PET/CT FAPI: Procedure and evidence review in oncology.

Neoplasms are composed of malignant tumor cells, which are surrounded by other non-tumor cellular elements, in what has been defined as the microenvironment or tumor stroma. Evidence on the importance of the tumor microenvironment has not stopped growing in recent years. It plays a central role in cell proliferation, tissue invasion, angiogenesis and cell migration. The paradigm is the family of new FAPI radiopharmaceuticals that show the density of the fibroblast activation protein (FAP) which is overexpressed in the cell membrane of activated cancer-associated fibroblasts (CAF), and its presence is related to poor prognosis. This educational document includes the procedure for performing PET/CT FAPI, biodistribution and the main potentially clinical applications in oncology to date.

Thallium-201SPECT assessment in the detection of recurrences of treated gliomas and ependymomas

INTRODUCTION: The aim of this study was to establish the value of thalium-(201) single-photon emission computed tomography ((201)Tl-SPECT) in the detection of recurrences in the follow-up of patients with treated primary neuroepithelial tumours. MATERIAL AND METHODS: Sixty-three (201)Tl-SPECT were performed in 36 patients with glioma (12 males, mean age of 46 +/- 13 years). All patients underwent surgery and adjuvant radiotherapy (and some of them received chemotherapy). All patients were submitted to morphological neuroimaging techniques as well (and (201) Tl-SPECT). Mean follow-up was 18.3 +/- 14.6 months. Gold standard was based on clinical follow-up, therapeutical decisions (at least 4 months after (201)Tl-SPECT) and imaging features. RESULTS: Sensitivity and specificity of (201)Tl-SPECT to detect glioma recurrences were 90% and 100% respectively and 93% accuracy. Sensitivity and specificity for high grade tumours, were 100% respectively. Due to 4 false negatives, sensitivity and specificity for low grade gliomas were 78% and 100%. In the positive (201)Tl-SPECT group of patients overall survival was 13.64% at the end of the study. The negative (201)Tl-SPECT group had 84.62% overall survival at the end of the study (p = 0.0003). CONCLUSIONS. (201)Tl-SPECT is a valuable and noninvasive diagnostic procedure to detect recurrence or progression disease for treated gliomas and ependymomas. (201)Tl-SPECT has a good correlation with short term prognosis with excellent diagnostic accuracy (AU)

[Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma]. / Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides.

UNLABELLED: Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. MATERIAL AND METHODS: Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2 ng/ml or negative TG<2 ng/ml) and whole-body radioiodine scan (positive or negative). RESULTS: TSHe: 62.9 +/- 55.48; TSHr: 113.16 +/- 50.6; (p: ns); TGe: 62.5 +/- 115.7; TGr: 54.6 +/- 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. CONCLUSIONS: Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan).

Estudio comparativo entre la utilización de TSH recombinante y la estimulación endógena con TSH. Valoración en el seguimiento de los pacientes con carcinoma diferenciado de tiroides / Comparison of administration of rhTSH with withdrawal of thyroid hormone. Follow-up of patients with differentiated thyroid carcinoma

En el seguimiento habitual de los pacientes con cáncer diferenciado (CDT) se ha introducido recientemente el uso de la hormona tirotropa (TSH) humana recombinante (rhTSH) como alternativa a la retirada del tratamiento supresivo hormonal. El objetivo de este estudio retrospectivo es comparar el resultado de la administración de rhTSH con respecto a la estimulación con TSH endógena en el seguimiento del CDT. Material y métodos. Hemos seleccionado 33 pacientes con CDT a los que se había practicado previamente una tiroidectomía total y la ablación de restos tiroideos con 131I. Todos los pacientes tenían un control previo de rastreo con yodo y tiroglobulina (TG) sérica con suspensión del tratamiento hormonal (TSHe, TGe) y un nuevo control con rhTSH (TSHr, TGr). La determinación de la TG se realizó el tercer día por motivos de infraestructura. Se incluyeron sólo los pacientes sin cambios clínicos ni actuaciones terapéuticas entre los dos controles realizados con un intervalo máximo de un año. Se definieron dos categorías para la TG (positiva si TG > 2 ng/ml y negativa si TG < 2ng/ml) y para el rastreo (positivo o negativo). Resultados. Los valores analíticos obtenidos para cada control fueron los siguientes: TSHe: 62,9 ± 55,48 U/ml; TSHr: 113,16 ± 50,6 U/ml; (p: ns); TGe: 62,5 ± 115,7 mg/ml; TGr: 54,6 ± 111,1 mg/ml; (p: 0,044). La valoración cualitativa de los resultados obtenidos (prueba positiva o negativa) en ambos controles no mostró diferencias significativas ni en el resultado de la TG ni en rastreo con yodo. Conclusiones. El incremento de la TSH con previa administración de rhTSH es significativamente mayor que el incremento mediante estimulación endógena, mientras que las cifras de TG son globalmente menores. No se aprecian diferencias en la valoración de la presencia o ausencia de la enfermedad mediante TG y rastreo con yodo

