Preoperative Positron Emission Research Articles

Exploring clinical factors to predict the survival of patients with resectable non-small cell lung cancer with neoadjuvant immunotherapy.

The goal was to explore clinical factors and build a predictive model for the disease-free and overall survival of patients with non-small cell lung cancer (NSCLC) receiving neoadjuvant chemotherapy combined with immune checkpoint inhibitors. Inclusion criteria for patients in this multicentre study were as follows: (i) Patients who were diagnosed with stages I-III NSCLC after a bronchoscopy biopsy or puncture; (ii) patients who were examined with computed tomography/positron emission tomography-computed tomography before treatment and surgery; (iii) patients who received neoadjuvant chemotherapy combined with immune checkpoint inhibitors for 2 to 6 cycles preoperatively; (iv) patients whose peripheral blood indicators and tumour markers were assessed before treatment and preoperatively; (v) patients who underwent radical lung cancer surgery after neoadjuvant therapy. Cases were divided into high- and low-risk groups according to 78 clinical indicators based on a 10-fold Least Absolute Shrinkage and Selection Operator selection. We used Cox proportional hazards models to predict disease-free and overall survival. Then, we used time-dependent area under the curve and decision curve analyses to examine the accuracy of the results. Data were collected continuously, and 212 and 85 cases were randomly assigned to training and testing sets, respectively. The area under the curve for the prediction of disease-free survival (training: 1 year, 0.83; 2 years, 0.81; 3 years, 0.83 versus testing: 1 year, 0.65; 2 years, 0.66; 3 years, 0.70), overall survival (training: 1 year, 0.86; 2 years, 0.85; 3 years, 0.86 versus testing: 1 year, 0.66; 2 years, 0.57; 3 years, 0.70) were determined. The coefficient factors including pathological response; preoperative tumour maximum diameter; preoperative lymph shorter diameter; preoperative tumour and lymph maximum standardized uptake value; change in tumour standardized uptake value preoperatively; and blood-related risk factors were favourably associated with prognosis (P < 0.001). Our prediction model, which integrated data from preoperative positron emission tomography-CT, preoperative blood parameters and pathological response, was able to make highly accurate predictions for disease-free and overall survival in patients with NSCLC receiving neoadjuvant immunity with chemical therapy.

Long-term outcomes and risk factors for recurrence after lung segmentectomy.

The long-term oncological outcomes and risk factors for recurrence after lung segmentectomy are unclear. The aims of this study were to investigate the long-term prognosis and to evaluate risk factors for recurrence after segmentectomy. Between January 2008 and December 2012, a total of 177 patients underwent segmentectomy for clinical stage I non-small cell lung cancer. The median follow-up period was 120.1 months. The overall survival (OS) and recurrence-free survival curves were analysed using the Kaplan-Meier method with a log-rank test. Univariable and multivariable analyses were used to identify significant factors that predicted recurrence. The study included 177 patients with a median age of 67 years. The median operative time was 155 min. No 30-day deaths were observed. Nine patients (5.1%) had recurrences: loco-regional in 3, distant in 3 and both in 3. The 5-year and 10-year recurrence-free survival rates were 89.7% and 79.8%, and the OS rates were 90.9% and 80.4%, respectively. On multivariable analysis, the risk factor associated with recurrence was a pure solid tumour [hazard ratio, 23.151; 95% confidence interval 2.575-208.178; P = 0.005]. The non-pure solid tumour group had a significantly better probability of survival (5-year OS: 95.4% vs 77.2%; 10-year OS: 86.5% vs 61.8%; P < 0.0001). A total of 113 patients received preoperative positron emission tomography/computed tomography. Patients with a higher maximum standardized uptake value had a significantly higher recurrence rate. Segmentectomy for clinical stage I non-small cell lung cancer produced acceptable long-term outcomes. Pure solid radiographic appearance was associated with recurrence and decreased survival.

Preoperative factors associated with lateral lymph node metastasis in lower rectal cancer and the evaluation of the middle rectal artery.

