Institute Of Nuclear Medicine Research Articles

Preoperative Serum Thyroglobulin Levels Predict Radioiodine Therapy Outcome in Papillary Thyroid Microcarcinoma Patients.

Our previous study showed that elevated preoperative thyroglobulin (pre-Tg) level predicted the risk of developing radioiodine refractory in PTC patients. In the present study, we aimed to evaluate the prognostic value of pre-Tg in papillary thyroid microcarcinoma (PTMC). After a specific inclusion and exclusion criteria were applied, a total of 788 PTMCs were enrolled from Jiangyuan Hospital affiliated to Jiangsu Institute of Nuclear Medicine between Jan, 2015 and Dec, 2019. Among them, 107 PTMCs were treated with radioiodine therapy (RAIT) and the response to therapy was grouped as excellent response (ER), and non-excellent response (NER: indeterminate response, IDR and biochemical incomplete response, BIR). Multivariable logistic regression was used to identify predictors for the response of RAIT in PTMCs. Higher pre-Tg levels were detected in PTMCs with RAIT as compared with PTMCs without RAIT (p = 0.0018). Higher levels of pre-Tg were also found in patients with repeated RAIT as compared with patients with single RAIT (p < 0.0001). Furthermore, pre-Tg level was higher in PTMC with IDR (n = 16) and much higher in BIR (n = 9) as compared with patients with ER (n = 82, p = 0.0003) after RAIT. Multivariate analysis showed that pre-Tg level over 16.79 ng/mL (OR: 6.55 [2.10-20.39], p = 0.001) was the only independent predictor for NER in PTMC with RAIT. We found high level of pre-Tg predicted a poor RAIT outcome in PTMC. Our finding explores a prospective way in identifying high-risk PTMCs with poor response to RAIT.

SUV max as Predictor of Metastatic Disease on 18 F-FDG PET-CT in Hepatocellular Carcinoma.

To ascertain the utility ofmaximum standardised uptake value (SUVmax) in 18F-FDG PET-CT in predicting metastatic disease burden in hepatocellular carcinoma (HCC) patients. Descriptive study. Place and Duration of the Study: Department of Nuclear Medicine and PET-CT Imaging, Institute of Nuclear Medicine and Oncology (INMOL), Lahore, Pakistan, from April to October 2022. 18F-FDG PET-CT data of 87 patients were analysed prospectively. Patients were considered regardless of resection status. The SUVmax measurements were performed, and their association with metastases was determined. Molecular docking studies were conducted to determine a mechanism behind the higher SUVmax at the metastatic sites. A higher number of patients (49) was found to have metastasis (1 to 5 in numbers) and demonstrated higher SUVmax, especially in cases of pre-surgery and post-transplant state. A positive correlation existed between SUVmax of pre-surgery (r = 0.419, p = 0.001) and post-transplant patients (r = 0.779, p = 0.001). Molecular docking studies revealed a strong binding affinity (-5.18± 0.25 kcal/mol) between the hexokinase (HK-II) and 18F-FDG. SUVmax positively correlated with metastatic tumour burden. The strong binding affinity between the HK-II and 18F-FDG may be the reason. 18F-FDG PET-CT appeared beneficial in providing prognostic information for HCC in a selected group. Hepatocellular carcinoma, 18F-FDG, Positron emission tomography, Maximum standardised uptake value, SUVmax, HK-II binding, PET-CT, Metastases.

Acetylcholinesterase enzyme among cancer patients a potential diagnostic and prognostic indicator a multicenter case–control study

Acetylcholinesterase enzyme (AChE) activity is impaired by a variety of inhibitors including organophosphorus pesticides, leading to the accumulation of acetylcholine. In this study, we aimed to determine the association between cancer and the blood level of the (AChE). This is a multicenter hospital-based case–control study conducted in the Radiation and Isotopes Center Khartoum, and Institute of Nuclear Medicine and Molecular Biology and Oncology Gezira. One hundred and fifty participants, half of them cancer patients and half cancer free were recruited. All participants were screened for demographic, environmental, occupational, and clinical characteristics. Blood for the (AChE) activity test was drawn from participants in the two groups. The mean age of the participants was 40.6 ± 14.8 years. Geographical distribution showed the Central Region of Sudan had the highest rate of cancer, followed by North State, Khartoum State, West State, and East State. The most common tumor subtype was breast cancer, followed by leukemia, colon, esophageal, and prostate cancer. Inferential analysis revealed significantly impaired (AChE) activity among cancer patients compared to controls (53.4 ± 20.3% vs. 93.8 ± 8.8, p-value 0.001). There was a significant statistical association between impaired (AChE) activity and cancer. (AChE) activity might be applied in the future as a diagnostic biomarker and therapeutic target. Further large sample and molecular studies are recommended.