Recombinant human thyrotropin (rhTSH) has been introduced recently in follow up of differentiated thyroid cancer (DTC) patients, as an alternative of thyroid hormone withdrawal. The aim of this retrospective study is to compare recombinant human thyrotropin versus endogenous stimulation. Material and methods. Thirty-three patients with DTC with previous thyroidectomy and thyroid ablation were selected. All patients underwent whole-body radioiodine scanning and third day serum thyroglobulin (TG) measurement by two techniques, the first one after conventional thyroid hormone withdrawal (TSHe, TGe), and the second one after rhTSH stimulation (TSHr, TGr). Measurement of TG was performed on the third day due to the infrastructure. We only included patients with stable disease, without therapeutic interventions between two consecutive controls in an interval inferior to one year. Two qualitative categories were defined for TG (positive TG > 2ng/ml or negative TG < 2ng/ml) and whole-body radioiodine scan (positive or negative). Results. TSHe: 62.9 ± 55.48; TSHr: 113.16 ± 50.6; (p: ns); TGe: 62.5 ± 115.7; TGr: 54.6 ± 111.1; (p: 0.044). Quantitative data analysis showed significant differences between two techniques. Qualitative data analysis showed no significant differences in clinical setting based in TG and radioiodine scan. Conclusions. Administration of rhTSH produces a significantly higher increase of TSH than thyroid hormone withdrawal and lower increase in TG levels. There were no significant differences in the stage of disease (TG and whole-body radioiodine scan)

Usefulness of sentinel lymph node detection in early stages of cervical cancer.

PURPOSE: Sentinel lymph node (SLN) mapping in combination with surgical biopsy is an emerging technique for use in the early stages of cervical cancer. The purpose of this study was to evaluate the technique in a series of 40 consecutive women with early stage cervical cancer. METHODS: Forty patients with early stage cervical cancer [FIGO stage IA2 (2), IB1 (34), IB2 (1) or IIA (3)] were referred for radical hysterectomy with pelvic lymphadenectomy. Patients were submitted to preoperative lymphoscintigraphy (four 99mTc-nanocolloid injections around the tumour) and intraoperative SLN detection. Hand-held or laparoscopic gamma probes were used to locate SLNs during surgery. RESULTS: The mean number of SLNs was 2.5 per patient (interiliac 49%, external iliac 19%). Of the total of 99 SLNs, six, in four women, showed metastases (all 68 non-SLNs removed were negative). In the other 36 patients, all the removed lymph nodes (sentinel and non-sentinel) were negative (0% false negative rate). During the follow-up (median 25 months), only two patients presented distant metastases: one died 6 months after surgery (two of three SLNs positive, both hot and blue), while the second patient is alive 4 years after surgery (lung metastasis, no isotope drainage, negative blue SLN). The survival rate was 95% and disease-free survival, 97%. CONCLUSION: SLN surgical biopsy based on lymphoscintigraphy and blue dye is a feasible and useful technique to avoid lymph node dissection in the early stages of cervical cancer. It has a high negative predictive value, can be incorporated into clinical routine (laparoscopy or open surgery) and is close to achieving validation in this setting.