This study aimed to identify cases in which lateral lymph node (LLN) dissection (LLND) can be excluded by clarifying preoperative factors, including an evaluation of the middle rectal artery (MRA), associated with LLN metastasis. Fifty-five consecutive patients who underwent preoperative positron emission tomography-computed tomography (PET/CT) and total mesorectal excision with LLND for rectal cancer were included. We retrospectively investigated the preoperative clinical factors associated with pathological LLN (pLLN) metastasis. We analyzed the regions of pLLN metastasis using MRA. pLLN metastasis occurred in 13 (23.6%) patients. According to a multivariate analysis, clinical LLN (cLLN) metastasis based on short-axis size and LLN status based on PET/CT were independent preoperative factors of pLLN metastasis. The negative predictive value (NPV) was high (97.1%) in patients evaluated as negative based on PET/CT and cLLN short-axis size. MRA was detected in 24 patients (43.6%) using contrast-enhanced CT, and there was a significant relationship between pLLN metastasis and the presence of MRA. pLLN metastasis in the internal iliac region but not in the obturator region was significantly correlated with the presence of MRA. Combined cLLN metastasis based on short-axis size and PET/CT showed a higher NPV, suggesting this to be a useful method for identifying cases in which LLND can be excluded.

An Investigation of the Relationship Between 18F-FDG PET/CT Parameters of Primary Tumors and Lymph Node Metastasis in Resectable Non-small Cell Lung Cancer.

Mediastinal lymph node metastasis is an important prognostic factor in non-small cell lung cancer (NSCLC) patients without distant metastases. 18F-2-fluoro-2-deoxy-Dglucose Positron Emission Tomography/Computed Tomography (18F-FDG PET/CT) is recommended for detecting and staging lymph nodes and distant metastases in NSCLC patients. This study aims to investigate whether maximum standardized uptake (SUVmax), mean standardized uptake (SUVmean), metabolic tumor volume (MTV), and tumor lesion glycolysis (TLG) values of the primary tumor measured by 18F-FDG PET/CT in resectable NSCLC can predict preoperative lymph node metastasis. This retrospective study included eighty NSCLC patients who underwent preoperative Positron Emission Tomography/Computed Tomography (PET/CT) for diagnosis and staging. The patients were stage I-III and had no distant metastases. Tumor metabolic parameters such as SUVmax, SUVmean, MTV, and TLG at PET/CT imaging were measured for preoperative diagnosis and staging, and the postoperative pathology results of the patients were examined. The pathology results divided patients with and without lymph node metastasis into two groups. The groups were compared with the student's t-test and chi-square test regarding 18F-FDG PET/CT tumor metabolic parameters and other parameters. Fifteen (18.8%) patients were female, and 65 (81.3%) were male. According to the postoperative pathology results, while 30 (37.5%) patients had lymph node metastasis, 50 (62.5%) did not. There was a significant difference between the groups regarding tumor SUVmax and SUVmean values (p = 0.036, p = 0.045). Overall survival in the N0 group was significantly higher than in the N1 + N2 group (p = 0.034); median survival was 30.2 months in N0 cases and 27.3 months in N1 and N2 groups. SUVmax and SUVmean values are significantly higher in patients with lymph node metastases than in patients without lymph node metastases, and this finding may provide useful information for predicting lymph node metastasis in patients with resectable NSCLC.

Utility of Preoperative Positron Emission Tomography (PET) in Localizing Perforator Vessels of Anterolateral Thigh Free Flap

Utility of Preoperative Positron Emission Tomography (PET) in Localizing Perforator Vessels of Anterolateral Thigh Free Flap

