La Pet amb 11c-metionina com a factor pronòstic i en la caracterització dels gliomes

Antecedents: La PET amb metionina és una eina de diagnòstic per la imatge útil per al diagnòstic i seguiment de tumors cerebrals. S’ha descrit la seva utilitat en la valoració de l’agressivitat tumoral tant per a la gradació tumoral com per a la valoració de la proliferació cel·lular en gliomes. No obstant hi ha poca evidència de la PET com a factor pronòstic, especialment en estudis multivariants, i per a la caracterització immunohistoquímica o molecular en gliomes. Els objectius del treball inclouen: 1. Avaluar la utilitat de la PET amb metionina (Ratio T/N) en la valoració de diferents factors pronòstic associats als gliomes: gradació (diferenciació entre gliomes de baix i d’alt grau), proliferació tumoral (Ki67%), perfusió per la RM (rCBV), i caracterització de marcadors pronòstic en immunohistoquímica (p53, p16, WT1, CD34 vascular, CD44, B-catenina, EGFR) i molecular (mutació IDH1, metilació MGMT, codeleció 1p/19q) en gliomes. 2. Anàlisi univariant i multivariant de factors associats a la supervivència inclosa la PET (mitjançant el mètode Ratio T/N) com són: les variables associades al pacient com l’edat i l’índex KPS, les característiques macroscòpiques del tumor, la captació de contrast a la RM, les troballes patològiques fonamentalment el grau tumoral i l’índex Ki67, i l’ús de tècniques quirúrgiques com el mapatge i el 5-ALA. El treball s’ha realitzat retrospectivament en una sèrie de 38 pacients diagnosticats de glioma, en els que es realitza PET amb 11C-metionina. Els resultats mostren una relació entre la PET amb metionina i els factors pronòstic descrits prèviament, en gliomes i també amb la supervivència. La corba ROC mostra un punt de tall òptim de la Ratio T/N de 2,07 en la classificació entre gliomes de baix i alt grau. S’observa una correlació entre la Ratio T/N de la PET amb metionina i l’índex Ki67 així com entre la Ratio T/N i la perfusió a la RM (rCBV). L’activitat metabòlica de la PET amb metionina es relaciona amb menor expressió dels marcadors d’immunosupressió tumoral en gliomes de baix grau; p53, p16 i WT1. S’observa una relació entre la Ratio T/N i la presencia de mutació o no de la IDH1. També s’observa una relació entre la Ratio T/N i la supervivència dels pacients tant en l’anàlisi univariant com multivariant: els pacients amb una menor activitat metabòlica de la PET al glioma mostren una major supervivència. En conclusió la PET amb metionina podria utilitzar-se com a eina complementària en la valoració del pronòstic en gliomes i en el seu maneig clínic.Background: Methionine PET is an imaging diagnostic tool useful in brain tumour diagnosis and follow up. PET utility to assess tumor aggressiveness for tumoral gradation as well as for the study of cell proliferation in gliomas has been described. However there is few evidence of PET both for prognostic factor evaluation, specially in the case of multivariate study, and for immunohistochemical or molecular characterization in gliomas. The aims of this study include: 1. To evaluate the utility of methionine PET (Ratio T/N) to assess several prognostic factors associated with gliomas: gradation (to classify between low grade and high grade gliomas), tumoral proliferation index (Ki67%), MRI perfusion (rCBV), and to characterize prognostic markers as immunohistochemical markers (p53, p16, WT1, vascular CD34, CD44, B-catenin, EGFR) and molecular markers (IDH1 mutation, MGMT methylation and LOH 1p/19q) in gliomas. 2. Univariate and multivariate analysis of survival factors including PET (evaluated with Ratio T/N method): patient variables like age and KPS index, macroscopic characteristics of tumour, MRI contrast uptake, pathological findings like tumoral grade and Ki67 index, and use of surgical techniques like mapping and 5-ALA. A retrospective study was performed including 38 patients diagnosed with glioma who were studied with methionine PET. The results show a relationship between methionine PET and the prognostic factors previously described in gliomas as well as with survival. ROC curve analysis shows an optimal cut-off of Ratio T/N of 2.07 in the classification between low-grade and high-grade gliomas. Correlation between Ratio T/N of methionine PET and Ki67 index as well as MRI perfusion (rCBV) is observed. There is a relationship between a lower expression of immunosuppression factors (p53, p16 and WT1) and the metabolic activity of PET in low-grade gliomas. A relationship between Ratio T/N and mutation IDH1 status in gliomas is observed. In addition, a relationship between Ratio T/N and patient survival is observed in univariate and multivariate analysis: patients with lower metabolic PET activity in a glioma lesion have longer survival. In conclusion methionine PET could be used as a complementary tool in the prognosis evaluation of gliomas and in their clinical management

