Langerhans Cell Histiocytosis with Good Response to Low-Dose Imatinib: Case Report and Literature Review.

Langerhans cell histiocytosis (LCH) is a rare neoplastic disease characterized by infiltration of histiocytes and dendritic cells into body organs. While treatment is better established in pediatrics, there is still no consensus on therapy in the adult population. Imatinib has shown promising results in some case reports and a small clinical trial. We present here a fifty-nine-year-old patient with LCH in the lung, liver, and bone who responded well to an imatinib dose of 100 mg daily. Her symptoms improved within 3 months of treatment, and subsequent positron emission tomography-computed tomography (PET/CT) showed resolution of 18F-fluorodeoxyglucose (FDG)-avid lesions.

Use of Diagnostic Imaging Modalities in Modern Screening, Diagnostics and Management of Breast Tumours 1st Central-Eastern European Professional Consensus Statement on Breast Cancer.

Breast radiologists and nuclear medicine specialists updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference in Kecskemét. A recommendation is hereby made that breast tumours should be screened, diagnosed and treated according to these guidelines. These professional guidelines include the latest technical developments and research findings, including the role of imaging methods in therapy and follow-up. It includes details on domestic development proposals and also addresses related areas (forensic medicine, media, regulations, reimbursement). The entire material has been agreed with the related medical disciplines.

Tuberculosis following programmed cell death receptor-1 (PD-1) inhibitor in a patient with non-small cell lung cancer. Case report and literature review.

Immune checkpoint inhibitors (ICIs)-anti-programmed death-1 (PD-1) and their ligands (PD-L1 and PD-L2) have become widely used in the treatment of several malignancies. Many immune-related adverse events (irAEs) have been linked to these agents. Nonetheless, tuberculosis (TB) reactivation during their use is increasingly recognized and reported. Herein, we present a 58-year-old lady with advanced non-small cell lung cancer (NSCLC) ALK-negative, EGFR wild, and PD-L1 immune histochemistry (IHC) strongly positive in 95% of tumor cells, on ongoing treatment with Pembrolizumab as a first-line monotherapy. Our patient presented with 1-week history of productive cough and high-grade fever. Further workup yielded the diagnosis of pulmonary tuberculosis after her Pembrolizumab sixth cycle with positive AFB smear and TB PCR from BAL (rifampin resistance not detected), with negative HIV status. Hence, immunotherapy was held, and patient was commenced on anti-TB regimen. History revealed contact with active TB patient over the past decade, without previous documentation of latent TB or previous TB infection. Her sputum AFB smear remained persistently positive 4 weeks through anti-TB regimen course. Later, the patient was discharged after her sputum was cleared from AFB (two negative sets). In light of pembrolizumab mechanism of action as an immune checkpoint inhibitor, we suspected its implication on reactivating latent TB which was observed in our patient demonstrating features of pulmonary tuberculosis. She was not re-challenged with Pembrolizumab following TB diagnosis.

[Radiology/Nuclear Medicine Group. Use of imaging methods in the current screening, diagnostics and treatment of breast cancer - Professional guidelines. 4th Breast Cancer Consensus Conference]. / A képalkotó vizsgálómódszerek alkalmazása az emlodaganatok korszeru szurésében, diagnosztikájában és ellátásában ­ Szakmai útmutató a IV. Emlorák Konszenzus Konferencia alapján.

Breast radiologists and nuclear medicine specialists have updated their previous recommendation/guidance at the 4th Hungarian Breast Cancer Consensus Conference. They suggest to adopt this actual protocol for the screening, diagnostics and treatment of breast tumors from now on. This recommendation includes the description of the newest technologies, the recent results of scientific research, as well as the role of imaging methods in the therapeutic processes and the followup. Suggestions for improvement of the current Hungarian practice and other related issues as forensic medicine, media connections, regulations, and reimbursement are also detailed. The guidance has been in agreement with the related medical disciplines.

Metabolic Parameters as Predictors for Progression Free and Overall Survival of Patients with Metastatic Colorectal Cancer.