Evaluating internal exposure due to intake of 131I at a nuclear medicine centre of Dhaka using bioassay methods

Handling of radioisotopes may cause external and internal contamination to occupational workers while using radiation for medical purposes. This research aims to monitor the internal hazard of occupational workers who handle 131I. Two methods are used: in vivo or direct method and in vitro or indirect method. The in vivo or direct method was performed by assessing thyroid intake with a thyroid uptake monitoring machine. The in vitro or indirect method was performed by assessing urine samples with the help of a gamma-ray spectroscopy practice using a High-Purity Germanium (HPGe) Detector. In this study, fifty-nine thyroid counts and fifty-nine urine samples were collected from seven occupational workers who were in charge of 131I at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Dhaka. The result showed that the average annual effective dose of seven workforces from thyroid counts were 0.0208 mSv/y, 0.0180 mSv/y, 0.0135 mSv/y, 0.0169 m Sv/y, 0.0072 mSv/y, 0.0181 mSv/y, 0.0164 mSv/y and in urine samples 0.0832 mSv/y, 0.0770 mSv/y, 0.0732 mSv/y, 0.0693 mSv/y, 0.0715 mSv/y, 0.0662 mSv/y, 0.0708 mSv/y.The total annual effective dose (in vivo and in vitro method) was found among seven workers in average 0.1039 mSv/y, 0.0950 mSv/y, 0.0868 mSv/y, 0.0862 mSv/y, 0.0787 mSv/y, 0.0843 mSv/y, 0.0872 mSv/y. Following the rules of the International Commission on Radiological Protection (ICRP), the annual limit of effective dose for occupational exposure is 20 mSv per year and the finding values from this research work are lesser than this safety boundary.

Risk-stratified Distant Metastatic Thyroid Cancer with Clinicopathological Factors and BRAF/TERT Promoter Mutations.

To assess the prognostic value of clinicopathological factors as well as BRAF and TERT promoter mutations in predicting distant metastasis in patients with papillary thyroid cancer. The status of BRAF and TERTp mutations were available in 1,208 thyroid cancer patients who received thyroidectomy at Jiangyuan Hospital Affiliated to Jiangsu Institute of Nuclear Medicine from January 2008 to December 2021. Based on inclusion criteria, 99 distant metastasis thyroid cancers (DM-TCs) and 1055 patients without DM (Non-DM-TCs) were retrospectively reviewed. After univariate and multivariate analyses, a risk model was established for DM prediction based on factors: T3/T4 stage, lymph node metastasis (LNM) number over 5, and BRAF/TERT mutations (TLBT). It was defined based on the number of TLBT factors: low risk (no risk factor, n=896), intermediate risk (1 risk factor, n=199), and high risk (≥2 risk factors, n=59). Notably, compared with patients with low and intermediate risks, patients assigned to high TLBT risk have a shorter time of DM disease-free survival. Except for gene mutation, other factors were also included in the 2015 American Thyroid Association (ATA) risk guideline. Comparing with the ATA risk category, this risk model showed a better performance in predicting DM-TCs. This study proposes a TLBT risk classifier consisting of T3/T4 stages, LNM (n>5), and BRAF+TERTp mutations for predicting DM-TCs. TLBT risk stratification may help clinicians make personalized treatment management and follow-up strategies.

Oxidative stress a potent risk factor for thyroid diseases in young pregnant females.