La Pet amb 11c-metionina com a factor pronòstic i en la caracterització dels gliomes

Antecedents: La PET amb metionina és una eina de diagnòstic per la imatge útil per al diagnòstic i seguiment de tumors cerebrals. S’ha descrit la seva utilitat en la valoració de l’agressivitat tumoral tant per a la gradació tumoral com per a la valoració de la proliferació cel·lular en gliomes. No obstant hi ha poca evidència de la PET com a factor pronòstic, especialment en estudis multivariants, i per a la caracterització immunohistoquímica o molecular en gliomes. Els objectius del treball inclouen: 1. Avaluar la utilitat de la PET amb metionina (Ratio T/N) en la valoració de diferents factors pronòstic associats als gliomes: gradació (diferenciació entre gliomes de baix i d’alt grau), proliferació tumoral (Ki67%), perfusió per la RM (rCBV), i caracterització de marcadors pronòstic en immunohistoquímica (p53, p16, WT1, CD34 vascular, CD44, B-catenina, EGFR) i molecular (mutació IDH1, metilació MGMT, codeleció 1p/19q) en gliomes. 2. Anàlisi univariant i multivariant de factors associats a la supervivència inclosa la PET (mitjançant el mètode Ratio T/N) com són: les variables associades al pacient com l’edat i l’índex KPS, les característiques macroscòpiques del tumor, la captació de contrast a la RM, les troballes patològiques fonamentalment el grau tumoral i l’índex Ki67, i l’ús de tècniques quirúrgiques com el mapatge i el 5-ALA. El treball s’ha realitzat retrospectivament en una sèrie de 38 pacients diagnosticats de glioma, en els que es realitza PET amb 11C-metionina. Els resultats mostren una relació entre la PET amb metionina i els factors pronòstic descrits prèviament, en gliomes i també amb la supervivència. La corba ROC mostra un punt de tall òptim de la Ratio T/N de 2,07 en la classificació entre gliomes de baix i alt grau. S’observa una correlació entre la Ratio T/N de la PET amb metionina i l’índex Ki67 així com entre la Ratio T/N i la perfusió a la RM (rCBV). L’activitat metabòlica de la PET amb metionina es relaciona amb menor expressió dels marcadors d’immunosupressió tumoral en gliomes de baix grau; p53, p16 i WT1. S’observa una relació entre la Ratio T/N i la presencia de mutació o no de la IDH1. També s’observa una relació entre la Ratio T/N i la supervivència dels pacients tant en l’anàlisi univariant com multivariant: els pacients amb una menor activitat metabòlica de la PET al glioma mostren una major supervivència. En conclusió la PET amb metionina podria utilitzar-se com a eina complementària en la valoració del pronòstic en gliomes i en el seu maneig clínic.Background: Methionine PET is an imaging diagnostic tool useful in brain tumour diagnosis and follow up. PET utility to assess tumor aggressiveness for tumoral gradation as well as for the study of cell proliferation in gliomas has been described. However there is few evidence of PET both for prognostic factor evaluation, specially in the case of multivariate study, and for immunohistochemical or molecular characterization in gliomas. The aims of this study include: 1. To evaluate the utility of methionine PET (Ratio T/N) to assess several prognostic factors associated with gliomas: gradation (to classify between low grade and high grade gliomas), tumoral proliferation index (Ki67%), MRI perfusion (rCBV), and to characterize prognostic markers as immunohistochemical markers (p53, p16, WT1, vascular CD34, CD44, B-catenin, EGFR) and molecular markers (IDH1 mutation, MGMT methylation and LOH 1p/19q) in gliomas. 2. Univariate and multivariate analysis of survival factors including PET (evaluated with Ratio T/N method): patient variables like age and KPS index, macroscopic characteristics of tumour, MRI contrast uptake, pathological findings like tumoral grade and Ki67 index, and use of surgical techniques like mapping and 5-ALA. A retrospective study was performed including 38 patients diagnosed with glioma who were studied with methionine PET. The results show a relationship between methionine PET and the prognostic factors previously described in gliomas as well as with survival. ROC curve analysis shows an optimal cut-off of Ratio T/N of 2.07 in the classification between low-grade and high-grade gliomas. Correlation between Ratio T/N of methionine PET and Ki67 index as well as MRI perfusion (rCBV) is observed. There is a relationship between a lower expression of immunosuppression factors (p53, p16 and WT1) and the metabolic activity of PET in low-grade gliomas. A relationship between Ratio T/N and mutation IDH1 status in gliomas is observed. In addition, a relationship between Ratio T/N and patient survival is observed in univariate and multivariate analysis: patients with lower metabolic PET activity in a glioma lesion have longer survival. In conclusion methionine PET could be used as a complementary tool in the prognosis evaluation of gliomas and in their clinical management

