Detection Of Recurrence In Patients Research Articles

Physiological MRI of microvascular architecture, neovascularization activity, and oxygen metabolism facilitate early recurrence detection in patients with IDH-mutant WHO grade 3 glioma

PurposeThis study aimed to determine the diagnostic performance of physiological MRI biomarkers including microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension for recurrence detection of IDH-mutant WHO grade 3 glioma.MethodsSixty patients with IDH-mutant WHO grade 3 glioma who received overall 288 follow-up MRI examinations at 3 Tesla after standard treatment were retrospectively evaluated. A conventional MRI protocol was extended with a physiological MRI approach including vascular architecture mapping and quantitative blood-oxygen-level-dependent imaging which required 7 min extra data acquisition time. Custom-made MATLAB software was used for the calculation of MRI biomarker maps of microvascular perfusion and architecture, neovascularization activity, tissue oxygen metabolism, and tension. Statistical procedures included receiver operating characteristic analysis.ResultsOverall, 34 patients showed recurrence of the WHO grade 3 glioma; of these, in 15 patients, recurrence was detected one follow-up examination (averaged 160 days) earlier by physiological MRI data than by conventional MRI. During this time period, the tumor volume increased significantly (P = 0.001) on average 7.4-fold from 1.5 to 11.1 cm3. Quantitative analysis of MRI biomarkers demonstrated microvascular but no macrovascular hyperperfusion in early recurrence. Neovascularization activity (AUC = 0.833), microvascular perfusion (0.682), and oxygen metabolism (0.661) showed higher diagnostic performance for early recurrence detection of WHO grade 3 glioma compared to conventional MRI including cerebral blood volume (0.649).ConclusionThis study demonstrated that the targeted assessment of microvascular features and tissue oxygen tension as an early sign of neovascularization activity provided valuable information for recurrence diagnostic of WHO grade 3 glioma.

Pictorial review of the clinical applications of MIBG in neuroblastoma: current practices

Neuroblastoma is the most common extra-cranial solid tumor in pediatrics. The objective of this manuscript is to present an image-rich review of the presentation, diagnosis, staging and response assessment in individuals with neuroblastoma with special attention to the role of I-123 mIBG (meta-iodobenzylguanidine). A literature search was performed in the PubMed and Scopus databases to identity articles published between 1980 and March 2020 regarding different aspects of neuroblastoma (presentation, diagnosis, pathologic classification, staging, and response monitoring). Different combinations of search terms were used including “neuroblastoma”, “presentation”, “diagnosis”, “staging”, “imaging”, “pathology”, “MIBG”, “FDG”, “norepinephrine transporter”, and “18F DOPA”. The references of the resultant articles were also used to identify additional manuscripts. A total of 101 key articles were identified that discussed the spectrum of presentation, diagnosis, staging and response assessment in individuals with neuroblastoma. These articles form the basis of this manuscript. Iodine-123-labeled meta-iodobenzylguanidine (mIBG) is the cornerstone of functional imaging for staging, therapeutic response monitoring, prognostication, and the detection of recurrence in patients with neuroblastoma. MIBG images are interpreted both qualitatively and semiquantitatively. The International Neuroblastoma Risk Group Staging System and the International Neuroblastoma Staging System are used to stage the disease extent before and after surgical resection, respectively. The Revised International Neuroblastoma Response Criteria, updated in 2017, stratify the treatment response based on findings on functional (with mIBG or if mIBG non-avid with [18F]-fluorodeoxyglucose) and anatomical (computed tomography or magnetic resonance) imaging and bone marrow aspirates.

66: Early Detection of Recurrence in Patients Treated with Lung Stereotactic Ablative Radiotherapy (SABR) Using Radiomics

66: Early Detection of Recurrence in Patients Treated with Lung Stereotactic Ablative Radiotherapy (SABR) Using Radiomics

Longitudinal Follow-Up with Radiologic Imaging Is Essential for Detection of Recurrence in Patients with Congenital Diaphragmatic Hernia - Results from a Large Prospective Cohort-Study at a Single Referral Centre

