Microwave ablation of solitary T1N0M0 papillary thyroid carcinoma: A case report.

BACKGROUND: The gold standard treatment for papillary thyroid carcinoma is total thyroidectomy and indications for microwave thermal ablation for primary thyroid cancers have not yet been clearly established However, some patients refuse surgery and others have no indication for it, for example patients under palliative care as in this case, or cannot undergo surgery, based on their comorbidities. These indications are described in the most recent Korean, North American and European guidelines. Laser ablation, radiofrequency ablation, and microwave ablation are similarly safe and effective, so the choice should be based on the specific competences and resources of the pertaining centers. These indications are Percutaneous minimally-invasive techniques; they can be useful to stop disease progression and as an alternative to surgery in patients with contraindication or who refuse surgery. We present a case of a thyroid papillary carcinoma with 17 mm effectively treated with microwave thermal ablation and without recurrence after one year of follow up. CASE SUMMARY: The authors present a case of a 71-years-old patient with a left lobe papillary thyroid carcinoma with 13 mm × 17 mm × 13 mm, with no indication for thyroid surgery given the context of another cancer in palliative treatment. Microwave thermoablation was performed on December 2021. Four months later he repeated computed tomography (CT) scan, which showed that the tumor had disappeared. Six months after ablation he underwent a positron emission tomography/CT-fluorodeoxyglucose scan, which didn't show any evidence of hypermetabolic tumor lesions. CONCLUSION: This case shows microwave thermoablation can be a safe and effective alternative to surgery in patients with no conditions to undergo surgery or when they refuse it. By treating the tumor, with this minimally invasive technique, we are stopping its growth and avoiding disease progression.

18F-FDG PET/CT in Patients with Vulvar and Vaginal Cancer: A Preliminary Study of 20 Cases.

INTRODUCTION: Despite the growing evidence supporting the use of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in cervical and ovarian malignant tumours, data on vulvar and vaginal cancer is sparse. Our aim was to assess the role of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in patients with vulvar and vaginal cancer. MATERIAL AND METHODS: A retrospective study was conducted on a cohort of 20 patients with biopsy-proven vulvar (n = 17) and vaginal (n = 3) cancer who performed 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, between January 2013 and April 2018. We collected the clinical data of all patients, as well as the indication for 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography, its results, and the main lesion maximum standard uptake value (SUVmax). In addition, we correlated the results of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography with other diagnostic modalities, namely histological findings, computed tomography and magnetic resonance imaging. Patients were divided into two groups, one with newly diagnosed disease and another with recurrent disease. RESULTS: Six patients had newly diagnosed disease and 14 had recurrent disease. The main lesion was detected by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in five out of six patients with newly diagnosed disease and in all 14 patients with recurrent disease. Additional sites of 2-[F-18]-fluor-2-desoxi-D-glucose uptake were identified in inguinal and iliac lymph nodes and in distant lesions. Magnetic resonance imaging and computed tomography were performed in 12 cases. In four patients with recurrent disease, abnormalities (main lesion/ metastatic lymph nodes) identified by 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography were not detected as suspicious by computed tomography. DISCUSSION: In our study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography identified abnormalities more often than conventional computed tomography scans in recurrent disease. In comparison with histology, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography had a sensitivity of 95% and a positive predictive value of 100% in identifying the primary tumour and the recurrent main lesion. Little data is available regarding the usefulness of 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography in the management of vulvar and vaginal cancers. The existing evidence supports a high accuracy in detecting lymph node metastases and a change of 36.0% - 61.5% in patient management. Our findings reinforce the usefulness of this technique in vulvar and vaginal cancer. Limitations of our study include its retrospective nature and the rareness of both vulvar and vaginal cancer, which leads to a small sample size and few comparative imaging tests. CONCLUSION: In this preliminary study, 2-[F-18]-fluor-2-desoxi-D-glucose positron emission tomography/computed tomography demonstrated it can be a useful method in patients with vulvar and vaginal cancers, namely in defining the extent of disease and contributing to accurate staging and restaging.

