment with 131I, the protective effect of acidic substances administered at 2 and 24 h on the salivary glands were different. The incidence of salivary gland injury in the 2 h acid stimulation group was lower than in the 24 h acid stimulation group. The present study revealed that 131I treatment did cause some injury to the salivary glands and that the protective effect of administering vitamin C at 2 and 24 h may be limited. Accordingly, protection against salivary gland injury should be conducted using comprehensive measures.

Scoring system and a simple nomogram for predicting radioiodine refractory differentiated thyroid cancer: a retrospective study.

BACKGROUND: Differentiated thyroid carcinoma (DTC) originates from abnormal follicular cells and accounts for approximately 90-95% of thyroid malignancies. The diagnosis of radioiodine refractory DTC (RR-DTC) is based on clinical evolution and iodine uptake characteristics rather than pathological characteristics. Thus, it takes a long time to become apparent, and the definition of RR-DTC covers multiple aspects. We aimed to analyze the clinical and molecular imaging characteristics of patients with RR-DTC and identify independent predictors to develop an RR-DTC scoring system and a simple nomogram for predicting the probability of RR-DTC. We reviewed the data of 404 patients with metastatic DTC who underwent both post-RAI WB therapy scintigraphy and 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography. Data on the clinical features and molecular characteristics of RR-DTC and non-RR-DTC cases were obtained from medical records. We screened for predictors using univariate analyses, obtained independent predictors through multivariate analyses, and then established a scoring system and a simple nomogram for predicting RR-DTC according to the corresponding odds ratio (OR) values. RESULTS: Diagnosis at age ≥ 48 years (OR, 1.037; 95% confidence interval [CI], 1.007-1.069), recurrence between the operation and iodine-131 treatment (OR, 7.362; 95% CI 2.388-22.698), uptake of 18F-FDG (OR, 39.534; 95% CI 18.590-84.076), and the metastasis site (OR, 4.365; 95% CI 1.593-11.965) were highly independently associated with RR-DTC. We established a scoring system for predicting RR-DTC, showing that the area under the receiver operating characteristic curve (AUC) with a cutoff value of 10 points (AUC = 0.898) had a higher discernibility than any other single independent predictor. The risk factors of RR-DTC in nomogram modeling include diagnosis at age ≥ 48 years, recurrence between the operation and iodine-131 treatment, uptake of 18F-FDG, and the site of metastasis. The concordance index (c-Index) of the nomogram was 0.9. CONCLUSIONS: We demonstrated that a predictive model based on four factors has a good ability to predict RR-DTC. An index score ≥ 10 points was found to be the optimal index point for predicting RR-DTC. Moreover, this nomogram model has good predictive ability and stability. This model may help establish an active surveillance or appropriate treatment strategy for RR-DTC cases.

Is it sufficient to evaluate metastatic bone involvement in breast cancer using SPECT/CT? A new approach of SPECT/CT-guided targeted bone marrow biopsy.