Background: Congenital diaphragmatic hernia is a rare and still challenging malformation with long-term-morbidity gaining more importance. Recurrence is reported in up to 50% after patch-implantation. Previous studies are difficult to compare, because surgical techniques differ, most are retrospective and do neither offer longitudinal follow-up nor radiologic imaging to all survivors. This is a large prospective cohort-study from one institution with a standardized surgical treatment-algorithm and a structured long-term follow-up to allow a reliant detection of recurrence-rate and determination of risk-factors. Methods: Data was collected over 12 years with a minimal follow-up of two years. 508 neonates with congenital diaphragmatic hernia were treated, 410 patients survived, and 90% were followed longitudinally. Findings: In open surgery 68 patients received a primary repair and 251 a cone-shaped patch. Recurrence after open surgery occurred in three patients until discharge, in 28 children thereafter. Six patients developed re-recurrences. Overall 38 recurrences were diagnosed (24 ‘true’ recurrences, eight hiatal hernias, six combined recurrences). Recurrence-rate after primary repair was 8.8% and 12.7% after repair with a cone-shaped patch (p=0.53). Recurrence was significantly associated with initial defect-size. Independent risk-factors for recurrence were a left-sided defect, intrathoracic liver-herniation, and the need for an abdominal wall patch. Interpretation: Long-term-results after diaphragmatic reconstruction highly depend on surgical technique. A reduced recurrence-rate in open surgery can even be achieved in a referral centre with predominantly large defects by implantation of a cone-shaped patch. It is essential to follow all patients longitudinally with regular radiologic imaging – since most showed no or minimal symptoms (97%) and because 45% of recurrences were diagnosed beyond one year of age. Only longitudinal follow-up with radiologic imaging of all patients allows a reliant detection of recurrence to prevent acute incarceration and chronic failure to thrive with their impact on prognosis. Funding Statement: There was no funding for this study. Declaration of Interests: KBZ, TS, MW and CW do not disclose any financial or personal conflict of interests. LMW received personal fees for his work in the Advisory Board Shire (intestinal failure in children due to short bowel syndrome) and for his lecture on pediatric surgery in neonatology (Chiesi). Ethics Approval Statement: This study was approved by our local ethic committee and informed consent was obtained from parents.

Diagnostic value of 11C-methionine PET/CT imaging for detecting the recurrence of supratentorial glioma

Objective To assess the diagnostic values of 11C-methionine (MET) PET/CT semiquantitative parameters for detecting recurrence in patients who were diagnosed with suspicious recurrence by MRI after resection of supratentorial gliomas. Methods A total of 164 patients (107 males, 57 females, age 6-74 years; high-grade 94, low-grade 63, unclear 7) with supratentorial gliomas who underwent 11C-MET PET/CT between June 2015 and June 2017 in Beijing Tiantan Hospital were enrolled respectively. All patients were with suspicious recurrence after surgery showed by MRI and followed up for 6 months at least. The final diagnosis was determined with histopathological analysis or clinical follow-up. The maximum and mean standardized uptake value (SUVmax and SUVmean), tumor-to-background ratios (TBR) of SUVmax and SUVmean (TBRmax and TBRmean) were recorded and compared between patients with recurrence or without recurrence using independent-sample t test. Receiver operating characteristic (ROC) curves were drawn to determine the threshold, and the diagnostic sensitivity and specificity of each parameter were calculated. Results According to the clinical diagnosis, there were 139 patients with recurrence and 25 without recurrence. SUVmax, SUVmean, TBRmax and TBRmean were significantly higher for patients with recurrence than those without recurrence (4.19±1.95 vs 2.59±1.18, 2.34±1.08 vs 1.46±0.72, 2.95±1.17 vs 1.83±0.79, 2.64±1.11 vs 1.59±0.71; t values: 5.126-6.183, all P 0.05), for which the optimal cut-off values were 3.05, 1.65, 1.96 and 1.79, respectively, and the corresponding sensitivities/specificities for the diagnosis of recurrence were 67.6%(94/139)/100%(25/25), 67.6%(94/139)/100%(25/25), 79.9%(111/139)/100%(25/25), 74.8%(104/139)/100%(25/25), respectively. Patients with (n=81) or without (n=13) recurrence had different semiquantitative parameters in high-grade glioma group (t values: 5.137-5.871, all P 0.05). Among 37 patients with recurrence confirmed by pathology, there were no significant differences in the semiquantitative parameters between the high-grade and low-grade glioma groups and AUCs were not different either (t values: 1.387-1.937, z values: 0.106-1.752, all P>0.05). Conclusions Semiquantitative parameters of 11C-MET PET/CT are equally accurate in the differentiation of recurrence from radiation injury in patients with gliomas, while TBRmean was superior than SUVmean in patients with the high-grade gliomas. Among the patients with recurrence confirmed by pathology, the value of the semiquantitative parameter is limited for the identification of high- and low- grade gliomas. Key words: Glioma; Supratentorial neoplasms; Neoplasm recurrence, local; Positron-emission tomography; Tomography, X-ray computed; Methionine

Early Detection of Recurrence in Patients With Locally Advanced Non–Small-Cell Lung Cancer via Circulating Tumor Cell Analysis

