Suspicious Recurrence Research Articles

Gasless trans-axillary endoscopic versus conventional open hemithyroidectomy for thyroid cancer patients: A propensity score-matched analysis of quality of life and oncological outcomes: A cross-sectional questionnaire study

BackgroundThyroid cancer predominantly affects young females who seek surgical intervention not only for excellent oncological outcomes but also for a high quality of life (QOL) and favorable cosmetic and functional outcomes. The gasless trans-axillary endoscopic (GTAE) approach is a commonly used remote access technique for thyroid surgeries. It holds the potential for comparable oncological outcomes and superior QOL, cosmetic, and functional outcomes. However, robust evidence supporting this hypothesis is scarce. Materials and MethodsWe collected data from patients diagnosed with papillary thyroid carcinoma who underwent hemithyroidectomy with central compartment dissection at Peking Union Medical College Hospital (PUMCH) between December 2019 and January 2023. After applying propensity-score matching analysis (PSMA), a total of 424 cases were included. For oncological outcomes, patients in both groups were prospectively followed through regular outpatient visits. The QOL, functional, and cosmetic outcomes were assessed using a cross-sectional online questionnaire, including EORTC-THY34 for QOL, PSAQ for cosmetic outcomes, SIS-6 for swallowing functions, and VHI-10 for voicing functions. We further compared oncological outcomes, QOL, functional, and cosmetic outcomes between these two groups. ResultsA total of 274 cases provided validated responses: 141 underwent the GTAE approach, and 134 underwent the conventional open (CO) approach. The operation time was approximately 60 minutes longer in the GTAE group. Notably, there was no difference in complications between the two approaches. Rates of suspicious recurrence in both groups remained low and showed no significant differences (2.55% vs. 1.57%, p>0.05). No pathological confirmed recurrence was reported in either group. Patients with the GTAE approach showed better body image and less joint pain (EORTC-THY34), better swallowing (SIS-6), and better cosmetic outcomes (PSAQ). Voice outcomes showed no difference between these two approaches (VHI-10). ConclusionCompared to the CO approach, hemithyroidectomy with central compartment dissection via the GTAE approach in low-risk patients maintains comparable oncological outcomes while offering better QOL, cosmetic benefits, and functional outcomes.

Clinicopathological characteristics and typing of multilocular cystic renal neoplasm of low malignant potential.

Up until now, no research has been reported on the association between the clinical growth rate of multilocular cystic renal neoplasm of low malignant potential (MCRNLMP) and computed tomography (CT) imaging characteristics. Our study sought to examine the correlation between them, with the objective of distinguishing unique features of MCRNLMP from renal cysts and exploring effective management strategies. To investigate optimal management strategies of MCRNLMP. We retrospectively collected and analyzed data from 1520 patients, comprising 1444 with renal cysts and 76 with MCRNLMP, who underwent renal cyst decompression, radical nephrectomy, or nephron-sparing surgery for renal cystic disease between January 2013 and December 2021 at our institution. Detection of MCRNLMP utilized the Bosniak classification for imaging and the 2016 World Health Organization criteria for clinical pathology. Our meticulous exploration has revealed compelling findings on the occurrence of MCRNLMP. Precisely, it comprises 1.48% of all cases involving simple renal cysts, 5.26% of those with complex renal cysts, and a noteworthy 12.11% of renal tumors coexisting with renal cysts, indicating a statistically significant difference (P = 0.001). Moreover, MCRNLMP constituted a significant 22.37% of the patient population whose cysts demonstrated a rapid growth rate of ≥ 2.0 cm/year, whereas it only represented 0.66% among those with a growth rate below 2.0 cm/year. Of the 76 MCRNLMP cases studied, none of the nine patients who underwent subsequent nephron-sparing surgery or radical nephrectomy following renal cyst decompression experienced recurrence or metastasis. In the remaining 67 patients, who were actively monitored over a 3-year postoperative period, only one showed suspicious recurrence on CT scans. MCRNLMP can be tentatively identified and categorized into three types based on CT scanning and growth rate indicators. In treating MCRNLMP, partial nephrectomy is preferred, while radical nephrectomy should be minimized. After surgery, active monitoring is advisable to prevent unnecessary nephrectomy.

