Postsurgical Histology Research Articles

18F]FDG PET metabolic patterns in mesial temporal lobe epilepsy with different pathological types.

To investigate [18F]FDG PET patterns of mesial temporal lobe epilepsy (MTLE) patients with distinct pathologic types and provide possible guidance for predicting long-term prognoses of patients undergoing epilepsy surgery. This was a retrospective review of MTLE patients who underwent anterior temporal lobectomy between 2016 and 2021. Patients were classified as having chronic inflammation and gliosis (gliosis, n = 44), hippocampal sclerosis (HS, n = 43), or focal cortical dysplasia plus HS (FCD-HS, n = 13) based on the postoperative pathological diagnosis. Metabolic patterns and the severity of metabolic abnormalities were investigated among MTLE patients and healthy controls (HCs). The standardized uptake value (SUV), SUV ratio (SUVr), and asymmetry index (AI) of regions of interest were applied to evaluate the severity of metabolic abnormalities. Imaging processing was performed with statistical parametric mapping (SPM12). With a mean follow-up of 2.8years, the seizure freedom (Engel class IA) rates of gliosis, HS, and FCD-HS were 54.55%, 62.79%, and 69.23%, respectively. The patients in the gliosis group presented a metabolic pattern with a larger involvement of extratemporal areas, including the ipsilateral insula. SUV, SUVr, and AI in ROIs were decreased for patients in all three MTLE groups compared with those of HCs, but the differences among all three MTLE groups were not significant. MTLE patients with isolated gliosis had the worst prognosis and hypometabolism in the insula, but the degree of metabolic decrease did not differ from the other two groups. Hypometabolic regions should be prioritized for [18F]FDG PET presurgical evaluation rather than [18F]FDG uptake values. This study proposes guidance for optimizing the operation scheme in patients with refractory MTLE and emphasizes the potential of molecular neuroimaging with PET using selected tracers to predict the postsurgical histology of patients with refractory MTLE epilepsy. • MTLE patients with gliosis had poor surgical outcomes and showed a distinct pattern of decreased metabolism in the ipsilateral insula. • In the preoperative assessment of MTLE, it is recommended to prioritize the evaluation of glucose hypometabolism areas over [18F]FDG uptake values. • The degree of glucose hypometabolism in the epileptogenic focus was not associated with the surgical outcomes of MTLE.

Efficacy of Ultrasound Shear Wave Elastography in the Diagnosis of Salivary Gland Tumors

Diagnostic accuracy of fine-needle aspiration cytology (FNAC) as the ability to discriminate between the target condition and health in the evaluation of salivary gland tumors is not perfected yet and false-negative results are possible. The purpose of the present study was to measure and compare the diagnostic accuracy of FNAC performed with conventional B-mode ultrasound and ultrasound with shear wave elastography (SWE) FNAC navigation. The investigators implemented a single-blind randomized study (sealed envelope method). The study population was composed of all patients presenting for evaluation and management of suspected benign or malignant tumors of the major salivary glands between July 2013 and December 2020. The involvement of SWE navigation was the primary predictor variable affecting FNA targeting. The method involved analysis of redistribution of SWE values within the affected gland expressed in kilopascals (kPa) and the four-point ES1 (soft tissue) to ES4 (stiff) scoring. The primary outcome variable was the success in obtaining diagnostic tissue resulting in a histologically confirmed FNAC diagnosis and coded as yes/no. Age and sex of the patients and topographical locations of lesions were covariates. Descriptive and bivariate statistics were computed and the P value was set at .05. The sample included 132 subjects (male/female 59/73; mean age 54±11years; 144 tumors). SWE+Group (n=66) consisted of patients presurgically diagnosed with salivary tumors SWE-guided FNAC and SWE- Group (n=66) was diagnosed with tumors by conventional ultrasound-(B-mode)-guided FNAC. The SWE-guided FNAC statistically significantly reduced the incidence of false-negative results (n=0; P=.001) and nondiagnostic cases (n=3 SWE FNAC vs n=7 B-mode US FNAC; P=.04). For SWE+Group, the FNAC diagnosis was confirmed by postsurgical histology in 95.5% with 91.0% sensitivity (confidence interval [CI] 0.62 to 0.97) and 84.4% specificity (CI 0.58 to 0.96). For SWE- Group, 81.8% confirmation was obtained (P=.05) with 82.3% sensitivity (CI 0.54 to 0.90) and 74.0% specificity. SWE can increase success in obtaining diagnostic tissue when used for FNAC navigation purposes. We suggest combining both SWE and standard B-mode US methods when the FNAC procedure is performed.