BackgroundAssays to identify circulating tumor cells (CTCs) might allow for noninvasive and sequential monitoring of lung cancer. We investigated whether serial CTC analysis could complement conventional imaging for detecting recurrences after treatment in patients with locally advanced non–small-cell lung cancer (LA-NSCLC). Patients and MethodsPatients with LA-NSCLC (stage II-III) who definitively received concurrent chemoradiation were prospectively enrolled, with CTCs from peripheral blood samples identified using an adenoviral probe that detects elevated telomerase activity present in nearly all lung cancer cells. A “detectable” CTC level was defined as 1.3 green flourescent protein-positive cells per milliliter of collected blood. Samples were obtained before, during (at weeks 2, 4, and 6), and after treatment (post-radiation therapy [RT]; at months 1, 3, 6, 12, 18, and 24). ResultsForty-eight patients were enrolled. At a median follow-up of 10.9 months, 22 (46%) patients had disease recurrence at a median time of 7.6 months post-RT (range, 1.3-32.0 months). Of the 20 of 22 patients for whom post-RT samples were obtained, 15 (75%) had an increase in CTC counts post-RT. In 10 of these 15 patients, CTCs were undetectable on initial post-RT draw but were then detected again before radiographic detection of recurrence, with a median lead time of 6.2 months and mean lead time of 6.1 months (range, 0.1-12.0 months) between CTC count increase and radiographic evidence of recurrence. One patient with an early recurrence (4.7 months) had persistently elevated detectable CTC levels during and after treatment. ConclusionThese results indicate that longitudinal CTC monitoring in patients with LA-NSCLC treated with chemoradiation is feasible, and that detectable CTC levels in many patients meaningfully precede radiologic evidence of disease recurrence.

Role of human epididymis protein 4 (HE4) in detecting recurrence in CA125 negative ovarian cancer patients.

There are no current guidelines regarding evaluation of patients with normal CA125 at initial diagnosis during routine surveillance after completion of treatment. Thus, the purpose of this study was to evaluate the role of human epididymis protein 4 (HE4) in the detection of recurrence in patients with ovarian cancer and a negative CA125 at diagnosis. All patients with ovarian cancer with a negative CA125 referred to the Division of Gynecologic Oncology of the University Campus Bio-Medico of Rome were included in the study. Inclusion criteria were: age between 18 and 70 years old, diagnosis of epithelial ovarian cancer, optimal primary surgery (residual tumor <1 cm), and normal CA125 at initial diagnosis. Patients with other malignancies or chronic diseases were excluded from the study. Statistical analysis was based on the calculation of percentages, means, medians, and ranges of the values. A total of eight patients were included in the study. The median age was 53 years (range 40-75). All patients had a normal CA125 at initial diagnosis while seven (87.5%) patients had abnormal HE4 levels at diagnosis. The International Federation of Gynecology and Obstetrics (FIGO) stages at enrollment varied from IC to IIIC (IB (1), IC (3), IIC (1), IIIC (3)). The most common histologic subtype was serous (62.5%). Seven patients recurred and had abnormal HE4 and normal CA125 values. The median HE4 at recurrence was 107 pmol/L. The median disease-free interval was 55 months (range 5-108) and all the patients underwent optimal cytoreductive surgery. HE4 levels may serve as a marker for recurrence in patients with a normal CA125 at initial diagnosis. Future studies are needed to evaluate the role of HE4 levels in earlier detection of recurrent ovarian cancer.

Association Between Intensity of Posttreatment Surveillance Testing and Detection of Recurrence in Patients With Colorectal Cancer

Surveillance testing is performed after primary treatment for colorectal cancer (CRC), but it is unclear if the intensity of testing decreases time to detection of recurrence or affects patient survival. To determine if intensity of posttreatment surveillance is associated with time to detection of CRC recurrence, rate of recurrence, resection for recurrence, or overall survival. A retrospective cohort study of patient data abstracted from the medical record as part of a Commission on Cancer Special Study merged with records from the National Cancer Database. A random sample of patients (n=8529) diagnosed with stage I, II, or III CRC treated at a Commission on Cancer-accredited facilities (2006-2007) with follow-up through December 31, 2014. Intensity of imaging and carcinoembryonic antigen (CEA) surveillance testing derived empirically at the facility level using the observed to expected ratio for surveillance testing during a 3-year observation period. The primary outcome was time to detection of CRC recurrence; secondary outcomes included rates of resection for recurrent disease and overall survival. A total of 8529 patients (49% men; median age, 67 years) at 1175 facilities underwent surveillance imaging and CEA testing within 3 years after their initial CRC treatment. The cohort was distributed by stage as follows: stage I, 25.0%; stage II, 35.2%; and stage III, 39.8%. Patients treated at high-intensity facilities-4188 patients (49.1%) for imaging and 4136 (48.5%) for CEA testing-underwent a mean of 2.9 (95% CI, 2.8-2.9) imaging scans and a mean of 4.3 (95% CI, 4.2-4.4) CEA tests. Patients treated at low-intensity facilities-4341 patients (50.8%) for imaging and 4393 (51.5%) for CEA testing-underwent a mean of 1.6 (95% CI, 1.6-1.7) imaging scans and a mean of 1.6 (95% CI, 1.6-1.7) CEA tests. Imaging and CEA surveillance intensity were not associated with a significant difference in time to detection of cancer recurrence. The median time to detection of recurrence was 15.1 months (IQR, 8.2-26.3) for patients treated at facilities with high-intensity imaging surveillance and 16.0 months (IQR, 7.9-27.2) with low-intensity imaging surveillance (difference, -0.95 months; 95% CI, -2.59 to 0.68; HR, 0.99; 95% CI, 0.90-1.09) and was 15.9 months (IQR, 8.5-27.5) for patients treated at facilities with high-intensity CEA testing and 15.3 months (IQR, 7.9-25.7) with low-intensity CEA testing (difference, 0.59 months; 95% CI, -1.33 to 2.51; HR, 1.00; 95% CI, 0.90-1.11). No significant difference existed in rates of resection for cancer recurrence (HR for imaging, 1.22; 95% CI, 0.99-1.51 and HR for CEA testing, 1.12; 95% CI, 0.91-1.39) or overall survival (HR for imaging, 1.01; 95% CI, 0.94-1.08 and HR for CEA testing, 0.96; 95% CI, 0.89-1.03) among patients treated at facilities with high- vs low-intensity imaging or CEA testing surveillance. Among patients treated for stage I, II, or III CRC, there was no significant association between surveillance intensity and detection of recurrence. clinicaltrials.gov Identifier: NCT02217865.