NIMG-53. IMAGING FEATURES AND CONSIDERATION OF PROGRESSION PATTERN OF DIFFUSE HEMISPHERIC GLIOMAS, H3 G34-MUTANT

Abstract BACKGROUND Diffuse hemispheric gliomas, H3 G34-mutant (DHGs-G34m) are newly recognized pediatric-type diffuse high-grade gliomas. We describe detail imaging features of seven cases of DHGs-G34m and consider about progression pattern of DHGs-G34m. RESULTS H3 G34R or H3 G34V was detected by sanger sequencing in all tumors. Mean age of onset was 16.5 years (range: 10-26). Tumors were located on frontal (2), parietal (2), temporal lobe (1) and insular cortex (1), respectively. In one case, gliomatosis cerebri-like multiple lesions involving the cortex and basal ganglia occurred. Magnetic resonance imaging showed T2/FLAIR high lesions with poor contrast enhancement in all cases. All tumors harbored restriction of diffusion. Cystic component and hemorrhage were observed in five and three cases, respectively. Six patients underwent preoperative positron emission tomography. Strong accumulation of methionine and partial accumulation of FDG in all cases. All tumors harbored T2/FLAIR high lesions in the deep white matter, most of which showed methionine accumulation. All patients underwent surgery (total resection in one case, partial resection in five cases, and biopsy in one case) followed by radiation chemotherapy. The mean progression free survival was 9.9 months (range: 1.6-33.1 months). All tumors harbored diffuse infiltration along the white matter, which was temporarily reduced by bevacizumab, but eventually invaded into cerebral peduncle via pyramidal tract and into contralateral brain via corpus callosum or anterior commissure in six cases. Extensive infiltration of tumor cells into the contralateral brain and brain stem was confirmed histopathologically in the autopsy brain of one case. The mean overall survival was 21.6 months (range: 8.9-48.3 months). CONCLUSION DHGs-G34m showed deep white matter infiltration from the time of initial onset, which made gross total resection difficult. Residual lesions extensively infiltrated along the white matter and eventually invaded the brainstem and contralateral brain, leading to death.

Cardiac cavernous hemangioma with high fluorodeoxyglucose uptake on preoperative positron emission tomography/computed tomography: a case report

BackgroundReports on cardiac hemangioma detection by F-18-deoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) are extremely rare.Case presentationHere we describe a case of a 61-year-old man with hemangioma. CT revealed a tumor with a size of 60 mm. Magnetic resonance imaging showed high signal intensity on T2-weighted images. Hemangioma was initially suspected. However, PET/CT showed high FDG absorption, which led us to suspect a malignant tumor. The tumor was resected, and a cavernous hemangioma diagnosis was made by postoperative histopathological examination.ConclusionsThis case may serve as a reference for clinicians to become more aware of the potential application of FDG PET/CT for cardiac hemangioma detection.

The value of preoperative positron emission tomography/computed tomography in differentiating the invasive degree of hypometabolic lung adenocarcinoma

ObjectivesTo investigate the value of preoperative positron emission tomography/computed tomography (PET/CT) in differentiating the invasive degree of hypometabolic lung adenocarcinoma.MethodsWe retrospectively analyzed the data of patients who underwent PET/CT examination, high-resolution computed tomography, and surgical resection for low-metabolism lung adenocarcinoma in our hospital between June 2016 and December 2021. We also investigated the relationship between the preoperative PET/CT findings and the pathological subtype of hypometabolic lung adenocarcinoma.ResultsA total of 128 lesions were found in 113 patients who underwent resection for lung adenocarcinoma, including 20 minimally invasive adenocarcinomas (MIA) and 108 invasive adenocarcinomas (IAC), whose preoperative PET/CT showed low metabolism. There were significant differences in the largest diameter (Dmax), lesion type, maximum standard uptake value (SUVmax), SUVindex (the ratio of SUVmax of lesion to SUVmax of contralateral normal lung paranchyma), fasting blood glucose, lobulation, spiculation, and pleura indentation between the MIA and IAC groups (p < 0.05). Multivariate logistic regression analysis showed that the Dmax (odds ratio (OR) = 1.413, 95% confidence interval (CI: 1.155–1.729, p = 0.001)) and SUVmax (OR = 12.137, 95% CI: 1.068–137.900, p = 0.044) were independent risk factors for predicting the hypometabolic IAC (p < 0.05). Receiver operating characteristic (ROC) curve analysis showed that the Dmax ≥ 10.5 mm and SUVmax ≥ 0.85 were the cut-off values for differentiating MIA from IAC, with high sensitivity (84.3% and 75.9%, respectively) and specificity (84.5% and 85.0%, respectively), the Combined Diagnosis showed higher sensitivity (91.7%) and specificity (85.0%).ConclusionsThe PET/CT findings correlated with the subtype of hypometabolic lung adenocarcinoma. The parameters Dmax and SUVmax were independent risk factors for predicting IAC, and the sensitivity of Combined Diagnosis prediction is better.

Role of minimally invasive secondary cytoreduction in patients with recurrent ovarian cancer

ObjectiveRetrospective series have shown minimally invasive secondary cytoreductive surgery is a feasible approach in selected cases of recurrent ovarian cancer. However, no predictors of minimally invasive secondary cytoreductive surgery feasibility...