A 5-year follow-up study on the efficacy and safety of ultrasound-guided laser ablation in elderly patients with papillary thyroid microcarcinoma: A retrospective, single-center study from China.

The aim of this study is to evaluate the long-term efficacy and safety of ultrasound-guided percutaneous laser ablation (PLA) for the treatment of elderly patients with papillary thyroid microcarcinoma (PTMC). From September 2015 to April 2017, 38 elderly patients with PTMC confirmed through fine-needle aspiration biopsy (FNAB) were treated with PLA. Before the treatment, the location and volume of the nodule together with the patients' symptoms were evaluated. Twenty-four hours after the treatment, contrast-enhanced ultrasound (CEUS) was performed to evaluate the completeness of the ablation. To evaluate the volume of the ablation area and recurrence or metastasis, ultrasound examination was performed at 1, 3, 6, and 12 months after the treatment and every 6 months thereafter. FNAB was performed for any suspicious recurrence or metastasis lesions. The ablation of all the 38 patients was all achieved completely as confirmed by CEUS. No obvious complications were found. The success rate of single ablation was 100%. The average follow-up time was 64.58 ± 5.29 months (60-78 months). By the time of the last follow-up, 31 (81.58%) ablation lesions disappeared completely and seven (18.42%) ablation lesions showed scar-like changes. The volume of nodules was 40.69 ± 16.45 mm3 before operation, which decreased to 0.22 ± 0.76 mm3 by the end of 42 months, and all nodules disappeared 4 years after ablation (P < 0.01). At 6, 12, 18, 24, 30, 36, and 42 months after ablation, the average volume reduction rates (VRRs) were 12.09%, 31.21%, 50.9%, 72.06%, 84.79%, 95.65%, and 100%, respectively. Of all the patients enrolled, one patient (2.6%) had local recurrence and was treated with PLA again. No regrowth of treated nodule or lymph node metastasis and distant metastases was detected. Ultrasound-guided PLA is effective and safe for the treatment of elderly patients with PTMC who are ineligible for surgery.

NIMG-28. PROSPECTIVE HISTOPATHOLOGY-VALIDATED MACHINE LEARNING FOR DISTINGUISHING TRUE PROGRESSION FROM TREATMENT-RELATED CHANGES IN GLIOBLASTOMA PATIENTS

Abstract PURPOSE Decision making about the best course of treatment for glioblastoma patients becomes challenging when a new enhancing lesion appears in the vicinity of the surgical bed on follow-up MRI (after maximal safe tumor resection and chemoradiation), raising concerns for tumor progression (TP). Literature indicates 30-50% of these new lesions describe primarily treatment-related changes (TRC). We hypothesize that quantitative analysis of specific and sensitive features extracted from multi-parametric MRI (mpMRI) via machine learning (ML) techniques may yield non-invasive imaging signatures that distinguish TP from TRC and facilitate better treatment personalization. METHODS We have generated an ML model on a retrospective cohort of 58 subjects, and prospectively evaluated on an independent cohort of 58 previously unseen patients who underwent second resection for suspicious recurrence and had availability of advanced mpMRI (T1, T1-Gd, T2, T2-FLAIR, DTI, DSC). The features selected by our retrospective model, representing principal components analysis of intensity distributions, morphological, statistical, and texture descriptors, were extracted from the mpMRI of the prospective cohort. Integration of these features revealed signatures distinguishing between TP, mixed response, and TRC. Independently, a board-certified neuropathologist evaluated the resected tissue by blindly classifying it in the above three categories, based on mitotic figures, pseudopalisading necrosis, geographic necrosis, dystrophic calcification, vascular changes, and Ki67. RESULTS Tissues classified as TRC by the neuropathologist were associated with imaging phenotypes of lower angiogenesis (DSC-derived features), lower cellularity (DTI-derived features), and higher water concentration (T2, T2-FLAIR features). Our ML model characterized TP with 78% accuracy (sensitivity:86%, specificity:70%, AUC:0.80 (95%CI, 0.68-0.92)) and TRC with 81% accuracy (sensitivity:80%, specificity:81%, AUC:0.87 (95%CI, 0.72-1.00)). CONCLUSION Our proposed ML model reveals distinct non-invasive markers of TP and TRC, directly associated with histopathological changes in prospective glioblastoma patients. Reliable stratification of TP and TRC entities may help to noninvasively determine whether the course of treatment should change.