Circulating epithelial cells as potential biomarkers for detection of recurrence in patients of papillary thyroid carcinoma with positive serum anti-thyroglobulin antibody

BackgroundSerum thyroglobulin (Tg) is not a reliable tumor marker for monitoring disease status after treatment in patients with papillary thyroid carcinoma (PTC) with positive anti-thyroglobulin antibody (TgAb). The aim of this study was to evaluate the clinical role of circulating epithelial cells (CECs) in PTC patients with positive serum TgAb and undetectable serum Tg. MethodsA pilot study was performed to evaluate CECs in 25 PTC patients with positive serum TgAb and undetectable serum Tg. CECs were isolated and enriched from peripheral blood with a negative selection system PowerMag. Immunofluorescence staining with anti-epithelial cell adhesion molecule (anti-EpCAM) and anti-thyroid stimulating hormone receptor (anti-TSHR) antibodies were used to define EpCAM+-CECs and TSHR+-CECs. After CECs testing, 25 patients were classified into two groups: recurrence group (n=7) and remission group (n=18) based on biopsy or imaging studies. The diagnostic accuracy and cutoff points of EpCAM+-CECs and TSHR+-CECs were evaluated using receiver operating characteristic (ROC) curves. The optimal cut-off values of CECs were determined by the Youden index (sensitivity+specificity−1). ResultsThe median numbers of EpCAM+-CECs (72.5 vs. 10.75) and TSHR+-CECs (54 vs. 5.25) were significantly increased in recurrence group compared to remission group. The area under the curve (AUC) showed good performance of EpCAM+-CECs (0.937) and TSHR+-CECs (0.825) to discriminate between recurrence and remission. The cut-off value for EpCAM+-CECs and TSHR+-CECs were set at 48cells/ml and 10cells/ml, respectively and showed a sensitivity (EpCAM+-CECs: 85.7%; TSHR+-CECs: 85.7%) and a specificity (EpCAM+-CECs: 100%; TSHR+-CECs: 77.8%) in predicting the recurrence. ConclusionsOur study suggests CECs testing could be a potential biomarker to identify recurrence in PTC patients with positive serum TgAb and undetectable serum Tg.

The current and evolving role of FDG–PET/CT in personalized iodine-131 therapy of differentiated thyroid cancer

Several approaches have been recommended for the selection of patients with differentiated thyroid cancer amenable for postoperative radioiodine remnant ablation or repeated radioiodine treatment, though with inadequate results. 2-[18F]-fluoro-2-deoxy-d-glucose positron emission tomography is gaining consideration for predicting disease-free or survival of differentiated thyroid carcinoma patients, in particular in the peri-or post-surgery setting and for the detection of recurrence in patients with elevated or rising thyroglobulin without evidence of disease on neck ultrasound or iodine scintigraphy. This paper aims to review the role of FDG–PET/CT in tailoring iodine-131 empiric therapy for radioiodine remnant ablation and the detection of recurrence in patients with elevated thyroglobulin and negative iodine-123 scan. A literature search up to May 2017 of MEDLINE® and SCOPUS® with the Mesh terms: “PET/CT”, “iodine-131 therapy”, “differentiated thyroid cancer” and “prognosis” was performed. Thereafter, papers dealing with radioiodine remnant ablation and empiric therapy were selected. Ninety papers were retrieved from the initial search and 19 considered for the review. The percentage of positive FDG–PET/CT performed at radioiodine remnant ablation or shortly after ranged from 17 to 69%, with highest values in high- and intermediate-to-high risk patients. The response rate to radioiodine remnant ablation and survival were consistently higher in negative FDG–PET/CT patients. Besides, FDG–PET/CT imaging was found to be a very accurate diagnostic tool for the detection of recurrence in patients with elevated thyroglobulin and negative iodine-123 scan, discriminating patients needing further empirical iodine-131 therapy from those who could benefit from alternative approaches. Although a meta-analysis was not possible due to the heterogeneity and the small population samples of the studies retrieved, the results of the present review support the use of FDG–PET/CT in tailoring iodine-131 therapy when used close to radioiodine remnant ablation and in patients amenable to iodine-131 empiric therapy.