We tested the prognostic relevance of metabolic parameters and their relative changes in patients with metastatic colorectal cancer (mCRC) treated with monoclonal antibody and chemotherapy. SUVmax (standardized uptake volume), SAM (standardized added metabolic activity) and TLG (total lesion glycolysis) are assessed with 18F-fluorodeoxyglucosepositron emission tomography and computed tomography (FDG-PET/CT) to evaluate total metabolic activity of malignant processes. Our purpose was to investigate the change of glucose metabolism in relation to PFS (progression free survival) and OS (overall survival). Fifty-three patients with mCRC with at least one measurable liver metastasis were included in this prospective, multi-center, early exploratory study. All patients were treated with first-line chemotherapy and targeted therapy. Metabolic parameters, like SUVmax, SAM, normalized SAM (NSAM) and TLG were assessed by FDG-PET/CT, carried out at baseline (scan-1) and after two therapeutic cycle (scan-2). Our results suggested neither SUVmax nor TLG have such prognostic value as NSAM in liver metastases of colorectal cancer. The parameters after the two cycles of chemotherapy proved to be better predictors of the clinical outcome. NSAM after two cycles of treatment has a statistically significant predictive value on OS, while SAM was predictive to the PFS. The follow up normalized SAM after 2 cycles of first line oncotherapy was demonstrated to be useful as prognostic biomarkers for OS in metastatic colorectal cancer. We should introduce this measurement in metastatic colorectal cancer if there is at least one metastasis in the liver.

Dynamic FDG-PET/CT in the Initial Staging of Primary Breast Cancer: Clinicopathological Correlations.

Our aim was to evaluate correlation between clinicopathological features (clinical T and clinical N stages; histological type; nuclear grade; hormone-receptor and HER2 status, proliferation activity and tumor subtypes) of breast cancer and kinetic parameters measured by staging dynamic FDG-PET/CT examinations. Following ethical approval and patients' informed consent we included 34 patients with 35 primary breast cancers in our prospective study. We performed dynamic PET imaging, and assessed plasma activity noninvasively. To delineate primary tumors we applied a frame-by-frame semi-automatic software-based correction of motion artefacts. FDG two-compartment kinetic modelling was applied to assess K1, k2, k3 rate coefficients and to calculate Ki (tracer flux constant) and MRFDG (FDG metabolic rate). We found that k3, Ki and MRFDG were significantly higher in higher grade (p = 0.0246, 0.0089 and 0.0076, respectively), progesterone-receptor negative (p = 0.0344, 0.0217 and 0.0132) and highly-proliferating (p = 0.0414, 0.0193 and 0.0271) tumors as well as in triple-negative and hormone-receptor negative/HER2-positive subtypes (p = 0.0310, 0.0280 and 0.0186). Ki and MRFDG were significantly higher in estrogen-receptor negative tumors (p = 0.0300 and 0.0247, respectively). Ki was significantly higher in node-positive than in node-negative disease (p = 0.0315). None of the assessed FDG-kinetic parameters showed significant correlation with stromal TIL. In conclusion, we confirmed a significant relationship between kinetic parameters measured by dynamic PET and the routinely assessed clinicopathological factors of breast cancer: high-grade, hormone-receptor negative tumors with high proliferation rate are characterized by higher cellular FDG-uptake and FDG-phosphorylation rate. Furthermore, we found that kinetic parameters based on the dynamic examinations are probably not influenced by stromal TIL infiltration.

Comparison of different motion correction techniques for dynamic FDG-PET/CT studies in breast cancer patients.

BACKGROUND: Our aim was to evaluate interchangeability of different motion correction methods in the assessment of dynamic FDG-PET/CT studies in breast cancer patients as well as to assess the interrater reliability of these methods. METHODS: In our prospective study we included patients with malignant breast tumours. Dynamic PET acquisition lasted for 60 minutes after tracer (FDG) injection. Every study was assessed by the same two experienced observers. We assessed plasma activity noninvasively. In case of the primary tumour VOIs we applied two different approaches to correct motion artefacts: method I) frame-by-frame manual motion correction; method II) frame-by-frame semi-automatic software-based motion correction. FDG two-compartment kinetic modelling was applied to assess K1, k2, k3 rate coefficients and to calculate Ki (tracer flux constant) and MRFDG (FDG metabolic rate). RESULTS: Thirty-five lesions detected during 34 dynamic studies were included in this current analysis. Interrater reliability of both applied motion correction methods proved to be excellent (ICC=0.89-0.99), except Ki measured by method I (ICC=0.66). Bland-Altman analysis revealed that method II resulted in significantly lower values than method I regarding k3 and Ki in case of both observers, and regarding MRFDG in one of the observers. In case of K1 and k2 the two methods were in good agreement. CONCLUSIONS: Both applied methods proved to be reproducible and reliable, especially method II, where every measured kinetic parameter showed excellent interrater reliability. Different approaches of motion correction could have a significant effect on the results of the kinetic modelling; therefore careful selection of the most reliable method is advised.