Outcomes of patients undergoing lung resection for drug-resistant TB and the prognostic significance of pre-operative positron emission tomography/computed tomography (PET/CT) in predicting treatment failure.

Surgery remains an adjunctive treatment for drug-resistant tuberculosis (DR-TB) treatment failure despite the use of bedaquiline. However, there are few data about the role of surgery when combined with newer drugs. There are no outcome data from TB endemic countries, and the prognostic significance of pre-operative PET-CT remains unknown. We performed a prospective observational study of 57 DR-TB patients referred for surgery at Groote Schuur Hospital between 2010 and 2016. PET-CT was performed if there was nodal disease or disease outside the area of planned resection but did not influence treatment decisions. 24-month treatment success post-surgery (cure or treatment completion), including all-cause mortality, was determined. 35/57 (61.4%) patients (median age 40 years; 26% HIV-infected) underwent surgery and 22/57 (38.6%) did not (11 patients were deemed unsuitable due to bilateral cavitary disease and 11 patients declined surgery). Treatment failure was significantly lower in those who underwent surgery compared to those eligible but declined surgery [15/35 (43%) versus 11/11 (100%); relative risk 0.57 (0.42-0.76); p<0.01). In patients treated with surgery, a post-operative regimen containing bedaquiline was associated with a lower odds of treatment failure [OR (95%CI) 0.06 (0.00-0.48); p=0.007]. Pre-operative PET-CT (n=25) did not predict treatment outcome. Resectional surgery for DR-TB combined with chemotherapy was associated with significantly better outcomes than chemotherapy alone. A post-operative bedaquiline-containing regimen was associated with improved outcome; however, this finding may have been confounded by higher use of bedaquiline and less loss to follow-up in the surgical group. However, PET-CT had no prognostic value. These data inform clinical practice in TB-endemic settings. This work was supported by the South African MRC (RFA-EMU-02-2017) and the EDCTP (TMA-2015SF-1043 & TMA- 1051-TESAII).

Preoperative evaluation of prostate cancer by 68Ga-PMSA positron emission tomography/computed tomography: comparison with magnetic resonance imaging and with histopathological findings.

To evaluate the accuracy of preoperative positron emission tomography/computed tomography with 68Ga-labeled prostate-specific membrane antigen (68Ga-PSMA PET/CT) for staging prostate cancer and compare it with magnetic resonance imaging (MRI) using histopathology of surgical specimens as the gold standard. In this retrospective study, 65 patients with prostate cancer were analyzed. The accuracy of 68Ga-PSMA PET/CT for tumor detection was 95%, and that of MRI was 91%. There was no difference between 68Ga-PSMA PET/CT and MRI regarding localization of the lesion. The sensitivity of 68Ga-PSMA PET/CT for detecting extraprostatic extension was quite low (14%). For detection of seminal vesicle invasion, 68Ga-PSMA PET/CT showed a sensitivity of 57% and accuracy of 91%. There was a moderate correlation between the maximum standardized uptake value (SUVmax) and the serum level of prostate-specific antigen (p < 0.01; ρ = 0.368) and between the SUVmax and the International Society of Urological Pathology (ISUP) grade (p < 0.01; ρ = 0.513). 68Ga-PSMA PET/CT is a promising tool for detecting and evaluating the primary tumor, which can alter the staging and management of the disease.

The Clinical Significance of Preoperative 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography for Predicting Distant Recurrence in Thymoma