Prospective Trial of Circulating Tumor Cells as a Biomarker for Early Detection of Recurrence in Patients with Locally Advanced Non–Small Cell Lung Cancer Treated with Chemoradiation Therapy

Prospective Trial of Circulating Tumor Cells as a Biomarker for Early Detection of Recurrence in Patients with Locally Advanced Non–Small Cell Lung Cancer Treated with Chemoradiation Therapy

FGFR3, TERT and OTX1 as a Urinary Biomarker Combination for Surveillance of Patients with Bladder Cancer in a Large Prospective Multicenter Study

Patients with nonmuscle invasive bladder cancer are followed with frequent cystoscopies. In this study FGFR3, TERT and OTX1 were investigated as a diagnostic urinary marker combination during followup of patients with primary nonmuscle invasive bladder cancer. In this international, multicenter, prospective study 977 patients with nonmuscle invasive bladder cancer were included. A total of 2,496 urine samples were collected prior to cystoscopy during regular visits. Sensitivity was estimated to detect concomitant recurrences. Kaplan-Meier curves were used to estimate the development of future recurrences after urinalysis and a negative cystoscopy. Sensitivity of the assay combination for recurrence detection was 57% in patients with primary low grade, nonmuscle invasive bladder cancer. However, sensitivity was 83% for recurrences that were pT1 or muscle invasive bladder cancer. Of the cases 2% progressed to muscle invasive bladder cancer. Sensitivity for recurrence detection in patients with primary high grade disease was 72% and 7% of them had progression to muscle invasive bladder cancer. When no concomitant tumor was found by cystoscopy, positive urine samples were more frequently followed by a recurrence over time compared to a negative urine sample (58% vs 36%, p <0.001). High stage recurrences were identified within 1year after a positive urine test and a negative cystoscopy. Recurrences in patients with primary nonmuscle invasive bladder cancer can be detected by a combination of urine assays. This study supports the value of urinalysis as an alternative diagnostic tool in patients presenting with low grade tumors and as a means to identify high stage tumors earlier.

18F-FDG PET/CT surveillance for the detection of recurrence in patients with head and neck cancer

BackgroundPosttreatment detection of recurrence may lead to salvage treatment and prognostic prediction in patients with head and neck squamous cell carcinoma (HNSCC). We evaluated the diagnostic and prognostic values of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) after definitive treatment of HNSCC. MethodsThis prospective study included 278 consecutive patients who underwent curative surgery (n = 143, 51.4%) or definitive radiotherapy/chemoradiotherapy (n = 135, 48.6%) for previously untreated HNSCC. The patients were regularly followed up and evaluated by 18F-FDG PET/CT, head and neck CT/magnetic resonance imaging (MRI), and chest CT at regular intervals after treatment. The imaging interpretations were compared with the histological results for recurrence. Receiver operating characteristics curves analysis, McNemar's test and logistic regression using generalised estimating equations were used to compare the diagnostic accuracy of 18F-FDG PET/CT and standard imaging of CT/MRI or chest CT, and a Cox proportional hazards model was used to assess the prognostic value of PET/CT. ResultsDuring a median follow-up of 44 months (range, 24–62 months), 73 patients (26.3%) had recurrence or persistent diseases. The area under curves for 18F-FDG PET/CT and CT/MRI were 0.975 (0.964–0.992) and 0.789 (0.713–0.874), respectively (P < 0.001). 18F-FDG PET/CT detected 65 of 66 recurrences (98.5%) not suggested by physical examination and endoscopy. Positive findings on 18F-FDG PET/CT scans were independent predictors of poorer cancer-specific and overall survival outcomes (P < 0.01). ConclusionsPosttreatment 18F-FDG PET/CT surveillance helps to properly detect recurrence and to predict the survival following treatment of HNSCC.

The usefulness of fluorine-18 fluorodeoxyglucose PET in the detection of recurrence in patients with differentiated thyroid cancer with elevated thyroglobulin and negative radioiodine whole-body scan.

