Comparison between 18F-FDG PET/CT and diffusion-weighted imaging in detection of invasive ductal breast carcinoma.

Objectives: Breast carcinoma is the most common type of cancer in females. This study aims to compare fluorine-18-fluorodeoxyglucose (18F-FDG) uptake pattern and apparent diffusion coefficient (ADC) value for the detection of the primary tumour and axillary metastases of invasive ductal breast carcinoma. Methods: This study included 40 breast carcinoma lesions taken from 39 patients. After staging by positron emission tomography-computed tomography (PET/CT) and diffusion-weighted magnetic resonance imaging (MRI), breast surgery with axillary lymph node dissection or sentinel lymph node biopsy was performed. Results: Primary lesion detection rate for PET/CT and diffusion-weighted MRI was high with 39 of 40 lesions (97.5%). The sensitivity and specificity for the detection of metastatic lymph nodes in axilla were 40.9%, 88.9%, with 18F-FDG PET/CT scans and 40.9%, 83.3%, for dw-MRI, respectively. No significant correlation was detected between ADC and SUVmax or SUVmax ratios. Estrogen receptor (p=0.007) and progesterone receptor (p=0.036) positive patients had lower ADC values. Tumour SUVmax was lower in T1 than T2 tumour size (p=0.027) and progesterone receptor-positive patients (p=0.029). Tumour/background SUVmax was lower in progesterone receptor-positive patients (p=0.004). Tumour/liver SUVmax was higher in grade III patients (p=0.035) and progesterone receptor negative status (p=0.043). Conclusions: This study confirmed the high detection rate of breast carcinoma in both modalities. They have same sensitivity for the detection of axillary lymph node metastases, whereas the PET/CT scan had higher specificity. Furthermore, ADC, SUVmax and SUVmax ratios showed some statistical significance among the patient groups according to different pathological parameters.

How Radioactive Iodine Treatment Affects the Retina.

Objective The aim of this study was to quantitatively assess the macular and retinal nerve fiber layer thicknesses in patients with hyperthyroidism and thyroid cancer undergoing radioactive iodine (RAI) therapy. Study Design This prospective study was conducted in accordance with the principles of the Declaration of Helsinki and approved by the Bagcilar Training and Research Hospital Clinical Research Ethics Committee. Written informed consent was obtained from the patients following a detailed explanation of the study objectives and protocol. Patient selection was randomized. Patients scheduled for RAI treatment in the Nuclear Medicine Clinic were referred to the ophthalmology clinic, respectively. Patients without additional ocular pathology were included in the study. Methods All patients had received RAI therapy using Iodine-131 for hyperthyroidism or thyroid cancer. A complete ophthalmological examination and measurement of macular and retinal nerve fiber layer thickness using optical coherence tomography were performed on all patients before and at the first and sixth months and in first year after RAI treatment. The results were prospectively evaluated. Results The study included 80 eyes of 40 patients. The hyperthyroid group was group 1, and the thyroid cancer group was group 2. There were 25 patients in group 1 and 15 patients in group 2. The mean age was 43.76 ± 11.85 years (range: 22-65 years) in group 1 and 39.87 ± 9.13 years (range: 30-58 years) in group 2. There was no significant difference between the two groups regarding age and sex ( p > 0.05). In both groups, no significant difference was found in the macular thickness and retinal nerve fiber layer thicknesses values obtained in both eyes before and after the RAI treatment. Conclusion As a result of our study, we observed that RAI intake did not harm the retinal layer.

The relationship between HER2 expression and 18F-FDG in gastric carcinoma.

