Recurrent Malignant Lesions Research Articles

Head‑to‑head assessment of [68Ga]Ga-DOTA-FAPI-04 PET/CT vs [18F]FDG PET/CT in fibroblastic tumors

ObjectivesWe aimed to evaluate [68Ga]Ga-DOTA-FAPI-04 versus [18F]FDG PET/CT in the application of fibroblastic tumors. MethodsTwenty participants with 6 subtypes of fibroblastic tumors prospectively underwent 18F-FDG and [68Ga]Ga-DOTA-FAPI-04 PET/CT examinations to evaluate the lesions. PET/CT findings were confirmed by surgical pathology of fifteen participants, puncture biopsy of two participants, or imaging follow-up of three participants. Two independent sample t tests were used to compare the uptake of [18F]FDG vs [68Ga]Ga-DOTA-FAPI-04 in primary, recurrent and metastatic lesions. One-way ANOVA was used to compare the uptake of [18F]FDG or [68Ga]Ga-DOTA-FAPI-04 among primary, recurrent, and metastatic lesions. The uptake of [68Ga]Ga-DOTA-FAPI-04 vs [18F]FDG in different histopathological lesions was compared by two independent sample t tests. ResultsTwenty participants were confirmed to have 38 lesions. Although there was no significant difference in the detection of lesions between [68Ga]Ga-DOTA-FAPI-04 and [18F]FDG PET/CT (38 vs 36, p = 0.493), the uptake of [68Ga]Ga-DOTA-FAPI-04 in lesions was significantly higher than that of [18F]FDG (p < 0.001), including primary (p < 0.001), recurrent (p = 0.018) and metastatic (p < 0.001) lesions. The SUVmax of [68Ga]Ga-DOTA-FAPI-04 in primary and recurrent lesions was higher than that in metastasis (p = 0.034 and p = 0.015, respectively). The SUVmax of [68Ga]Ga-DOTA-FAPI-04 in primary and recurrent malignant lesions was significantly higher than that of the intermediate (p < 0.001). The SUVmax of [68Ga]Ga-DOTA-FAPI-04 in one participant of recurrent SFT with 5 lesions was significantly lower after treatment than before treatment (p = 0.016). Conclusions[68Ga]Ga-DOTA-FAPI-04 outperformed [18F]FDG PET/CT in displaying the primary, recurrent and metastatic lesions of fibroblastic tumors.

Assessment of Suspected Breast Lesions in Early-Stage Triple-Negative Breast Cancer during Follow-Up after Breast-Conserving Surgery Using Multiparametric MRI.

Background The local recurrence rate of triple-negative breast cancer (TNBC) can be as high as 12%.The standard treatment for early-stage TNBC is breast-conserving surgery (BCS), followed by postoperative radiotherapy with or without chemotherapy. However, detection of the local recurrence of the disease after radiotherapy is a major issue. Objective The aim of this study was at investigating the role of dynamic and functional magnetic resonance imaging (MRI) during follow-up after BCS and radiotherapy with/without chemotherapy to differentiate between locoregional recurrence and postoperative fibrosis. Patients and Methods. This prospective study was conducted at the oncology, radiology, and pathology departments, Tanta University. It involved 50 patients with early-stage TNBC who were treated with BCS, followed by radiotherapy with/without chemotherapy. The suspected lesions were evaluated during the follow-up period by sonomammography. All patients were subjected to MRI, including conventional sequences, diffusion-weighted imaging (DWI), and dynamic postcontrast study. Results Ten cases were confirmed as recurrent malignant lesions. After contrast administration, they all exhibited irregular T1 hypodense lesions of variable morphology with diffusion restriction and positive enhancement. Eight cases displayed a type III curve, while two showed a type II curve. Histopathological assessment was consistent with the MRI findings in all eight cases. The combination of the data produced by DWI-MRI and dynamic contrast-enhanced (DCE) MRI resulted in 100%sensitivity, 92.5% specificity, 90.9% positive predictive value, 100% negative predictive value, and 98% accuracy. Conclusion Combination of DWI-MRI and DCE-MRI could have high diagnostic value for evaluating postoperative changes in patients with TNBC after BCS, followed by radiotherapy with/without chemotherapy. Trial Registrations. No trial to be registered.