Imaging Recommendations for Diagnosis, Staging, and Management of Ovarian and Fallopian Tube Cancers

AbstractOvarian malignancy the third most common gynecological malignancy and is the leading cause of death in women. Non-specific clinical presentation delays the diagnosis, and they often present in the advanced stage of disease. No imaging modality is recommended for screening as there is no significant mortality reduction. Ultrasound (USG) is usually the initial modality in suspected ovarian mass. MRI is recommended for the characterization of indeterminate ovarian or adnexal mass on USG. CT abdomen and pelvis with oral and IV contrast is the recommended imaging modality in staging the disease, predicting the resectability and in selecting the patients who would benefit from neoadjuvant chemotherapy. Early ovarian cancers are staged by post-surgical histology and undergo upfront surgery. Advanced disease benefit by neoadjuvant chemotherapy and less morbidity by interval cytoreduction where image-guided biopsy is performed for histological diagnosis. Follow-up recommendations are based on tumor histology. CT/PET CT is recommended for diagnosing recurrence.

Longitudinal hippocampal diffusion-weighted imaging and T2 relaxometry demonstrate regional abnormalities which are stable and predict subfield pathology intemporallobeepilepsy.

High-resolution (1 mm isotropic) diffusion tensor imaging (DTI) of the hippocampus in temporal lobe epilepsy (TLE) patients has shown patterns of hippocampal subfield diffusion abnormalities, which were consistent with hippocampal sclerosis (HS) subtype on surgical histology. The objectives of this longitudinal imaging study were to determine the stability of focal hippocampus diffusion changes over time in TLE patients, compare diffusion and quantitative T2 abnormalities of the sclerotic hippocampus, and correlate presurgical mean diffusivity (MD) and T2 maps with postsurgical histology. Nineteen TLE patients and 19 controls underwent two high-resolution (1 mm isotropic) DTI and 1.1 × 1.1 × 1 mm3 T2 relaxometry scans (in a subset of 16 TLE patients and 9 controls) of the hippocampus at 3T, with a 2.6 ± 0.8 year inter-scan interval. Within-participant hippocampal volume, MD and T2 were compared between the scans. Contralateral hippocampal changes 2.3 ± 1.0 years after surgery and ipsilateral preoperative MD maps versus postoperative subfield histopathology were evaluated in eight patients who underwent surgical resection of the hippocampus. Reduced volume and elevated MD and T2 of sclerotic hippocampi remained unchanged between longitudinal scans. Focal regions of elevated MD and T2 in bilateral hippocampi of HS TLE were detected consistently at both scans. Regions of high MD and T2 correlated and remained consistent over time. Volume, MD, and T2 remained unchanged in postoperative contralateral hippocampus. Regional elevations of MD identified subfield neuron loss on postsurgical histology with 88% sensitivity and 88% specificity. Focal T2 elevations identified subfield neuron loss with 75% sensitivity and 88% specificity. Diffusion and T2 abnormalities in ipsilateral and contralateral hippocampi remained unchanged between the scans suggesting permanent microstructural alterations. MD and T2 demonstrated good sensitivity and specificity to detect hippocampal subfield neuron loss on postsurgical histology, supporting the potential that high-resolution hippocampal DTI and T2 could be used to diagnose HS subtype before surgery.

An innovative synthetic support for immunocytochemical assessment of cytologically indeterminate (Bethesda III) thyroid nodules.

Fine needle aspiration (FNA) is the procedure of choice in the evaluation of thyroid nodules. Nodules with indeterminate cytological categories, Bethesda III and IV, pose challenges in clinical practice and are frequently submitted to diagnostic surgery. CytoFoam Core (CFCS) uses an absorbent foam device inserted into the needle hub to collect the cytological sample aspirated during FNA. Specimen is formalin-fixed and paraffin-embedded. Assessing diagnostic efficacy of CFCS, compared to traditional cytology, in re-evaluating thyroid nodules classified as Bethesda III, using post-surgical histology as reference standard. Retrospective study on 89 patients with a first indeterminate cytological report who were referred to the Department of Endocrinology of Regina Apostolorum Hospital (Albano L. Rome, Italy) for a second FNA. FNA was performed after at least one month under ultrasound guidance with a 23G needle according to the established procedure. During the second procedure, both traditional cytological (TC) smears and a single-pass CFCS specimen were obtained for each patient. On CFCS samples immunocytochemical staining for Galectin-3, HBME-1, and CK-19 was also performed. 51 patients eventually underwent surgery, and their histological diagnoses were compared to the TC and CFCS reports. Four parameters were evaluated: inadequacy rate, rate of persistent indeterminate (Bethesda III and IV) reports, rate of malignancy in persistently indeterminate nodules, and rate of cancer in lesions cytologically classified as malignant. Non-diagnostic samples were 6 (11.8%) in TC vs 3 (5.9%) in CFCS (p=0.4). Persistent indeterminate samples were 31 (60.8%) in TC vs 19 (37.2%) in CFCS (p=0.01). Rate of malignancy in persistently indeterminate nodules was 8/19 (42.1%) in CFCS vs 9/31 (29%) in TC group (p=0.3). Nine/51 (17.6%) samples were classified as benign by TC vs 21/51 (41.2%) samples by CFCS (p<0.01). All nodules resulted benign at post-surgical evaluation. Five/51 (9.8%) samples were classified as suspicious for malignancy/malignant in TC group against 8/51 (15.7%) samples in CFCS (p=0.5). Post-surgical evaluation confirmed malignancy in all these cases. CFCS demonstrated greater diagnostic accuracy than TC in repeat FNA assessment of cytologically indeterminate nodules. CFCS increased the conclusive diagnosis rate and decreased the number of cytologically indeterminate cases.

