Is mediastinoscopy still the gold standard to evaluate mediastinal lymph nodes in patients with non-small cell lung carcinoma?

OBJECTIVES: In this study, we aimed to define the efficacy of F-18 FDG PET/CT for the detection of mediastinal lymph node metastases by comparing the mediastinal findings of F-18 FDG PET/CT with the histopathological results obtained either by mediastinoscopy or thoracotomy in patients with clinically operable non-small cell lung cancer (NSCLC). MATERIAL AND METHODS: This is a prospective, single-institution study of 68 consecutive patients with suspected or pathologically proven, localized, clinically resectable NSCLC (8 females and 60 males; mean age: 60.36 ± 1.01 years, range: 43-78 years). The patients underwent integrated PET/CT scanning at the same PET center. Standard cervical mediastinoscopy and extended mediastinoscopy were performed to sample the lymph nodes. During thoracotomy, complete mediastinal lymph node dissection was routinely performed. RESULTS: Mediastinoscopy gave true positive results in 9 patients and true negative results in 57 patients. There were two false negative results. Mediastinoscopy had a sensitivity of 81.8% (95% CI: 63-82), a specificity of 100% (95% CI: 96-100), a PPV of 100% (95% CI: 77-100), a NPV of 96.6% (95% CI: 93-96), and an accuracy of 97% for the detection of mediastinal lymph node metastases. When PET/CT results were compared with postoperative pathological examination results, PET/CT correctly identified 48 out of 50 patients (96%) who did not have metastatic lymph node involvement. N2/N3 disease was correctly determined by PET/CT in 8 of 11 patients (72.7%) who had positive results on histological analysis. When only N2 and N3 nodal diseases were included in the calculation with the aim of making a comparison with mediastinoscopy (for mediastinal nodes), integrated PET/CT had a sensitivity of 72.7% (95% CI: 51-80), a specificity of 97.7% (95% CI: 92-99), a PPV of 88.9% (95% CI: 62-97), a NPV of 93.3% (95% CI: 88-95) and an accuracy of 92.6% (95% 83-95) for the detection of intrathoracic N2 and N3 nodal metastases. CONCLUSION: Our data shows that due to its high sensitivity and accuracy, mediastinoscopy is still the most reliable method to evaluate mediastinal lymph nodes in patients with NSCLC.

F18-FDG coincidence-PET in patients with suspected gynecological malignancy.

PURPOSE: To assess the role of F18-FDG imaging with a dual-head coincidence mode gamma camera (Co-PET) in identifying malignant tumors in patients with a suspicious adnexal mass depicted by conventional imaging methods. MATERIAL AND METHODS: F18-FDG Co-PET was performed preoperatively in 18 women (mean age 56.38 years) with suspected malignant gynecologic tumors according to clinical and abdomino-pelvic/transvaginal ultrasound or computed tomography findings. Exploratory laparotomy was performed in all patients within the 10 days post-F18-FDG Co-PET study, and the definitive diagnosis of the adnexal masses was established by histopathological examination. RESULTS: Histopathological examinations of the surgically excised adnexal masses revealed eight malignant, one borderline, and nine benign neoplastic tumors. Four benign tumors had no F18-FDG uptake, while the remaining five tumors, all leiomyomas, showed mild FDG accumulation. Eight malignant tumors showed intense F18-FDG uptake. Sensitivity, specificity, PPV, and NPV of F18-FDG co-PET in differentiating benign from malign adnexal masses were 88%, 44%, 61%, and 80%, respectively. Tumor to background ratios (T/B) in benign lesions (2.04 +/- 0.27) were significantly lower than in malignant lesions (7.4 +/- 0.99). CONCLUSION: F18-FDG Co-PET is of clinical value when assessing suspicious malignant adnexal masses. False-negative F18-FDG results might arise from borderline disease. Moderate F18-FDG uptake in leiomyomas can result false-positive, but T/B ratios may be helpful in such cases.

The prevalence of fibromyalgia in women aged 20-64 in Turkey.