OBJECTIVE: To investigate the feasibility, safety, and clinical application value of single photon emission computed tomography/computed tomography (SPECT/CT)-guided bone marrow biopsy (BMB) in breast cancer (BC) patients with suspected bone metastases (BM) and compare its diagnostic performance for detection of BM with SPECT/CT. METHODS: The records of breast cancer patients referred for bone scintigraphy (BS), SPECT/CT and SPECT/CT-guided BMB from January of 2018 to June of 2021 in our hospital were retrospectively reviewed. 49 Patients were consecutively included in this study, all 49 specimens were analyzed by pathological and immunohistochemical studies.The biopsy success rate, total examination time, biopsy operation time, complications, CT radiation dose, and pathological and immunohistochemical results were recorded. The diagnostic performance based on SPECT/CT and SPECT/CT-guided BMB were compared with pathological, immunohistochemical examinations and the results of subsequent follow-up. RESULTS: Bone samples of the sites with high uptake were obtained in all 49 patients under BMB. No severe postoperative complications occurred. Among all 49 cases, 34 specimens were positive for metastatic breast cancer (69%, 34/49), and positive for benign tissue in 15 cases (31%, 15/49). 1 case of 15 cases was subsequently diagnosed as metastatic breast cancer according to the follow-up result. SPECT/CT-guided BMB demonstrated significantly higher negative predictive value (NPV) when compared to SPECT/CT (p = 0.021 < 0.05). Patients with differential expression of ER, PR, and HER-2 between primary lesions and metastatic lesions accounted for 12, 17, and 5 cases, respectively, and the changing rates were 35.2% (12/34), 50% (17/34), and 14.7% (5/34), respectively. Molecular subtype changes occurred in 7 patients, accounting for 47% (16/34) of metastatic patients. CONCLUSION: It is insufficient to evaluate BM in BC patients using SPECT/CT imaging. SPECT/CT-guided BMB provided significantly higher sensitivity and NPV than SPECT/CT for detection of BM in BC patients. Our research redefines a new approach which can confirm diagnosis and potential molecular subtype changes for suspected bone metastatic lesions in BC patients, which can offer important opportunities for precision treatment and improved quality of life of BC patients with BM.

Rare Distribution of Sclerotic Bony Lesions in Multiple Myeloma: A Case Report.

ABSTRACT: A 66-year-old man was referred to our hospital due to a newly discovered left chest wall mass, which was diagnosed as plasmacytoma on biopsy. The patient underwent 18F-FDG PET/CT scanning before treatment. PET imaging revealed intense FDG signal in osseous lesions, and the CT showed most of the lesions were osteoblastic. The osseous lesions were predominantly localized to the humerus, femur, tibia, and phalanx of toe.

Current state of prostate-specific membrane antigen PET/CT imaging-targeted biopsy techniques for detection of clinically significant prostate cancer.

Clinically significant prostate cancer (csPCa) is the focus of clinical diagnosis and treatment of prostate cancer (PCa). The current standard for diagnosing csPCa in men at risk relies on a transrectal (and in some instances transperineal) ultrasound-guided biopsy (TRUS-GB) that is blind to the location of cancer, leading to false-negative csPCa diagnoses. Over the past decade, PSMA PET/CT imaging-targeted prostate biopsy (PSMA PET/CT-TB), which obtains tissue samples from a defined suspicious area, has emerged as a promising solution for improving csPCa detection. Its feasibility and higher csPCa diagnostic value have been reported by a few case reports and studies. The current manuscript will review this latest targeted prostate puncture technology, summarize the existing applications of PSMA PET/CT-TB, including technical considerations, and discuss the advantages and challenges of each technique.

Clinicopathological characteristics and prognosis of gastrointestinal stromal tumors containing air-fluid levels.

An air-fluid level within a gastrointestinal stromal tumor (GIST) is unusual and indicates the presence of a fistula within the lumen of the GI tract. Until recently, the optimal management of such patients was not clear-cut. This retrospective study investigated the clinicopathological characteristics, surgical procedures, pre-and post-operative management, and prognosis of patients with GIST containing an air-fluid level. Data of GIST patients, spanning 5 years, including 17 GIST patients with air-fluid levels in the experimental group and 34 GIST patients without air-fluid levels in the control group, were retrieved from two hospitals in China. The clinicopathological characteristics, types of surgery, management, and clinical outcomes of GIST patients were compared between the two groups. GISTs containing air-fluid levels were significantly different from GISTs without air-fluid levels regarding tumor morphology, NIH risk category, invasion of adjacent organs, and necrosis or ulceration. Most GIST patients with air-fluid levels (14/17, 82.4%) received open surgery, significantly higher than the 20.6% in the control group. Targeted therapy with Imatinib mesylate (IM) was implemented in all GIST patients in the experimental group (17/17, 100%); markedly higher than those (3/34, 8.8%) in the control group. During follow-up, recurrence and death rates (5.9% and 5.9%) in the experimental group were higher than those (2.9% and 0%) in the control group. Open surgery is commonly performed in GIST patients with air-fluid levels who also require targeted therapy with IM. The Torricelli-Bernoulli sign could be a risk factor, adversely affecting the patient's prognosis.