Interference of Known or Suspected Endometriosis in Reporting FDG PET/CT Performed in Another Indication.

IntroductionEndometriosis is a common gynecologic condition that may be visualized on 18F-FDG PET/CT and mimic lesions of malignancy. We analyzed the interference of known or suspected endometriosis in reporting 18F-FDG PET/CT performed in another indication.ResultsThe PET/CT images of 18 women with known (n = 15) or suspected (n = 3) endometriosis were analyzed. Based on clinical follow-up and results of other imaging, biopsy, and/or postsurgical histology, the presence of lesions of endometriosis at the time of 18F-FDG PET/CT was confirmed in 13 of 18 patients (72%). The per-patient positivity rate of 18F-FDG PET/CT was 8/18 (44%; 95% confidence interval, 22%–69%). The patient-based detection rate of 18F-FDG PET/CT in patients with confirmed lesions of endometriosis was 8/13 (62%; confidence interval, 32%–86%). On per-lesion/site basis, 18F-FDG PET/CT detected 11 of 20 sites (55%) of endometriosis. The SUVmax of these lesions/sites ranged between 1.8 and 5.3 (median, 3.8). In 9 of 18 patients (50%), a total of 13 non–endometriosis-related lesions/sites were detected by 18F-FDG PET/CT; their SUVmax ranged between 2.7 and 23 (median, 9.4).ConclusionThe interference of known or suspected endometriosis in reporting 18F-FDG PET/CT performed in another indication was limited but possible and should be kept in mind, even in postmenopausal women, as the oldest patient with 18F-FDG–positive endometriosis was aged 63 years. The lesions of endometriosis showed inconstant 18F-FDG uptake with overlap of SUVmax with low-grade malignancies. In our series, the greatest SUVmax value of lesion of endometriosis was 5.3, somewhat higher than the threshold of 4 previously proposed for identification of malignant transformation of endometriosis.

The diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules is not affected by coexistent chronic autoimmune thyroiditis: results from a cyto-histological series of patients with indeterminate cytology.

Indeterminate cytological result at fine-needle aspiration cytology (FNAC) remains a clinical challenge for endocrinologists. Aim of the present study was to evaluate whether a coexistent chronic autoimmune thyroiditis (CAT) might affect the diagnostic accuracy of fine-needle aspiration cytology for thyroid nodules. A retrospective cohort study was designed including all nodules receiving an indeterminate cytology result (TIR3A or TIR3B) undergoing thyroid surgery and subsequent histological confirmation. Patients were stratified into two groups according to the presence or absence of CAT. The hypothesis to be tested was whether follicular cell alterations induced by CAT might increase the rate of indeterminate cytological results in histologically benign thyroid nodules. Additional control groups were represented by nodules with determinate cytology, either benign (TIR 2) or malignant (TIR5). One hundred and eighty-nine indeterminate thyroid nodules were included (67 TIR3A and 122 TIR3B). At post-surgical histology, 46 nodules (24.3%) were malignant. No significant differences were observed in the rate of histologically proven malignancy between patients without CAT and patients with CAT in the TIR3B (29.4% vs 32.4%; P = 0.843) nor TIR3A (13.0% vs 11.4%; P = 1.000) nodules. The rate of coexistent CAT was similar between TIR3B and TIR5 nodules harboring PTC at histology (30.4% vs 39.4%, P = 0.491) and between indeterminate nodules and a control group of TIR2 nodules (39.2% vs 37.0%; P = 0.720). The similar rates of histologically proven malignancy found in cytologically indeterminate nodules in the presence or absence of concomitant CAT would not support that CAT itself affects the diagnostic accuracy of fine-needle aspiration cytology.

Regional hippocampal diffusion abnormalities associated with subfield-specific pathology in temporal lobe epilepsy.