Risk factors for 30-day readmissions in patients with tumor lysis syndrome and solid malignancies: Analysis from the National Readmission Database.

e18863 Background: Tumor lysis syndrome (TLS) is a well-known potentially fatal complication of chemotherapy and an oncologic emergency. It is most prevalent in hematologic malignancies, but there are case reports and clinical series of occurrence after the treatment of solid tumors. Hospital readmissions are indicators of quality of care and cost control. We aim to look at the prevalence of readmissions after an initial episode of TLS in patients with solid malignancies and their financial burden on the United States healthcare system. Methods: We conducted a retrospective analysis of the 2017 National Readmission Database (NRD) of adult patients readmitted within 30 days after an initial “index” admission of TLS (ICD10 code E88.3) with a concomitant diagnosis of solid malignancy. We aimed to identify the 30-day readmission rate, mortality, healthcare-related utilization resources, and independent predictors of readmission by performing a COX regression analysis. Results: A total of 874 patients with solid tumors were admitted with TLS in 2017. The 30-day readmission rate was 20.4%. The main causes for readmission were sepsis, recurrent malignant lesions, metastasis to CNS, bleeding, acute kidney failure (AKI). Compared to initial admissions, readmitted patients were less likely to have acute kidney failure (AKI) (64.6% vs 30.8%; P &lt; 0.01), less likely to require mechanical ventilation (17.9% vs 5.7%; P &lt; 0.01), less likely to suffer shock (7.3% vs 2.3%; P = 0.03) and ileus (4.8% vs 0.7%; P = 0.04). Readmission was associated with higher in-hospital mortality rate (0.1% vs. 1.5%; P &lt; 0.01), more likely to have private insurance (29.9% vs 36.1%; P &lt; 0.01), and more likely to be discharged home (26.2% vs 36.8%; P &lt; 0.01). The total health care in-hospital economic burden of readmission was $14.9 million in total charges to patients and $4 million in total costs for hospitals. Independent predictors of readmission were prolonged length of stay (during index admission), tobacco abuse, VTE, thrombocytopenia, and admission to an urban hospital. We identified the following preventive factors for readmission: radiation therapy, admission to a smaller hospital, total parenteral nutrition during the index admission and a primary gynecologic malignancy. Conclusions: Readmissions after TLS in patients with solid malignancy are associated with a higher in-hospital mortality rate and pose an increased health care burden. We identified risk factors that, if targeted, could lead to reducing readmissions, health care burden, and patient morbidity.

Diffusely Decreased Liver Uptake on FDG PET and Cancer-Associated Cachexia With Reduced Survival.

We investigated clinical characteristics of patients with extremely increased or decreased physiologic F-FDG uptake of the liver and their prognosis. One thousand four hundred eighty-seven PET/CT scans of patients with known or suspected malignancy were retrospectively analyzed. A spherical volume of interest (3 cm in diameter) was set on the right lobe of the liver to calculate the SUVmean. Scans with extremely high (SUVmean >97.5th percentile) and low (SUVmean <2.5th percentile) FDG uptake in the liver were evaluated. Physical and laboratory data among a control group (n = 30), the extremely high liver uptake group (HG, n = 36), and the extremely low liver uptake group (LG, n = 36) were compared. Overall survival (OS) of the 3 groups was also compared. Body weight and body mass index in the HG (SUVmean ≥3.04) were significantly higher than those in the control group. The LG cases (SUVmean ≤1.78) had anemia, impaired liver function, and systemic inflammation. They were also in a poor nutritional state. The characteristics of LG cases had many things in common with those of cachectic patients. Indeed, 36.1% of LG cases met the diagnostic criteria for cachexia. Moreover, in LG cases with viable and/or recurrent malignant lesions on FDG PET, the proportion of cachexia increased by 52.6%. The OS of LG cases (median, 33 months) was significantly worse than that of controls and HG cases. Our data indicate that cancer patients with extremely decreased liver FDG uptake were likely to have cancer cachexia and a lower OS.