OBJECTIVE: The aim of this retrospective study was to evaluate the relationship between human epidermal growth factor receptor 2 (HER2) expression and fluorine-18-fluorodeoxyglucose (18F-FDG) uptake in positron emission tomography with computed tomography (PET/CT) in gastric carcinoma. MATERIALS AND METHODS: Gastric carcinoma patients who had 18F-FDG PET/CT scans before treatment were enrolled in this study. Ninety PET/CT images were evaluated before resection or neoadjuvant treatment of 69 patients with gastric carcinoma who had HER2 examination tests. The maximum standardized uptake value (SUVmax) at early (SUV1) and delayed images (SUV2) if any were calculated. In addition, liver SUVmax was measured from the normal liver parenchyma at the dual time (SUV1 liver and SUV2 liver). Tumor-to-liver SUVmax ratio (TLR), retention indexes (RI) from SUVmax, and TLR values obtained from dual-time images were calculated. RESULTS: Histological type of 69 patients were 85.5% adenocarcinoma, 10.1% signet ring cell carcinoma, 2.9% adenosquamous carcinoma, 1.4% mucinous adenocarcinomas. Human epidermal growth factor receptor 2 negative group included 56 (81.2%) patients and the positive group had 10 (14.35%) patients. We did not find any statistical difference for the values of SUVmax and tumor-to-liver SUVmax on all histological types of gastric carcinoma on the dual-phase PET scan. High-level SUV1 was found in the HER2 positive group (8.01±3.11) than negative group (6.15±3.76) in early PET/CT imaging (P=0.043) for adenocarcinoma patients. A positive correlation was observed between HER2 and SUV1 in adenocarcinoma patients (r=0.254,P=0.042). An inverse correlation was determined for histological grade with SUV1 (r=-0.29,P=0.048), TLR1 (r=-0.29,P=0.048) and TLR2 (r=-0.324, P=0.03). CONCLUSION: Patients with HER2 expression in gastric adenocarcinomas had higher SUVmax values, but no significant difference was found between the groups when the tumor/liver ratio was measured by SUVmax from normal liver parenchyma when background activity was excluded. Signet ring cell carcinoma type and the presence of the signet ring component had no effect on 18F-FDG uptake.

Amelanotic nodular appearance within superficial spreading melanoma.

Usual clinical types of malignant melanoma (MM) are lentigo maligna, superficial spreading, nodular, and acral lentiginous MMs. Rarer variants of MM are amelanotic, neurotropic, desmoplastic, metastatic, invisible, pedunculatedmelanoma (PM), or nodal melanoma (NM), which constitute less than 5% of cases. Recognition and discrimination of these variants are important to avoid misdiagnosis of MM. We report a 42-year-old Caucasian woman presented with a superficial spreading malignant melanoma (SSM) with an amelanotic nodular center. The lesion simulated a NM or PM clinically, but its histopathology showed an SSM. This misleading appearance of SSM has not been reported previously.

Dual-Time 18F-FDG PET/CT Imaging in Initial Locoregional Staging of Breast Carcinoma: Comparison with Conventional Imaging and Pathological Prognostic Factors.

The aims of this retrospective study were to consider the diagnostic role of dual-time 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG PET/CT) in detection of breast carcinoma and axillary lymph node (ALN) status and to evaluate the primary tumor 18F-FDG uptake pattern. Preoperative staging was performed by 18F-FDG PET/CT in 78 female patients with breast carcinoma. Conventional imaging results were evaluated by breast magnetic resonance imaging (MRI) of 79 lesions in 78 patients, bilateral mammography (MMG) of 40 lesions in 40 patients, and breast ultrasonography (USG) of 47 lesions in 46 patients. The primary tumor detection rate using 18F-FDG PET/CT was higher than those using MRI, USG, and MMG. The sensitivity and specificity of 18F-FDG PET/CT scans for detecting multifocality were higher than those of MRI. The specificity of ALN metastasis detection with MRI was higher than that with 18F-FDG PET/CT, but 18F-FDG PET/CT had higher sensitivity. Higher 18F-FDG uptake levels were detected in patients with ALN metastasis, histologic grade 3, estrogen-progesterone-negative receptor status, lymphatic invasion, and moderate to poor prognostic groups. There was no statistical difference for the retention index in categorical pathological parameters except for progesterone-negative status. In conclusion, 18F-FDG PET/CT scans may be a valuable imaging technique for evaluating primary tumor and axillary status in staging breast carcinoma and 18F-FDG uptake may be a prognostic factor that indicates aggressive tumor biology and poor prognosis. Dual-time imaging in breast carcinoma staging may not be used for predicting pathological criteria and the aggressiveness of primary lesions.