ObjectiveHippocampal sclerosis (HS) is the most common pathology and best predictor of surgical outcome for medically refractory patients with temporal lobe epilepsy (TLE). Current clinical MRI methods can detect HS, but subfield pathology is poorly characterized, limiting accurate prediction of seizure‐free outcomes after surgery. Diffusion tensor imaging (DTI) can probe regional microstructural changes associated with focal hippocampal pathology, but is typically limited by low‐resolution whole‐brain acquisitions.MethodsHigh‐resolution (1 × 1 × 1 mm3) DTI, T1, and quantitative T2 of the hippocampus was acquired in 18 preoperative TLE patients and 19 healthy controls. Diffusion images were qualitatively assessed for loss of internal architecture, and whole‐hippocampus diffusion, volume, and quantitative T2 were compared across groups. Regional hippocampal diffusion abnormalities were examined in all subjects and compared to histology in four subjects who underwent anterior temporal lobectomy.ResultsHigh‐resolution mean diffusion‐weighted images enabled visualization of internal hippocampal architecture, used to visually identify HS with 86% specificity and 93% sensitivity. Mean diffusivity (MD) elevations were regionally heterogenous within the hippocampus and varied across TLE patients. The spatial location of diffusion abnormalities corresponded with the location of focal subfield neuron loss, gliosis, and reduced myelin staining abnormalities identified with postsurgical histology in four subjects who underwent anterior temporal lobectomy. Whole‐hippocampus MD and T2 relaxation times were higher, and fractional anisotropy (FA) and volumes were lower in TLE patients relative to controls. Left hippocampus MD correlated with verbal memory in the TLE group.SignificanceVisualization of internal architecture and focal diffusion abnormalities on high‐resolution diffusion imaging suggests potential clinical utility of diffusion imaging in TLE and may have significant implications for surgical planning and prediction of seizure‐free outcomes in individual patients.

Effectiveness of Respiratory-gated Positron Emission Tomography/Computed Tomography for Radiotherapy Planning in Patients with Lung Carcinoma – A Systematic Review

AimsA systematic review of the literature evaluating the clinical use of respiratory-gated (four-dimensional; 4D) fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) compared with non-gated (three-dimensional; 3D) PET/CT for radiotherapy planning in lung cancer. Materials and methodsA search of MEDLINE, Cochrane, Web of Science, SCOPUS and clinicaltrials.gov databases was undertaken for articles comparing 3D and 4D PET/CT tumour volume or 4D PET/CT for radiotherapy planning. PRISMA guidelines were followed. ResultsThirteen studies compared tumour volumes at 3D and 4D PET/CT; eight reported significantly smaller volumes (6.9–44.5%), three reported significantly larger volumes at 4D PET/CT (16–50%), one reported no significant difference and one reported mixed findings. Six studies, including two that reported differences in tumour volumes, compared target volumes or studied geographic misses. 4D PET/CT target volumes were significantly larger (19–40%) when compared with 3D PET/CT in all but one study, where they were smaller (3.8%). One study reported no significance in 4D PET/CT target volumes when compared with 4D CT, whereas another study reported significantly larger volumes (38.7%). ConclusionThe use of 4D PET/CT leads to differences in target volume delineation compared with 3D PET/CT. These differences vary depending upon technique and the clinical impact currently remains uncertain. Correlation of pretreatment target volumes generated at 3D and 4D PET/CT with postsurgical histology would be ideal but technically challenging. Evaluation of patient outcomes based on 3D versus 4D PET/CT derived treatment volumes warrants further investigation.

Aseptic-avascular osteonecrosis: local "silent inflammation" in the jawbone and RANTES/CCL5 overexpression.

Of the definitions listed in the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10), two disease descriptions can be found together: “idiopathic aseptic bone necrosis” and “avascular bone necrosis.” The relevant literature on both the conditions abbreviates both as “aseptic ischemic osteonecrosis in the jawbone” (AIOJ). To shed light on the clinical details of this condition, osteolytic jawbone samples of 24 patients with different systemic immunological diseases were examined using four steps: presurgical dental X-ray, postsurgical histology, polymerase chain reaction DNA analysis (PCR DNA) of bacteria, and RANTES/CCL5 (R/C) expression. These four steps showed that neither X-ray nor histology delivered unambiguous results with respect to inflammatory processes; furthermore, the PCR results did not show evidence of any microbial load within the jaw samples. However, there is a striking, coherent overexpression of chemokine R/C in the AIOJ samples. This study proved the aseptic existence of “silent inflammation” within the jawbone. The ICD-10 (AIOJ) definition, which is hard to interpret, can now be substantiated with clinical evidence, while the cytokine expressions described in this report can explain the systemic immunological effects observed within the group of examined patients.

