Does 18F-Fluorocholine PET/CT add value to positive parathyroid scintigraphy in the presurgical assessment of primary hyperparathyroidism?

IntroductionTo investigate the value of presurgical 18F-FCH PET/CT in detecting additional hyperfunctioning parathyroids despite a positive 99mTc-sestamibi parathyroid scintigraphy in patients with primary hyperparathyroidism (pHPT).MethodsThis is a retrospective study involving patients with pHPT, positive parathyroid scintigraphy performed before 18F-FCH PET/CT, and parathyroid surgery achieved after PET/CT. Imaging procedures were performed according to the EANM practice guidelines. Images were qualitatively interpreted as positive or negative. The number of pathological findings, their topography, and ectopic location were recorded. Histopathology, Miami criterion, and biological follow-up were considered to ensure effective parathyroidectomy confirming the complete excision of all hyperfunctioning glands. The impact of 18F-FCH PET/CT on therapeutic strategy was recorded.Results64/632 scanned pHPT patients (10%) were included in the analysis. According to a per lesion-based analysis, sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-sestamibi scintigraphy were 82, 95, 87, and 93%, respectively. The same values for 18F-FCH PET/CT were 93, 99, 99, and 97%, respectively. 18F-FCH PET/CT showed a significantly higher global accuracy than 99mTc-sestamibi scintigraphy: 98% (CI: 95–99) vs. 91% (CI: 87–94%). Youden Index was 0.79 and 0.92 for 99mTc-sestamibi scintigraphy and 18F-FCH PET/CT, respectively. Scintigraphy and PET/CT were discordant in 13/64 (20%) patients (49 glands). 18F-FCH PET/CT identified nine pathologic parathyroids not detected by 99mTc-sestamibi scintigraphy in 8 patients (12.5%). Moreover, 18F-FCH PET/CT allowed the reconsideration of false-positive scintigraphic diagnosis (scinti+/PET-) for 8 parathyroids in 7 patients (11%). The 18F-FCH PET/CT influenced the surgical strategy in 7 cases (11% of the study population).ConclusionIn a preoperative setting, 18F-FCH PET/CT seems more accurate and useful than 99mTc-sestamibi scan in pHPT patients with positive scintigraphic results. Positive parathyroid scintigraphy could be not satisfactory before neck surgery particularly in patients with multiglandular disease, suggesting a need to evolve the practice and define new preoperative imaging algorithms including 18F-FCH PET/CT at the fore-front in pHPT patients

Oncoplastic surgery in elderly patients with breast cancer: overtreatment or a goal worth pursuing?

Breast cancer is the most common cancer in women in Western countries, which increases with age. The improvement of reconstructive methods in light of the principles and techniques borrowed directly from cosmetic surgery has helped raise the quality in terms of aesthetic results in conservative treatment. This approach has reached results, which merits a more precise role of self-autonomy and the name of oncoplastic breast surgery. Today this approach is becoming, in the centers dedicated to the treatment of breast cancer, the gold standard in the surgical treatment of patients with this cancer. So if the role of oncoplastic in the surgical treatment of breast cancer is to be established, it remains crucial to have a selection of patients who could benefit from this approach: today, age is one of the determining factors in the selection of patients and, in fact, patients over 75 years, are often excluded from surgery of this type. In our opinion, after a multidisciplinary assessment, also the older women could be able to receive this type of surgical approach