The Influence of Liver Resection on Intrahepatic Tumor Growth.

The high incidence of tumor recurrence after resection of metastatic liver lesions remains an unsolved problem. Small tumor cell deposits, which are not detectable by routine clinical imaging, may be stimulated by hepatic regeneration factors after liver resection. It is not entirely clear, however, which factors are crucial for tumor recurrence. The presented mouse model may be useful to explore the mechanisms that play a role in the development of recurrent malignant lesions after liver resection. The model combines the easy-to-perform and reproducible techniques of defined amounts of liver tissue removal and tumor induction (by injection) in mice. The animals were treated with either a single laparotomy, a 30% liver resection, or a 70% liver resection. All animals subsequently received a tumor cell injection into the remaining liver tissue. After two weeks of observation, the livers and tumors were evaluated for size and weight and examined by immunohistochemistry. After a 70% liver resection, the tumor volume and weight were significantly increased compared to a laparotomy alone (p <0.05). In addition, immunohistochemistry (Ki67) showed an increased tumor proliferation rate in the resection group (p <0.05). These findings demonstrate the influence of hepatic regeneration mechanisms on intrahepatic tumor growth. Combined with methods like histological workup or RNA analysis, the described mouse model could serve as foundation for a close examination of different factors involved in tumor growth and metastatic disease recurrence within the liver. A considerable number of variables like the length of postoperative observation, the cell line used for injection or the timing of injection and liver resection offer multiple angles when exploring a specific question in the context of post-hepatectomy metastases. The limitations of this procedure are the authorization to perform the procedure on animals, access to an appropriate animal testing facility and acquisition of certain equipment.

Application of whole-body MRI to detect the recurrence of lung cancer

Although some therapeutics provide an opportunity for cure, recurrence is a major obstacle to achieve a complete remission for lung cancers. Therefore, precise assessment of lung cancers has been a task with challenge. In recent years, integration of positron emission tomography and computed tomography (PET–CT) and whole-body magnetic resonance imaging (WB-MRI) have been introduced as an alternative to standard multimodality imaging strategies and are now increasingly applied to various malignancies. However, there is little information on the surveillance capability of WB-MRI in patients with lung cancers. We aimed to investigate the clinical potential of WB-MRI as a novel surveillance modality after curative treatments for lung cancers, comparing it with PET–CT. Sixty two consecutive patients with lung malignancy who underwent both WB-MRI and PET–CT were selected to assess the recurrent malignant lesions. The clinical data including radiologic and pathologic findings were collected and analyzed retrospectively. On each lymph node station, the ability of WB-MRI to detect malignant lesions significantly correlated with that of PET–CT (γ=0.86; P<.01). The correlation coefficient ranged from 0.999 to 1 for assessing distant metastases from lung cancers by two modalities (P<.01). Based on the pathologic confirmation, both modalities showed an equivalent diagnostic accuracy (PET–CT: sensitivity 85.71%, specificity 47.27% versus WB-MRI: sensitivity 85.71%, specificity 56.25%). This study demonstrates the clinical potential of WB-MRI, together with PET–CT, as a novel surveillance modality for lung cancers after curative treatments.