AimsThymomas sometimes require treatment for various recurrence patterns, despite their relatively good survival rates after resection. We focused on their maximum standardised uptake value (SUVmax) on preoperative 18F-fluorodeoxyglucose positron emission tomography as a tumour recurrence predictor in completely resected thymomas. Those with a high SUVmax might be at an increased recurrence risk, irrespective of tumour size. We categorised cases into axes (tumour size and SUVmax) and determined whether cluster analysis predicts recurrence patterns and freedom from recurrence (FFR). Materials and methodsOf the 115 patients who underwent primary surgery for thymoma between 2005 and 2018, 66 were evaluated. According to the Masaoka stage and World Health Organization (WHO) histological type, all histological diagnoses were obtained after resection. All recurrences were diagnosed using computed tomography and categorised into three patterns: distant, local and regional recurrences. A multiple regression analysis was carried out to identify predictors for each recurrence pattern. Cluster analysis was carried out based on tumour size and SUVmax. The FFR rate was evaluated. ResultsAll patients with preoperative SUVmax <3.4 were free from recurrence regardless of Masaoka stage, WHO histological classification and tumour size. Multiple regression analysis revealed that the SUVmax was the only significant predictor for distant recurrence. All cases were divided into three clusters. Cluster 3, with average tumour size and a high SUVmax, showed a higher risk of distant recurrence rate (60%) and a significantly lower FFR rate (P = 0.003). ConclusionsThe preoperative positron emission tomography/computed tomography SUVmax could be a useful thymoma recurrence predictor, especially for distant recurrences. In addition, cluster analysis revealed that cases with average tumour sizes and extremely high SUVmax were identified to have a higher recurrence risk and a significantly lower FFR rate than those in other clusters. Even after complete resection, such cases should be closely followed-up and screened for distant recurrence.

The oncological characteristics of non-prostate-specific membrane antigen (PSMA)-expressing primary prostate cancer on preoperative PSMA positron emission tomography/computed tomography.

The oncological characteristics of non-prostate-specific membrane antigen (PSMA)-expressing primary prostate cancer on preoperative PSMA positron emission tomography/computed tomography.

380. UTILITY OF PET/CT FOR LYMPH NODE METASTASIS DETECTION IN PT1 EARLY ESOPHAGEAL SQUAMOUS CELL CARCINOMA

Abstract Nodal staging for early esophageal squamous cell carcinoma (ESCC) was mandatory to decide therapy strategy. Utility of preoperative Positron Emission Tomography/Computed Tomography (PET/CT) for lymph node metastasis (LNM) detection in early ESCC was evaluated in the study. 186 consecutive patients with pathologically confirmed T1 tumors undergoing preoperative PET/CT at Zhongshan Hospital between 2015 August to 2020 December were retrospectively enrolled. Clinical characteristics and PET/CT results were collected and compared between patients with or without LNM. A PET integrated risk score model for prediction of LNM was established and validated. Survivals were compared between high risk group and low risk group by Log Rank test. 40 out of 186 patients were diagnosed with LNM on PET-CT. PET/CT alone for LNM detection was with a 53.3% sensitivity, 84.65% specificity, and 90.4% negative predictive value. Tumor size &amp;gt;2.5 cm (P = 0.015), tumor depth (P = 0.012), LVI (P &amp;lt; 0.001), differentiation (P = 0.066) and PET LN (+) (P &amp;lt; 0.001) were included in the prediction model for LNM. The AUC of ROC in derivation cohort and validation cohort was 0.860 and 0.846 respectively. High risk group scoring &amp;gt;3 points showed poorer 5-year recurrence free survival (62.6% VS. 74.7%, P = 0.046) and similar overall survival (87.6% VS. 86.9%, P = 0.942) as compared to low risk group. PET/CT for LNM detection in early ESCC was of 53.3% sensitivity and 84.65% specificity. PET integrated risk score model for LNM was of fair property with 0.860 AUC and was predictive of recurrence.

A progressive and refractory case of breast cancer with Cowden syndrome

BackgroundCowden syndrome is a rare autosomal-dominant disease with a high risk of malignant tumors of the breast, commonly caused by germline mutations in the PTEN gene. Most breast cancers related to Cowden syndrome showed typically a slow-growing and favorable clinical course. Here, we report a progressive case of triple-negative breast cancer in a patient who was diagnosed with Cowden syndrome.Case presentationA 35-year-old female with breast cancer was referred to our hospital. Histopathological examination of the tumor showed that it was triple-negative breast cancer with high proliferation marker. Preoperative positron emission tomography-computed tomography showed abnormal uptake in the left cerebellar hemisphere in addition to the right breast and axillary lymph node. Brain T2-weighted magnetic resonance imaging revealed hyperintense bands in the left cerebellar hemisphere lesion, which demonstrated a “tiger-stripe” appearance. The patient’s mother had died of endometrial cancer. Subsequently, she underwent genetic testing, leading to a diagnosis of Cowden syndrome with a pathogenic variant c.823_840del.18 at exon 8 in PTEN. She was treated with neoadjuvant chemotherapy of eribulin and cyclophosphamide followed by adriamycin and cyclophosphamide. However, her tumors increased after these treatments. She was immediately surgically treated and received adjuvant chemotherapy of capecitabine. Unfortunately, the cancer recurred in the lung nine months after surgery. We then administered paclitaxel and bevacizumab therapy, but the disease rapidly progressed. Consequently, the patient died due to breast cancer about three months after recurrence.ConclusionWe report an aggressive case of cancer with Cowden syndrome which was resistant to standard chemotherapy. Alteration of the phosphatidylinositol-3 kinase/Akt/mammalian target of rapamycin pathway due to inactivating PTEN protein may be associated with chemoresistance and serves as a candidate for therapeutic intervention in PTEN-related cancers.