OBJECTIVE: The objectives of this study were to determine the prevalence of fibromyalgia syndrome (FMS) in women aged 20-64 in the city of Trabzon, Turkey, and to evaluate associated demographic variables. METHODS: A minimum of 1825 subjects eligible for the study was calculated, and 2000 subjects were eventually planned for inclusion. Of these, 1930 subjects participated in the screening phase (a participation rate of 96.5%). The screening protocol included several interview items that have been defined as components of FMS. Subjects were also asked questions concerning demographics. Individuals with positive screening results were invited to be examined by a specialist in physical medicine and rehabilitation in order to confirm or exclude FMS using the 1990 American College of Rheumatology (ACR) classification criteria. RESULTS: Seventy of the 1930 women were diagnosed with FMS. The prevalence of fibromyalgia was 3.6% (95% CI 2.8-4.4). The prevalence was highest in the 50-59 age group (10.1%, 95% CI 8.8-11.4), in the uneducated (10.7%, 95% CI 9.3-12.1), in the widowed (8.8%, 95% CI 7.5-10.1), and in subjects with an annual household income of < USD 2000 (7.3%, 95% CI 6.1-8.5). CONCLUSION: This cross-sectional study is the first report of the prevalence of FMS in Turkey. These data will assist decision-making in the health system.

F-18 FDG PET in detecting renal cell carcinoma.

PURPOSE: To assess the role of F-18 FDG imaging with a dual head coincidence mode gamma camera (Co-PET) in the detection of renal cell carcinoma (RCC) in patients with renal masses. MATERIAL AND METHODS: An F-18 FDG Co-PET study was performed in 19 patients (7 F, 12 M; mean age 58.15 +/- 2.5 years, age range 45-79 years) with suspected primary renal tumors based on conventional imaging techniques, including computed tomography (CT) and ultrasonography (US) before nephrectomy or surgical resection of the mass. RESULTS: Histologically documented RCC was present in 15 patients. Of the 19 patients with suspected primary renal tumors, F-18 FDG Co-PET was true-positive in 13, false-negative in 2, true-negative in 3, and false-positive in I patient. Two angiomyolipomas and one renal mass due to infarction and hemorrhage showed a true-negative Co-PET result. The patient with false-positive FDG Co-PET study was diagnosed as xantogranulomatous pyelonephritis. Overall sensitivity, specificity, and accuracy of FDG Co-PET for RCC were 86% (13/15), 75% (3/4), and 84% (16/19), respectively. Positive predictive value for RCC was 92% and negative predictive value 60%. CONCLUSION: These findings suggest that F-18 FDG Co-PET may have a role in the diagnostic evaluation of patients with RCC and primary staging of disease. Positive F-18 FDG study may be predictive of the presence of RCC. However, a negative study does not exclude the RCC.

Assessment of the P-glycoprotein expression by 99mTc-MIBI bone marrow imaging in patients with untreated leukaemia.

The ability of cancer cells to become simultaneously resistant to different drugs is a significant impediment to successful chemotherapy. 99mTc-MIBI has been reported to be a transport substrate for P-glycoprotein (Pgp). The aim of the study was to ascertain the relationship between the degree of 99mTc-MIBI uptake and the level of Pgp expression in patients with newly diagnosed leukaemia. A total of 26 patients (12 female and 14 male; mean age 46.8+/-3.7 years) with newly diagnosed leukaemia were included in the study. None of the patients had been previously treated with chemotherapy. Images were obtained 20 min post-injection of 740 MBq 99mTc-MIBI. Whole-body and planar spot images of the pelvis and thorax were acquired. The uptake of the MIBI in the bone marrow was evaluated using a qualitative and also a quantitative scoring system with determination of the tumour-to-background (T/B) ratios. Flow cytometry was performed for determining the Pgp expression of the blast cells in the bone marrow aspiration samples. There was a statistically significant inverse relationship between the Pgp level in numeric values and both mean qualitative (P<0.001; r=-0.665) and quantitative (P=0.001; r=-0.606) results of 99mTc-MIBI imaging. Both the mean qualitative score and the T/B ratios were higher in patients who were Pgp negative than in those who were Pgp positive (P<0.001 and P<0.001, respectively). These data indicate that an increased level of Pgp expression is correlated with a low accumulation of 99mTc-MIBI in bone marrow of patients with leukaemia. 99mTc-MIBI bone marrow imaging, as a method of functional imaging, can give in vivo information concerning the functional expression of the MDR phenotype in patients with untreated leukaemia.

Tc-99m methoxyisobutylisonitrile bone marrow imaging for predicting the levels of myeloma cells in bone marrow in multiple myeloma: correlation with CD38/CD138 expressing myeloma cells.