Análise computacional da textura de tumores de mama em imagens por ultrassom de pacientes submetidas a cirurgia conservadora

OBJETIVO: Avaliar as características de textura de lesões de mama em imagens por ultrassom de pacientes submetidas a cirurgia conservadora que apresentaram, ou não, recidiva. MATERIAIS E MÉTODOS: As imagens de ultrassom de 36 pacientes submetidas a cirurgia conservadora, com 12 tendo apresentado recidiva local e 24 que não apresentaram recidiva no local da cirurgia, foram divididas em: 3 malignas na mama oposta, 7 nódulos benignos, 5 hiperplasias atípicas e 9 alterações fibrocísticas. A textura das lesões foi quantificada utilizando-se dez parâmetros calculados da matriz de coocorrência e da curva de complexidade. Análise discriminante linear foi aplicada aos parâmetros para discriminação de lesões de mama em pacientes submetidas a cirurgia conservadora que apresentaram, ou não, recidiva. RESULTADOS: Avaliando-se a capacidade dos parâmetros em distinguir as recidivas do grupo composto por lesões não recidivas benignas e hiperplasias atípicas, obteve-se especificidade de 100%, com valores de acurácia e sensibilidade superiores a 91%. Num segundo teste, foi possível distinguir as cinco hiperplasias, das lesões não recidivas benignas. CONCLUSÃO: Apesar do número reduzido de casos, os resultados obtidos são encorajadores, sugerindo que o uso da quantificação da textura pode auxiliar na diferenciação entre lesões benignas, hiperplasias atípicas e lesões malignas de origem recidiva.

Skin cancer: preventive photodynamic therapy in patients with face and scalp cancerization. A randomized placebo-controlled study

Background Patients with a previous medical history of nonmelanoma skin cancers (NMSCs) often develop multiple or recurrent malignant lesions around the site of the primary tumour. This finding led to the field cancerization theory, which suggests that the entire epithelial surface of the regional skin has an increased risk for the development of malignant lesions. Management of field change is challenging, taking into account the high impact of NMSCs on public health and healthcare costs. Objectives We sought to investigate whether field-photodynamic therapy (PDT) of extreme photodamaged skin would prevent new NMSCs, in comparison with a control area receiving placebo-PDT, in patients with clinical and histological signs of field cancerization. Methods Forty-five patients, previously diagnosed as having NMSCs of the face or scalp, with actinic keratoses symmetrically distributed over the same regions, were randomized for field treatment with 20% aminolaevulinic acid (ALA)-PDT on one side and placebo-PDT on the other. During the next 12-month period of follow up, patients were clinically evaluated for new NMSCs. Results A significant delay in the mean time of appearance and a reduction in the total number of new lesions were observed in the field-PDT protocol, when compared with the control. Conclusions The results obtained showed that field therapy with ALA-PDT confers a significant preventive potential against the formation of new NMSCs in patients with field changes.

Hydrogen-1 MR Spectroscopy of the Peritumoral Zone in Patients with Cerebral Glioma: Assessment of the Value of the Method

Rationale and Objectives The determination of tumor boundaries, especially in high-grade glioma, is critically important for the proper planning of treatment, but the standard diagnostic imaging methods do not enable precise delimitation of the extent of tumor cell infiltration into the surrounding tissue. The objective of this study was to assess the usefulness of hydrogen-1 (H-1) magnetic resonance (MR) spectroscopy for determining the extent of gliomatous infiltrate in the “uncertain zone”—the peritumoral area that appears unchanged on standard diagnostic MR images. Materials and Methods The study group consisted of 64 patients with cerebral glioma scheduled for tumor resection and subsequent radiation therapy. All patients were examined prior to resection with MR imaging and MR spectroscopy. MR spectra were obtained from examination of the solid part of the tumor and from two peritumoral volumes of interest located approximately along the axis of surgical access to the tumor. MR spectra obtained from a group of 32 healthy volunteers were used as control data. Results Analysis of the consequent voxels in the peritumoral zone revealed statistically significant differences in lipid/creatine and lactate/creatine metabolite ratios between patient subgroups with recurrent malignant lesions and without recurrent lesions. Significant differences also were found between the patient group and the control group in most metabolite ratios assessed. Conclusion H-1 MR spectroscopic demonstration of metabolic changes in the peritumoral zone can guide treatment for cerebral glioma, enabling the physician to identify patients who have a high risk of recurrence.