Activation of brain-heart axis during REM sleep: a trigger for dreaming

: Dreams may be recalled after awakening from sleep following a defined electroencephalographic pattern that involves local decreases in low-frequency activity in the posterior cortical regions. Although a dreaming experience implies bodily changes at many organ, system, and timescale levels, the entity and causal role of such peripheral changes in a conscious dream experience are unknown. We performed a comprehensive, causal, multivariate analysis of physiological signals acquired during rapid eye movement (REM) sleep at night, including high-density electroencephalography and peripheral dynamics including electrocardiography and blood pressure. In this preliminary study, we investigated multiple recalls and nonrecalls of dream experiences using data from nine healthy volunteers. The aim was not only to investigate the changes in central and autonomic dynamics associated with dream recalls and nonrecalls, but also to characterize the central-peripheral dynamical and (causal) directional interactions, and the temporal relations of the related arousals upon awakening. We uncovered a brain-body network that drives a conscious dreaming experience that acts with specific interaction and time delays. Such a network is sustained by the blood pressure dynamics and the increasing functional information transfer from the neural heartbeat regulation to the brain. We conclude that bodily changes play a crucial and causative role in a conscious dream experience during REM sleep

A Three-Domain Scoring System to Customize the Risk of Relapse of Differentiated Thyroid Carcinoma

Purpose: the validation of a new scoring model considering the principal risk factors of differentiated thyroid cancer (DTC) relapse. Methods: we evaluated all DTC patients treated with thyroidectomy and radioactive iodine (RAI) therapy. Three domains were considered: the demographic domain (age and gender), the surgical domain (histology and the American Thyroid Association risk categories), and the RAI-related domain (pre-RAI thyroglobulin and post-therapeutic 131I whole-body scan). The progression-free survival was assessed. The patients’ sample was randomly split into a training and validation set. The three-domain score was calculated as the weighted sum of the levels of each significant factor, then scaled to an integer range (0–100) and, finally, stratified into terciles: mild risk 0–33, moderate risk 34–66, and severe risk 67–100. Results: 907 DTC patients were included. The RAI-related domain was the most relevant factor in the score calculation. The tercile stratification identified significantly different survival curves: patients within the two upper terciles showed approximately 6 to 30 times more progressive risk than patients at mild risk. Conclusion: we have validated a three-domain scoring system and the principal impact on this score is provided by the peri-RAI findings, whose prognostic role seems to be essential in risk identification

The FDG Pattern of Autonomously Functioning Thyroid Nodules Correlates With Thyroid-Stimulating Hormone and Histopathology

Whereas the 18F-FDG PET/CT pattern of malignant thyroid neoplasia is known, the glucose uptake of autonomously functioning thyroid nodules (AFTNs) has not been fully investigated. We aimed to analyze the FDG uptake of AFTNs and its correlation with clinical, laboratory, ultrasonography, and histological features

Does it work in childhood and adolescence? The predictive role of postoperative/preablative stimulated thyroglobulin levels in paediatric thyroid cancer. A systematic review of the literature

Background: Thyroglobulin is a well-established disease marker during follow-up in paediatric differentiated thyroid cancer. However, no conclusive data on the role of endogenously stimulated thyroglobulin after thyroidectomy (ptTg) in predicting disease-specific outcomes are available. This review aims to establish the prognostic value of ptTg in children with DTC. Methods: Online medical databases were searched for studies evaluating the association between ptTg and disease-specific outcomes in DTC-affected children. Documents not in English, preclinical studies, other review articles, case reports, and small case series were excluded. The risk of bias was assessed with the QUADAS-2 tool. Results: Twelve studies, analysing 1043 children in total, were included in the review. They all had a retrospective design and were published between 2016 and 2022. Of all patients, 1008 (97%) and 849 (81%) had undergone thyroidectomy and RAI, respectively. Eight studies (756 children) evaluated the correlation between ptTg and disease persistence/relapse: six reported a significant association between these parameters; a specific ptTg cut-off (10-14 ng/ml) was identified at the multivariate analysis in three studies. The remaining four studies assessed the link between ptTg levels and disease extension, with three reporting a correlation between ptTg and lung/nodal metastases. Discussion: ptTg is a readily available and inexpensive parameter, bearing a strong prognostic power in identifying disease persistence, relapse, and the presence of metastases in children affected by DTC

Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology

to evaluate the role of 18F-FDG-PET/CT in predicting malignancy of thyroid nodules with indeterminate cytology