A prospective evaluation of 18F-FDG and 11C-acetate PET/CT for detection of primary and metastatic hepatocellular carcinoma.

UNLABELLED: Because (18)F-FDG PET has insufficient sensitivity for the detection of hepatocellular carcinoma (HCC), (11)C-acetate PET has been proposed as another technique for this use. We prospectively evaluated the value of PET/CT using these 2 tracers for the detection of primary and metastatic HCC. METHODS: One hundred twelve patients (99 with HCC, 13 with cholangiocellular carcinoma) underwent biopsy and (18)F-FDG and (11)C-acetate PET/CT. RESULTS: The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT in the detection of 110 lesions in 90 patients with primary HCC were 60.9%, 75.4%, and 82.7%, respectively. Elevated serum alpha-fetoprotein levels, an advanced tumor stage, portal vein tumor thrombosis, large tumors, and multiple tumors were significantly associated with positive (18)F-FDG PET/CT results. Uptake of (11)C-acetate was associated with large and multiple tumors. For (18)F-FDG, the sensitivities according to tumor size (1-2, 2-5, and >/=5 cm) were 27.2%, 47.8%, and 92.8%, respectively; for (11)C-acetate, these respective values were 31.8%, 78.2%, and 95.2%. (18)F-FDG was more sensitive in the detection of poorly differentiated HCC. Overall survival was lower in patients with (18)F-FDG PET/CT positive for all indexed lesions than in those with FDG negative or partially positive through the entire follow-up period. In analysis based on biopsied lesions, the sensitivity of (18)F-FDG PET/CT was 64.4% for primary HCC and 84.4% for (11)C-acetate PET/CT. The overall sensitivities of (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT for 35 metastatic HCCs were 85.7%, 77.0%, and 85.7%, respectively. There was no significant difference in the sensitivity of tracers according to metastatic tumor size, location, or differentiation. CONCLUSION: The addition of (11)C-acetate to (18)F-FDG PET/CT increases the overall sensitivity for the detection of primary HCC but not for the detection of extrahepatic metastases. (18)F-FDG, (11)C-acetate, and dual-tracer PET/CT have a low sensitivity for the detection of small primary HCC, but (18)F-FDG PET/CT has a relatively high sensitivity for the detection of extrahepatic metastases of HCC.

Survival analysis of 904 patients with hepatocellular carcinoma in a hepatitis B virus-endemic area.

BACKGROUND AND AIM: To investigate the clinical characteristics and survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients treated at a single institute in a hepatitis B virus (HBV)-endemic area. METHODS: Between 2000 and 2003, 904 patients with HCC treated at our institute were enrolled, and followed until 2005. RESULTS: The mean age of the patients was 56 years and 76.3% were HBV-positive. The 1-, 2-, 3-, and 4-year survival rates were 53.8%, 40.0%, 31.4%, and 25.7%, respectively. The 4-year survival rates for Child-Pugh class A patients treated by resection or transarterial chemoembolization (TACE) were 77.3% and 63.2% for those with modified International Union Against Cancer (UICC) stage I or II disease (P = 0.043), and 58.6% and 19.2% for those with modified UICC stage III disease (P < 0.001). In patients with Child-Pugh class A and stage IVa, the median survival times differed between TACE and chemotherapy treatments (6.9 vs 4.0 months, P = 0.003), whereas in patients with stage IVb there was no difference between treatments (8.5 vs 6.1 months, P = 0.173) Serum alpha-fetoprotein level, presence of portal vein tumor thrombosis, Child-Pugh class, tumor, node, and metastasis stage, and the number and type of HCC were all related to prognosis. Significant differences in survival curves were observed among the Japanese Integrated Staging scores. CONCLUSIONS: The results of this study will be helpful in determining the survival outcomes and treatment strategies for HCC patients in HBV-endemic areas.

[Amputation neuroma mimicking common bile duct cancer: a case report].

Amputation neuroma or traumatic neuroma is a tumor-like secondary hyperplasia that may develop after an accidental or surgical trauma. Amputation neuroma of the bile duct has occasionally been reported which occurred in the cystic duct stump late after the cholecystectomy. However, even if the amputation neuroma is suspected in a patient with late-onset jaundice after cholecystectomy, the differential diagnosis from a malignancy is difficult preoperatively. We experienced a case of the amputation neuroma of common bile duct (CBD) developed in a 70-year-old man who presented with a polypoid mass in CBD. He had undergone cholecystectomy 25 years ago and choledochojejunostomy 12 years ago, respectively. We have performed pylorus-preserving pancreatico-duodenectomy (PPPD) under the impression of CBD cancer. He had not been diagnosed of amputation neuroma until having undergone PPPD. We report a case of CBD neuroma mimicking CBD cancer, which was confirmed after PPPD.

[Five-year survival analysis of a cohort of hepatocellular carcinoma patients who treated at the National Cancer Center, Korea].