Exploración de ganglios regionales en carcinoma de pene mediante gammagrafía con 99mTc-MIBI

99mTc-MIBI scintigraphy has proven utility as a clinically valuable technique for the diagnosis of various primary and recurrent malignant lesions. We report the case of a 65 year old man with penile squamous cell carcinoma and clinically questionable bilateral inguinal lymph nodes. 99mTc-MIBI scan shows increased focal uptake in both groins and in the right iliac region. The patient underwent penile amputation with bilateral lymphadenectomy. Histopathologic report revealed metastatic lymph nodes in all lymphatic basins seen with 99mTc-MIBI. We conclude that this technique has the potential of supplying clinically relevant information for the diagnosis of regional extension of patients with penile carcinoma.

Doppler evaluation in gynecological tumor recurrences

Diagnosis of recurrent malignant disease in the abdomen and in the pelvis is a challenging problem. Because the survival of patients with disease recurrence is improved only in patients with small recurrent lesions, the detection of recurrences at a very early stage is of great importance. Clinical examination and tumor markers are used for the follow up of oncological patients; however, their diagnostic value is not very reliable. Computed tomography (CT) and magnetic resonance (MR) have been studied extensively and their diagnostic accuracy varies from 50 to 84%. Transrectal ultrasound has been used in monitoring recurrent female cancer with a diagnostic accuracy of 90.5% for pelvic lesions. However the ultrasound approach cannot be used to differentiate between radiation fibrosis and recurrent malignancy on the basis of tissue appearance. Color Doppler examination was proposed in the management of patients treated for rectal tumor. The aim of our study was to evaluate the ultrasound diagnostic accuracy in the detection of recurrent gynecological disease in a group of 350 patients, followed up every 3–6 months at our Department after surgical treatment of a pelvic gynecological malignancy. The ultrasound data have been compared to clinical examination, tumor markers and instrumental tools such as CT and MR. The usefulness of color Doppler velocimetry in the examination of recurrent malignant lesions has been analyzed. In a selected group of patients with small‐sized pelvic masses located in the central region of the pelvis, color Doppler analysis was able to differentiate recurrent vs. benign lesions.

Expression of epidermal growth factor receptor (EGFR) in non-affected and tumorous mammary tissue of female dogs

Epidermal growth factor (EGFR), oestrogen (ER), and progestin (PR) receptor concentrations were determined by radioligand binding assay in non-affected mammary tissues (n = 13) and benign (n = 11) and primary/locally recurrent malignant proliferative mammary lesions (n = 45) and metastases (n = 19) in 65 female dogs. The number of specimens expressing EGFR was not significantly different among these tissues, but EGFR concentration was lower in metastases (P = 0.02) than in benign or primary/locally recurrent malignant lesions not mixed with non-affected mammary tissue. The presence of non-affected mammary tissue in primary cancer specimens was noticed as a factor that may influence results of receptor measurements. No relation was found between the expression of EGFR and that of ER or PR in non-affected or in tumorous mammary tissues. It was concluded that in the dog mammary gland EGFR expression is not associated with conditions of steroid receptor absence of biological agressiveness of neoplastic growth.

Cancer detection with whole-body PET using 2-[18F]fluoro-2-deoxy-D-glucose.