Objective: To evaluate the potent role of oxidative stress in thyroid disease development and progression in young pregnant females during 1st and second trimesters compared with matched healthy pregnant females of the same gestational age. Study Design: Cross-sectional Comparative study. Setting: Institute of Molecular Biology and Biotechnology (IMBB), The University of Lahore, Pakistan. Samples were collected at the Punjab Institute of Nuclear Medicine (PINUM), Faisalabad, and the Department of Obstetrics at DHQ Hospital, Chiniot. Period: July 2019 to July 2021. Material &amp; Methods: Thyroid disease- comorbid pregnant women and euthyroid pregnant women were compared for serum levels of oxidative stress markers and antioxidants. The markers were evaluated between 68 healthy subjects in Group A and 43 subjects in Group B known for having thyroid diseases. Blood samples were taken under highly sterile conditions after gaining written consent from all subjects and stored at –8°c to –30°c. A spectrophotometer at 532nm was used to measure serum concentrations of oxidative stress markers. ELISA kits were used to determine serum levels of triiodothyronine, thyroxin, and thyroid-stimulating hormone. Data was analyzed using independent student t-test, multiple logistic regression, and receiver operating characteristic curve (ROC) analysis using SPSS version 25. Results: Group A and Group B had a mean age of 26.07±4.88 and 29.19±4.17 years, respectively. Pregnant women having thyroid dysfunction had decreased superoxide dismutase levels (0.05±0.01 nmol/ml) than group A (0.06±0.01). Other indicators of lipid peroxidation showed a non-significant mean difference compared between both groups (p&gt;0.05). Multiple linear regression studies revealed healthy pregnant women with a positive thyroid medication history had higher SOD levels among group B than those without antithyroid medicine, with a Beta coefficient of +0.26 and p=0.04. According to ROC curve analysis, the Superoxide Dismutase biomarker area under ROC was 67.25% at p=0.002. Thus, it may be used as a diagnostic and predictive biomarker. A cutoff value of 51.5pg/ml was proposed, at which sensitivity is 79% and specificity is 69%. It can be a diagnostic and predictive biomarker. Conclusion: The results of the current study concluded that oxidative stress can be considered a potent risk factor for the development and progression of thyroid disease in young pregnant females.

Psychological Burden of Breast Cancer Predicted Quality of Life: A Case Study of Multan Institute of Nuclear Medicine and Radiology

Breast cancer is a highly prevalent cancer in females worldwide, with new cases around one million every year. The study was aimed to investigate psychological burden and quality of among women with breast cancer. The nature of study was quantitative that was completed through correlational research design. Questionnaires were administered with breast cancer patients by conducting a survey as method of data collection. Sample of 139 breast cancer patients were recruited from Multan Institute of Nuclear Medicine and Radiology through purposive sampling technique. Findings of study reveal that depression, anxiety and stress are the most frequent psychological disorders in BC patients. In addition, psychological burden due to BC among women is a significant negative predictor of quality of life. Moreover, results suggest that young breast cancer patients reported propounding level of psychological problems. Several psychotherapeutic and supportive approaches have proven effective in managing psychological disorders in BC patients.

Assessment of Acute Side Effects Among 3D-Concurrent Radiotherapy With Cisplatin-Treated Head and Neck Cancer Patients.

Three-dimensional conformal radiation therapy has become one of the basic components of multidisciplinary treatment for head and neck cancer. Generally, patients with squamous-cell carcinoma of the head and neck receive cisplatin-based chemoradiation. In the current project, the goal was to assess 3D-CRT with cisplatin-induced acute side effects (dermatitis plus xerostomia) among head and neck cancer patients. This descriptive case series was held at the Institute of Nuclear Medicine and Oncology, Lahore, Pakistan, with an enrollment of 106 head and neck cancer patients following the hospital's ethical approval. All patients received 3D-CRT with concurrent cisplatin chemotherapy according to the oncology treatment protocol at the Institute of Nuclear Medicine and Oncology. The evaluation of enrolled patients was done during treatment at a weekly interval and at one-month post-radiation. Stage 3 patients (17.9%) received chemo-radiation therapy with 40 mg/m2 cisplatin once weekly for seven weeks. All patients received 70 grays in 35 fractions with two grays per fraction over the course of seven weeks following a standard protocol. All enrolled cases had biopsy-proven squamous cell carcinoma of the head and neck. IBM Corp. Released 2015. IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. analyzed the data. Chi-square and Fisher's exact tests were applied, while a p-value ≤ 0.05 was taken as statistically significant. All patients developed acute skin changes (dermatitis plus xerostomia) as a side effect of radiation therapy, with cisplatin having different grades during treatment until seven weeks. However, these changes improved and became less severe in terms of grade after one month of post-treatment among all patients. It was concluded that 3D-CRT was associated with dermatitis and xerostomia during and immediately after follow-up, even though the treatment response was good. However, clinical signs and symptoms improved, indicating that radiation therapy is a relatively safe treatment modality among cancer patients. Moreover, 40 mg/m2 cisplatin once weekly for seven weeks resulted in better loco-regional control and survival among advanced-stage head and neck cancer patients as a part of treatment. Although, higher doses of cisplatin (100 mg/m2 ) every three weeks have more harmful acute side effects and delay treatment for patients due to poor compliance.