The percentage of myeloma cells in bone marrow is subsequently an important index of disease in patients with multiple myeloma (MM). Bone marrow myeloma cells can be detected by strong CD38/CD138 positivity and light scatter characteristics using flow cytometry. The aim of the study was to evaluate the relationship between the degree of Tc-99m methoxyisobutylisonitrile (MIBI) uptake and the percentage of CD38/CD138 expressing myeloma cells in the bone marrow of patients with MM. A total of 15 patients with MM (mean age: 61.7+/-2.4 years; 7 F and 8 M) were included in the study. Tc-99m MIBI imaging was obtained 20 min after injection of 740 MBq Tc-99m MIBI. Planar spot images of the pelvis and thorax were acquired. The uptake of Tc-99m MIBI in the bone marrow was evaluated using a qualitative and also a semiquantitative scoring system for the bone marrow in areas that included the proximal femurs, anterior iliac crest, and sternum. In all patients, flow cytometry was performed for assessing the percentage of CD38/CD138 expressing myeloma cells in the bone marrow samples. There was a statistically significant positive correlation between the percentage of CD38/CD138 expressing plasma cells in bone marrow and both mean qualitative (r=0.689, p=0.005) and semiquantitative (r=0.669, p=0.006) results of Tc-99m MIBI uptake. In conclusion, our results indicate that increased Tc-99m MIBI uptake of bone marrow is related to the percentage of plasma cell infiltration of bone marrow. Tc-99m MIBI bone marrow imaging may be a useful tool for predicting the levels of myeloma cells in bone marrow of patients with MM.

Alexithymia in patients with antisocial personality disorder in a military hospital setting.

We investigated the prevalence of alexithymic features and other psychometric correlates in patients diagnosed with antisocial personality disorder in a military hospital setting. Forty soldiers diagnosed with antisocial personality disorder in a general military hospital and 50 normal soldiers with no known medical or psychiatric disorder were assessed by sociodemographic data form, the Toronto Alexithymia Scale (TAS)-26 items, the Beck Depression Scale, the Beck Hopelessness Scale, the Brief Symptom Inventory and the State-Trait Anxiety Inventory. Antisocial patients showed significantly higher rates of unemployment, lower educational and socioeconomic status, higher rates of self mutilation, previous suicide attempts, substance abuse, history of incarceration and broken family bonds. The patient group also displayed significantly higher scores on alexithymia, depression, hopelessness and general psychological distress measures. Alexithymia was not associated with other psychological measures but was associated with socioeconomic and educational status. The failure in the socialization process of these patients may pave the way for an inability to identify and communicate their feelings. To draw a more definitive conclusion on this issue, a study which recruits ASPD patients from the community and compares them with a sociodemographically matched patient control group is necessary.

The clinical value of 18F-FDG detection with a dual-head coincidence camera: a review.

Positron emission tomography (PET) has evolved into a technique that can accurately determine the distribution of positron-emitting radionuclides. The addition of a coincidence detection mode to a standard dual-head detector system has resulted in the option of single-photon and annihilation coincidence detection. This new device for imaging fluorine-18 2-fluoro-2-deoxy-D-glucose (18F-FDG) accumulation in neoplasms became commercially available in 1994. Besides conventional low-energy imaging in the collimated single-photon mode, it offers a relatively inexpensive opportunity to perform uncollimated PET by switching to the coincidence acquisition mode. This review summarises the clinical value of 18F-FDG detection with a dual-head coincidence camera in oncology. The results are compared with the overall results obtained using dedicated PET scanners. With respect to head and neck tumours, 18F-FDG coincidence mode gamma camera imaging (CGI) yields results that are in agreement with those obtained with dedicated PET scanners. With regard to other malignancies, such as lung cancer, lymphoma and brain tumours, data in the literature are too scarce to draw any definite conclusions. In general, the results of 18F-FDG CGI in tumours >15 mm seem to be comparable to those obtained with dedicated PET scanners, whereas in tumours <15 mm, the relative sensitivity of 18F-FDG CGI is approximately 80%. Using attenuation correction, the diagnostic yield of 18F-FDG CGI may increase. However, further clinical investigation is required to definitely establish its value in staging primary disease, therapy monitoring and assessment of tumour recurrence in clinical oncology.

The clinical value of (18)F-FDG detection with a dual-head coincidence camera: a review.