La Pet amb 11c-metionina com a factor pronòstic i en la caracterització dels gliomes

Antecedents: La PET amb metionina és una eina de diagnòstic per la imatge útil per al diagnòstic i seguiment de tumors cerebrals. S'ha descrit la seva utilitat en la valoració de l'agressivitat tumoral tant per a la gradació tumoral com per a la valoració de la proliferació cel·lular en gliomes. No obstant hi ha poca evidència de la PET com a factor pronòstic, especialment en estudis multivariants, i per a la caracterització immunohistoquímica o molecular en gliomes. Els objectius del treball inclouen: 1. Avaluar la utilitat de la PET amb metionina (Ratio T/N) en la valoració de diferents factors pronòstic associats als gliomes: gradació (diferenciació entre gliomes de baix i d'alt grau), proliferació tumoral (Ki67%), perfusió per la RM (rCBV), i caracterització de marcadors pronòstic en immunohistoquímica (p53, p16, WT1, CD34 vascular, CD44, B-catenina, EGFR) i molecular (mutació IDH1, metilació MGMT, codeleció 1p/19q) en gliomes. 2. Anàlisi univariant i multivariant de factors associats a la supervivència inclosa la PET (mitjançant el mètode Ratio T/N) com són: les variables associades al pacient com l'edat i l'índex KPS, les característiques macroscòpiques del tumor, la captació de contrast a la RM, les troballes patològiques fonamentalment el grau tumoral i l'índex Ki67, i l'ús de tècniques quirúrgiques com el mapatge i el 5-ALA. El treball s'ha realitzat retrospectivament en una sèrie de 38 pacients diagnosticats de glioma, en els que es realitza PET amb 11C-metionina. Els resultats mostren una relació entre la PET amb metionina i els factors pronòstic descrits prèviament, en gliomes i també amb la supervivència. La corba ROC mostra un punt de tall òptim de la Ratio T/N de 2,07 en la classificació entre gliomes de baix i alt grau. S'observa una correlació entre la Ratio T/N de la PET amb metionina i l'índex Ki67 així com entre la Ratio T/N i la perfusió a la RM (rCBV). L'activitat metabòlica de la PET amb metionina es relaciona amb menor expressió dels marcadors d'immunosupressió tumoral en gliomes de baix grau; p53, p16 i WT1. S'observa una relació entre la Ratio T/N i la presencia de mutació o no de la IDH1. També s'observa una relació entre la Ratio T/N i la supervivència dels pacients tant en l'anàlisi univariant com multivariant: els pacients amb una menor activitat metabòlica de la PET al glioma mostren una major supervivència. En conclusió la PET amb metionina podria utilitzar-se com a eina complementària en la valoració del pronòstic en gliomes i en el seu maneig clínic.Background: Methionine PET is an imaging diagnostic tool useful in brain tumour diagnosis and follow up. PET utility to assess tumor aggressiveness for tumoral gradation as well as for the study of cell proliferation in gliomas has been described. However there is few evidence of PET both for prognostic factor evaluation, specially in the case of multivariate study, and for immunohistochemical or molecular characterization in gliomas. The aims of this study include: 1. To evaluate the utility of methionine PET (Ratio T/N) to assess several prognostic factors associated with gliomas: gradation (to classify between low grade and high grade gliomas), tumoral proliferation index (Ki67%), MRI perfusion (rCBV), and to characterize prognostic markers as immunohistochemical markers (p53, p16, WT1, vascular CD34, CD44, B-catenin, EGFR) and molecular markers (IDH1 mutation, MGMT methylation and LOH 1p/19q) in gliomas. 2. Univariate and multivariate analysis of survival factors including PET (evaluated with Ratio T/N method): patient variables like age and KPS index, macroscopic characteristics of tumour, MRI contrast uptake, pathological findings like tumoral grade and Ki67 index, and use of surgical techniques like mapping and 5-ALA. A retrospective study was performed including 38 patients diagnosed with glioma who were studied with methionine PET. The results show a relationship between methionine PET and the prognostic factors previously described in gliomas as well as with survival. ROC curve analysis shows an optimal cut-off of Ratio T/N of 2.07 in the classification between low-grade and high-grade gliomas. Correlation between Ratio T/N of methionine PET and Ki67 index as well as MRI perfusion (rCBV) is observed. There is a relationship between a lower expression of immunosuppression factors (p53, p16 and WT1) and the metabolic activity of PET in low-grade gliomas. A relationship between Ratio T/N and mutation IDH1 status in gliomas is observed. In addition, a relationship between Ratio T/N and patient survival is observed in univariate and multivariate analysis: patients with lower metabolic PET activity in a glioma lesion have longer survival. In conclusion methionine PET could be used as a complementary tool in the prognosis evaluation of gliomas and in their clinical management