Metastasis of missed cholangiocarcinoma in the left lobe through abdominal wall laparoscopic port-site and umbilicus after laparoscopic cholecystectomy: Case report and literature review.

Laparoscopic cholecystectomy (LC) has been widely used by surgeons. However, the missed diagnosis of intraperitoneal malignant tumor may occur. If the malignancy exists, the changes of the abdominal environment or the laparoscopic operation might brought the cancer cells to abdominal cavity or wall, to more extreme condition, will be located in the navel, which is known as Sister Mary Joseph's nodule(SMJN). A 63-year-old female who had undergone cholecystectomy and choledocholithotomy ten months ago was hospitalized for upper abdominal pain. Laboratory examination indicated that most of tumor markers were increased. CT revealed a progressively enhanced mass around the left lobe bile duct, multiple enlarged lymph nodes in the abdominal cavity and nodular lesions were found under the costal margin of the right side of abdominal wall and the umbilicus. Biopsy of the nodules under the original surgical scar showed middle differentiated adenocarcinoma. In laparoscopic cholecystectomy, surgeons should not only focus on the local lesions, but also look around other the tissues and organs to avoid missing the abdominal malignant tumor. When atypical symptoms or abnormalities have been found pre-operation, all abdominal organs should be evaluated in detail to avoid missed diagnosis of potential malignant tumors. On the other hand, when there is a nodule in the umbilicus, all organs in abdomen should be examined to find the potential malignant tumor. Finally, multiple cholelithiasis in the left lobe of the liver should be regarded as a high risk factor for cholangiocarcinoma.

H. pylori infection induces CXCL8 expression and promotes gastric cancer progress through downregulating KLF4.

Tumour-derived CXCL8 facilitates the movement of myeloid-derived suppressor cells, which are able to restrain antitumour immune responses to the tumour microenvironment. Kruppel-like factor 4 (KLF4) is a potential tumour suppressor in gastric cancer (GC). However, knowledge regarding correlations between KLF4 and CXCL8 in GC is limited. We use cellular and molecular biological methods to assess whether these two factors interact in GC. Expression CXCL8 and KLF4 was altered in human GC tissues compared to normal gastric tissues in opposite ways. Additionally, cytotoxin-associated gene A protein (CagA) gene transduction or Helicobacter pylori (H. pylori) infection upregulated CXCL8 expression. Knockdown of KLF4 expression increased CXCL8 protein and RNA expression, whereas its overexpression had the opposite effect. CXCL8-mediated enhancement of GC cell migration and proliferation was reversed by upregulation of KLF4 expression. Further mechanistic research revealed that KLF4 binds the CXCL8 promoter, suppressing CXCL8 transcription. Moreover, CXCL8 stimulation reduced KLF4 protein expression and promoted GC cell proliferation and migration, eventually promoting neoplasm growth in vivo. Together, our findings demonstrate that CagA promotes CXCL8 and inhibits KLF4. CXCL8 is a decisive downstream target gene of KLF4, and KLF4 negatively regulates CXCL8 in GC. Furthermore, CXCL8's negative regulation of KLF4 in vivo and in vitro, indicates that CagA may downregulate KLF4 by inducing CXCL8 expression, low expression of KLF4 further promotes that of CXCL8, forming a vicious circle in GC. Targeted KLF4 activation might improve the immunosuppressive microenvironment through direct negative regulation of CXCL8, providing a new potential target to strengthen the efficacy of immunotherapy in GC patients.

Zinner syndrome: an updated pooled analysis based on 214 cases from 1999 to 2020: systematic review.