PET/computed tomography (CT) using fluorine-18 fluorodeoxyglucose (F-FDG) has been used in the diagnosis of recurrence and metastases of differentiated thyroid cancer (DTC) in cases of negative whole-body scan (WBS) despite elevated concentrations of stimulated thyroglobulin (Tg). To assess the utility of PET/CT in the detection of recurrence among patients with DTC with increased Tg levels and negative results of WBS. PET/CT results were retrospectively analyzed in patients with DTC with increased Tg and negative results of WBS as well as negative cervical ultrasonography and chest radiography. PET-CT was performed 1-2 weeks after recent diagnostics under conditions of endogenous or exogenous thyroid-stimulating hormone stimulation. PET/CT was performed using a Discovery ST scanner 1 h after an intravenously F-FDG injection (activity 4-5 MBq/kg). To determine the cutoff value of Tg, receiver operating characteristic curves were analyzed. Sixty-nine patients with DTC (48 women, 21 men) aged 22-83 years (mean 50.9±17.5 years) were qualified. In 44 patients (63.8%), PET/CT indicated lesions of DTC. Thirty (43.5%) patients had F-FDG positive findings. In the remaining 14 patients (20.3%), lesions were found in CT only. Patients with a positive PET/CT scan had significantly higher Tg values than patients with a negative PET/CT (mean 143.8 vs. 26.5 ng/ml, P=0.03). The cutoff value of Tg concentration measured with the receiver operating characteristic analysis was 32.9 ng/ml. PET/CT is a useful tool in the detection of recurrence among thyroid cancer patients in cases of conflicting results of standard procedures, particularly for those with high Tg levels and negative WBS. The probability of obtaining a positive PET-CT result increases with the level of Tg.

Seguimiento mediante prueba de ELISA para anticuerpos IgE de pacientes con equinococosis quística tratados con albendazol

Antecedentes: En un estudio previo, los autores estandarizaron una prueba de ELISA IgE para hidatidosis con alta sensibilidad (95,6%) y especificidad (100%) para el diagnóstico y seguimiento de pacientes tratados con albendazol, con resultados alentadores. Objetivo: Confirmar la utilidad de la medición de los niveles de los anticuerpos IgE en pacientes con equinococosis quística tratados con albendazol y considerados curados clínica y ecográficamente y en pacientes mejorados o curados que recurrieron. Diseño: Estudio retrospectivo-prospectivo, de tipo cuasi experimental, corte longitudinal, con pre prueba y post prueba en un solo grupo para evaluar el diagnóstico y seguimiento en los casos prospectivos y el seguimiento y recurrencia en ambos grupos. Institución: Instituto de Medicina Tropical «Daniel A. Carrión», Universidad Nacional Mayor de San Marcos, Lima, Perú. Participantes: Pacientes con equinococosis quística. Métodos: Se incluyó 17 pacientes, 15 mujeres y 2 hombres, entre 25 y 80 años de edad (promedio 58 años), con uno más quistes hepáticos y en uno además quistes pulmonares; 16 fueron tratados con albendazol a la dosis de 12-15 mg/kg, en 3 a 5 ciclos de 28 días y uno recibió tratamiento con albendazol y cirugía por una complicación. Todos fueron seguidos entre dos y 12 años post-tratamiento, con evaluación clínica y ecográfica en 2 a 7 oportunidades y cuantificación de los niveles de anticuerpos IgE para equinococosis en muestras de sangre. La técnica utilizada para la detección de anticuerpos IgE mediante prueba de ELISA para IgE fue estandarizada por los autores. Principales medidas de resultados: Relación de niveles de anticuerpos IgE en sangre y comportamiento de la enfermedad. Resultados: En 10 de los 17 pacientes se mantuvieron los niveles de IgE por debajo del punto de corte, lo que se consideró como evidencia de curación, lo que además coincidía con los cambios en la eco estructura que iba de CE1 y CE2 a CE4 Y CE5, según la clasificación de la OMS para las imágenes ultrasonográficas, y que significan en los primeros alta actividad y en los últimos actividad baja o nula. Siete pacientes que al final del tratamiento mostraron evidencia de curación o gran mejoría clínica y ultrasonográfica y cuyos niveles de IgE descendieron de manera significativa, en algunos por debajo de los niveles de corte, presentaron incremento sostenido de estos niveles como expresión de recurrencia o de aparición de nuevos quistes. Conclusiones: La prueba de ELISA para la detección de anticuerpos IgE de equinococosis quística estandarizada por los autores demostró ser una prueba útil para el seguimiento del tratamiento con albendazol, de manera de confirmar la curación clínica y ultrasonográfica de la equinococosis quística hepática. También aparece útil para la detección temprana de las recurrencias de los pacientes curados o con marcada mejoría.

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in the Detection of Ovarian Cancer Recurrence in Patients with Elevated Serum Ca-125 Levels and Whether the Recurrence appears by Conventional Imaging

Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/ Computed Tomography in the Detection of Ovarian Cancer Recurrence in Patients with Elevated Serum Ca-125 Levels and Whether the Recurrence appears by Conventional Imaging

Saliva and plasma quantitative polymerase chain reaction-based detection and surveillance of human papillomavirus-related head and neck cancer.