MP79-07 LYMPH NODE STAGING IN BIOCHEMOCAL RECURRENT PROSTATE CANCER: DOES THE TRACER MATTERF-18-FLUOROETHYLCHOLINE VERSUS GA-68-PSMA-HBED-CC PET/CT

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2016MP79-07 LYMPH NODE STAGING IN BIOCHEMOCAL RECURRENT PROSTATE CANCER: DOES THE TRACER MATTERF-18-FLUOROETHYLCHOLINE VERSUS GA-68-PSMA-HBED-CC PET/CT David Pfister, Daniel Porres, Florian Steib, Ruth Knuechel, Axel Heidenreich, Floroian Behrend, and Frederik Verburg David PfisterDavid Pfister More articles by this author , Daniel PorresDaniel Porres More articles by this author , Florian SteibFlorian Steib More articles by this author , Ruth KnuechelRuth Knuechel More articles by this author , Axel HeidenreichAxel Heidenreich More articles by this author , Floroian BehrendFloroian Behrend More articles by this author , and Frederik VerburgFrederik Verburg More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2005AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ga-68-PSMA-HBED-CC (PSMA) is a novel and promising tracer for highly sensitive PET/CT diagnosis in recurrent prostate cancer (PCA). The aim of the present work was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV) per lesion as well as the positive predictive value per patient of PSMA PET/CT in patients with recurrent prostate cancer referred for surgery after a positive PET/CT and to compare this with a collective of patients scanned using the current de-facto PET/CT standard tracer F-18-Fluoroethylcholine (FEC). METHODS In this retrospective study results of PET/CTs and post-surgical histological analysis were compared. 38 patients had FEC and 27 patients had PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results. RESULTS In 30/38 FEC and 22/27 PSMA patients at least one focus of PCA was identified in postsurgical histology, leading to a PPV of 78.9% for FEC and 81.5% for PSMA. In FEC and PSMA patients a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For FEC and PSMA the respective sensitivity was 71.2% and 86.9%, specificity 86.9% and 93.1%, PPV 67.3% and 75.7% and NPV 88.8% and 96.6%. CONCLUSIONS In the present series PSMA PET/CT shows a better diagnostic accuracy compared to the current de-facto PET/CT standard tracer FEC. Due to the very high NPV of PSMA PET/CT a selective locoregional lympadenectomy involving only the regions affected on imaging can be discussed. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e1037 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Pfister More articles by this author Daniel Porres More articles by this author Florian Steib More articles by this author Ruth Knuechel More articles by this author Axel Heidenreich More articles by this author Floroian Behrend More articles by this author Frederik Verburg More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Apparent diffusion coefficient value is a strong predictor of unsuspected aggressiveness of prostate cancer before radical prostatectomy.

To evaluate the use of multiparametric MRI (mp MRI) parameters in order to predict prostate cancer aggressiveness as defined by pathological Gleason score or molecular markers in a cohort of patients defined with a Gleason score of 6 at biopsy. Sixty-seven men treated by radical prostatectomy (RP) for a low grade (Gleason 6) on biopsy and mp MRI before biopsy were selected. The cycle cell proliferation (CCP) score assessed by the Prolaris test and Ki-67/PTEN expression assessed by immunohistochemistry were quantified on the RP specimens. 49.25% of the cancers were undergraded on biopsy compared to the RP specimens. Apparent diffusion coefficient (ADC)<0.80×10(-3)mm(2)/s (P value 0.003), Likert score >4 (P value 0.003) and PSA density >0.15ng/ml/cc (P value 0.035) were significantly associated with a higher RP Gleason score. Regarding molecular markers of aggressiveness, ADC<0.80×10(-3)mm(2)/s and Likert score >4 were also significantly associated with a positive staining for Ki-67 (P value 0.039 and 0.01, respectively). No association was found between any analyzed MRI or clinical parameter and the CCP score. Decreasing ADC value is a stronger indicator of aggressive prostate cancer as defined by molecular markers or postsurgical histology than biopsy characteristics.

Clinical accuracy of detecting recurrent prostate cancer lesions with F-18-Fluoroethylcholine or Ga-68-PSMA-HBED-CC PET/CT.

