Search

Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.

Purpose Coregistered SPECT/CT can improve accuracy of sentinel node biopsy (SNB) for staging melanoma. This benefit has implications for pathology services and surgical practice with increased diagnostic and surgical workload. The purpose of this study was to investigate the effectiveness of SPECT/CT imaging. Methods SNB data were collected over a 10-year period. Preoperative SLN mapping was performed by using planar lymphoscintigraphy (LSG) for all patients (n = 1522) and after October 2015, patients underwent a second co-registered SPECT/CT scan (n = 559). The patients were stratified according to the imaging protocol. The number of nodes and nodal basins were assessed. The reasons for cancellation also were assessed. Results A total of 95% (1446/1522) of patients underwent a successful SNB procedure. Significantly more sentinel nodes were identified by the SPECT/CT protocol (3 vs. 2; p < 0.0001). More patients were cancelled in the SPECT/CT cohort (9.3% vs. 2.5%; p < 0.0001). Head & neck, lower limb, and AJCC IB primaries were significantly less likely to proceed to SNB. SPECT/CT identified significantly more positive SNBs (20.9% vs. 16.5%; p = 0.038). SPECT/CT imaging was associated with improved disease-free (hazard ratio [HR] = 0.74; 95% confidence interval [CI]: 0.54–1.0); p = 0.048) and disease-specific survival (HR = 0.48; 95% CI: 0.3–0.78; p = 0.003). Patients who did not proceed to SNB had a significantly increased nodal relapse rate (23.5% vs. 6.8%; HR = 3.4; 95% CI: 1.9–6.2; p < 0.0001) compared with those who underwent SNB. Conclusions This large cohort study confirms the increased accuracy of SPECT/CT for identifying SLN metastases, which would appear to have a significant therapeutic benefit, although an increased risk of cancellation of the SNB procedure on the day of surgery.

INTRODUCTION AND OBJECTIVE:Survival in penile cancer is largely determined by lymph node (LN) metastasis. Dynamic Sentinel Node Biopsy (DSNB) staging procedure has a false negative rate of 5-13%. W...

The increased use of PET/CT in cancer staging has resulted in more incidental findings in unexpected locations, making this a challenge for the radiologist interpreting the study. Our aim was to determine the frequency of parotid incidentalomas and to assess the ability of PET/CT to characterize them.At the Norfolk and Norwich University Trust, in between October 2010 to October 2015, 4044 patients had a PET/CT examination. The issued clinical reports that contained the word 'parotid' were traced and all patients selected for this study had no known or suspected parotid disease before the PET/CT scan.The prevalence of parotid incidentalomas was 1.73%; higher than expected as was the mean age of our study group. Ten per cent of patients had no focal lesion identified on subsequent ultrasound. Thirty-two per cent of patients had a biopsy which showed that the majority of these findings were benign and 13% had metastatic deposits, with the primary carcinoma in these cases being neuroendocrine colon carcinoma, non-Hodgkin's lymphoma and melanoma.The most common benign salivary tumour in our study was Warthin's tumour and the majority of these patients had a primary lung carcinoma. Given that the main predisposing factor for both pathologies is smoking, potentially this suggests an association between the incidence of primary lung carcinoma and Warthin's tumour. Ten (14%) patients in our study had a standardized uptake value of below 3.2 (using the VUE Point HD algorithm). These patients had either no identifiable lesion on ultrasound or no malignant features on histology; therefore, we propose that a cut-off of 3.2 on PET/CT could be used to differentiate between physiological or benign uptake from malignant fluorine-18-fluorodeoxyglucose uptake in the parotid gland.