Sickle Cell Anemia and Functioning Splenic Tissue: Correlation of Scintigraphic Findings and CT

We report the case of a 16-year-old girl from Central Africa who was hospitalized with an acute vasoclusive crisis and lumbar pain. She had a medical history of malaria at 6 years of age, yellow fever at 14, sickle cell disease at 2, and hepatopathy by hepatitis C virus. Splenic ultrasound revealed splenic enlargement with multiple hypoechogenicity intrasplenic masses of. A standard whole-body CT showed a moderate splenomegaly with splenic nodular masses with high density that suggested splenomas. Technetium-99m heat-damaged red blood cells showed multiple focal rounded masses with radiotracer activity indicating functioning intrasplenic tissue and regenerating nodules, whereas the rest of the parenchyma was nonfunctioning

Sentinel lymph node biopsy in prostate cancer patients: results from an injection technique targeting the index lesion in the prostate gland

Objectives: to determine the accuracy of nodal staging in patients with prostate cancer (PCa) when 99 m Tc-nanocolloid radiotracer is injected into an index lesion (IL). Methods: this prospective study was conducted at our institution between June 2016 and October 2020. It included 64 patients with localized PCa with at least a 5% possibility for lymph node involvement in the Memorial Sloan Kettering Cancer Center nomogram, suitable for surgical treatment. All patients underwent magnetic resonance imaging (MRI) with IL and were pathologically confirmed. The day before surgery, transrectal ultrasound-guided injection (TRUS) of 99 m Tc-nanocolloid into the IL was performed. Surgical procedures included radical prostatectomy (RP), sentinel lymph node biopsy (SLNB), and extended pelvic lymphadenectomy (ePLND). Analysis was performed, including histopathological findings of RP, ePLND, and SLNB. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), false negative (FN), false positive (FP), diagnostic yield, and non-diagnostic rate were calculated. Results: a total of 1,316 lymph nodes were excised, including 1,102 from the ePLND (83.7%) and 214 (16.3%) sentinel lymph nodes (SLN). 26 SLN were dissected outside the ePLND template. The final pathology demonstrated 46 (3.5%) lymph node metastasis, 31 (67.4%) in the SLNB and 15 (32.6%) in the non-SLN ePLND. At the patient level, 18 (28.1%) patients had pN1. With a mean follow-up of 33.1 months, 4/19 (21.1%) pN1 patients had undetectable PSA, and 3/19 (15.8%) had a PSA < 0.1 ng/mL. Lymph node dissection included 20.6 lymph nodes per patient (IQR 15-24.2), with 3.3 SLNB nodes per patient (IQR 2-4.2). PPV and NPV were 100 and 97.8%, respectively. Sensitivity and specificity were 94.4 and 100%, respectively. FN was 5.5% and FP was 4.3%. Diagnostic yields were 95.3% and the non-diagnostic rate was 4.7%. Conclusion: radiotracer injection into the prostate IL offers promising results for staging purposes in cases in which ePLND is considered. Negative SLNB is a predictor of negative ePLND. Patients with a limited burden of nodal metastasis have a significant chance of remaining free of biochemical recurrence at mid-term follow-up

FDG PET- CT SUVmax and IASLC/ATS/ERS histologic classification: a new profile of lung adenocarcinoma with prognostic value