Interrelationship between Skeletal and Visceral Metastases in Invasive Ductal Carcinoma of Breast- Observational Study at INMAS, Mitford, Dhaka

Background: Invasive Ductal Carcinoma (IDC) is the most common of all diagnosed breast cancers, and it frequently presents with metastatic spread to the bone as well as other viscera. Bone scintigraphy is the primary tool for detecting bone metastases, while different imaging modalities can be useful in detecting visceral metastases. The purpose of this study was to determine the relationship between skeletal and visceral metastases in female patients with IDC referred to INMAS, Mitford, for bone scintigraphy. Patients and Methods: This observational study was conducted at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford, Dhaka, from July 2020 to July 2021. Bone scintigraphy was done with a Siemens dual-head gamma camera after an intravenous injection of 20 mCi of 99mTc-MDP. Both anterior and posterior views were obtained, with additional SPECT images when needed. Images were interpreted and analysed by Nuclear Medicine (NM) physicians of this institute. Data about visceral metastases were collected from patients’ record files. Results: The patients were divided into two groups based on the presence of visceral metastases. Group-A had 95 patients with no known metastases to the viscera, and in Group-B, there were 50 patients who had documented visceral metastases. The majority of the patients in the first group (53.7%) showed no bone metastasis, while a small portion (5.3%) revealed a solitary skeletal metastatic lesion and the rest (41.1%) presented with multiple skeletal metastases. Sixty-six percent of patients in Group B had solitary visceral metastases, with the remaining 34% having metastases to multiple viscera. All the patients in this group were affected at various levels by secondary skeletal deposits. Conclusion: The findings of the study revealed that the presentation of visceral metastases was related to the extent and severity of bone metastases in patients with carcinoma of the breast. Bangladesh J. Nuclear Med. 25(2): 117-120, 2022

Follicular Thyroid Carcinoma Metastasis to the Skull and Brain: Case Series with Literature Review

Distant metastasis is more common in follicular thyroid carcinomas (FTC) than papillary thyroid carcinomas (PTC), as vascular invasion is often characteristic of FTC. Lung, bone, brain, liver, bladder, and skin are potential sites of distant metastases. On the other hand, lymph node involvement is much less common (8–10%) in cases of FTC compared to PTC. The therapy of patients may be significantly impacted by learning more about the epidemiological features of thyroid metastases at uncommon sites. In our experience, metastases in uncommon sites do not always indicate a poor prognosis for differentiated thyroid carcinoma (DTC), which might be due to the disease patterns. Every year, around 5% new FTC patients are registered, treated with radioiodine, and followed up in the thyroid division of National Institute of Nuclear Medicine and Allied Sciences (NINMAS). Four FTC patients (F=3, M=1) with skull bone and brain metastases are discussed in this case series. All of them were post thyroidectomized and were referred to NINMAS for radioiodine ablation therapy (RAIT). Two of them had skull and brain metastases, third patient had extensive skull, facial bone and pubic bone invasion, whereas, fourth patient had multiple skull metastases. Bangladesh J. Nuclear Med. 25(2): 128-137, 2022

Role of F-18 FDG PET-CT in Follow up Patients with Rectal Carcinoma: Single Institute Based Study