Metastatic follicular thyroid carcinoma masquerading as olfactory neuroblastoma: with skull-base, cranium, paranasal sinus, lung, and diffuse bone metastases.

Skull-base metastasis is rarely reported in thyroid carcinoma. We are presenting an unusual interesting case mimicking metastatic renal cell carcinoma with intense clear cell morphology, the thyroid origin of which was detected via positron emission tomography/computerized tomography scan proposed by the oncology council, while we were monitoring the subject with the initial diagnosis of paranasal sinus tumor. A mass was detected in the left nasal cavity in the endoscopic examination of the 68-year-old female patient referred by the ophthalmology clinic with the preliminary diagnosis of retro-orbital tumor upon being admitted with proptosis. A soft tissue lesion at a size of 68 × 39 × 53 mm located intracranially was detected by the brain computerized tomography. The biopsy taken and the immunohistochemical results were not satisfactory. Intense fluorodeoxyglucose involvement was observed in both lobes of the thyroid gland at positron emission tomography/computerized tomography taken with the recommendation of the council. Moreover, hypermetabolic nodules were seen in both lung parenchyma areas, whereas intense hypermetabolic lytic lesions were observed in the skeletal system. Thyroglobulin and thyroid transcription factor 1 stains displayed a strong staining on paraffin block. On the basis of these characteristics, the case was regarded as compatible metastatic follicular thyroid carcinoma, with skull-base, cranial, retro-orbital, paranasal sinus, lung, and bone metastases. This case showed us that multidisciplinary work and assessment of the oncology council play a highly critical role in making the diagnosis and guiding the treatment.

Comparison of the Relative Renal Function Calculated with 99mTc-Diethylenetriaminepentaacetic Acid and 99mTc-Dimercaptosuccinic Acid in Children.

The aim was to compare the relative renal functions measured with technetium-99m dimercaptosuccinic acid (99mTc-DMSA) and technetium-99m diethylenetriaminepentaacetic acid (99mTc-DTPA) in children with renal diseases. Relative renal function of 128 children who applied to three hospitals from 2009 to 2011 were analyzed retrospectively. The mean value measured with 99mTc-DTPA and 99mTc-DMSA were 51.58 ± 14.95 and 51.96 ± 14.99 for the right kidney, 47.87 ± 15.27 and 47.94 ± 15.17 for the left kidney, respectively. A significant positive correlation was found between the relative renal functions (r = 0.963, P < 0.001). In Bland-Altman plots, the mean difference between two methods was 0.7 and the correlation limits were between 10.1 and-10.8. As a result, although 99mTc-DMSA is accepted as the most reliable method for the determination of relative renal function, 99mTc-DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in pediatric patients who require renogram curve and GFR calculations.

Electron microscopic analysis of an angiosarcoma of the thyroid from a non-Alpine endemic goiter region: A case report and brief review of the literature.

Angiomatoid tumors of the thyroid gland are rare endocrine neoplasms, which exhibit an aggressive behavior. Angiosarcomas of the thyroid are generally reported from the European Alpine region and have a histogenesis that has been under debate for a number of years. The current study presents a rare case of angiosarcoma of the thyroid in a 62-year-old Turkish female. The patient had a 10-year history of goiter and was from the Black Sea region, an endemic goiter region of Turkey. The patient was not taking any medication at the time of admission and swelling had been observed on the right side of the neck throughout the previous few months. Thyroid function tests, which analyzed the levels of thyroid-stimulating hormone, thyroxine and triiodothyronine, were within the normal limits, however, the histopathological findings were consistent with an angiosarcoma of the thyroid. The patient rejected the complementary surgery and chemotherapy options, and is currently disease-free (as per the 15-month follow-up). The current study describes a case of angiosarcoma that was characterized by Weibel-Palade bodies, and light microscopy and immunohistochemical findings, as well as an endothelial origin, which was demonstrated via electron microscopy. To the best of our knowledge, this is the first reported case of angiosarcoma of the thyroid in a patient from Turkey to be validated by electron microscopy. Furthermore, this case is one of the few reported thyroid angiosarcoma cases in a non-Alpine region.