Introdução: Apesar da crescente evidência que suporta o uso da tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose em tumores malignos do colo do útero e do ovário, os dados sobre o carcinoma da vulva e da vagina são escassos. O nosso objetivo foi avaliar o papel da tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose em doentes com carcinoma da vulva e da vagina. Material e Métodos: Entre janeiro de 2013 e abril de 2018 foi realizado um estudo retrospetivo numa coorte de 20 doentes com carcinoma da vulva (n = 17) e da vagina (n = 3), comprovados por biópsia, que efetuaram tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose. Recolheram-se os dados clínicos de todos os doentes, bem como a indicação clínica para a realização da tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose, os seus resultados e o valor de captação padronizado máximo da lesão principal (SUVmax). Para além disso, correlacionaram-se os resultados da tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose com os de outras modalidades diagnósticas, nomeadamente com os achados histológicos, a tomografia computadorizada e a ressonância magnética. Os doentes foram divididos em dois grupos, um com doença recém diagnosticada e outro com doença recorrente. Resultados: Seis doentes tinham doença recém diagnosticada e 14 tinham doença recorrente. A lesão principal foi detetada em cinco dos seis doentes com doença recém diagnosticada e nos 14 com doença recorrente. Foram identificados outros locais de captação de 2-[F-18]-fluor-2-desoxi-D-glucose, nomeadamente gânglios linfáticos ilíacos e inguinais, e lesões à distância. Em 12 casos foram realizadas ressonância magnética e tomografia computadorizada. Em quatro casos com doença recorrente, as anomalias (lesão principal /gânglios linfáticos metastáticos) identificadas na tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose não haviam sido descritas como suspeitas pela tomografia computadorizada. Discussão: No nosso estudo, a tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose identificou mais anomalias que a tomografia computadorizada na doença recorrente. Comparando com os resultados histológicos, a tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose apresentou sensibilidade de 95% e um valor preditivo positivo de 100% na identificação do tumor primário/ lesão principal recorrente. Poucos dados estão disponíveis sobre a utilidade da tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose no seguimento de carcinomas da vulva e da vagina. As evidências atuais sugerem uma elevada exatidão na deteção de metástases ganglionares e uma mudança de 36,0% - 61,5% no tratamento destes doentes. Os nossos achados reforçam a utilidade desta técnica no carcinoma da vulva e da vagina. As limitações do nosso estudo decorrem da sua natureza retrospetiva e da raridade das patologias estudadas, o que condiciona o tamanho da amostra e a quantidade de exames de imagem comparativos. Conclusão: Neste estudo preliminar, a tomografia por emissão de positrões/ tomografia computadorizada com 2-[F-18]-fluor-2-desoxi-D-glucose demonstrou poder ser um método útil em doentes com carcinoma da vulva e da vagina, nomeadamente na definição da extensão da doença e na contribuição para o estadiamento e restadiamento precisos.

68Ga-PSMA Uptake in Prostate Cancer Sciatic Nerve Metastasis.

Most prostate cancers spread to regional lymph nodes, axial skeleton and lungs. Perineural malignant involvement is very rare. We present a Ga-PSMA PET/CT image of a sciatic nerve metastasis in a 65-year-old man with recurrent prostate cancer.

Interobserver agreement on cortical tracer transit in 99mTc-MAG3 renography applied to congenital hydronephrosis.

OBJECTIVE: This study aims to evaluate interobserver agreement on visual analysis of technetium-99m mercaptoacetyltriglycine (Tc-MAG3) renal tissue transit used for the evaluation of antenatal hydronephrosis. MATERIALS AND METHODS: Thirty-eight Tc-MAG3 diuretic renograms were retrospectively collected between 1 and 31 December 2015. The 1-min reframed images were presented to four nuclear medicine consultants and to two nuclear medicine residents, one in the first year of the training program and the others in their fourth and final year. These observers were asked to classify the radiotracer cortical transit (normal/delayed) based solely on visual assessment of the images. For the interobserver agreement, modified Fleiss' kappa (κ) analysis for multiple raters was carried out. For both groups, percentages of agreement were also calculated. RESULTS: A total of 69 kidneys were evaluated. All four nuclear medicine consultants agreed on the classification of 88.4% of the kidneys. When the agreement of at least three of the four observers was considered, the percentage of agreement reached 98.6%. The two nuclear medicine residents agreed on the classification of 69.6% of the kidneys. The modified Fleiss' κ-value was 0.88 (95% confidence interval: 0.79-0.95) for the group of nuclear medicine consultants, indicating almost perfect agreement. For the residents, it was 0.39 (95% confidence interval: 0.16-0.59), suggesting fair agreement. CONCLUSION: Our results seem to indicate that there is an almost perfect agreement in the qualitative identification of delayed cortical transit among physicians with experience at observing renographic images.