Detection of Recurrent Cervical Cancer and Prediction of Its Patient Survival with Serum Squamous-Cell Carcinoma-Antigen and 2-[18F] Fluoro-2-Deoxy-d-Glucose-Positron Emission Tomography/Computed Tomography.

Aim: To evaluate the usefulness of serum squamous-cell carcinoma antigen (SCC-Ag) and 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) for the detection of recurrent squamous-cell carcinoma (SqCC) of the uterine cervix, and its prediction of patient survival. Methods: FDG-PET/CT was performed for patients with serum SCC-Ag levels elevated to ≥1.5 ng/mL (Group 1) and those with suspicious recurrences without any increase in serum SCC-Ag levels (Group 2). The results were analyzed on the basis of histological data, disease progression and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 6 months of FDG-PET/CT. The outcome was determined using medical records. Results: In total, 88 consecutive patients with cervical SqCC cancer with suspected recurrence (62 in Group 1 and 26 in Group 2) were enrolled. Recurrences were observed in 55 patients (77.4% (48/62) in Group 1 vs. 26.9% (7/26) in Group 2, p < 0.001). The overall sensitivity, specificity and accuracy of serum SCC-Ag were 87.3%, 57.6% and 76.1%, respectively, and those of FDG-PET/CT were 98.2%, 90.9% and 95.5%, respectively; the corresponding values were 97.9%, 92.9% and 96.8% for Group 1 and 100%, 89.5% and 92.3% for Group 2. Surgical resection was performed for 16 patients. At the end of the study, 40.3% (25/62) of Group 1 patients and 88.5% (23/26) of Group 2 patients were alive (p < 0.001). The survival of patients who underwent surgical resection for recurrent tumors was higher than that of patients who did not undergo resection (62.5% (10/16) vs. 17.9% (7/39), p = 0.001). Metabolic tumor volume (MTV) and total lesion glycolysis (TLG) derived from FDG-PET/CT showed significantly different in-patient survival. Conclusions: Serum SCC-Ag could predict tumor recurrence and the survival of patients with SqCC cervical cancer. As such, the surgical resection of limited recurrent disease, as determined using FDG-PET/CT, might improve the survival of patients with cervical cancer. MTV and TLG may serve as a prognostic biomarker of survival in patients with recurrent cervical cancer.

Magseed localisation for loco-regional breast and lymph node recurrences: Placement prior to chemotherapy to allow focused removal of the initially diseased tissue.

e12610 Background: Multi-disciplinary meeting decisions may suggest chemotherapy prior to surgery. Prior to chemotherapy, localisation of the diseased tissue is important to ensure accurate retrieval. Magseed is induced to become a magnet when used in conjunction with a detector. The aim of this study was to assess the accuracy of placement, retrieval, and localisation of a Magseed into a radiologically suspicious loco-regional recurrence in patients requiring chemotherapy. Methods: Patients with loco-regional recurrence that had been assessed in the multidisciplinary meeting as requiring chemotherapy, as well as being potential candidates for surgery post-chemotherapy, were referred for placement of a Magseed prior to commencing chemotherapy or during treatment. The seed was placed by a senior radiologist in the unit. Ten patients have currently completed chemotherapy and surgery. Two patients had more than one Magseed placed. Giving a total seed placement number of 14 seeds. Results: Seed localisation with the Sentimag probe was successful in all cases at 100% localisation, however the retrieval rate was less at 93% due to a case where a lymph node underwent fibrosis. The maximum number of days between the seed placement and surgery was 249 days. Conclusions: Magseed is successful and accurate in localising and retrieving loco-regional recurrences in patients requiring surgery post chemotherapy. Retrieval is possible due to high recordings on the sensor in all cases. Magseed thus provides the treating clinician with an alternative to conventional radiological markers with the added benefit of a single placement to retrieval methodology.