218 Background: Ga-68-PSMA-HBED-CC (PSMA) is a novel and promising tracer for highly sensitive PET/CT diagnosis in recurrent prostate cancer (PCA). The aim of the present work was to assess the sensitivity, specificity, positive and negative predictive value (PPV/NPV) per lesion as well as the positive predictive value per patient of PSMA PET/CT in patients with recurrent prostate cancer referred for surgery after a positive PET/CT and to compare this with a collective of patients scanned using the current de-facto PET/CT standard tracer F-18-Fluoroethylcholine (FEC). Methods: In this retrospective study results of PET/CTs and post-surgical histological analysis were compared. 38 patients had FEC and 27 patients had PSMA. We performed a pelvic and/or retroperitoneal lymphadenectomy, if necessary supplemented by resection of locally recurrent lesions in accordance with imaging results. Results: In 30/38 FEC and 22/27 PSMA patients at least one focus of PCA was identified in postsurgical histology, leading to a PPV of 78.9% for FEC and 81.5% for PSMA. In FEC and PSMA patients a total of 378 and 308 lymph nodes and local lesions were removed, respectively. For FEC and PSMA the respective sensitivity was 71.2% and 86.9%, specificity 86.9% and 93.1%, PPV 67.3% and 75.7% and NPV 88.8% and 96.6%. Conclusions: In the present series PSMA PET/CT shows a somewhat better performance than the current de-facto PET/CT standard tracer FEC. Due to the very high NPV of PSMA PET/CT a selective locoregional lymphadenectomy involving only the regions affected on imaging can be discussed.

PWE-292 How many cases does it take to learn how to do trus?

<h3>Introduction</h3> Three dimensional transrectal endosonography (3D TRUS) is a very sensitive technique for preoperative staging of early rectal cancer and is recommended as an adjunct for these patients to optimise therapy. Major limitations include complexity of interpretation and operator variability. A learning curve definitely exists. If a centre wants to establish a service, how many cases do they need to do before they can reliably interpret the scans? A cumulative sum (CUSUM) analysis provides a simple and practical tool for monitoring cumulative performance. <h3>Method</h3> This is a descriptive single-centre study using routinely collected clinical data from 233 patients who were diagnosed of early rectal cancer between 1 Jan 2008 to 31 Dec 2014. 3D TRUS was performed to identify the pre-operative T staging of the tumour. This was compared to post-surgical pathological T staging of the lesion. A CUSUM analysis chart based on sequential monitoring of cumulative performance was used for evaluating the learning curve for 3D TRUS. <h3>Results</h3> Two hundred and thirty three patients (153 male) had 3D TRUS over the six years. 172 (73.8%) were available for analysis (52 did not have post-surgical histology for comparison and 9 could not be staged). Overall accuracy of T staging was 75%. The CUSUM analysis demonstrated a learning curve of 31 cases to reach a level of steady state performance. <h3>Conclusion</h3> These data provide some insight into the number of cases required to achieve an acceptable accuracy if a TRUS service is to be established in a hospital or region. <h3>Disclosure of interest</h3> None Declared.

Image-defined risk factor assessment of neurogenic tumors after neoadjuvant chemotherapy is useful for predicting intra-operative risk factors and the completeness of resection.

Patients with neuroblastoma are now stratified at diagnosis according to the presence and number of image-defined risk factors (IDRFs). We examined the added value of IDRF assessment after neoadjuvant chemotherapy for predicting surgical resection. From 2009-2012, 39 out of 91 patients operated on in our institution for neuroblastic tumors received neoadjuvant chemotherapy based on ongoing SIOPEN protocols or treatment guidelines. IDRFs were assessed both at diagnosis and preoperatively on CT and/or MRI. Median age at diagnosis was 30 months [range 2-191]. The tumor locations were adrenal (n = 20), paravertebral (n = 13) and perivascular (n = 6). INRGSS stages were L2 (n = 13), M (n = 25) and Ms (n = 1). Eleven tumors (28%) were MYCN-amplified. Chemotherapy reduced the number of IDRFs in 54% of patients overall (21/39): 61.5% (16/26) of M and Ms patients, and 38.5% (5/13) of non metastatic patients (P < 0.001). The number of IDRFs lost after chemotherapy was proportional to the degree of tumor shrinkage (P = 0.002), independent of the primary tumor location (P = 0.73), although the number was higher in patients with left versus right adrenal locations (P = 0.004). Patients with neuroblastoma on post-surgical histology lost more IDRFs (median: 1[0-9]) than patients with ganglioneuroblastoma (median: 0[0-4]) (P < 0.001). The completeness of resection was related only to the number of preoperative IDRFs (P = 0.028). IDRF assessment after neoadjuvant chemotherapy is useful for predicting completeness of resection of neurogenic tumors. A larger international study is needed to confirm these results and to explore a possible correlation between preoperative IDRF status and survival.

