Correlation of the ADC values assessed by diffusion-weighted MRI and 18F­FDG PET/ CT SUV in patients with lung cancer

Background: Diffusion-weighted magnetic resonance imaging (DW-MRI) provides information on the cellularity and movement of water molecules in tissues and 18F­fluorodeoxyglucose (18F­FDG) positron emission tomography/computed tomography (18F­FDG PET/CT) assesses cellular glucose metabolism, however both variables are related to tumour aggressiveness. The aim of this study is to investigate the potential correlation of the apparent diffusion coefficient (ADC) assessed by diffusion-weighted MRI (DWI) and glucose metabolism determined by the standardized uptake value (SUV) calculated from 18F­FDG PET/CT data in non-small cell lung cancer (NSCLC) with the occurrence of metastasis to the lymph nodes. Methods: 18F­FDG PET/CT and DWI (TR/TE, 1800/93 ms; b-values, 0 and 600 s/mm2) were performed in 37 consecutive patients with histologically verified NSCLC. SUVmax was calculated based on the PET-CT data. The minimum ADC (ADCmin) was determined by placing a region-of-interest (ROI) covering the entire tumou. Results of 18F­FDG PET/CT and DWI were compared on a per-patient basis. Pearson's correlation coefficient was used for statistical analysis. Results: Correlation analysis of the ADCmin and SUVmax revealed that the inverse correlation was good for all the masses (p< 0.001) and the lymph nodes (p < 0.001) for each histological subtype, for both adenocarcinomas (p < 0.001) lymph nodes (p = 0.005) and squamous cell carcinomas (p < 0.001). No significant correlation was found in the comparison of the ADCmin and SUVmax of the lymph nodes for squamous cell carcinomas (p = 0.066). Conclusions: This study verified the relationship between the SUVmax and the ADCmin in NSCLC. The significant inverse correlation of these two quantitative imaging approaches highlights the association between metabolic activity and tumour cellularity. Therefore, DWI with ADC measurement might represent a new biomarker in NSCLC.

Technical note: CT-guided paravertebral adrenal biopsy using hydrodissection--a safe and technically easy approach.

The adrenal glands are an important site of both primary and secondary disease processes. Image-guided percutaneous biopsy of the adrenal gland is an accurate and safe alternative to surgical biopsy. This procedure is most often performed in patients with a suspicion of metastatic disease where an accurate pathological diagnosis plays an important role in disease staging and defining therapy. There are many different approaches to performing adrenal biopsy under CT guidance such as anterior transhepatic/transpancreatic, lateral transhepatic/transplenic or posterior transpulmonary/transpleural/paravertebral. We describe a technique in which the adrenal gland was biopsied using a CT-guided percutaneous paravertebral approach with the use of a hydrodissection manoeuver. 13 CT-guided adrenal gland percutaneous biopsies using this technique were performed at our institution between April 2009 and July 2010. All biopsies yielded sufficient material for pathological analysis and there were no complications reported after the procedure. Saline injection can expand the posterior paravertebral space and facilitate a posterior extrapleural approach with high accuracy and low complication rates, and we believe that this may be the best approach for adrenal gland biopsy.

Prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center in Brazil.

OBJECTIVE: Anxiety disorders have been shown to undermine the quality of life of cancer patients. Unfortunately, medical professionals often neglect to screen for anxiety in their patients. The aim of the present study was to describe the prevalence of anxiety in patients awaiting diagnostic procedures in an oncology center waiting room, and to investigate possible relationships between anxiety and demographic and clinical variables. METHODS: A cross-sectional study was performed with 398 patients who completed a self-administered questionnaire containing the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). RESULTS: Results of the HADS indicated that 38% of participants had anxiety, while data from the STAI showed that 46% had either high state or trait anxiety. The most frequently cited source of anxiety was concern over test results. Age, gender, employment status, and education level were correlated with anxiety. CONCLUSIONS: The prevalence of anxiety is high among patients awaiting diagnostic procedures. Patients in the waiting room should be routinely screened for anxiety. Careful assessment and treatment of anxiety are important components in the care of patients with cancer.