Prognostic parameters in recurrent colorectal cancer: A role of control or restaging by FDG-PET/CT

Background/Aim. Colorectal cancer ranks the third most frequent cancer in the world. Approximately 40% of the disease recurs after surgical resection. Determination of predictive parameters for recurrence may help in stratification of patients and contribute to patient management. There are still very few studies which sought factors to predict the recurrence of colorectal cancer. The aim of this study was to examine the predefined risk factors in metastatic development and evaluate clinical significance of 18Ffluorodeoxyglucose (FDG) uptake. Methods. The study was conducted with 56 patients for whom FDG-PET/CT (FDG-positron emission tomography/computed tomography) was requested for the suspicious recurrence or metastasis by routine conventional screening tests. Thirty three patients in whom recurrence/metastases were established with final histopathologic diagnosis formed the malignant group, and 23 patients with no recurrence/metastases formed the benign group. Risk factors [age, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (Ca 19-9) levels, the maximum standardized uptake volume (SUVmax), tumor size (TS), CT/magnetic resonance imaging (MRI) findings, sex, primary tumor localization, lymphovascular invasion, perineural invasion (PNI), initial neoadjuvant therapy, lymph node initial metastasis (ILNM) excision, stage, tumor differentiation] were compared between these groups. Results. CEA, Ca 19-9, SUVmax, TS, PNI, ILNM, FDG uptake pattern, pattern of lesions on CT and tumor differentiation were found statistically significant by univariate analysis. After multivariate analysis, SUVmax and ILNM remained as the main risk parameters impacting recurrence/metastases. Mean SUVmax was 7.25 in the benign group, while it was 11.7 in the malignant group (p = 0.019). ILNM was present in 66.5% of patients in the malignant group, and in 30.5% of patients in the benign group (p = 0.015). For an estimated cut-off value of 6.3 and 12.5, respectively on ROC curve, the calculated specificities were 61% and 87%, respectively. Conclusion. ILNM and SUVmax are the main risk factors for recurrence of colorectal cancer and the patients with these factors must be followed up carefully. FDG-PET/CT is very sensitive for the detection of recurrence/metastases of colorectal cancer and SUVmax appears to improve its specificity.

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

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

Clinical value of delayed 18F-FDG PET/CT imaging after diuresis in male patients with locally recurrent rectal cancer

Objective To explore the diagnostic value of delayed 18F-FDG PET/CT pelvic imaging after forced diuresis in detecting male patients with locally recurrent rectal cancer. Methods Thirty-two male patients (32-79 years) with clinically suspicious recurrences of rectal cancer were retrospectively analyzed. All patients underwent a standard 18F-FDG PET/CT followed by a delayed pelvic imaging after 2.5 h of administration of 20 mg furosemide intravenously and extra water intake of 500 ml at least. Final diagnosis was made by pathology or clinical follow-up (>10 months). Diagnostic efficiency of 18F-FDG PET/CT standard and delayed pelvic images were calculated and compared. χ2 test was used for data analysis. Results A total of 25 patients were diagnosed with recurrent rectal cancer, including 10 cases with invasion of surrounding tissue, and 5 cases with metastases. Among the 7 patients without local recurrences, 2 had distant metastases. The sensitivity, specificity, and accuracy of standard FDG PET/CT were 92.0%(23/25), 3/7, 81.2%(26/32), respectively. The corresponding values of the delayed imaging were 96.0%(24/25), 6/7, and 93.8%(30/32), respectively. The specificity of delayed imaging was higher than that of standard FDG PET/CT (χ2=14.333, P 0.05). The urinary bladder activity reached or approached the background during the delayed imaging. Twenty-two malignant lesions of surrounding invasion were confirmed. The positive rate of delayed imaging was higher than that of standard FDG PET/CT: 95.5%(21/22) vs 63.6%(14/22); χ2=6.400, P<0.05. Conclusions 18F-FDG PET/CT delayed pelvic imaging after diuresis and hydration is useful for eliminating the artifacts from urinary bladder activity, and for detecting the invasion to the rectal surrounding tissue more effectively. It could be a supplement to standard FDG PET/CT. Key words: Rectal Neoplasms; Neoplasm recurrence, local; Diuresis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose

Role of 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography in the post-therapy surveillance of breast cancer.