A pilot comparison of 18F-fluorodeoxyglucose and 18F-fluorocholine PET/CT to predict early recurrence of unifocal hepatocellular carcinoma after surgical resection

Presurgical identification of patients at high risk for early recurrence of hepatocellular carcinoma (HCC) after resection could warrant additional therapies. F-fluorodeoxyglucose (FDG) uptake by the tumour on preoperative PET can predict HCC recurrence after resection as effectively as poor differentiation or presence of microvascular invasion (MVI) on postsurgical histology. A better sensitivity for the detection of HCC nodules has been reported with F-fluorocholine (FCH), a PET tracer of lipid metabolism. This pilot study aimed to compare preoperative FDG and FCH PET/CT for predicting early recurrence of unifocal HCC, occurring within 6 months after surgical resection. FDG and FCH tumour uptakes were assessed on preoperative PET/CT by two masked readers. On FCH PET/CT, a photopenic lesion and a hot focus were considered as indicative of malignancy. During postoperative follow-up, recurrence was searched for by regularly performing CT and MRI. In 11 consecutive HCC patients, the detection rate was greater with FCH (80%) than with FDG (27%). After resection, the overall recurrence rate was 55%. Early recurrence occurred in four patients, who were the only ones with an FDG-positive and FCH-photopenic tumour, with a significant reduction in disease-free survival. On postsurgical histology, those four patients also presented with MVI and satellite nodules. Histological differentiation and capsule disruption appeared less accurate than PET/CT or MVI in predicting early recurrence. In unifocal HCC, the FCH photopenic pattern was associated with MVI and predicted early HCC recurrence after surgical resection as accurately as did an FDG uptake. Larger studies with FCH are warranted.

À propos de 22 cas de carcinosarcomes utérins

Twenty-two uterine carcinosarcomas were treated and followed in two centers over 10 years. We wanted to describe them and review the literature on the subject. We describe all uterine carcinosarcomas treated in Lille, over 10 years, both in department of gynecology, Hospital Jeanne-de-Flandre (11 patients), and in department of gynecologic oncology of Centre Oscar-Lambret (11 patients). For the 22 patients included, we give age at time of diagnosis, body mass index, pre and post surgical histology, details of surgical treatment, adjuvant treatment and evolution of the pathology. Mean age at time of diagnosis was 69.6. Sixty-eight percent of patients had overweight or obesity. Revealing symptoms were in 91% of cases post-menopausal meno- or metrorrhagias. Preoperatively, histology had an important number of false negative and, 57% of diagnoses were ignored in our study. All patients had first intention surgery, only 54% were yet at an early stage. Sixteen had association radiotherapy, eight of chemotherapy, two declined any adjuvant treatment. Ten patients died with a mean survival of 12.9 months, eight had a good evolution still at 35 months, two had recent pelvic relapse, two were lost to follow-up. Uterine carcinosarcomas are rare, aggressive, yet not very well known tumors. First line treatment will be surgery with peritoneal cytology, hysterectomy, bilateral adnexectomy, pelvic and sometimes lumbo-aortic lymphadenectomy, omentectomy, peritoneal biopsies. Adjuvant chemotherapy has shown its interest in this type of tumor. Radiotherapy is still debated.

Anterior Knee Pain: Two Cases of Synovial Cell Sarcoma

HISTORY: A 27 y/o and 30 y/o woman presented with anterior knee pain in a sports medicine clinic. Both had noticed a mass in their quadriceps muscle for several years. The 27 y/o had previously seen a provider who ordered a MRI of the respective knee and was given a diagnosis of patellofemoral syndrome. The 30 y/o woman had no prior work-up. Neither patient had weight loss, fevers or symptoms on the contralateral side. PHYSICAL EXAMINATION: The 27 y/o female had a 7 cm × 7 cm mass along the left medial thigh, firm to palpation and immovable. The 30 y/o female had a 4 cm × 5 cm mass on the lateral aspect of the R thigh, firm to palpation and immovable. DIFFERENTIAL DIAGNOSIS: Neoplasm, Arteriovenous malformation, quadriceps tendon rupture, quadriceps hematoma, metastasis TEST AND RESULTS: MRI with contrast of the respective knees and thighs demonstrate masses consistent with neoplasms. Post-surgical histology of the masses showed monophasic synovial cell sarcomas. Review of the 27 y/o patient's prior MRI showed a neoplasm in the same location as the current mass that was falsely read as a negative study. FINAL WORKING DIAGNOSIS: Synovial cell sarcoma of the quadriceps TREATMENT AND OUTCOMES: Both patients had surgical resection, radiation and chemotherapy with good clinical outcomes without recurrence. These cases illustrate that synovial cell sarcomas may be more prevalent than once thought. Also, care should be taken not to diagnose all anterior knee pain as patellofemoral syndrome. Careful examinations and histories are paramount in correct localization of the pain which in both of these patients was superior to their knees. Also a thorough examination revealed large masses that are not consistent with most knee pathologies and should raise the provider's suspicion for neoplasm. Lastly, imaging needs to be carefully reviewed and correlated with history and physical examination. In the case of the 27 y/o patient, her tumor could have been diagnosed five years prior to her presentation in our clinic. Earlier diagnosis could have hastened treatment and lowered her risk of recurrence and metastasis.