Human papillomavirus type 16 (HPV-16) is a major causative factor in oropharyngeal squamous cell carcinoma (OPSCC). The detection of primary OPSCC is often delayed owing to the challenging anatomy of the oropharynx. To investigate the feasibility of HPV-16 DNA detection in pretreatment and posttreatment plasma and saliva and its potential role as a marker of prognosis. This is a retrospective analysis of a prospectively collected cohort. Among a cohort of patients with oropharyngeal and unknown primary squamous cell carcinoma with known HPV-16 tumor status from the Johns Hopkins Medical Institutions and Greater Baltimore Medical Center (from 1999 through 2010), 93 patients were identified with a complete set of pretreatment and posttreatment plasma or saliva samples, of which 81 patients had HPV-16-positive tumors and 12 patients had HPV-16-negative tumors. Real-time quantitative polymerase chain reaction was used to detect HPV-16 E6 and E7 DNA in saliva and plasma samples. Main outcomes included sensitivity, specificity, negative predictive value of combined saliva and plasma pretreatment HPV-16 DNA status for detecting tumor HPV-16 status, as well as the association of posttreatment HPV DNA status with clinical outcomes, including recurrence-free survival and overall survival. The median follow-up time was 49 months (range, 0.9-181.0 months). The sensitivity, specificity, negative predictive value, and positive predictive value of combined saliva and plasma pretreatment HPV-16 DNA status for detecting tumor HPV-16 status were 76%, 100%, 42%, and 100%, respectively. The sensitivities of pretreatment saliva or plasma alone were 52.8% and 67.3%, respectively. In a multivariable analysis, positive posttreatment saliva HPV status was associated with higher risk of recurrence (hazard ratio [HR], 10.7; 95% CI, 2.36-48.50) (P = .002). Overall survival was reduced among those with posttreatment HPV-positive status in saliva (HR, 25.9; 95% CI, 3.23-208.00) (P = .002) and those with HPV-positive status in either saliva or plasma but not among patients with HPV-positive status in plasma alone. The combined saliva and plasma posttreatment HPV-16 DNA status was 90.7% specific and 69.5% sensitive in predicting recurrence within 3 years. Using a combination of pretreatment plasma and saliva can increase the sensitivity of pretreatment HPV-16 status as a tool for screening patients with HPV-16-positive OPSCC. In addition, analysis of HPV-16 DNA in saliva and plasma after primary treatment may allow for early detection of recurrence in patients with HPV-16-positive OPSCC.

The Effectiveness of Cytologic Evaluation of Urinary Diversion Specimens and UroVysion Assay as Surveillance Tests in the Detection of Recurrent Bladder Cancer

Introduction: Different surveillance protocols exist for the detection of urothelial carcinoma recurrence in patients that have undergone radical cystectomy (RC) and each protocol varies in choice of test and frequency of testing. Cytologic examination of urinary diversion specimens and UroVysion assay are two surveillance tests that may be used to detect recurrent disease. The cytologic interpretation of urinary diversion specimens is suboptimal since they contain abundant degenerate glandular cells, histiocytes, bacteria, acute inflammation and non-specific debris. In this milieu recurrent disease can be obscured and identification made difficult, if not impossible. The purpose of this study is to evaluate the effectiveness of cytology and UroVysion assay in this subset of patients. Materials and Methods: A Retrospective chart review of 97 patients who underwent RC with cutaneous diversion or orthotopic neobladder reconstructions for bladder cancer andwho also had a LIS (Laboratory Information System) word search result containing “ileal conduit urine” between January 2001 and January 2012was performed. The cytopathology reports for urinary diversion specimens and any UroVysion assays from these patients were reviewed. Cytologic results were divided into positive, suspicious, atypical, negative and unsatisfactory. The atypical category did not imply malignancy or the potential for malignancy, but was used to indicate some degree of variation from cytology seen in traditional urine specimens. Results: A total of 355 urinary diversion cytology reportswere reviewedwith diagnoses as follows: positive e 0, suspicious e 3 (0.8%), atypical e 136 (38.3%), negative e 213 (60%) and unsatisfactory e 3 (0.8%). A total of 56 Urovysion molecular tests were reviewed with interpretations as follows: positive e 3 (5.3%), negative e 39 (69.6%), indeterminate e 2 (3.6%), insufficient e 12 (21.4%). Four of 97 patients (4.1%) had at least one abnormal cytologic result. One cytologic diagnosis of atypical showed no abnormality on pouch biopsy. The remaining 3 patients with abnormal cytologies had no subsequent biopsies at our institution. Two patients had positive Urovysion assays and both these patients had orthotopic neobladder reconstructions. One patient had two subsequent positive Urovysion assay results which are accounted for by the presence of residual transitional cell carcinoma in-situ (TCIS) in the urethra as this patient had a positive urethral margin at the time of his cystoprostatectomy. The second patient with a positive UroVysion assay result occurred in a patient with 5 normal urinary diversion cytologies who was ultimately diagnosed with Stage 4 urothelial cancer (urothelial carcinomametastasis to skin). Thiswas deemed to be a false positive test result based on clinical assessment. None of the four patientswith abnormal cytology results were found to have recurrent disease. Conclusion: The results of this study question the effectiveness of cytologic evaluation of urinary diversion specimens and UroVysion assay as surveillance tests for detecting recurrent bladder cancer.We did not detect any upper tract/urethral recurrence in our series. Furthermore, the UroVysion assay is not FDA-approved for testing urine specimens derived from patients