Sentinel lymph node biopsy (SLNB) is an important staging tool for the management of melanoma. A multicentre study was done to validate previous findings that the timing of lymphoscintigraphy influences the accuracy of SLNB and patient outcomes, particularly survival.Data were reviewed on patients undergoing SLNB for melanoma at three centres in the UK and Sweden, examining the effect of timing of SLNB after nuclear medicine scanning. Kaplan-Meier survival analysis was used to assess overall (OS), disease-specific (DSS) and progression-free (PFS) survival, stratified by timing of lymphoscintigraphy. Independent risk factors for survival were identified by Cox multivariable regression analysis.A total of 2270 patients were identified. Median follow-up was 56 months. Univariable analysis showed a 4·2 per cent absolute and 35·5 per cent relative benefit in DSS (hazard ratio 1·36, 95 per cent c.i. 1·05 to 1·74; P = 0·018) for 863 patients whose SLNB was performed up to 12 h after lymphoscintigraphy compared with 1407 patients who had surgery after more than 12 h. There were similar OS and PFS benefits (P = 0·036 and P = 0·022 respectively). Multivariable analysis identified timing of lymphoscintigraphy as an independent predictor of OS (P = 0·017) and DSS (P = 0·030). There was an excess of nodal recurrences as first site of recurrence in the group with delayed surgery (4·5 versus 2·5 per cent; P = 0·008).Delaying SLNB beyond 12 h after lymphoscintigraphy withLa biopsia de ganglio centinela (sentinel lymph node biopsy, SLNB) es una técnica importante para la estadificación y tratamiento del melanoma. Se realizó un estudio multicéntrico para validar hallazgos previos según los cuales el momento de la linfogammagrafía (lymphoscintigraphy, LS) influye en la precisión de la SLNB y en los resultados de los pacientes, especialmente en la supervivencia. MÉTODOS: Se revisaron los datos de los pacientes a los que se realizó una SLNB por melanoma en 3 centros en el Reino Unido y Suecia, con especial atención al efecto del período entre la inyección el material radioactivo y la SLNB. Se realizó un análisis de supervivencia mediante el método de Kaplan-Meier para la supervivencia específica de la enfermedad (disease-specific survival, DSS), supervivencia global (overall survival, OS) y supervivencia libre de progresión (progression-free survival, PFS), todas ellas estratificadas por el momento de la LS. Los factores de riesgo independientes para la supervivencia se determinaron mediante un análisis de regresión multivariable de Cox.Se incluyeron 2.270 pacientes. La mediana de seguimiento fue de 49 meses. El análisis univariado mostró un beneficio absoluto del 4,2% y relativo del 35,5% (cociente de riesgos instantáneos, hazard ratio, HR: 1,36 (i.c. del 95% 1,05-1,74, P = 0.02)) en la DDS para los pacientes a los que la SLNB se realizó 12 horas después de la LS (n = 863) en comparación con aquellos realizados 12 horas (n = 1407). Se detectaron beneficios similares para la OS y la PFS (P = 0,04 y P = 0,02, respectivamente). El análisis multivariable identificó el tiempo entre la LS y la SLNB como un factor independiente de OS (P = 0,017) y DSS (P = 0,03). Hubo un aumento en las recidivas ganglionares como primer sitio de recidiva en el grupo de 12 horas (2,5% versus 4,5%; P = 0,008). CONCLUSIÓN: Estos datos validan nuestra investigación previa y tienen implicaciones significativas para las unidades de melanoma, en el sentido de que retrasar la SLNB más allá de las 12 horas después de realizar la LS con nanocoloides marcados con Tc99 tiene un impacto negativo significativo en la supervivencia de los pacientes y debe evitarse. Se presenta la hipótesis de que la causa subyacente es la migración temporal del trazador que determina una SLNB incorrecta. .

Introduction: Sentinel lymph node biopsy (SLNB) in cutaneous melanoma (CM) is performed to identify patient at risk of regional and distant relapse. We hypothesized that timing of lymphoscintigraphy may influence the accuracy of SLNB and patient outcomes. Methods: We reviewed prospective data on patients undergoing SLNB for CM at a large university cancer-center between 2008-2015, examining patient and tumor demographics and time between lymphoscintigraphy (LS) and SLNB. Kaplan-Meier survival analysis assessed disease-specific (DSS) and overall-survival (OS), stratified by timing of LS. Cox multivariate regression analysis assessed independent risk factors for survival. Results: We identified 1015 patients. Median follow-up was 45 months (IQR 26-68 months). Univariate analysis showed a 6.8% absolute DSS (HR 1.6 [1.03-2.48], p= 0.04) benefit and a 10.7% absolute OS (HR 1.64 [1.13-2.38], p=0.01) benefit for patients whose SLNB was performed < 12 hrs of LS (n= 363) compared to those performed >12 hours (n=652). Multivariate analysis identified timing of LS as an independent predictor of OS (p=0.007) and DSS (p=0.016) when competing with age, sex, Breslow thickness (BT) and SLN status. No difference in nodal relapse rates (5.2% v 4.6%; p=0.67) was seen. Both groups were matched for age, sex, BT and SLN status. Conclusion: These data have significant implications for SLNB services, suggesting delaying SLNB >12 hours after LS using a Tc99-labelled nanocolloid has a significant negative survival impact for patients and should be avoided. We hypothesise that temporal tracer migration is the underlying cause and advocate further trials investigating alternative, 'stable' tracer-agents.