[Treatment of Gastroenteropancreatic Neuroendocrine Tumors with 177Lu-DOTA-TATE: Experience of the Portuguese Institute of Oncology in Porto]. / Tratamento de Tumores Neuroendócrinos Gastroenteropancreáticos com 177Lu-DOTA-TATE: Experiência do Instituto Português de Oncologia do Porto.

INTRODUCTION: The purpose of this article is to report the experience of the Portuguese Institute of Oncology - Porto in the treatment of gastroenteropancreatic neuroendocrine tumors with 177Lu-DOTA-TATE, regarding the safety and efficacy of this treatment modality. MATERIAL AND METHODS: A retrospective analysis of clinical reports of patients with gastroenteropancreatic neuroendocrine tumors undergoing treatment with 177Lu-DOTA-TATE between April 2011 and November 2013 was performed. RESULTS: Thirty six cases were reviewed and 30 completed all 3 cycles of 177Lu-DOTA-TATE (83.3%). In these patients it was registered: acute side effects in 8.9% of cycles; grade 3 CTCAE liver toxicity in 13.3% of patients (all with previous abnormal liver function); absence of significant renal or hematologic toxicity; symptomatic improvement in 71.4% of patients; median overall time to progression of 25.6 months; median overall survival from diagnosis of 121.7 months. Patients with higher expression of somatostatin receptors had longer progression-free survival and overall survival times (p < 0.05). DISCUSSION: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is an effective, safe and well-tolerated treatment, as evidenced in our study by the following findings: symptomatic improvement in most patients and increased time to disease progression and survival (especially in those with higher sstr expression), with acute and significant subacute/chronic side effects reported only in a minority of cases. CONCLUSION: Peptide receptor radionuclide therapy with 177Lu-DOTA-TATE is a promising treatment for patients with gastroenteropancreatic neuroendocrine tumors, with demonstrated benefits in terms of safety and efficacy.

Introdução: O objetivo deste artigo é rever a experiência do Instituto Português de Oncologia do Porto na terapêutica de tumores neuroendócrinos gastroenteropancreáticos com 177Lu-DOTA-TATE, tendo como principais pontos de análise a segurança e eficáciaterapêutica. Material e Métodos: Foi realizada uma análise retrospetiva dos processos clínicos de doentes com tumores neuroendócrinos gastroenteropancreáticos, submetidos a terapêutica com 177Lu-DOTA-TATE entre abril de 2011 e novembro de 2013. Resultados: Dos 36 casos revistos, 30 completaram os três ciclos de 177Lu-DOTA-TATE (83,3%). Nesses doentes foram registados: efeitos colaterais agudos em 8,9% dos ciclos; toxicidade hepática grau 3 CTCAE em 13,3% dos doentes (todos com alterações prévias da função hepática); ausência de toxicidade renal ou hematológica significativa; melhoria sintomática em 71,4% dos doentes; tempo mediano global desde o início da terapêutica até progressão de doença de 25,6 meses; tempo mediano global de sobrevivência desde o diagnóstico de 121,7 meses. Verificou-se um maior tempo livre de progressão de doença e de sobrevivência nos doentes com expressão elevada de recetores da somatostatina (p < 0,05). Discussão: A peptide receptor radionuclide therapy com 177Lu-DOTA-TATE apresenta respostas clínicas favoráveis com segurança e boa tolerabilidade terapêutica, conforme evidenciado no nosso estudo pelos seguintes achados: melhoria dos sintomas na maioria dos doentes e aumento significativo do tempo livre de progressão de doença e da sobrevivência (sobretudo nos doentes com expressão elevada de sstr), com efeitos colaterais agudos e subagudos/crónicos significativos numa minoria de doentes. Conclusão: A peptide receptor radionuclide therapy com 177Lu-DOTA-TATE é uma terapêutica promissora, com benefícios reais em termos de eficácia e segurança nos doentes com tumores neuroendócrinos gastroenteropancreáticos.