Anaplastic thyroid carcinoma with diffuse thoracic skin metastasis: A case report.

Anaplastic thyroid carcinoma is a significantly fatal endocrine neoplasm, with an average survival time of 4-12 months following diagnosis. The present study reports the case of a 57-year-old male patient who presented to the Bagcilar Training and Research Hospital (Istanbul, Turkey) due to swelling in the neck and difficulty swallowing. The jugular mass biopsy results were consistent with a diagnosis of anaplastic thyroid cancer. The patient was regarded to have advanced-stage subcarinal, paratracheal, aortopulmonary, trancheobronchial and mediastinal lymphadenopathies and exhibited a good prognosis following chemotherapy. However, the patient succumbed one month later due to the emergence of diffuse skin lesions. The histopathological and immunohistochemical assessment of the skin biopsy displayed the characteristics of the underlying thyroid carcinoma.

Hip structural changes and fracture risk in osteopenia and osteoporosis.

OBJECTIVE: Although bone mineral density (BMD) is an important predictor of hip fracture, there is a large overlap of BMD values between those who fracture their hips and those who do not. The aim of this study was to evaluate differences in the structural parameters of the hip in patients with osteopenia and osteoporosis in the hip region and to assess their relationship with osteoporotic fracture risk, age and gender. MATERIALS AND METHODS: In this observational retrospective study, 150 patients with osteopenia (100 postmenopausal women and 50 men ≥50 years of age) and 125 patients with osteoporosis in the hip (100 postmenopaussal women and 25 men ≥50 years of age) were included. In addition to densitometry measurements by DEXA (Dual Energy X-ray Absorbimetry), structural variables were determined using the Hip Strength Analysis program (HSA). RESULTS: In logistic regression analyses, the femoral neck BMD (odds ratio (OR), 2.6; 95% Confidence Interval (CI) 1.8-3.8), age (OR per 10 years 1.4; 95% CI, 1.1-1.9), femoral neck shaft angle (NSA) (OR 1.5; 95% CI, 1.2-2.1), Femur Strength Index (FSI) (OR 1.6; 95% CI 1.3-2.2), and Cross sectional area (CSA) (OR 1.6; 95% CI 1.2-2.1) were all associated with osteoporotic fractures in women and men. Osteopenic patients had smaller femoral neck-shaft angles (NSA) compared to osteoporotic patients (p<0.05). This angle was larger in women (p<0.05); and women had decreased (FSI) (p<0.001) and CSA (p<0.05), which cause increased fracture risk. CONCLUSION: Spatial distribution of bone tissue is a useful determinant of fracture risk.

Can Tc 99m DTPA be Used in Adult Patients in Evaluation of Relative Renal Function Measurement as the Reference Tc 99m DMSA Method?

OBJECTIVE: In the literature, there are many reports comparing relative renal function calculated with Tc 99m DTPA and Tc 99m DMSA in adults and children. However, there is no consensus about the results. As there is indeterminacy in the reliability of Tc 99m DTPA for the calculation of the relative renal functions, we retrospectively designed a study to compare the relative renal functions measured with Tc 99m DMSA and Tc 99m DTPA in adult patients with renal diseases Material and Methods: We retrospectively analyzed the data of 144 patients who applied to Nuclear Medicine Department of three hospitals between 2009 and 2010 and who had both dynamic and static renal imaging. Renal dynamic scintigraphies were compared to the relative function measured using Tc 99m DMSA static scintigraphy. Comparison of relative renal function measurements using dynamic and static renal scintigraphies was performed using Pearson correlation test. The comparison results were expressed with Bland-Altman analysis. RESULTS: The study was conducted with 144 patients and 288 kidneys. Fifty six of patients were male. Mean age was 39.9±15.2 years. Thirty four patients had hydronephrosis, 28 pyelonephritis, 53 renal calculi, 3 chronic renal failure, 2 acute renal failure, 1 benign renal neoplasia, 15 renal atrophy, 8 ureteropelvic junction stenosis. Relative renal function was calculated in Tc 99m DMSA and 99m Tc-DTPA studies. The mean relative renal functions measured with Tc 99m DTPA was 52.54±23.09% and 47.25±23.09, with Tc 99m DMSA 52.85±21.80% and 47.07±21.77% for right and left kidneys, respectively. In bivariate correlation analysis (Pearson) a significant positive correlation was found between the relative renal functions calculated with Tc 99m DTPA and Tc 99m DMSA (r =0.937, p< 0.001). In Bland-Altman plots, the mean difference between two methods was 0.3 and the correlation limits were between 16.2 to -15.5. CONCLUSION: As a result, we concluded that Tc 99m DTPA is also a good method for the relative renal function evaluation when compared to Tc 99m DMSA scan. Although Tc 99m DMSA is the most reliable method for the calculation of relative renal function, Tc 99m DTPA can be another choice for the calculation of relative renal function without a complementary DMSA scan particularly in patients who require renogram curve and GFR calculations. CONFLICT OF INTEREST: None declared.