BACKGROUND AND AIMS: We investigated the five-year survival outcomes of a large cohort of hepatocellular carcinoma (HCC) patients who were treated at a single institute, and this is a follow-up study of a previous report. METHODS: Nine hundred four HCC patients who were treated at the National Cancer Center Korea were enrolled and they were followed till February 2007. RESULTS: The mean age of the patients was 56.0 years and 731 patients were male. Six hundred seventy-seven (74.9%) patients died and the overall 5-year survival rate (5-YSR) was 23.9%. The 5-YSRs of the patients with modified UICC stage I, II and III were 61.2%, 54.4% and 18.4%, respectively, and the median survival time was 4.3 and 3.7 months for the stage IVa and IVb patients, respectively. For the analysis of the treatment modality, surgical resection showed significantly better outcomes for the five-year survival as compared with transcatheter arterial chemoembolization (TACE) for Child-Pugh A patients with modified UICC stage I or II disease (80.1% vs 52.8%, respectively, P<.001), or stage III disease (60.7% vs 17.0%, respectively, P<.001). For patients with advanced stage IVb disease, TACE, systemic chemotherapy and radiotherapy increased the median survival period more than conservative management for the Child-Pugh class A patients. The serum alpha-fetoprotein level, portal vein tumor thrombosis, the Child-Pugh class, the tumor stage, the tumor type and symptoms were related to the prognosis. CONCLUSIONS: This study presented, for the first time, the 5-YSRs of a cohort of HCC patients.

Electron paramagnetic resonance study reveals a putative iron-sulfur cluster in human rpS3 protein.

The human ribosomal protein S3 (rpS3) functions as a component of the 40S subunit and as a UV DNA repair endonuclease. This enzyme has an endonuclease activity for UV-irradiated and oxidatively damaged DNAs. DNA repair endonucleases recognize a variety of UV and oxidative base damages in DNA from E. coli to human cells. E. coli endonuclease III is especially known to have an iron-sulfur cluster as a co-factor. Here, we tried an electron paramagnetic resonance (EPR) method for the first time to observe a known iron-sulfur cluster signal from E. coli endonuclease III that was previously reported. We compared it to the human rpS3 in order to find out whether or not the human protein contains an iron-sulfur cluster. As a result, we succeeded in observing a Fe EPR signal that is apparently from an iron-sulfur cluster in the human rpS3 endonuclease. The EPR signal from the human enzyme, consisting of three major parts, is similar to that from the E. coli enzyme, but it has a distinct extra peak.

Optimization of wet radiofrequency ablation using a perfused-cooled electrode: a comparative study in ex vivo bovine livers.

OBJECTIVE: To determine the optimized protocol for wet monopolar radiofrequency ablation (RFA) using a perfused-cooled electrode to induce coagulation necrosis in the ex vivo bovine liver. MATERIALS AND METHODS: Radiofrequency was applied to excised bovine livers in a monopolar mode using a 200W generator with an internally cooled electrode (groups A and B) or a perfused-cooled electrode (groups C, D, E, and F) at maximum power (150-200 W) for 10 minutes. A total of 60 ablation zones were created with six different regimens: group A-dry RFA using intra-electrode cooling; group B-dry RFA using intra-electrode cooling and a pulsing algorithm; group C-wet RFA using only interstitial hypertonic saline (HS) infusion; group D-wet RFA using interstitial HS infusion and a pulsing algorithm; group E-wet RFA using interstitial HS infusion and intra-electrode cooling; and group F-wet RFA using interstitial HS infusion, intra-electrode cooling and a pulsing algorithm. In groups C, D, E, and F, RFA was performed with the infusion of 6% HS through the perfused cooled electrode at a rate of 2 mL/minute. During RFA, we measured the tissue temperature at a distance of 15 mm from the electrode. The dimensions of the ablation zones and the changes in impedance, currents, and liver temperature during RFA were compared between these six groups. RESULTS: During RFA, the mean tissue impedances in groups A (243+/-88 ohm) and C (252.5+/-108 ohm) were significantly higher than those in groups B (85+/-18.7 ohm), D (108.2+/-85 ohm), E (70.0+/-16.3 ohm), and F (66.5+/-7 ohm) (p < 0.05). The mean currents in groups E and F were significantly higher than those in groups B and D, which were significantly higher than those in groups A and C (p < 0.05): 520+/-425 mA in group A, 1163+/-34 mA in group B, 652.5+/-418 mA in group C, 842.5+/-773 mA in group D, 1665+/-295 mA in group E, and 1830+/-109 mA in group F. The mean volumes of the ablation regions in groups E and F were significantly larger than those in the other groups (p < 0.05): 17.7+/-5.6 cm(3) in group A, 34.5+/-3.0 cm(3) in group B, 20.2+/-15.6 cm(3) in group C, 36.1+/-19.5 cm(3) in group D, 68.1+/-12.4 cm(3) in group E, and 79.5+/-31 cm(3) in group F. The final tissue temperatures at a distance of 15 mm from the electrode were higher in groups E and F than those in groups A, C, and D (p < 0.05): 50+/-7.5 degrees C in group A, 66+/-13.6 degrees C in group B, 60+/-13.4 degrees C in group C, 61+/-12.7 degrees C in group D, 78+/-14.2 degrees C in group E, and 79+/-12.0 degrees C in group F. CONCLUSION: Wet monopolar RFA, using intra-electrode cooling and interstitial saline infusion, showed better performance in creating a large ablation zone than either dry RFA or wet RFA without intra-electrode cooling.