Zinner syndrome (ZS) is a rare anomaly of the Wolffian duct. We searched for case reports and case series to identify the most effective methods for examination and treatment. The PubMed/Medline, Embase, and Scopus databases were searched. Our searches yielded 160 case reports/case series and included 214 patients. The mean age at diagnosis was 29.35 years. The R:L distribution was 1:1. The most common symptoms were: frequency (24.3%), dysuria (23.1%) and perineal pain (20.2%) in ZS patients with clinical symptoms. The diagnostic investigations used most frequently were magnetic resonance imaging (MRI) (67.8%) and ultrasonography (65.0%). Maximum flow rate on uroflowmetry, semen ejaculate volume, sperm count, and sperm motility were significantly lower in patients with ZS. Among 193 patients with treatment details, 65.8% underwent surgery; 9.8% underwent aspiration; 24.3% were followed with observation. Two patients died after surgery; all other patients remained asymptomatic after surgery. Fifty-two patients had complications and comorbidities. In patients with ZS, the most common symptoms are seminal vesicle cyst enlargement and compression of the bladder, ureter, and reproductive system. The diagnosis mostly depends on radiological examination. Surgery may be effective, but complications may occur.

18F-FDG PET/CT Findings in a Patient With Neutrophilic Leukemoid Reaction Associated With Multiple Myeloma.

F-FDG PET/CT was performed on a 48-year-old woman with leukocytosis (white blood cell count 57.10 × 10/L, 84.0% neutrophils) and monoclonal gammopathy to investigate the possibility of reactive neutrophilia secondary to plasmacytoma. On the background of skeletal "superscan," the maximum intensity projection image of PET demonstrated the highest metabolic region in the left sacrum, which was confirmed as an osteolytic lesion by CT. Biopsy of the sacral lesion revealed a plasma cell myeloma, indicating the diagnosis of neutrophilic leukemoid reaction associated with multiple myeloma. The white blood cell counts dramatically dropped to the normal level after 1 cycle of chemotherapy for multiple myeloma.

Comparative research on 99mTc-Rituximab and 99mTc-sulfur colloid in sentinel lymph node imaging of breast cancer.

BACKGROUND: 99mTc-Rituximab is a new specific radiopharmaceutical that binds to the CD20 receptor which is highly expressed on the surface of B cells. We conducted a study in which 99mTc-Rituximab was compared with filtered 99mTc-sulfur colloid (fTcSC) for sentinel lymph node (SLN) detection in patients with breast cancer. METHOD: The study is divided into three parts. 1. Initially, 25 patients were selected for an internal controlled trial to received both 99mTc-Rituximab and fTcSC, the interval time is separated by ≥2 days. 2. Then, 91 patients were selected for a randomized controlled trial (41 and 50 patients in the 99mTc-Rituximab and fTcSC groups, respectively). All patients were administered either agent at the 6- and 12-o' clock positions by subareolar injection technique. SLN mapping was then performed 2 h after injection. 3. Serial dynamic images were further acquired for 2 h in 31 patients (22 and 9 patients from 99mTc-Rituximab and fTcSC cohorts, respectively). RESULTS: The identification rate of lymphoscintigraphy and SLNB in all and axilla regions for 99mTc-Rituximab and 99mTc-SC were 98.5% vs 98.7, 100% vs 98.4%, respectively. The mean number of SLNs identified by 99mTc-Rituximab and fTcSC was respectively 2.72 and 3.28, with a significant difference of P = 0.013 (paired sample t-test). The difference exists in the internal mammary and clavicular area, not in the axillary. The mean number of axillary sentinel lymph node biopsy (SLNB) for 99mTc-Rituximab and fTcSC was 2.95 vs 3.14, respectively, and no significant difference existed. 99mTc-Rituximab also exhibited a significantly faster injection site clearance rate when compared with fTcSC (0.193 ± 0.057 h- 1 vs 0.021 ± 0.007 h- 1, respectively). CONCLUSION: No significant difference was observed in identification rate and number of axillary SLN imaging and SLNB, between the two tracers. Compared to fTcSC, 99mTc-Rituximab based imaging demonstrated a fewer number of secondary lymph nodes and had faster injection site clearance rate. TRIAL REGISTRATION: www.chictr.org.cn, ChiCTR1900024990 (retrospectively registered August 6, 2019).