The effects of the factors related to the patient and the disease on the performance of ablation therapy in patients with differential thyroid cancer who have received I-131 ablation theraphy

Diferansiye Tiroid Kanseri Tanılı I-131 Ablasyon Tedavisi Verilen Hastalarda Hastaya ve Hastalığa Ait Faktörlerin Ablasyon Başarısı Üzerine Etkileri. Tarık ŞENGÖZ, Dokuz Eylül Üniversitesi Tıp Fak. Hastanesi Nükleer Tıp Anabilim Dalı Dokuz Eylül Üniversitesi Tıp Fakültesi Hastanesi Nükleer Tıp Anabilim Dalı 35340, İnciraltı ? İzmir Amaç ve Hipotez: Diferansiye tiroid kanseri tanısı almış ve I-131 ablasyon tedavisi verilmiş hastalarda, hastaya ve hastalığa ait faktörlerin ablasyon başarısı üzerinde etkilerinin olup olmadığının araştırılmasıdır. Yöntem: Temmuz 2007- Eylül 2009 tarihleri arasında Dokuz Eylül Üniversitesi Tıp Fakültesi Nükleer Tıp ABD Radyonüklid Tedavi Polikliniği'ne başvuran, diferansiye tiroid karsinomu tanısı almış, total/totale yakın tiroidektomi yapılmış ve I-131 ablasyon tedavisi verilmesi için refere edilmiş hastalar ve çalışma süresi içinde en az 6. ay kontrollerine gelen tüm hastalar değerlendirmeye alındı. Hasta dosyaları retrospektif olarak tarandı. Hastalara ait yaş, cinsiyet, tümör tipi, tümör subtipi, tümör kapsül varlığı ve invazyonu, tümör boyutu, tümör sayısı, tümör lokalizasyonu, tiroid kapsül ve lenf/damar invazyonu, patolojik lenf nodu varlığı, operasyon şekli, preablasyon Tg, AntiTg, TSH, metastaz tarama için görüntülemeler (tiroid ve kemik sintigrafisi, boyun ve abdomen USG, toraks ve beyin BT), verilen doz, post ablasyon I-131 TVT, 6. ayda diagnostik I-131 TVT, boyun USG, Tg, ATG sonuçları değerlendirildi. Tiroid lojunda rezidü saptanmayan hastalar `ablasyon başarılı' , rezidü saptanan hastalar ise `ablasyon başarısız' olarak kabul edildi. Tetkik sonuç raporlarında tiroid lojunda rezidü doku varlığı tanımlanan ve `ablasyon başarısız' grupta değerlendirilen hastaların I-131 TVT görüntüleri rezidü varlığı ve rezidü odak sayısı yönünden 2 nükleer tıp uzmanı tarafından tekrar değerlendirildi ve konsensus ile karar verildi. Hastaya ve hastalığa ait ablasyon başarısını etkileyebilecek değişkenler sayısal ve kategorik değişkenler olarak gruplandı. İstatistik analiz için ki-kare, Mann-Whitney U ve çoklu analiz yöntemi olarak da logistik regresyon yöntemleri kullanıldı, testler SPSS 15.0 programında yapıldı. Bulgular: Çalışmaya diferansiye tiroid karsinom tanılı 191 hasta alındı. İlk ablasyon tedavisi sonrası ablasyon başarısı %74.3 olarak hesaplandı. Hastaların 15'inde (%7.8) ablasyon öncesi metastaz saptanmıştı. Metastatik hastalarda ilk doz sonrası ablasyon başarısı %66 iken metastaz negatif grupta ise %75 idi. Kümülatif ablasyon başarıları metastatik grupta %93, metastaz negatif grupta ise %80 idi. Patolojik lenf nodu sayısı ile ablasyon başarısı arasında anlamlı bir ilişki bulunurken (p=0.025), diğer faktörler ( lenf nodu sayısı, yaş, cinsiyet, tümör tipi, tümör odak sayısı, tiroid kapsül ve lenf/kan damar invazyonu vb.) ile ablasyon başarısı arasında anlamlı bir ilişki saptanmadı. Sonuç: Diferansiye tiroid kanser tanılı ve I-131 ablasyon tedavisi verilen hastalarda patolojik lenf nodu sayısı ile ablasyon başarısı arasında anlamlı bir ilişki mevcuttur. Ancak bu bulgunun örneklem büyüklüğünün küçük olması nedeniyle istatistiksel hataya bağlı da olabileceği düşünülmüştür. Bu değişken dışında diğer prognostik faktörler ile ablasyon başarısı arasında anlamlı bir ilişki bulunamamıştır. Ablasyon başarısı hastaya ve hastalığa ait prognostik faktörlerden bağımsızdır. The effects of the factors related to the patient and the disease on the performance of ablation therapy in patients with differential thyroid cancer who have received I-131 ablation theraphy. Tarık ŞENGÖZ, Dokuz Eylül University, School of Medicine, Department of Nuclear Medicine, Izmir, Turkey, Aim and hypothesis: To investigate whether the factors related to the patient and the disease have any effect on the success of ablation therapy in patients with differential thyroid cancer who have received I-131 ablation therapy. Method: All the patients with differential thyroid cancer who had undergone total or near- total thyroidectomy referred for I-131 ablation therapy to the Nuclear Medicine Department between July 2007 and September 2009 were within the scope of this evaluation. The patients had at least the sixth month follow-up. Each patient was evaluated in terms of the following factors: age, gender, type of tumor, the presence of capsule and invasion, the size of tumor, the number of the tumors, the localization of the tumor, the invasion of thyroid capsule, lymph/vessels invasion, the presence of metastatic lymph nodes, the type of surgery, the preablation values of thyroglobulin (Tg), AntiTg, TSH, the images for the evaluation of metastatic diseases (thyroid and bone scan, neck and abdomen USG, thorax and brain CT), the administered dosage, postablation I-131 whole body scan (WBS), diagnostic I-131 WBS in the 6th month, neck USG in the 6th month, the values of Tg and AntiTg in the 6th month. The presence of residual thyroid activity on the 6th month diagnostic I-131 WBS image was accepted as the criterion for ablation performance. The patients with and without residual thyroid activity on I-131 WBS images were grouped as ablation negative and ablation positive, respectively. In the the ablation negative group I-131 WBS were re-evaluated independently by two experienced nuclear medicine physicians with the aim of confirming the presence of residual thyroid activity. Final decision was made by consensus. The variables related to the patient and the disease that might have effect on the success of ablation were grouped as quantitative and categorical variables. For statistic analysis, chi square test, Mann-Whitney U and for multivariant analysis, logistic regression test was used. The evaluation was made in SPSS 15.0. Results: 191 patients with differential thyroid cancer were evaluated in this study. The overall success rate of the first ablation therapy was 74.3%. The success rate of the first ablation therapy was 66% and 75% in metastatic group and non-metastatic group, respectively. The cumulative success rate of the ablation therapy was 93% in metastatic group and 80% in non-metastatic group. Despite significant correlation between pathologic lymph node number and the success of ablation was found (p=0.025), there was no significant correlation between the patients/disease related factors (age, gender, types of tumors, the number of the tumor focuses, the invasion of thyroid capsule, lymph and blood vessels et.) and the success of ablation therapy, except for . Discussion: There is a significant correlation between the number of the pathologic lymph node and the ablation therapy performance. However, it has been deemed that, this result can also be due to statistical error because of the limited sample size. There was no significant correlation between other patient/disease releated prognostic factors and the success of ablation therapy