PurposeTo evaluate the usefulness of 2-[18F] fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of breast cancer tumor recurrences and its role in post-therapy surveillance.MethodsFDG-PET/CT was performed on patients with increased serum CA 15-3 levels and/or clinical/radiologic suspicion of recurrence. A group of asymptomatic patients who underwent FDG-PET/CT in the post-therapy surveillance of breast cancer served as the controls. The results were analyzed based on the patients' histological data, other imaging modalities and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 12 months of the FDG-PET/CT scan.ResultsBased on elevated serum CA15-3 levels (n = 31) and clinical/radiologic suspicion (n = 40), 71 scans were performed due to suspected recurrence, whereas 69 scans were performed for asymptomatic follow-up. The sensitivity and specificity of FDG-PET/CT were 87.5% and 87.1% in the patients with suspected recurrence and 77.8% and 91.7% in the asymptomatic patients. The positive predictive value in the patients with suspected recurrence (mainly due to elevated serum CA 15-3 levels) was higher than that in asymptomatic patients (P = 0.013). Recurrences were proven in 56.3% (40/71) of the patients with suspected recurrence and in 13% (9/69) of the asymptomatic patients (P<0.001). FDG-PET/CT resulted in changes in the planned management in 49.3% (35/71) of the patients with suspected recurrence and 10.1% (7/69) of the asymptomatic patients (P<0.001). After follow-up, 77.5% (55/71) of the patients with suspicious recurrences and 97.1% (67/69) of the asymptomatic patients were surviving at the end of the study (P<0.001).ConclusionsFDG-PET/CT was able to detect recurrence, and the results altered the intended patient management in the post-therapy surveillance of breast cancer. FDG-PET/CT should be used as a priority in patients with increased serum CA 15-3 levels, or with clinical/radiologic suspicion of recurrence, and might be useful for asymptomatic patients.

Surveillance du cancer de l’endomètre

Available data on appropriate follow-up in endometrial cancer highlight the need of well-conducted studies. Most recurrences tend to occur within three years and involve symptoms. Routine tests are not advocated without symptoms. In case of suspicious recurrence, TEP/CT seems to be the most sensitive and specific method. There is limited evidence to decide whether follow-up schedules with multiple visits result in survival benefits. An appropriate follow-up should be discussed based upon the risk of recurrence. Counselling on the potential symptoms of recurrence should be a major aim.

FDG PET/CT Images Demonstrating Fournier Gangrene With Bilateral Pelvic Muscle Extension in a Patient With Recurrent Rectosigmoid Cancer

A 71-year-old male patient with Parkinsonism was referred for an F-FDG PET/CT scan for suspicious recurrence of rectosigmoid adenocarcinoma. The FDG PET/CT scan revealed increased FDG uptakes in the lower pelvic region around the wall of the rectal stump, with extension to the bilateral pelvic sidewalls and the right gluteous minimus muscle. In addition, multiple small air bubbles were noted in the lesions on the attenuation CT images. Fournier gangrene was diagnosed. After treatment with intravenous antibiotics and debridement with sigmoidoscopic irrigation, the patient was discharged and remained uneventful during clinical follow-up for 50 days.