Introduction: F-18 Fluorodeoxyglucose Positron Emission Tomography (18F-FDG PET/CT) is a hybrid non-invasive imaging tool that integrates PET and CT into a single imaging device. It is used to detect and measure metabolic activity in a cancer cell and, hence, can provide anatomic and metabolic information. 18F-FDG PET/CT is useful for the detection of loco-regional recurrence, distant metastases, and monitoring therapy response in patients with rectal carcinoma. This study was done to see the usefulness of 18F-FDG PET/CT in the follow-up evaluation of patients with rectal carcinoma. Materials and Methods: This retrospective study was done in the PET/CT division of the National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS) between January 2021 and December 2022. A total of 26 patients with rectal carcinoma, requested for an F-18 FDG PET-CT scan were enrolled in this study. Image findings were analyzed and properly documented in a predesigned format to evaluate the results. Results: Total 26 patients with an average age of 47.69 and a follow up period of 6 months to 5 years were enrolled in this study. Histologically adenocarcinoma was seen in 21 patients, four patients were mucinous, two were papillary, and carcinoid tumor was found in one patient. On PET/CT imaging, no metastases were found in 17 (65.4%) out of 26 patients and metastases was seen in 9 (34.6%) patients. Among them four (44.5%) had lung, two (22.2%) had lymph nodes, one (11.1%) had liver and lymph node metastases, one (%11.1) had skeletal metastases, and one (11.1%) had peritoneal metastases. No significant association was observed with histopathology or treatment protocol. CEA was higher in patients with metastases and lower in those without. Conclusion: 18F-FDG PET/CT is an effective tool in follow up patients with rectal carcinoma as it can accurately detect locoregional recurrence or distant metastases. Bangladesh J. Nuclear Med. 25(2): 105-109, 2022

Abstract #1386026: Outcome of Radioactive Iodine Treatment and its Association with Various Parameters in People Presenting with Hyperthyroidism at Tertiary Care Hospital of Karachi, Pakistan

Hyperthyroidism is a common disorder of thyroid gland with multiple etiologies and radioactive iodine (RAI) is one of the important modalities to treat it. The outcome after RAI treatment is unpredictable as it is influenced by many factors. Successful treatment is determined by development of euthyroidism and / or Hypothyroidism within 6 months of radioactive iodine treatment. The aim of this study was to find out the outcome of RAI treatment and its association with factors like age, gender various etiologies of hyperthyroidism, and baseline TSH, FT4 in our population. This retrospective case series study was conducted at Karachi institute of Radiology and Nuclear Medicine” (KIRAN) from January 2018 to June 2020. Among 537 who were given RAI for hyperthyroidism a total of 199 participants with complete data were recruited in study after IRB approval. Demographic details, age, gender, underlying cause of hyperthyroidism (graves disease, toxic multinodular goitre, solitary toxic nodule etc,) were obtained from medical records along with baseline FT4 & TSH. A fixed dose of 15mci of radioactive iodine was given to all patients and TSH and FT4 were measured at 6 weeks 3, 6, and 12 months to evaluate the outcome of RAI treatment. The data was analyzed by SPSS version 20 to compute mean standard deviation and percentages. A total of 199 participant’s data was analyzed, 77.9% were females and 22.1% males with mean age of 41.32±0.99 years. Seventy-four 74.4% participants had diffuse toxic goiter (Graves’ disease) and 15% had solitary toxic nodule or toxic multinodular goiter. Post RAI TSH target (either normal or high) was achieved earlier at 6 weeks in comparison to FT4 (normal or low) that attained at 3months. Outcome of RAI treatment in patients with Graves’ disease and toxic nodule revealed statistically significant and early result by normalization and or increased TSH at 6 weeks 3, 6 and 12 months (p-value <0.05), and FT4 normalization was only seen in patients with graves’ disease in each measurement compared to other etiologies. Females revealed statistically significant and early improvement in both biochemical markers i-e TSH and FT4 at all point of time (normalization of TSH at 6 weeks, increased TSH / and normalization of FT4 at 3, 6 and 12 months) in comparison to males who showed statistically significant improvement in TSH in all points of measurement. Patients with aged greater than 40 years observed early response after RAI by normalization of FT4 at 6 weeks compared to those aged < 40 years. The treatment failure rate was 24.5% at 6 and 12months whereas successful treatment was noticed in 35%, 56%, 75.6%, 75.6% at 6 weeks, 3,6,12 months respectively. Female Participants with Graves’ disease of age greater than 40 years responds better and early to RAI treatment by achieving successful treatment goals compared to elderly males with underlying diagnosis other than graves for hyperthyroidism.