Diagnostic accuracy of 18F-FDG PET/CT for detection of suspected recurrence in patients with oesophageal carcinoma

To evaluate the role of (18)F-FDG PET/CT in the detection of recurrence in patients with oesophageal carcinoma, suspected clinically or following conventional investigations. This was a retrospective study. Data from 180 patients (age 56.3 ± 10.4 years; 126 men, 54 women) with histopathologically proven oesophageal carcinoma (squamous cell 115, adenocarcinoma 59, neuroendocrine carcinoma 4, small cell 1, poorly differentiated 1) who had undergone 227 (18)F-FDG PET/CT studies for suspected recurrence were analysed. Recurrence was suspected clinically or following conventional investigations. PET/CT images were revaluated by two nuclear medicine physicians in consensus. Findings were grouped into local, nodal and distant recurrence. Results were compared to those from contrast-enhanced (CE) CT when available (109 patients). Clinical/imaging follow-up (minimum 6 months) with histopathology (when available) was taken as the reference standard. Of the 227 (18)F-FDG PET/CT studies,166 were positive and 61 were negative for recurrent disease. PET/CT showed local recurrence in 134, nodal recurrence in 115 and distant recurrence in 47, with more than one site of recurrence in 34. The PET/CT findings were true-positive in 153 studies, true-negative in 54, false-positive in 13 and false-negative in 7. The sensitivity of (18)F-FDG PET/CT was 96%, the specificity was 81%, the positive and negative predictive values were 92% and 89%, respectively, and the accuracy was 91%. PET/CT showed similar accuracy in patients with squamous cell carcinoma and in those with adenocarcinoma (P = 0.181).(18)F-FDG PET/CT was more specific than CECT (67% vs. 21%; P < 0.0001). PET/CT was superior to CECT for the detection of nodal recurrence (P < 0.0001), but not local recurrence (P = 0.093) or distant metastases (P = 0.441). (18)F-FDG PET/CT shows high accuracy in the detection of suspected recurrence in patients with oesophageal carcinoma. It is more specific than and is superior to CECT in the detection of nodal recurrence.

18F-FDOPA PET/CT for detection of recurrence in patients with glioma: prospective comparison with 18F-FDG PET/CT

Differentiation between recurrence and radiation necrosis in patients with glioma is crucial, since the two entities have completely different management and prognosis. The purpose of the present study was to compare the efficacies of (18)F-FDG PET/CT and 3,4-dihydroxy-6-[(18)F]fluoro-phenylalanine ((18)F-FDOPA) PET/CT in detection of recurrent gliomas. A total of 28 patients (age 38.82 ± 1.25 years; 85.7% men) with histopathologically proven glioma with clinical/imaging suspicion of recurrence were evaluated using (18)F-FDG PET/CT and (18)F-FDOPA PET/CT. (18)F-FDG PET/CT and (18)F-FDOPA PET/CT images were evaluated qualitatively and semiquantitatively. The combination of clinical follow-up, repeat imaging and/or biopsy (when available) was taken as the reference standard. Based on the reference standard, 21 patients were positive and 7 were negative for tumour recurrence. The sensitivity, specificity and accuracy of (18)F-FDG PET/CT were 47.6%, 100% and 60.7%, respectively, and those of (18)F-FDOPA PET/CT were 100%, 85.7% and 96.4%, respectively. The results of (18)F-FDG PET/CT and (18)F-FDOPA PET/CT were concordant in 57.1% of patients (16 of 28) and discordant in 42.9% (12 of 28). The difference in the findings between (18)F-FDG PET/CT and (18)F-FDOPA PET/CT was significant (P = 0.0005, McNemar's test). The difference was significant for low-grade tumours (P = 0.0039) but not for high-grade tumours (P = 0.250). (18)F-FDOPA PET/CT is highly sensitive and specific for detection of recurrence in glioma patients. It is superior to (18)F-FDG PET/CT for this purpose and is especially advantageous in patients with low-grade gliomas.