Is it possible to achieve more accurate mediastinal nodal radiotherapy planning for NSCLC with PET/CT?

Objective: To assess whether more accurate mediastinal lymph nodes radiotherapy can be performed with fluorode oxyglu cosepositron emission tomogaphy/computed tomography. METHODS: The retrospective study was conducted at Inonu University Medical Faculty, Malatya, Turkey, and Afyon Kocatepe University Medical Faculty, Afyon, Turkey, and comprised record of patients histopathologically diagnosed with non-small cell lung carcinoma and who underwent fluorodeoxyglucose positron emission tomography / computed tomography between January 2013 and December 2016. Surgery and pathology reports of the patients were reviewed. Histopathologically proven malignant and benign lymph nodes were re-identified with fluorodeoxyglucose positron emission tomography / computed tomography imaging. Anatomical and metabolic parameters of lymph nodes were re-assessed by specialists and compared with histopathology reports. Maximum standardised uptake values were used to assess sensitivity, specificity, positive predictive value, and negative predictive values. SPSS 22 was used for data analysis. RESULTS: The study included 144 mediastinal lymph nodes related to 42 patients who had a mean age of 62.4±9.8 years (range: 41-79 years). In terms of subtypes of the primary squamous cell carcinoma was found in 24(57.2%) patients, adenocarcinoma in 12(27.5%), and other subtypes in 6(15.3%) patients. Of the 144 lymph nodes, 48(33.3%) were metastatic. Sensitivity, specificity, positive predictive value, and negative predictive value were 92.8%, 64.3%, 56.9%, and 94.7%, respectively when maximum standardised uptake value >2.5 was used as the malignancy criterion. When lymph node maximum standardised uptake value / liver standardised uptake value-mean>1.69 was used as the criterion, the sensitivity, specificity, positive predictive value, and negative predictive value were 95.83%, 91.67%, 85.2%, and 97.8%, respectively. When the same values with lymph node >8mm was used as the criterion, the four resultant values were 89.6%, 93.8%, 87.8%, and 94.7%, respectively. When lymph node was replaced with mean attenuation >35 as the criterion, the consequent values were 79.2%, 93.8%, 86.4%, and 90.0%, respectively. CONCLUSIONS: Lymph node maximum standardised uptake value / liver standardised uptake valuemean> 1.69 was associated with higher negative predictive value and more useful positive predictive value compared to maximum standardised uptake value >2.5. When this parameter was used along with short axis or mean attenuation value, there were no significant increase in positive predictive value, but there was a decrease in negative predictive value.

Efficiency of radioactive I-131 therapy in geriatric patients with toxic nodular goiter.

BACKGROUND AND AIMS: The success of I-131 therapy in geriatric patients who were referred to an endocrinology clinic with toxic nodular goiter and who lived in iodine-deficiency regions was studied. MATERIALS AND METHODS: Patients older than 60 years who received I-131 therapy were included via retrospective data analyses. Fifty-nine patients between 60 and 82 years of age were enrolled in the study. The patients received an oral capsular form of I-131 (10-25 mCi) and were followed up for 1 year with clinical and laboratory results. Euthyroid or hypothyroid status at the end of the year after treatment was deemed to be a response to treatment. RESULTS: Of the 21 (36%) male and 38 (64%) female patients, 29 (49%) had a solitary toxic nodule and 30 (51%) had toxic multinodular goiter. Twenty-nine (49%) of the patients received propylthiouracil therapy. At the end of the year, 38 (64%) patients were euthyroid, 11 (19%) were hypothyroid, and 10 (17%) were thyrotoxic. Forty-nine (83%) patients who were euthyroid and hypothyroid were considered responders. CONCLUSION: Geriatric patients with toxic nodular goiter were shown to have a high response rate to I-131 therapy. Thus, we suggest that radioactive iodine treatment should be the first-line treatment in these patients.