This study was done to determine the feasibility and potential utility of whole-body PET using the glucose analogue 2-[18F]fluoro-2-deoxy-D-glucose (FDG) for the detection of primary malignancies and metastatic lesions. This was a prospective, nonrandomized study of whole-body FDG-PET imaging carried out at a large university teaching hospital in Los Angeles, CA, U.S.A. The study group consisted of all patients referred for PET imaging (87) with a suspected diagnosis of primary or recurrent malignancy and who had eventual histological confirmation of their lesions. In the 87 patients, whole-body PET studies were positive (presence of focal FDG uptake relative to surrounding tissues uptake) in 61 of 70 patients (87%) with subsequent biopsy-confirmed primary or recurrent malignant lesions, including carcinomas of breast, lung, ovary, prostate, colon, urinary bladder, and gallbladder origin, as well as malignant melanoma, carcinoid, osteosarcoma, lymphoma, and spinal cord astrocytoma. The PET images revealed no focal hypermetabolism at the known site of tumor in patients with primary prostate carcinoma (two), microscopic ovarian carcinoma (two), breast carcinoma (one), low-grade carcinoid tumors (two), and one patient with recurrent microscopic osteogenic sarcoma. The PET studies detected the primary lesion in 15 of 17 patients with breast carcinoma and in 6 of 6 patients with primary lung carcinoma. Of the 17 patients with benign biopsies, 13 patients had FDG-PET studies without focal areas of uptake. Because of the high glycolytic rate of malignant tissue, the whole-body FDG-PET technique has promise in the detection of a wide variety of both primary and metastatic malignancies. The presence of FDG uptake in benign inflammatory conditions may limit the specificity of the technique. The sensitivity for the detection of malignant lesions was 87% and the positive predictive value was 94%. The whole-body FDG-PET method is promising both in determining the nature of a localized lesion and in defining the systemic extent of malignant disease.

Advances in Gynecologic Imaging and Intervention

Advances in diagnostic imaging of the female genital tract facilitate characterization of many pelvic masses. Preoperative assessment of gynecologic malignant tumors provides information that may alter the surgical approach or timing of radiation therapy. Image-guided biopsy accurately confirms recurrent malignant lesions. Transcervical techniques have improved diagnostic assessment of infertile couples; thus, effective and inexpensive treatment options can be offered. Postoperative complications of gynecologic procedures can be detected with imaging, and many can be treated with image-guided techniques.

Vermilionectomy for Lower Lip Leukoplakia

A method for excision of lower lip leukoplakia is described. Utilization of the Johns Hopkins bull dog vascular clamp to obtain hemostasis simplifies the procedure and shortens the operative time. The absence of recurrent malignant lesions heads the list of advantages of vermilionectomy as compared with other methods of treatment for this condition.

Radiation—Excision

<h3>To the Editor:—</h3> The attention of the Cincinnati Dermatological Society, consisting of 45 diplomates of the American Board of Dermatology, has been directed to the news item, "Radiotherapy Belongs to History." The Society believes that the author's statements regarding poor results and recurrences following x-ray therapy for skin cancers are open to question. He also implies that dermatologists and radiotherapists are inadequate in the management of radiation therapy for carcinomas. He consigns radiotherapy to the scrap heap when radiotherapy itself is not to blame but rather the improper use of this modality in the treatment of skin cancers. The results that he quotes are certainly not substantiated by any statistical results that can be found in this country and certainly his estimate of 39% recurrent malignant lesions estimated by some workers is in no way comparable to the results of radiation therapy in this country, where the cure rate is

Lesions of the vaginal vault following complete hysterectomy

Benign and recurrent malignant lesions occur in the vaginal scar line following complete hysterectomy. The incidence, with the exception of granulation tissue, is low.Eight cases are reported, two with benign lesions and six with recurrent malignant lesions in the vaginal scar.The appearance of granulation tissue varies; it may be an elevated red nodule, or it may be similar to an ulcer of the vaginal mucous membrane. In like manner malignant recurrence in the vaginal scar may assume one of the above forms. The importance of correct diagnosis is emphasized.Prolapse of a portion of the oviduct or some portion of the bowel is observed only after vaginal hysterectomy and not after abdominal hysterectomy. Oviduct prolapse is not a serious complication and requires only the correct diagnosis to institute the simple treatment necessary. In contradistinction, prolapse of bowel through the vaginal wound is serious and requires more radical treatment.Malignant lesions may recur in the vaginal scar by implantation of viable cells, by direct extension, or by lymphatic or vascular extension.Biopsy is a necessary procedure in the differential diagnosis of these various lesions.