Liver metabolic activity changes over time with neoadjuvant therapy in locally advanced rectal cancer

Objective The aim of this study was to evaluate, using PET/computed tomography (CT), changes in liver metabolic activity in patients with locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (CRT). Patients and methods A total of 29 biopsy-proven LARC patients between 2009 and 2012 were studied. Liver standardized uptake values (SUVs) and SUVs adjusted for lean body mass (SULs) were obtained from PET/CT images obtained at 1 h (early) and 2 h (late) after 18F-fluorodeoxyglucose (18F-FDG) administration both before and after neoadjuvant CRT. Age, sex, BMI, lean body mass, blood glucose level, and 18F-FDG dose, which can influence liver SUVs and SULs, were also analyzed. Results Fourteen (48%) men and 15 (52%) women with a mean age of 62±11 years (range 34-80 years) were included in the study. The mean SUVs and SULs were significantly decreased in the late scans. Sex was significantly correlated with the mean liver SUV in early and late scans. The mean SUV differed significantly between male and female patients in early and late images (P<0.05). In a multivariate stepwise regression analysis, only liver SUVs (maximum and mean) were significantly associated with BMI before and after therapy. SUVs were significantly higher in the high (≥25) BMI group after but not before therapy. Mean SUL was not influenced by BMI. Conclusion Liver 18F-FDG uptake is consistent before and after neoadjuvant CRT therapy in patients with LARC. When assessing response to therapy and using liver metabolic activity to indicate background activity, BMI should be considered as it can influence liver metabolic activity. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved

The clinical contribution of SPECT/CT with 99mTc-HMPAO-labeled leukocyte scintigraphy in hip and knee prosthetic infections

Objectives: White blood cell scanning with 99mTc-hexamethylpropylene amine oxime (HMPAO) has proven a sensitive and specific imaging method in the diagnosis of suspected prosthesis infection. The aim of this retrospective study was to evaluate the usefulness of SPECT/CT performed simultaneously using a hybrid imaging device of prosthesis infections. Materials and methods: 99mTc-HMPAO scintigraphy was performed on 37 patients (11 men and 26 women; age range 38-84 years; mean age ± SD, 65.7 ± 5.6 years). Planar scans were acquired 2.4 and 24 hour after injection. SPECT/CT was obtained 4 h after injection, using a dual-head hybrid gama camera coupled with a low-power x-ray tube. In all patients, scintigraphic results were matched with the results of surgery, cultures and clinical follow-up. Results: Seventeen (45,9%) out of 37 patients had prosthesis infection and 20 (54,1%) out of 37 patients had non-infectious prosthesis pathologies with 99mTc-HMPAO scintigraphy and SPECT/CT. The 99mTc-HMPAO scintigraphy was true-positive for infection in 16 of 37 patients and true-negative in 20 of 37 patients. SPECT/CT provided an accurate anatomic localization of all positive foci. With regard to the final diagnosis, SPECT/CT added a significant clinical contribution in 22 of 37 patients (59,4%). Sensitivity, specificity, negative predictive value and positive predictive values were 100%,59.1%,100%,62.5% in planar images with 99mTc-HMPAO scintigraphy and 100%,90.1%,100%,88.2% in the planar+SPECT/CT imaging, respectively. Discussion: Our results indicate that SPECT/CT performed using a hybrid device can improve imaging with 99mTc-HMPAO scintigraphy in patients with suspected osteomyelitis by providing accurate anatomic localization and precise definition of the extent of infection. © 2019 Sociedad Española de Medicina Nuclear e Imagen Molecula