Pediatric differentiated thyroid carcinoma in stage I: risk factor analysis for disease free survival

<p>Abstract</p> <p>Background</p> <p>To examine the outcomes and risk factors in pediatric differentiated thyroid carcinoma (DTC) patients who were defined as TNM stage I because some patients develop disease recurrence but treatment strategy for such stage I pediatric patients is still controversial.</p> <p>Methods</p> <p>We reviewed 57 consecutive TNM stage I patients (15 years or less) with DTC (46 papillary and 11 follicular) who underwent initial treatment at Ito Hospital between 1962 and 2004 (7 males and 50 females; mean age: 13.1 years; mean follow-up: 17.4 years). Clinicopathological results were evaluated in all patients. Multivariate analysis was performed to reveal the risk factors for disease-free survival (DFS) in these 57 patients.</p> <p>Results</p> <p>Extrathyroid extension and clinical lymphadenopathy at diagnosis were found in 7 and 12 patients, respectively. Subtotal/total thyroidectomy was performed in 23 patients, modified neck dissection in 38, and radioactive iodine therapy in 10. Pathological node metastasis was confirmed in 37 patients (64.9%). Fifteen patients (26.3%) exhibited local recurrence and 3 of them also developed metachronous lung metastasis. Ten of these 15 achieved disease-free after further treatments and no patients died of disease. In multivariate analysis, male gender (p = 0.017), advanced tumor (T3, 4a) stage (p = 0.029), and clinical lymphadenopathy (p = 0.006) were risk factors for DFS in stage I pediatric patients.</p> <p>Conclusion</p> <p>Male gender, tumor stage, and lymphadenopathy are risk factors for DFS in stage I pediatric DTC patients. Aggressive treatment (total thyroidectomy, node dissection, and RI therapy) is considered appropriate for patients with risk factors, whereas conservative or stepwise approach may be acceptable for other patients.</p

Clinical performance and radiation dosimetry of no-carrier-added vs carrier-added 123I-metaiodobenzylguanidine (MIBG) for the assessment of cardiac sympathetic nerve activity

Purpose We hypothesized that assessment of myocardial sympathetic activity with no-carrier-added (nca) I-123-metaiodobenzylguanidine (MIBG) compared to carrier-added (ca) I-123-MIBG would lead to an improvement of clinical performance without major differences in radiation dosimetry. Methods In nine healthy volunteers, 15 min and 4 h planar thoracic scintigrams and conjugate whole-body scans were performed up to 48 h following intravenous injection of 185 MBq I-123-MIBG. The subjects were given both nca and ca I-123-MIBG. Early heart/mediastinal ratios (H/M), late H/M ratios and myocardial washout were calculated. The fraction of administered activity in ten source organs was quantified from the attenuation-corrected geometric mean counts in conjugate views. Radiation-absorbed doses were estimated with OLINDA/EXM software. Results Both early and late H/M were higher for nca I-123-MIBG (ca I-123-MIBG early H/M 2.46 +/- 0.15 vs nca I-123-MIBG 2.84 +/- 0.15, p = 0.001 and ca I-123-MIBG late H/M 2.69 +/- 0.14 vs nca I-123-MIBG 3.34 +/- 0.18, p = 0.002). Myocardial washout showed a longer retention time for nca I-123-MIBG (p <0.001). The effective dose equivalent (adult male model) for nca I-123-MIBG was similar to that for ca I-123-MIBG (0.025 +/- 0.002 mSv/MBq vs 0.026 +/- 0.002 mSv/MBq, p = 0.055, respectively). Conclusion No-carrier-added I-123-MIBG yields a higher relative myocardial uptake and is associated with a higher myocardial retention. This difference between nca I-123-MIBG and ca I-123-MIBG in myocardial uptake did not result in major differences in estimated absorbed doses. Therefore, nca I-123-MIBG is to be preferred over ca I-123-MIBG for the assessment of cardiac sympathetic activit

Starre konfokale Laser Scanning Endoskopie zur Frühdiagnostik des Oropharynxkarzinoms - eine tierexperimentelle Studie