A Dosimetric Comparison of VMAT and IMRT for Head &amp; Neck and Pelvis Cancers

Cancer, which is the uncontrolled division of cells, is a leading fatal disease in the world with high mortality rates. It can be treated using several methods, including radiotherapy, which involves ionizing radiation. Radiotherapy on the basis of source placement has two types, i.e. brachytherapy and external beam radiotherapy. External beam radiotherapy has evolved from 2-D conventional therapy to 3-D Conformal radiotherapy (3D-CRT) and then intensity-modulated radiotherapy (IMRT). Modern radiation therapy techniques such as IMRT improve dose conformity and sparing of organs at risk. Volumetric modulated arc therapy (VMAT) is a newly developed technique that uses treatment in arcs. In this report, a dosimetry comparison was performed between IMRT and VMAT. This study was conducted in the Radiotherapy Department of the Institute of Nuclear Medicine and Oncology Lahore (INMOL). Two types of cancer patients were selected for this comparison, i.e., five patients with Nasopharyngeal Carcinoma and ten patients with Prostate Carcinoma. Simulation of these patients was done with the help of a CT Simulator. The oncologists delineated all target volumes and organs. Then suitable fields/arcs were applied, which cover volumes effectively. This was followed by the optimization of plans for both techniques for every patient. Finally, evaluating parameters were compared, including volume coverage, conformity index, homogeneity index, organ doses, and monitor units. We obtained better results of target conformity indices from VMAT (1.16 and 1.25) than IMRT (1.24 and 1.30). VMAT was better in organ sparing too. Also, VMAT shows very few monitor units (468 and 733) as compared to IMRT (2325 and 2149). On the basis of the results obtained, it was concluded that VMAT is better than IMRT. This technique will enhance treatment efficiency as it takes less time to obtain the required results. Also, a very less scatter dose will be delivered to the patient.

18F FDG PET/CT Scan in the Evaluation of Metabolic and Morphologic Change of Breast Cancer after Neoadjuvant Chemotherapy

Background: Breast cancer remains the most commonly occurring cancer among women across the world and accounts for 69% of cancer deaths. Neoadjuvant chemotherapy (NACT) has been effective in downstaging a primary tumor before surgery. In this study, a fluorine-18, 2-fluoro-2-deoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) scan was used to determine the metabolic and morphological changes of breast cancer after therapy. An 18F-FDG PET/CT scan was done before and after NACT. The change in maximum standard uptake value (SUVmax) ultimately reflects the metabolic status of tumor cells, and the change in tumor diameter represents the morphology of the tumor. Objective: To determine the therapeutic response by assessing metabolic and morphologic changes in breast cancer patients using an 18F-FDG PET/CT scan after NACT. Patients and methods: The study was conducted at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS), Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, from March 2020 to June 2021, on biopsy-proven female patients diagnosed with breast cancer (stage II to stage IV as defined by the AJCC). A total of nine patients were enrolled in this study. Before and after NACT, a PET/CT scan was performed in accordance with the IAEA CRP guidelines (in a prone posture with breast hanging supported by a breast cushion) and following the NINMAS protocol. Morphological and metabolic data were recorded and analyzed to ascertain the tumor's metabolic and morphologic (as per RECIST 1.1) outcomes. A follow-up 18F-FDG PET/CT after NACT was done using the same dose and the same number of beds (1 minute per bed) as done before NACT. Results: About 89% of patients showed a reduction in tumor size following NACT. The mean tumor size reduction rate was 23.66±22.19 (%) and the difference was statistically significant between prior and after NACT (P &lt; 0.05). Only 11% of patients developed higher SUVmax following NACT. According to RECIST 1.1 criteria, 11.11% of patients had progressive disease, 44.44% had a partial response, and 44.44% were stable. In PET/CT scans, approximately 66.67% of patients responded to NACT. Conclusion: 18F-FDG PET/CT can be used as a potential state-of-the art imaging approach in breast cancer patients before and after NACT. Following NACT, metabolic and morphological changes are visible in the 18F-FDG PET/CT scan, distinguishing responder and non-responder, which must be compared with pathologic response. Bangladesh J. Nuclear Med. 26(1): 13-18, 2023

Association of High TPO Antibody Titer with Differentiated Thyroid Carcinoma: A Case-Control Study