Survival after liver resection and liver transplantation for colorectal liver metastases: a comparative analysis stratified by metabolic tumor volume assessed by 18F-FDG PET/CT.

Many patients undergoing resection for colorectal liver metastases (CRLM) recur with poor survival. Overall survival (OS) following liver transplantation (LT) for CRLM is reported to be about 80% at 5 years. In this study, survival following resection versus transplantation for CRLM in patients with moderate (6-70cm3) metabolic tumor volume (MTV) from the preoperative positron emission tomography (PET) was compared. Disease-free survival (DFS), OS and post recurrence survival (PRS) following resection (n=18) and LT (n=12) was compared by using the Kaplan Meier method and log rank test for patients with moderate MTV. Patients undergoing LT had unresectable metastases, significantly lower age, higher tumor burden score and number of liver metastases, longer time from diagnosis to surgery, and more patients received neoadjuvant chemotherapy. OS at 5 years was 39% in the resection group and 83% in the LT group (P=0.012). PRS was significantly improved in patients treated with LT compared to resection with 71% alive at 5 years from recurrence compared to 17% in the resection group (P=0.017). LT for selected patients seems to be superior to resection as treatment for CRLM for patients with moderate MTV.

The Relationship between Preoperative FDG PET/CT Uptake and Survival in Patients with Lung Cancer

IntroductionDespite all advances in diagnosis and treatment, lung cancer is the leading cause of cancer death in both sexes worldwide. Because of the different survival rates in lung cancer, additional factors are needed to determine prognosis. In this study, we aimed to investigate the relationship between survival and clinical data of primary tumor SUV (Standardized Uptake Value) to evaluate the role of FDG-PET ([18F]-fluoro-2-deoxy-D-glucose Positron Emission Tomography) as a prognostic factor in lung cancer.Material and methodsThe data of patients who underwent anatomic resection and preoperative positron emission tomography/computed tomography (PET/CT) were performed retrospectively between February 2006 and October 2019 in the Department of Thoracic Surgery, Faculty of Medicine, Gaziantep University.ResultsAll cases were 666 patients, 64 of whom (9.6%) were females and 602 of them (90.4%) were males. The mean age of the patients was 61.91±9.6 years. Histologically, there were 369 (55.4%) epidermoid carcinomas, 233 (34.9%) adenocarcinomas. The overall mean survival was 68.2 months and the median survival was 63.6 months. The mean mass SUV values of the patients were 13.73 ± 6.65. The effect of histological type, TNM stage, metastasis and recurrence on survival was statistically significant (p &lt; 0.05). According to the univariate analysis (Cox regression analysis), it was found that 1 unit increase in SUV value contributed to a statistically significant increase in mortality risk (p = 0.002, HR: 1.024, 95% CI: 1.009-1.040).ConclusionsIn our study on 666 patients, unlike literature, no statistically significant relationship was found between SUV value and survival.

Does 18F-FDG PET/CT change the surgical management of potentially resectable colorectal liver metastases?