Response to chemotherapy in patients with lung metastases: how many nodules should be measured?

OBJECTIVE: With the introduction of cross-sectional imaging methods the number of lesions per patient that can be evaluated is frequently large and most oncologists and study protocols use only one lesion or a few 'representative' lesions to evaluate chemotherapy response. Intra-patient response variability can therefore affect evaluation reproducibility. This study evaluates intra-individual variation in response to chemotherapy in patients with multiple lung metastases. METHODS: We prospectively studied chest CT images of patients with solid tumors and pulmonary metastases under systemic chemotherapy being evaluated for tumor response. The response of 566 pulmonary nodules in 41 evaluations was determined by both WHO and RECIST criteria in order to determine intra-individual tumor response variation. RESULTS: There was almost perfect agreement between the WHO and the RECIST criteria for the evaluation of tumor response. High intra-individual variability of tumor response was observed in a significant proportion of the evaluations. A new nodule was the main criterion for determination of disease progression. A mean of 35% of the total number of nodules of a patient have a response evaluation different from that calculated with all the nodules together. CONCLUSIONS: Intra-individual variation in tumor response of pulmonary metastases is elevated in some patients. Selecting any or some nodules for response evaluation could significantly influence therapeutic response perception.

Intestinal paracoccidioidomycosis simulating colon cancer.

We report a case of intestinal involvement of Paracoccidioidomycosis, in a patient considered to have colonic cancer. The diagnosis of this mycosis should be considered when an abdominal mass associated with intra-lesional calcifications on X-ray is observed. CT scans increase the findings.

Fine needle aspiration of thoracic lesions: experience in a Brazilian cancer center.

STUDY OBJECTIVES: This study is a retrospective analysis of cytological specimens of fine needle aspiration (FNA) of thoracic lesions under computed tomography guidance, over a 2-year period to assess the diagnostic performance of cytology method. DESIGN: A total of 134 aspirations were performed using a 22 and 20 gauge needle (spinal long). The cytological diagnosis was achieved in 126 cases (94%). The histopathological findings were correlationed in order observe the cytologic diagnosis performance. PATIENTS: The cases were obtained from patients examined at A. C. Camargo Hospital ambulatory. RESULTS: There were 89 cases of malignant lesions (66.4%), 27 benign lesions (20%) and 10 cases (7.5%) of suspected for malignancy. The correlation with histopathology was possible in cases with previous histopathological exams and with tissue diagnosis after puncture. The correlation between FNA and histology showed an overall sensitivity of 77%, specificity of 100%, false-negative rate of 20% and no false-positive results. CONCLUSIONS: We conclude that FNA is a sensitive and highly specific technique for the diagnosis of thoracic neoplasms.

Solitary plasmocytoma of bone in an adolescent.

PURPOSE: To describe an adolescent with solitary plasmocytoma of bone and compare the pathologic and radiographic findings with osteomyelitis. PATIENT AND METHODS: A 17-year-old girl had a 3-year history of swelling of the right tibia, local pain, and hyperemia. RESULTS: Initial biopsy was interpreted as osteomyelitis. The lesion was rebiopsied 3 years later and showed a plasma cell neoplasm. A review of the first biopsy confirmed a similar histologic picture. CONCLUSION: Although solitary plasmocytoma of bone is a rare neoplasm in adolescence, it must be considered in the differential diagnosis of chronic osteomyelitis.

Abdominal recurrence of osteogenic sarcoma: a case report.