Background: The most common well-differentiated thyroid carcinomas are papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC). PTC accounts for 80–90% of all thyroid cancers, and follicular carcinoma accounts for 10–15% of all thyroid cancers. Common established risk factors for thyroid carcinoma are head-neck irradiation, a positive family history, and a few genetic disorders. High anti-thyroglobulin antibodies (TgAb) have already been established as predictive markers for thyroid carcinoma, but anti-thyroid peroxidase antibodies (TPO Ab) have not been established as predictive markers till now. Objective: To find out the association of high TPO Ab titer with differentiated thyroid carcinoma (DTC). Patients and Methods: This case-control study was carried out at the National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS), Dhaka, from September 2020 to November 2021. A total of 52 cytologically diagnosed DTC patients who underwent thyroidectomy were selected as cases. Another 52 age- and sex-matched healthy individuals who had sonographically normal thyroid glands and a biochemically euthyroid state were selected as controls. The total number of participants was 104. Written informed consent was obtained from each of the participants. A detailed history was taken, and a thorough clinical examination was carried out on each patient. High resolution ultrasonography (HRUS) of the thyroid gland, serum thyroid-stimulating hormone (TSH) level, and fine needle aspiration cytology (FNAC) report of the thyroid nodule of each participant were collected. Serum TPO antibody levels were measured in patients with DTC prior to thyroid surgery, as well as in the control group, in the NINMAS laboratory using the CLIA method. After the collection of all the required data, analysis was done by SPSS 24.0. Results: The mean age of the cases was 35.8 ± 13.3 years and 34.6 ± 13.0 years in the control groups. Female patients were predominant in both the case and control groups (63.5% and 69.2%, respectively). Both groups were statistically almost similar in terms of age and sex. Around 46.2 % (n=24) patients in the case group had high serum TPO Ab levels and 15.4 % (n=8) of participants in the control group had high serum TPO Ab levels. The mean serum TPO Ab level in the case group was 306.77± 452.57 U/mL, and the mean serum TPO Ab level in the control group was 75.85±181.47 U/mL. Serum TPO antibody level was significantly higher in the case group compared to the control group (306.77±452.57 vs 75.85±181.47 U/mL, p = 0.001). Conclusion: There was a significant association of high TPO Ab titer found with DTC Bangladesh J. Nuclear Med. 26(1): 34-38, 2023

Association of Excess Dietary Iodine Intake with Papillary Thyroid Carcinoma

Background: Papillary thyroid carcinoma (PTC) is the most common type of differentiated thyroid carcinoma and accounts for 70–80% of all thyroid carcinomas. After the global iodine fortification of salt and food, the incidence of PTC has been increasing throughout the world in recent years. Aims: To determine the relationship between excessive dietary iodine intake and PTC. Patients and methods: This cross-sectional study was carried out at the National Institute of Nuclear Medicine &amp; Allied Sciences (NINMAS), Dhaka, from March 2020 to June 2021. A total of 111 patients were included in this study, of whom 53 were pre-operative papillary thyroid carcinoma patients and the rest, 58, were age- and sex-matched healthy individuals. Their urinary iodine concentrations were measured in the laboratory of the Bangladesh Reference Institute for Chemical Measurements (BRICM). Urinary iodine concentration is a good marker of dietary iodine intake. Statistical analysis of the results was obtained using Windows-based computer software devised with Statistical Packages for Social Sciences (SPSS) version 23.0. Results: The mean urinary iodine concentration was 223.54±55.78 microgram/liter in the PTC group and 154.29±61.83 microgram/liter in the healthy group. A remarkable number of participants in both the PTC group 42 out of 53 (79.3%) and the healthy group 18 out of 58 (31.0%) had biochemical evidence of excess iodine intake. Excess iodine intake significantly (p&lt;0.05) increased with 8.48 times odds (95% CI 3.30-22.33) in PTC patients. Conclusion: This study revealed that a significant number of participants in the PTC group had evidence of excess iodine intake compared to that of the healthy group, which suggests that excess dietary iodine intake may be related to the occurrence of PTC. Bangladesh J. Nuclear Med. 26(1): 25-30, 2023

Complementary Role of Thyroid Scintigraphy, Neck Ultrasonography and Biochemical Assay to Delineate Thyroid Disease Pattern in Southern Part of Dhaka

Thyroid disorders are among the most common endocrinopathies, and a wide array of patients are referred to Nuclear Medicine (NM) institutes for different thyroid-related investigations. In this study, we analyzed the findings of thyroid scintigraphy, high-resolution thyroid gland ultrasound, and thyroid hormone assays of 279 referred patients in the thyroid division of the Institute of Nuclear Medicine and Allied Sciences (INMAS), Mitford. The complementary role of the aforementioned investigations not only helped portray the pattern of thyroid disease in the historic southern part of Dhaka but also once again emphasized the importance of multidisciplinary diagnostic tools in disease management. Bangladesh J. Nuclear Med. 26(1): 31-33, 2023

