A Comparative Evaluation of Mediastinal Nodal SUVmax and Derived Ratios from 18F-FDG PET/CT Imaging to Predict Nodal Metastases in Non-Small Cell Lung Cancer.

18F-FDG positron emission tomography with computed tomography (PET/CT) is a standard imaging modality for the nodal staging of non-small cell lung cancer (NSCLC). To improve the accuracy of pre-operative staging, we compare the staging accuracy of mediastinal lymph node (LN) standard uptake values (SUV) with four derived SUV ratios based on the SUV values of primary tumours (TR), the mediastinal blood pool (MR), liver (LR), and nodal size (SR). In 2015-2017, 53 patients (29 women and 24 men, mean age 67.4 years, range 53-87) receiving surgical resection have pre-operative evidence of mediastinal nodal involvement (cN2). Among these, 114 mediastinal nodes are resected and available for correlative PET/CT analysis. cN2 status accuracy is low, with only 32.5% of the cN2 cases confirmed pathologically. Using receiver operating characteristic (ROC) curve analyses, a SUVmax of N2 LN performs well in predicting the presence of N2 disease (AUC, 0.822). Based on the respective selected thresholds for each ROC curve, normalisation of LN SUVmax to that for mediastinum, liver and tumour improved sensitivities of LN SUVmax from 68% to 81.1-89.2% while maintaining acceptable specificity (68-70.1%). In conclusion, normalised SUV ratios (particularly LR) improve current pre-operative staging performance in detecting mediastinal nodal involvement.

Developing a coordinate-based strategy to support cognitive targeted prostate biopsies and correlative spatial-histopathological outcome analysis.

Lack of investment for magnetic resonance (MR) fusion systems is an obstacle to deliver targeted prostate biopsies within the prostate cancer diagnostic pathway. We developed a coordinate-based method to support cognitive targeted prostate biopsies and then performed an audit on cancer detection and the location of lesions. In each patient, the prostate is considered as two separate hemiprostates, and each hemiprostate is divided into 4 × 4 × 4 units. Each unit is therefore defined by a three-dimensional coordinate. We prospectively applied our coordinates approach to target 106 prostatic lesions in 93 men. Among 45 (of 106; 42.5%) lesions positive for cancer, 27 lesions (60.0%) harbored clinically significant disease. PSA density was significantly higher in patients with proven cancer (median: 0.264 ng ml-2) when compared to the noncancer group (median: 0.145 ng ml-2; P = 0.003, Wilcoxon rank-sum test). Lesions with Prostate Imaging-Reporting and Data System (PIRADS) score of 5 were found to have a cancer incidence of 65.2%, while PIRADS 4 and 3 lesions have a lower risk of cancer detection, as expected, at 37.3% and 31.3%, respectively. The probability of a lesion being cancerous in our series significantly decreases as we go from the "apex-to-base" dimension (odds ratio [OR]: 2.62, 95% confidence interval [CI]: 1.55-4.44, P = 0.00034). Our analysis also indicates that the probability of cancer decreases as the prostate volume increases (OR: 1.03, 95% CI: 1.01-1.05, P = 0.00327). Based on this feasibility study, the use of coordinates to guide cognitive targeted prostate biopsies warrants future validation study in additional centers.

Slow, medium, or fast re-warming following post-traumatic hypothermia therapy? An ultrastructural perspective.

It was hypothesized that rapid rather than slow re-warming following traumatic brain injury (TBI) and short-term hypothermia results in secondary, ultrastructural pathology. After stretch injury to the right optic nerve, adult guinea pigs were randomly allocated to one of six experimental groups. Either (1) sham (all procedures but not stretch-injured; n = 4); injured and (2) maintained at normal temporalis core temperature (38.5 degrees C) for 8 hours (n = 6); (3) cooled rapidly to 32.5 degrees C (temporalis temperature), maintained for 4 h and re-warmed to 38.5 degrees C at 1 degrees C rise every 10 min (fast; n = 6); (4) cooled and re-warmed at 1 degrees C rise every 20 min (medium; n = 6); (5) cooled and rewarmed at 1 degrees C rise every 40 min (slow; n = 6) before being killed 8 h after injury; and (6) uninjured animals (n = 6) cooled to 32.5 degrees C for 4 h and then re-warmed at 1 degrees C every 10 min before killing 4 h later. Tissue was processed for light immunocytochemistry (beta-APP and RMO-14) and ultrastructural stereology. In both uninjured and injured fast re-warmed animals, there was almost total loss of axonal microtubules (MT) and an increased number of neurofilaments (NF) within the axoplasm. In the former, there was also compaction of NF. The number of MT was reduced to 40% of control values, NFs were increased but were not compacted after medium rate re-warming. Following slow re-warming the axonal cytoskeleton did not differ from that in control animals. It is concluded that re-warming faster than 1 degrees C every 40 min following mild post-traumatic hypothermia induces secondary axonal pathology.