PURPOSE: Nonpulmonary metastases from osteogenic sarcoma are rare. A patient had a localized osteogenic sarcoma of the left femur which recurred in the abdomen, a previously unreported metastatic site. PATIENT AND METHODS: An 18-year-old boy was treated for osteosarcoma. He had abdominal pain, vomiting, weight loss, and symptoms of intestinal obstruction at the time of relapse. RESULTS: The patient had diffuse widespread intraabdominal osteogenic sarcoma as the only site of initial recurrence. Abdominal computerized tomography revealed ascites and calcified masses on the hepatic and peritoneal surfaces. Laparoscopic visualization of the abdomen showed hemorrhagic ascites and multiple calcified tumor on the peritoneum, diaphragm, and liver. A biopsy of a representative lesion confirmed the diagnosis of osteogenic sarcoma. The patient died from progressive disease. CONCLUSION: As the initial treatment for patients with osteogenic sarcoma is intensified, the pattern of metastases may change. Unusual sites of recurrence such as in this patient may become more prevalent. A clinical presentation of an acute abdomen in a patient previously treated for osteogenic sarcoma should prompt suspicion of intraabdominal recurrence.

Abdominal recurrence of osteogenic sarcoma: a case report

Nonpulmonary metastases from osteogenic sarcoma are rare. A patient had a localized osteogenic sarcoma of the left femur which recurred in the abdomen, a previously unreported metastatic site. An 18-year-old boy was treated for osteosarcoma. He had abdominal pain, vomiting, weight loss, and symptoms of intestinal obstruction at the time of relapse. The patient had diffuse widespread intraabdominal osteogenic sarcoma as the only site of initial recurrence. Abdominal computerized tomography revealed ascites and calcified masses on the hepatic and peritoneal surfaces. Laparoscopic visualization of the abdomen showed hemorrhagic ascites and multiple calcified tumor on the peritoneum, diaphragm, and liver. A biopsy of a representative lesion confirmed the diagnosis of osteogenic sarcoma. The patient died from progressive disease. As the initial treatment for patients with osteogenic sarcoma is intensified, the pattern of metastases may change. Unusual sites of recurrence such as in this patient may become more prevalent. A clinical presentation of an acute abdomen in a patient previously treated for osteogenic sarcoma should prompt suspicion of intraabdominal recurrence.

Solitary plasmocytoma of bone in an adolescent

To describe an adolescent with solitary plasmocytoma of bone and compare the pathologic and radiographic findings with osteomyelitis. A 17-year-old girl had a 3-year history of swelling of the right tibia, local pain, and hyperemia. Initial biopsy was interpreted as osteomyelitis. The lesion was rebiopsied 3 years later and showed a plasma cell neoplasm. A review of the first biopsy confirmed a similar histologic picture. Although solitary plasmocytoma of bone is a rare neoplasm in adolescence, it must be considered in the differential diagnosis of chronic osteomyelitis.

Computed tomography-guided fine-needle aspiration biopsy.

The therapeutic and prognostic evaluation of malignant neoplasias depends largely upon a precise morphologic diagnosis. Several papers have focused on the importance of fine-needle aspiration under computed tomography guidance in the diagnosis of unresectable neoplasms and in the investigation of metastases. The objective of this study is to evaluate the diagnostic accuracy, the sensitivity, and the negative predictive value obtained with the technique. Fine-needle aspiration cytology (FNAC) was performed on 207 patients, with a total of 210 cases, from 1991 to 1994, under computed tomography (CT) guidance. There were 128 (61.8 percent) males and 79 (38.2 percent) females with a mean age of 41 years (range 1 to 91 years). Lung and liver were the most frequent anatomic sites. The analysis of this material disclosed 41 cases with cytological diagnosis of negative for malignancy (19.52 percent), and in 131 (62.38 percent), the diagnosis was positive. It was possible to define the cytologic lineage in 54 percent of the cases. The diagnosis in 14 (6.67 percent) cases was suspicious for malignancy, and in 24 (11.43 percent) cases the material was insufficient for the cytologic diagnosis. Of the 210 cases, 106 showed histological diagnosis and/or clinical follow-up. Forty-seven (44.3 percent) had histological diagnosis before the FNAC and 50 cases (56.7 percent) histological diagnosis after the procedure. The comparison between cytological and histological diagnosis showed a sensibility of 80.4 percent, specificity of 100 percent, positive predictive value of 100 percent and negative of 16.7 percent. The efficiency of the test was 81.1 percent. This study showed that FNAC, under computed tomography guidance, is a sensitive and specific technique for the diagnosis of deep-seated lesions.