Resectability assessment of patients with colorectal liver metastases is based on computed tomography and liver magnetic resonance imaging. Addition of fluorine-18-fluorodeoxyglucose positron emission tomography/computed tomography has been recommended, but the impact of the added information remains unclear. The primary aim of this study was to determine how preoperative positron emission tomography/computed tomography changed management in patients with potentially resectable colorectal liver metastases. The secondary aim was to investigate whether findings on positron emission tomography/computed tomography correlated to metastatic disease in cases with extended surgery and influenced oncological outcomes. A retrospective observational study of the impact of adding positron emission tomography/computed tomography to conventional imaging in the surgical decision-making of colorectal liver metastases. All patients with colorectal liver metastases diagnosed by conventional imaging were included and assessed by a multidisciplinary team conference at Umeå University Hospital between June 2013 and December 2017. Eligibility criteria were all patients with potentially resectable colorectal liver metastases. Patients who underwent preoperative positron emission tomography/computed tomography in addition to conventional radiology were compared with those who underwent conventional imaging only. 151/220 patients underwent preoperative positron emission tomography/computed tomography. Findings on positron emission tomography/computed tomography changed the management in 10.6% of the patients. Eight patients were excluded from surgery after detection by positron emission tomography/computed tomography of extrahepatic disease. Eight patients underwent more extended surgery than initially planned due to positron emission tomography/computed tomography. Five of these positron emission tomography-positive resected sites were verified by pathology as metastatic disease. No difference in overall survival was seen following surgical resection in patients with and without a preoperative positron emission tomography/computed tomography. Preoperative positron emission tomography/computed tomography resulted in a changed surgical management in 10.6% of cases in a selected cohort.

\u201cMYH9 mutation and squamous cell cancer of the tongue in a young adult: a novel case report\u201d

BackgroundThe incidence of tongue cancer in young adults is on the rise. This trend is more pronounced in females. Although the aetiology is still unclear, there is mounting evidence that genetic syndromes can play a key role in development of oral cancers in this patient group. We report the first case of oral squamous cell carcinoma (oSCC) in a young adult with an MYH9-related disorder (MYH9-RD).Case presentationA 19-year-old female with a germline MYH9 variant (missense variant in exon 2: c.287C > T, (p.Ser96Leu)) was referred to the head and neck surgery department for investigation of a painful, thick right tongue ulcer. She was diagnosed with Epstein syndrome, an MYH9-RD, at 12 years of age. Her main phenotypic features were profound thrombocytopenia and marked renal impairment. The tongue biopsy confirmed SCC. Preoperative positron emission tomography (PET) revealed avidity in the right tongue and ipsilateral level 2A neck lymph node. With substantial preoperative multidisciplinary input, she underwent cancer ablation and microvascular free flap reconstruction. Her pathology showed a 35 mm diameter, 14 mm thick moderately differentiated SCC with perineural and lymphovascular invasion. Two out of 38 right neck nodes were positive for metastasis with extranodal extension. None of the 34 left neck nodes was involved.She had an uneventful recovery and was discharged home on day 6 postoperative day. On day 15 postoperative day, she had catastrophic bleeding in the neck with a respiratory arrest after a forceful cough. She required an emergency tracheostomy and returned to the theatre for haemostasis. Following a short inpatient stay, she was again discharged home and underwent adjuvant therapy consisting of external beam radiotherapy of 60Gy in 30 fractions. On clinical examination and PET at 6 months after surgery, she had no evidence of disease recurrence.ConclusionsMYH9-RD can present with advanced locoregional oral cavity malignancy at an early age. The combination of profound thrombocytopenia and marked renal impairment can impact heavily on routine major head and neck cancer surgery and adjuvant treatment. This rare and challenging condition underlines the importance of early detection of cancer and multidisciplinary team input.

The clinical characteristics of patients with primary non-prostate-specific membrane antigen-expressing prostate cancer on preoperative positron emission tomography/computed tomography.

Prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT) is a modern imaging tool used in the diagnosis of prostate cancer (PCa). Approximately 10% of patients who underwent PSMA PET/CT have a biopsy-proven, primary PCa without PSMA expression on PET/CT (non-PSMAPET -expressing PCa), according to a recent systematic review[1]. However, the definition of non-PSMAPET -expression in these studies was poorly defined and no immunohistochemical studies for confirmation of PSMA protein expression were performed. The aim of this retrospective study was to report the prevalence, characteristics, and immunohistochemical assessment of non-PSMAPET -expressing hormone-sensitive PCa in a cohort of 362 patients who underwent PSMA PET/CT and robot-assisted radical prostatectomy (RARP).