Evaluation of Physiochemical and Microbiological Stability of 2-[18F] Fluoro-2-Deoxy-D-Glucose, [18F]FDG: Synthesized in the Cyclotron Facility of National Institute of Nuclear Medicine and Allied Sciences

2-[18F]Fluoro-2-Deoxy-D-Glucose ([18F]FDG) is very effective and the most successful radiotracer for the assessment of glucose metabolism in the brain, heart, and lungs. It has also been used for imaging different tumors in oncology. The purpose of this study was to evaluate the stability and quality of [18F]FDG synthesized by the newly installed 18MeV Cyclotron facility at the National Institute of Nuclear Medicine and Allied Sciences (NINMAS). [18F]FDG was synthesized by nucleophilic fluorination of Mannose-triflate followed by basic hydrolysis with an IBA Synthera® auto synthesizer. [18F]FDG solution was collected in a sterilized vial after the filtration by a vented Millex®-GS 0.22µm syringe-driven hydrophilic filter. An aliquot of [18F]FDG solution was taken 0, 2, 4, 6, and 8 hours after the synthesis. All quality control parameters were measured in the first evaluated period, immediately (i.e., 0 hours) after synthesis. Radiochemical purity (RCP) was measured for all [18F]FDG samples and for all time points. The radiochemical and radionuclidic purity was more than 95% and 99.99% respectively. The [18F]FDG was physiochemically &amp; microbiologically stable over 8 hours. Bangladesh J. Nuclear Med. 26(1): 44-50, 2023

Papillary Thyroid Carcinoma Arising in Thyroglossal Duct Cyst and Locally Infiltrated to Hyoid Bone: Issue of Individualized Management

Thyroglossal duct cyst (TGDC) is the most common developmental anomaly of the thyroid gland, while TGDC carcinoma with local infiltration to the hyoid bone is extremely rare. The reported case of papillary thyroid carcinoma (PTC) was diagnosed in TGDC along with local infiltration to the hyoid bone and needed individualized management. A 70-year-old male patient presented with a history of PTC arising in TGDC and locally infiltrated to the hyoid bone followed by total thyroidectomy and radical sistrunk operations and was referred to National Institute of Nuclear Medicine and Allied Sciences (NINMAS) for radioactive iodine therapy (RAIT). His post-operative ultrasound of the neck revealed an irregular shaped, fungating, grossly non-homogenous mixed echogenic mass lesion invading the hyoid bone, measuring about 25 X 28 mm. Radioactive iodine(131I) of 150 mCi was administered because the residual hyoid bone mass was inoperable and he was on thyroxine suppression therapy. The post-therapy 131I scan (RxWBS) showed two intense foci of radiotracer concentration (RTC) in the upper area (above the thyroid bed) and an intense focal RTC in the fundal region of the stomach. The activity in the stomach region was evaluated by ultrasound imaging, which revealed a soft tissue mass or thickening of the mid-region of the posterior wall of the stomach (3.3 cm X 1.6 cm). A CT scan of the chest was also performed to rule out metastasis, and it revealed multiple nodular lesions in both lung fields (most likely secondary) as well as tiny subcentric lymphnodes in the lower pre- and right paratracheal regions after nearly one month of RAIT when the patient was stable for examination. EBRT is still under consideration as adjuvant therapy. Tyrosine kinase inhibitors (TKI) may be considered in cases of refractoriness to radioiodine and disease progression. Bangladesh J. Nuclear Med. 26(1): 67-70, 2023

Exploring Sufferings in Unmarried Women with Breast Cancer and Surgery

The current research was intended to uncover sufferings of unmarried women who had gone through breast surgery or having breast cancer, using Interpretive Phenomenological Analysis (IPA). Purposive sample of 45 women was recruited from Bahawalpur Institute of Nuclear Oncology (BINO), Bahawalpur, Shaukat Khanum Memorial Cancer Hospital, and Institute of Nuclear Medicine &amp; Oncology (INMOL) Hospital, Lahore. Semi-structured interviews were recorded, transcribed and analyzed using IPA. Four core themes were extracted from the experiences of the patients that went through breast cancer diagnosis, surgery and beyond. Themes included undesirable feelings, flattered self, emotional affliction and, dreadful future. Cancer, breast surgery, post-surgical complications and social stigma were main factors that revealed fears in patients.