Comparison of efficacy of Tc-99m HIG and Tc-99m nanocolloid on sentinel lymph node mapping in patients with breast cancer.

BACKGROUND AND AIM: This study compared the effectiveness of Tc-99m human polyclonal immunoglobulin (HIG) and Tc-99m nanocolloid at detecting sentinel lymph nodes (SLNs) with lymphoscintigraphy and an intraoperative gamma-probe (IGP) in patients with early breast cancer. METHODS: The study group consisted of 50 women; 25 patients each were given Tc-99m HIG or Tc-99m nanocolloid for lymphoscintigraphy. Then, intraoperative SLN localization with IGP was performed. The results of IGP, lymphoscintigraphy, blue dye injected just before surgery, and pathology were compared. RESULTS: In the Tc-99m HIG group, one patient had tumours in both breasts. In two patients, we could not detect SLNs with lymphoscintigraphy, although they were detected with IGP and blue dye. We found SLNs for all tumours with IGP. With the intraoperative blue dye, SLNs were identified for 25 tumours; for one tumour, no SLN was detected with blue dye. In the histopathological examination, 13 tumours showed metastasis in the SLN and in 11 of these 13, there were also metastases in the axilla. One patient had a skip metastasis. In the Tc-99m nanocolloid group, SLNs were identified in 24 patients with lymphoscintigraphy. IGP found SLNs in 24 patients. The blue dye detected SLNs in all patients. On histopathological examination, 10 patients had metastasis in the SLN and there were also metastases in the axilla in all of these patients. CONCLUSION: Tc-99m HIG can be used in SLN detection with preoperative lymphoscintigraphy and IGP in early-stage breast cancer patients.

The efficacy of 99mTc-HIG for sentinel lymph node mapping in breast cancer patients.

OBJECTIVE: To evaluate the efficacy of Tc-HIG on SLN identification in patients with early-stage breast cancer. MATERIALS AND METHODS: Seventeen women (18 tumours) with early-stage breast cancer were included. On the day of the operation, 111 MBq Tc-HIG was injected around the tumour or biopsy scar in all patients. Subsequently, dynamic lymphoscintigraphic images were taken for 30 min. After this, static images were recorded at 15-20 min intervals until the SLN was visualized. Patients were taken to the operating room 2-4 h after radiopharmaceutical injection. Before the incision, 5 ml of isosulfan blue dye solution was injected peritumourally in all subjects. Aided by blue dye and gamma probe SLN detection was done during the operation. RESULTS: In 17/18 tumours, SLN was detected with Tc-HIG lymphoscintigraphy. The mean visualization time for axillary SLNs was 49.94+/-11.25 min and for internal mammary SLNs was 52.50+/-10.60 min. In 15 of the tumours, only one SLN was detected in the axillary region. However, in two tumours, SLNs were found in both axillary and internal mammary regions. With blue dye mapping, axillary SLNs were found in 17/18 tumours. With the application of intraoperative gamma probe, all axillary and internal mammary SLNs were detected in 18 tumours. CONCLUSION: We conclude that Tc-HIG may be a suitable agent for SLN detection by lymphoscintigraphy and intraoperative gamma probe application in early-stage breast cancer patients.