Prospective Comparison of FDG and FET PET/CT in Patients with Head and Neck Squamous Cell Carcinoma

The clinical usefulness of 2-deoxy-2-[F-18]fluoro-D-glucose-positron emission tomography (FDG-PET) in head and neck squamous cell carcinoma (HNSCC) is now well-documented. However, its sensitivity is greater than its specificity due to false-positive results in inflammatory or infectious lesions, which are frequent in this area, in particular after treatment by surgery and/or radiotherapy. O-2-fluoro-(18F)-ethyl-L-thyrosine (FET) has been reported not to be taken up by such lesions, and a preliminary study indicated that this may be clinically useful in HNSCC. We performed a prospective study to compare the diagnostic performances of FDG and FET PET/CT in the different settings of HNSCC. Twenty-seven patients (20 men and seven women, aged 48-76, among 30 patients included) and 69 suspected cancer sites are now evaluable on basis of postsurgical histology and/or follow-up greater than 6 months; 15 patients were referred for initial staging and 12 during posttherapy follow-up, a recurrence being suspected in eight of them. FDG and FET PET/CT were performed on two different days, the patient fasting for 6 h, 1 h after injection of 5 MBq/kg of body mass of each radiopharmaceutical. Both PET/CT examinations were blind read more than 6 months after the end of inclusions in a random order for each tracer and with a time interval greater than 1 month between FDG and FET PET/CT blind readings. Overall diagnostic performances, derived from blind reading: FDG PET/CT on a per patient basis: sensitivity 100%, specificity 71%, accuracy 93%; FDG PET/CT on a per site basis: sensitivity 95%, specificity 63%, accuracy 83%; FET PET/CT on a per patient basis: sensitivity 70%, specificity 100%, accuracy 78%; FET PET/CT on a per site basis: sensitivity 64%, specificity 100%, accuracy 78%. At site level, sensitivity was significantly greater with FDG (p<0.02) and specificity with FET (p<0.01). The statistical level of significance was not reached at patient level. Although its good specificity was confirmed, FET did not appear to be suited as a first-line PET tracer in HNSCC imaging and cannot replace FDG for staging due to insufficient sensitivity. However, it was useful in a few selected cases to favor a wait and see attitude when a FDG+ FET- focus was discovered in patients referred for systematic FDG PET during follow-up. In contrast, second primary cancers should not be ruled out if FDG was clearly positive in the lungs or the digestive tract.

15. Sensitivity of FDG CDET (2D Dual-Head Coincidence Gamma Camera) for the Detection of Occult or Doubtful Recurrences of Colorectal Cancer: Histopathological Correlation

Purpose: The aim of this study was to evaluate the efficacy of FDG-CDET for the detection of recurrences of colorectal cancer, in occult disease or in doubtful cases at conventional imaging (CI). In all the evaluated cases, the result of FDG-CDET was compared with post surgical histology both on patient and on site bases.Methods and patients: After fasting for 6h or more, 150-250 MBq of 18F-FDG were injected i.v. and 2D imaging (whole-body scan and at least a tomoscintigram) was started 45 min. later, using a PICKER CDET gamma camera. Among the 214 examinations (ex) performed for detection of recurrences of colorectal cancer between Jul 1997 and Feb 2000, we only considered the 58 cases with negative or questionable CI and a post surgical histologic proof.Results: Patients were referred in three different contexts:1. suspicion of recurrence (SR) due to raising CEA levels with normal CI i.e. occult disease (18 ex: 13 TP, 3 FN, 2 FP on patient basis, 17 TP, 9 FN, 4 FP on site basis)2. SR due to equivocal image(s) at follow-up CI (25 ex: 18 TP, 5 FN, 2 TN on patient basis, 21 TP, 10 FN, 2 TN on site basis)3. SR due to both raising CEA levels and equivocal CI (15 ex: 13 TP, 2 FN on patient basis, 16 TP, 8 FN, 3 TN, 1 FP on site basis).4. The overall sensitivity was 44/54 = 81% on patient basis and 54/81 = 67% on site basis. Specificity could not be evaluated because of the very small number of patients re-operated in case of negative FDG-CDET.5. Conclusion: When conventional imaging could not contribute, i.e. a sensitivity of zero by definition, FDG-CDET accurately diagnosed a recurrence in 81% of the patients and located 67% of all recurrent lesions. These results confirm, with post surgical histology as the only gold standard, that FDG-CDET is a powerful tool for diagnosis of recurrent colorectal cancer in difficult cases. It could be used as the first line examination as soon as a recurrence is suspected, in order to avoid less contributive imaging procedures.