Einleitung: Ziel der tierexperimentellen Untersuchungen ist es, die für die HNO-Heilkunde neue Technologie, die starre konfokale Endoskopie (SKE), auf einen möglichen Einsatz zur Diagnostik von präneoplastischen Schleimhautveränderungen zu prüfen. Methoden: Die Tumorinduktion im Tiermodell wurde mit einem wasserlöslichen Quinolin-Derivat vorgenommen (4-NQO). Insgesamt 50 Mäuse (C57Bl/6) erhielten das chemische Kanzerogen 4-NQO über das Trinkwasser über einem Zeitraum von 8 bis 18 Wochen (5 Gruppen). Der Kontrollgruppe (n=10) wurde nichtkontaminertes Wasser verabreicht. Nach definierten Zeitintervallen (8, 10, 12, 14 und 18 Wochen) wurden post mortem die konfokalen Untersuchungen der Zungen durchgeführt. Es wurde ein Prototyp eines SKE (Fa. Storz), angekoppelt an den Heidelberg Retina Tomographen (HRTII/RCM), verwendet. Ergebnisse: Mit der LSM lassen sich Parameter, wie Zellkernmorphologie und Kern-Plasma-Relation, erfassen. Dysplastische und kanzeröse Läsionen weisen konfokalmikroskopisch Unterschiede bezüglich dieser Parameter im Vergleich zu gesundem Epithel des Oropharynx auf. Für die Differenzierung benigner Veränderungen und leichter Dysplasien von Dysplasiegraden II, III und CIS ergaben sich Werte für die Sensitivität und Spezifität sowie für den positiven und negativen prädiktiven Vorhersagewert von 73%, 93%, 91% bzw. 54%. Schlussfolgerungen: Mit der SKE konnten konsistente Unterschiede zwischen gesundem und keratotisch sowie dysplastisch verändertem Zungenepithel aufgezeigt werden. Weitere Entwicklungen am Endoskop, insbesondere ein automatischer Tiefenscan, sind erforderlich, um Aussagen über die potentielle Eignung dieser Technologie zur Frühdiagnostik des Oropharynxkarzinoms treffen zu können

PET-Mammographie zur Diagnose von Brustkrebs. Ist der maximale PEM-Uptake als Grenzwert zur Erkennung von bösartigem Brustkrebs geeignet?

AIM To evaluate the diagnostic value (sensitivity, specificity) of positron emission mammography (PEM) in a single site non-interventional study using the maximum PEM uptake value (PUVmax). PATIENTS, METHODS In a singlesite, non-interventional study, 108 patients (107 women, 1 man) with a total of 151 suspected lesions were scanned with a PEM Flex Solo II (Naviscan) at 90 min p.i. with 3.5 MBq 18F-FDG per kg of body weight. In this ROI(region of interest)-based analysis, maximum PEM uptake value (PUV) was determined in lesions, tumours (PUVmaxtumour), benign lesions (PUVmaxnormal breast) and also in healthy tissues on the contralateral side (PUVmaxcontralateral breast). These values were compared and contrasted. In addition, the ratios of PUVmaxtumour / PUVmaxcontralateral breast and PUVmaxnormal breast / PUVmaxcontralateral breast were compared. The image data were interpreted independently by two experienced nuclear medicine physicians and compared with histology in cases of suspected carcinoma. RESULTS Based on a criteria of PUV>1.9, 31 out of 151 lesions in the patient cohort were found to be malignant (21%). A mean PUVmaxtumour of 3.78 ± 2.47 was identified in malignant tumours, while a mean PUVmaxnormal breast of 1.17 ± 0.37 was reported in the glandular tissue of the healthy breast, with the difference being statistically significant (p < 0.001). Similarly, the mean ratio between tumour and healthy glandular tissue in breast cancer patients (3.15 ± 1.58) was found to be significantly higher than the ratio for benign lesions (1.17 ± 0.41, p < 0.001). CONCLUSION PEM is capable of differentiating breast tumours from benign lesions with 100% sensitivity along with a high specificity of 96%, when a threshold of PUVmax >1.9 is applied