Quantitative analysis of glucose consumption measured by maximum standardized uptake value (SUVmax) in lung adenocarcinoma (LA) remains in discussion and metabolic information provided by FDG-PET is not included in cancer staging. The first aim of this work was to evaluate the correlation between SUVmax and different histologic subtypes of LA. The second aim was to establish the correlation between SUVmax and TNM, genetic mutations and prognostic. Glucose consumption of primary tumor was quantified using SUVmax in 112 patients with histologically-confirmed LA. Specimens were classified according to the IASLC/ATS/ERS into in situ -AIS-, minimally invasive -MIA-, invasive (lepidic, papillary, acinar, solid and micropapillary) and invasive mucinous adenocarcinoma. Tumors were grouped according to three histological grades; low-grade: AIS, MIA, intermediate-grade: lepidic, acinar, papillary and high-grade: micropapillary, solid and mucinous. Comparisons between SUVmax and histologic subtypes were performed with Kruskal-Wallis followed by a Dunn's test. Overall (OS) and disease-free survival (DFS) were calculated. SUVmax was histologically-dependent (P<0.001): AIS 0.5±0.1, MIA 1.1±0.9 lepidic 3.3±3.1, acinar 8.6±6.7, papillary 3.9±5.1, micropapillary 4.9±3.4, solid 10.4±5.4 and invasive mucinous 2.7±1.2. SUVmax was associated with TNM stage in stage IA and IB. SUVmax was significantly lower in patients with K-RAS and EGFR mutation. Low SUVmax was associated with low-grade histology and with a higher OS and DSF compared to high SUVmax (intermediate and high-grade histology). SUVmax on FDG-PET is a powerful information in the presurgical evaluation of LA patients. It provides prognostic data and should be considered in the staging algorithm of patients with LA

FDG PET- CT SUVmax and IASLC/ATS/ERS histologic classification: a new profile of lung adenocarcinoma with prognostic value

Quantitative analysis of glucose consumption measured by maximum standardized uptake value (SUVmax) in lung adenocarcinoma (LA) remains in discussion and metabolic information provided by FDG-PET is not included in cancer staging. The first aim of this work was to evaluate the correlation between SUVmax and different histologic subtypes of LA. The second aim was to establish the correlation between SUVmax and TNM, genetic mutations and prognostic. Glucose consumption of primary tumor was quantified using SUVmax in 112 patients with histologically-confirmed LA. Specimens were classified according to the IASLC/ATS/ERS into in situ -AIS-, minimally invasive -MIA-, invasive (lepidic, papillary, acinar, solid and micropapillary) and invasive mucinous adenocarcinoma. Tumors were grouped according to three histological grades; low-grade: AIS, MIA, intermediate-grade: lepidic, acinar, papillary and high-grade: micropapillary, solid and mucinous. Comparisons between SUVmax and histologic subtypes were performed with Kruskal-Wallis followed by a Dunn's test. Overall (OS) and disease-free survival (DFS) were calculated. SUVmax was histologically-dependent (P<0.001): AIS 0.5±0.1, MIA 1.1±0.9 lepidic 3.3±3.1, acinar 8.6±6.7, papillary 3.9±5.1, micropapillary 4.9±3.4, solid 10.4±5.4 and invasive mucinous 2.7±1.2. SUVmax was associated with TNM stage in stage IA and IB. SUVmax was significantly lower in patients with K-RAS and EGFR mutation. Low SUVmax was associated with low-grade histology and with a higher OS and DSF compared to high SUVmax (intermediate and high-grade histology). SUVmax on FDG-PET is a powerful information in the presurgical evaluation of LA patients. It provides prognostic data and should be considered in the staging algorithm of patients with LA

p53 expression in breast cancer predicts tumors with low probability of non-sentinel nodes infiltration.

AIM: Several predictive tools of non-sentinel lymph nodes neoplastic involvement when a positive sentinel lymph node is found have been described. However, molecular factors have been rarely evaluated to build these tools. The aim of this study was to establish which factors predicted non-sentinel lymph nodes infiltration in our setting, including some molecular factors. MATERIAL AND METHODS: We carried out a retrospective review of 161 patients with breast cancer and a positive sentinel lymph node who had undergone axillary lymph node dissection, none of whom had received neoadjuvant treatment. Features evaluated as predictive factors for non-sentinel node positivity were: menopausal status, tumor size, histological subtype, histological grade, lymphovascular invasion, extracapsular invasion, Ki67 index, hormonal receptors, CerbB2 and p53 expression, size of sentinel lymph node metastases and number of sentinel lymph nodes affected. RESULTS: Tumor size (P = 0.001), size of sentinel lymph node metastases (P = 0.001), lobular invasive carcinoma (P = 0.05) and lymphovascular invasion (P = 0.006) were significantly associated with non-sentinel lymph node positivity. Tumor p53 positive expression was strongly associated with non-sentinel lymph node negativity (P = 0.000). In multivariate analysis, all these factors but tumor size maintained their significance. The discrimination power of the model calculated by the area under the receiver-operator curve was 0.811 (95% confidence interval, 0.741-0.880). CONCLUSION: p53 expression in breast cancer was highly predictive of non-sentinel lymph node negativity in our study. New studies should evaluate if it would be useful to add p53 expression to other existing predictive tools.This research was funded by theinternal resources of the departments involved (Breast Functional Unit, Obstetrics and Gynecology Department, Nuclear Medicine Department and Pathology Departmen