Usefulness of magnetic resonance imaging-guided vacuum-assisted breast biopsy in Korean women: a pilot study

BackgroundMagnetic resonance imaging (MRI)-guided vacuum-assisted biopsy is the technique of choice for lesions that are visible only with breast MRI. The purpose of this study was to report our clinical experience with MRI-guided vacuum-assisted biopsy in Korean women.MethodsA total of 13 patients with 15 lesions for MRI-guided vacuum-assisted biopsy were prospectively entered into this study between September 2009 and November 2011. Biopsy samples were obtained in a 3-T magnet using a 9-guage MRI-compatible vacuum-assisted biopsy device. We evaluated clinical indications for biopsy, lesion characteristics on prebiopsy MRI, pathologic results, and postbiopsy complication status.ResultsThe clinical indications for MRI-guided vacuum-assisted biopsy were as follows: abnormalities in patients with interstitial mammoplasty on screening MRI (n = 10); preoperative evaluation of patients with a recently diagnosed cancer (n = 3); and suspicious recurrence on follow-up MRI after cancer surgery (n = 1) or chemotherapy (n = 1). All lesions have morphologic features suspicious or highly suggestive of malignancy by the American College of Radiology Breast Imaging Reporting and Data System category of MRI (C4a = 12, C4b = 2, C5 = 1). In two of the 15 lesions (13.3%, <6 mm), MRI-guided 9-gauge vacuum-assisted breast biopsy was deferred due to nonvisualization of the MRI findings that led to biopsy and the lesions were stable or disappeared on follow up so were considered benign. Of 13 biopsied lesions, pathology revealed four malignancies (4/13, 30.8%; mean size 15.5 mm) and nine benign lesions (9/13, 69.2%; size 14.2 mm). Immediate postprocedural hematoma (mean size 23.5 mm) was observed in eight out of 13 patients (61.5%) and was controlled conservatively.ConclusionsOur initial experience of MRI-guided vacuum-assisted biopsy showed a success rate of 86.7% and a cancer diagnosis rate of 30.8%, which was quite satisfactory. MRI-guided vacuum-assisted breast biopsy is a safe and effective tool for the workup of suspicious lesions seen on breast MRI alone without major complication. This biopsy may contribute to the early diagnosis of breast cancer in interstitial mammoplasty patients in Korea.

Detection of resectable recurrences in colorectal cancer patients with 2-[18F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography.

To evaluate the usefulness of 2-[(18)F]fluoro-2-deoxy-D-glucose-positron emission tomography/computed tomography (FDG-PET/CT) in the early detection of resectable recurrences of colorectal cancer (CRC) and the impacts on the clinical disease management. FDG-PET/CT was performed on patients with elevated serum carcinoembryonic antigen (CEA) levels >5 ng/mL (Group 1) or suspicious recurrences without rise in serum CEA levels (Group 2). The results were analyzed on the basis of histological data, disease progression, and/or clinical follow-up. Recurrence was defined as evidence of recurrent lesions within 6 months of the FDG-PET/CT scan. Resectable recurrences and changes in management were calculated based on medical records. In our study, 128 consecutive FDG-PET/CT analyses (n=49 in Group 1 and n=79 in Group 2) were performed on 96 recruited patients. Recurrences were proven in 63. The overall sensitivity, specificity, and accuracy of FDG-PET/CT were 98.4%, 89.2%, and 93.8%, respectively, and were 100%, 88.9%, and 95.9% in Group 1 and 96.9% and 89.4% and 92.4% in Group 2, respectively. Surgical resections were performed in 38.7% (12/31) of Group 1 patients and 53.1% (17/32) of Group 2 patients. FDG-PET/CT induced changes in planned management in 48.4% (62/128) of all patients, which included 63.3% (31/49) of Group 1 patients and 39.2% (31/79) of Group 2 patients (p=0.008). After a follow-up, 3.4% (1/29) of patients who underwent surgical resection of recurrent lesions and 34.3% (11/34) patients who did not undergo resection died at the end of study (p=0.004). The surgical resection of limited recurrent disease, as determined by FDG-PET/CT, improves the survival of CRC patients. FDG-PET/CT should be performed not only in patients with elevated serum CEA levels, but also in those in whom recurrences are suspected to improve the early detection of resectable disease.