Objective To determine whether superior semicircular canal dehiscence (SSCD) is more prevalent with advancing age. Study Design Retrospective observational study. Methods High-resolution computed-tomographic temporal bone scans were identified for patients of all ages and analyzed by two independent assessors. Multiplanar reconstruction was applied, and the thinnest area of temporal bone overlying each superior semicircular canal (SSC) was measured. Results A sample of 121 patients was analyzed that contained an almost identical number of male and female patients. In total, 242 temporal bone images were reviewed. Patients' ages ranged between 6 and 86 years. Age was shown to have a significant linear relationship (P

To determine whether superior semicircular canal dehiscence (SSCD) is more prevalent with advancing age.Retrospective observational study.High-resolution computed-tomographic temporal bone scans were identified for patients of all ages and analyzed by two independent assessors. Multiplanar reconstruction was applied, and the thinnest area of temporal bone overlying each superior semicircular canal (SSC) was measured.A sample of 121 patients was analyzed that contained an almost identical number of male and female patients. In total, 242 temporal bone images were reviewed. Patients' ages ranged between 6 and 86 years. Age was shown to have a significant linear relationship (P 0.001) such that for every unit increase in age the predicted thickness was reduced by 0.0047 mm.The thickness of the SSC decreases with advancing age.4.

The purpose of this study was to compare the measurements of primary T1 and T2 non-small cell lung carcinomas (NSCLCs) at PET/CT to determine which modality has the more accurate correlation with the histologic findings.A retrospective study was performed with the images of 59 patients who underwent surgical resection of T1 and T2 NSCLC and preoperative PET/CT. The maximum measurement of the primary lung tumor was recorded on the PET and unenhanced CT (soft-tissue and lung windows) scans in the largest plane and compared with the maximum dimensions of the histologic specimen.PET and CT measurements both had high concordance with the histologic measurements. CT soft-tissue window measurements had the highest concordance with histologic measurements, but PET had a smaller SD. The greatest linear correlation was between CT soft-tissue and CT lung window measurements, indicating they can be used interchangeably. Outliers were found in both the PET (four tumors) and the two CT (five tumors) groups owing to low (18)F-FDG uptake due to tumor type and surrounding consolidation, respectively.PET is better for delineating primary NSCLC if surrounding collapse or consolidation is present. Otherwise, CT with either soft-tissue or lung windows is accurate. Owing to low FDG accumulation, CT is more accurate for assessment of alveolar cell carcinoma.

I-123 metaiodobenzylguanidine (MIBG) scintigraphy is the examination of choice for visualizing tumor sites of pheochromocytoma. We report a middle-aged woman with incomplete Carney's Triad (association of pheochromocytoma/paraganglioma, gastrointestinal stromal tumor [GIST], and pulmonary chondromas) in whom a GIST was identified on the basis of its MIBG uptake. She had undergone surgical resection of a pheochromocytoma and postoperatively developed a mass in the epigastrium, which was thought to be recurrence. The lesion was MIBG-positive. However, following surgery, histologic examination of the specimen revealed findings suggestive of GIST.

To review our experience of doing whole gut transit scintigraphy in patients presenting with functional gastrointestinal problems and to determine its clinical usefulness.All whole gut transit studies using a liquid meal over a 5-year-period were reviewed and clinical outcome assessed.Fifty-five patients (44 women; mean age 43 years) underwent whole gut transit scintigraphy using indium-111 diethylene triamine penta-acetic acid in water. The main symptoms were constipation (49%), dyspepsia (25%) and diarrhoea (25%). Colonic transit was delayed in 63% of patients with constipation, which was significantly (P=0.005) higher than that in patients with dyspepsia. Delayed colonic transit was also seen in 43% of patients with diarrhoea. Only 26% of patients with constipation had a delay in liquid gastric emptying and small bowel transit. Gastric emptying, small bowel transit and colonic transit were normal in 43, 79 and 29% of patients with dyspepsia, respectively. There was no statically significant difference in gastric emptying and small bowel transit between patients with constipation, diarrhoea and dyspepsia.Liquid-phase whole gut transit scintigraphy seems to be a useful investigation in patients with chronic gastrointestinal symptoms. Rational use of this modality may help the clinician change the management or better characterize the underlying problem/diagnosis in the majority of patients with functional symptoms.

The importance of monitoring renal function in patients undergoing cystectomy and urinary diversion is well established. Dynamic renography using Tc-99m MAG3 in combination with furosemide challenge has been widely used to determine the differential function of the kidneys, occurrence of reflux as well as the patency of the outflow tract in this context. The authors have described here a patient in whom significant urinary reflux from the neo-bladder into the nonfunctioning kidney was demonstrated during MAG3 diuretic renography.