Positron emission tomography (PET) has evolved into a technique that can accurately determine the distribution of positron-emitting radionuclides. The addition of a coincidence detection mode to a standard dual-head detector system has resulted in the option of single-photon and annihilation coincidence detection. This new device for imaging fluorine-18 2-fluoro-2-deoxy-D-glucose ((18)F-FDG) accumulation in neoplasms became commercially available in 1994. Besides conventional low-energy imaging in the collimated single-photon mode, it offers a relatively inexpensive opportunity to perform uncollimated PET by switching to the coincidence acquisition mode. This review summarises the clinical value of (18)F-FDG detection with a dual-head coincidence camera in oncology. The results are compared with the overall results obtained using dedicated PET scanners. With respect to head and neck tumours, (18)F-FDG coincidence mode gamma camera imaging (CGI) yields results that are in agreement with those obtained with dedicated PET scanners. With regard to other malignancies, such as lung cancer, lymphoma and brain tumours, data in the literature are too scarce to draw any definite conclusions. In general, the results of (18)F-FDG CGI in tumours >15 mm seem to be comparable to those obtained with dedicated PET scanners, whereas in tumours <15 mm, the relative sensitivity of (18)F-FDG CGI is approximately 80%. Using attenuation correction, the diagnostic yield of (18)F-FDG CGI may increase. However, further clinical investigation is required to definitely establish its value in staging primary disease, therapy monitoring and assessment of tumour recurrence in clinical oncology.

Positron emission tomography with 2-[18F]fluoro-2-deoxy-D-glucose in oncology. Part II. The clinical value in detecting and staging primary tumours.

The tumoral uptake of 2-[18F]fluoro-2-deoxy-D-glucose (18FdGlc) is based upon enhanced glycolysis. Positron-emission tomography (PET) using 18FdGlc provides the physiological and metabolic information. 18FdGlc PET has been used successfully for assessing primary tumours and metastases, prognosis, and planning and for monitoring tumour therapy as well as for early detection of recurrent tumour growth. This review summarises the uptake mechanism of 18FdGlc in benign and malignant lesions, its relation to histopathology, and its clinical value for detecting and staging primary tumours.

Cutaneous malignant melanoma: clinical aspects, imaging modalities and treatment.

Cutaneous melanoma is a highly malignant tumour of the melanocytes presenting characteristic metabolic and biological features. Early detection decreases mortality and morbidity and provides the best chance for optimal clinical management. Imaging techniques, including scintigraphy, have assumed an important role in detection strategies. As a functional modality, nuclear medicine offers a variety of possibilities to assist in the clinical management of malignant melanoma. This review discusses the clinical aspects and treatment of melanoma, and the imaging techniques used for its diagnosis, staging and follow-up. A survey of currently available techniques is presented.

The comparison of the effects of fluticasone propionate and budesonide on clinical indices and on bone mineral density in the asthmatic patients: a one year treatment study.

BACKGROUND: it is well accepted that the inhaled administration of steroids is efficacious and has fewer side effects than the systemic use. Among them fluticasone propionate (FP) has been said to cause the similar antiasthma effect without unfavorable side effect at half the dose of the other ICS. The aim of the study was to compare the effects of FP 500 microg/day and budesonide (BUD) 800 microg/day as a pressurized metered dose inhaler (pMDI) for one year on clinical indices determined by FEV1 and diurnal variation of PEFR (peak expiratory flow rates) and on laboratory indices determined by serum cortisol and bone mineral density (BMD). METHODS: a total of 30 nonsmoking mild to moderate asthmatic patients were recruited the study. 15 patients were given 800 microg/day BUD and 15 patients were given 500 microg/day FP as a pMDI. BMD measurements were done with dual energy X-ray absorbtiometry (DEXA) before and after the treatment at the lumbar area of the spine (L1-4) and left hip (trocanter major, neck of femur, intertrocanteric region and Ward's triangle). 10 patients of BUD group and 13 of FP group completed the study. After a year of treatment period, patients were compared on the basis of clinical indices (FEV1 and variability of PEFR), on serum cortisol levels and on BMD in both groups. RESULTS: after the treatment, variability of PEFR (in BUD group p < 0,01, in FP group p < 0,001) and FEV1 (in BUD group p < 0,05, in FP group p < 0,05) were both improved in the groups. Serum cortisol levels and BMD of the patients in both groups were not changed significantly (p > 0,05). CONCLUSIONS: the results suggested that FP 500 microg/d and BUD 800 microg/d as a pMDI results in a similar antiasthma effect without causing any adverse effect on BMD in mild and moderate asthmatics after one year treatment period.