Long-term Outcomes of Laparoscopic Totally Extraperitoneal Inguinal Herniorrhaphy

Purpose: Laparoscopic inguinal herniorrhaphy, especially laparoscopic TEP repair, has become a standard method of inguinal herniorrhaphy. Favorable short-term results of laparoscopic inguinal hernia repair, compared with open surgery, have been reported, however, data on the long-term outcome are limited. Based now on more than 55 months of follow-up, we report here on the long-term results for patients who underwent laparoscopic TEP inguinal hernia repair. Methods: Between January 2002 and December 2007, of patients who underwent laparoscopic TEP repair for an inguinal hernia by a single surgeon, 180 patients who have had a follow-up check with a physical examination or telephone interview were enrolled. Results: A total of 196 TEP procedures in 180 patients (age range 15∼88 years; men, 88.3%) were performed successfully without conversion to transabdominal preperitoneal (TAPP) or open surgery. During the follow-up period of more than 55 months (55∼120 months), chronic inguinal discomfort or pain was noted in 14 patients (n=14, 7.7% per patient or 7.1% per repair) and the severity of pain was mild (n=11), moderate (n=2), or severe (n=1). In most patients, occurrence of groin pain was very infrequent and the duration of the pain varied from a few seconds to a few minutes. There was one suspicious recurrence (0.5%), which was comparable to that of open surgery. Four cases of mesh infection (2.03%) were noted. Chronic mesh infection may be more frequent than previously reported. Otherwise, most of the patients were satisfied with their results. Conclusion: According to the long-term results of the study, laparoscopic TEP is a safe procedure for repair of inguinal hernia, with a low incidence of chronic pain and very low recurrence rate. However, among mesh-related complications, mesh infections have become increasingly important. For clinicians the possibility of mesh infection should be promptly considered in any patient who has undergone hernia surgery involving mesh, and who has any manifestations of abdominal wall.

Preliminary Results of Ongoing Phase II Study of Postoperative Intensity Modulated Radiation Therapy (IMRT) Combined With Capecitabine for High-risk Gastric Cancer Patients

Preliminary Results of Ongoing Phase II Study of Postoperative Intensity Modulated Radiation Therapy (IMRT) Combined With Capecitabine for High-risk Gastric Cancer Patients

Postradioiodine Treatment Whole-Body Scan in the Era of 18-Fluorodeoxyglucose Positron Emission Tomography for Differentiated Thyroid Carcinoma with Elevated Serum Thyroglobulin Levels

Patients with differentiated thyroid cancer (DTC) who have a suspicious recurrent or persistent disease based on an elevated serum thyroglobulin (Tg) or Tg antibodies (TgAb) are usually referred for empiric radioiodine ((131)I) administration to localize and treat the disease. The aim of this retrospective monocentric study was to assess the sensitivity of postempiric (131)I whole-body scan (WBS) compared to 18-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) in such patients who had an initial normal postablation WBS. Among 47 consecutive patients with DTC who had a normal postablation WBS and were referred for empiric (131)I administration, 34 patients (12M, 22F; mean age 53 years) underwent FDG PET/CT and form the basis of this report: 23 patients had persistently elevated serum Tg levels, 10 had elevated Tg levels observed during follow-up after they initially became under 1 ng/mL, and 1 had appearance of TgAb during follow-up. Postempiric (131)I WBS and FDG PET/CT were analyzed by independent readers. A total of 75 lesions were found in 23 patients, distributed in 36 organs. Lesions were located in the neck (30), lungs (28), mediastinum (11), and bones (6). The sensitivities for the detection of individual lesions and for the diagnosis of metastatic organs were 88% and 97% for PET/CT and 16% and 22% for WBS, respectively (p<0.01). PET/CT was abnormal in 22 patients, among which 5 also had an abnormal postempiric (131)I WBS. There was only one patient with an abnormal postempiric (131)I WBS and a normal FDG PET/CT. This patient underwent two further (131)I administrations, with the last WBS being normal and the last stimulated Tg level being undetectable. Other patients were either treated with surgery, or classified as radioactive iodine refractory and treated with levothyroxine suppressive therapy or tyrosine kinase inhibitors. In patients with suspicious recurrence based on the Tg level after a normal postablation WBS, FDG PET/CT is the preferred scintigraphic method to localize disease rather than postempiric (131)I WBS. Empiric (131)I administration may be used only in patients who do not have a significant FDG uptake.

Does HE4 have a role in the recurrence of ovarian cancer?

e15550 Background: Human epididymis protein 4 (HE4) has been recently described as a new marker for early ovarian cancer, with higher sensitivity (76.9%) compared to CA125. This is the third study in literature on the role of HE4 in recurrence of ovarian cancer and the first evaluating the sensitivity of HE4 and CA125 in these patients Methods: Plasma was obtained 24 hours before secondary cytoreductive surgery from consecutive patients with suspicious recurrence ovarian cancer operated from November 2010 to April 2011 at University Campus Bio-Medico of Rome. CA125 levels were evaluated by a one-step "sandwich" radioimmunoassay. HE4 levels were determined using the HE4 enzymatic immune assay. The CA125 cut-off was less than 35 U/mL. Two cut-off were considered for HE4: less than 150 pmol/L (according to the manufacturer's indications) and less than 70 pmol/L. Results: Fourteen patients were histologically confirmed as recurrence ovarian cancer. Mean Ca125 plasma concentration was 31.95 ± 22.09 U/mL (range 1.1 – 64.3). Mean HE4 plasma concentration was 225.83± 286.82 pmol/L (range 21.61- 633.6). The sensitivity of CA125 was 35.7 %. The sensitivity of HE4 was 71.4% and 28.6% above the cut-off of 70 pmol/L and 150 pmol/L, respectively. The dual marker combination of CA125 and HE4 at 70 pmol/L cut-off yielded the highest sensitivity (85.7%) to detect recurrence ovarian cancer. Conclusions: Even if a standard cut-off point has not been determined, this study suggested that HE4 may potentially be a more sensible marker for recurrence ovarian cancer than CA125 and the association between CA125 and HE4 at cut-off of 70 pmol/L seems to yield the highest sensitivity.

NBI flexible laryngoscopy targeted tissue sampling in head and neck cancer patients with difficult airways

Direct suspension laryngoscopic biopsy of neoplasms in larynx, oropharynx, and hypopharynx was an arduous procedure in patients with a history of head and neck cancer and difficult airways. This preliminary study was aimed to report the efficacy and safety of a narrow band imaging-guided biopsy of this category by flexible laryngoscopy. This is a retrospective chart review study conducted in setting of tertiary referral centre. Nineteen consecutive head and neck cancer patients with difficulty in general anesthesia and rigid endoscopic approach due to trismus, craniofacial deformities, and/or limited neck extension after cancer therapy were referred for endoscopic biopsy of their suspicious lesions in larynx, hypopharynx, or parts of oropharynx. Following topical anesthesia, a flexible laryngoscope was introduced through the nose into the pharynx. Under narrow band imaging magnified view, the specified tumor foci were biopsied in an office-based setting. All of the lesions were reached and biopsied to obtain sufficient tissue samples. The procedure took <20 min in every case. Twelve of the 19 pathologic examinations disclosed the malignancies at the first biopsy, and another underwent a second biopsy to prove cancer recurrence. The other six patients with benign lesions received further follow-up for at least 6 months and showed no recurrence. There were no complications associated with the technique. This study introduced that flexible laryngoscopy with narrow band imaging has the advantages of nimbleness, precision, and minimal morbidity. This combined technique may be a safe and promising method for tissue sampling of suspicious recurrence in head and neck cancer patients with difficult airways.

Calcified metastases from ovarian carcinoma highlighted by F-18 FDG PET/CT: report of two cases

Two cases of postoperative female patients with ovarian serous papillary carcinoma were referred for F-18 Fluorodeoxyglucose (F-18 FDG) PET/CT to evaluate suspicious recurrence and/or metastasis. One patient presented with multiple extensive calcified lesions with increased FDG uptake in the abdominopelvic cavity and the series of PET/CT scans showed progression of disease after chemotherapy. The other patient presented with three calcified masses with intensive uptake of FDG located in the left pelvis, the right subphrenic region, and the right supradiaphragmatic area, respectively. These suggest that F-18 FDG PET/CT can be useful in identifying malignant calcification and assessing therapeutic response of calcified malignancy.