Pancytopenia And Limbic Encephalopathy Complicating Immunotherapy For Clear Cell Endometrial Cancer With Microsatellite Instability-High (MSI-H).

BACKGROUND: Clear cell carcinoma of the endometrium (CCE) has a tendency to occur in a mismatch repair protein deficient molecular background. Treatment with immunotherapy can predict a favorable response. CASE PRESENTATION: We are presenting a 53-year-old female, diagnosed with CCE 17 years ago, who was treated initially with hysterectomy and left salpingo-oophorectomy, who relapsed a few months later, and was then treated with left pelvic mass excision and sigmoidectomy. Recently, the disease recurred as a retroperitoneal lymphadenopathy, which was resected but then relapsed locally, spread to the lungs, and progressed further after three lines of chemotherapy. On pathological review of the tumor, it was found to harbor loss of nuclear expression of MLH-1 and PMS-2. Based on a strong predictor of response to immunotherapy, pembrolizumab was tried. However, within a few days of the single dose of pembrolizumab, immune thrombocytopenia followed by pancytopenia, recurrent seizures, visual hallucination, and cerebellar signs consistent with limbic encephalitis developed, which were not responding to steroid and intravenous immunoglobulin. CONCLUSION: We are presenting a case of a CCE with deficient mismatch repair that developed two autoimmune side effects, pancytopenia and limbic encephalitis, within a few days of a single injection of pembrolizumab.

[The role of positron emission tomography (PET) in tumor diagnostics and therapy monitoring]. / A pozitron emissziós tomográfia (PET) helye a tumordiagnosztikában és a terápia követésében.

Positron emission tomography (PET) is a medical imaging method belonging to the realm of nuclear medicine. It has been a clinical research tool since the sixties but during the late nineties it became widely utilized in clinical practice too. PET technique requires special radioactive isotopes, which may be generated only in particle accelerators (cyclotrons) and their transport is limited owing to the short physical half-life. PET/CT was born from the combination of PET and CT (computer tomography). The first combined PET/CT scanner began to operate in 1998 and the method has been used in clinical practice since 2001. It is a hybrid (multi-modality) medical imaging equipment which can provide anatomical, morphologic (CT) and functional, metabolic information (PET) simultaneously. PET/CT imaging has gained clinical acceptance mainly in oncology - owing to the attributes of the most frequently used PET tracer, fluoro-deoxy glucose (FDG) - and in a lesser extent in neuropsychiatry and cardiology. The authors in this paper review the basics and key indications of the method, the wider used radiofarmacons, including potential neurological and psychiatric applications, and the possible causes of false positivity and false negativity.

Predictive and prognostic value of FDG-PET/CT imaging and different response evaluation criteria after primary systemic therapy of breast cancer.

OBJECTIVES: (1) To predict pathological complete remission (pCR) and survival after primary systemic therapy (PST) in patients diagnosed with breast cancer by using two different PET/CT based scores: a simplified PERCIST-based PET/CT score (Method 1) and a combined PET/CT score supplemented with the morphological results of the RECIST system (Method 2) and (2) to assess the effect of different breast carcinoma subtypes on tumor response and its evaluation. METHODS: Eighty-eight patients were enrolled in the study who underwent PET/CT imaging before and after PST. PET/CTs were evaluated by changes in maximum Standardized Uptake Value (SUVmax) and tumor size. Method 1 and 2 were applied to predict pathological complete remission (pCR). Kaplan-Meier analyses for survival were performed. Classification into biological subtypes was performed based on the pre-therapeutic tumor characteristics. RESULTS: A total of 30/88 patients showed pCR (34.1 %). Comparing pCR/non-pCR patient groups, significant differences were detected by changes in SUVmax (p < 0.001) and tumor size (p < 0.001) regarding the primary breast lesions. To predict pCR, Method 2 had higher sensitivity (72.4 % vs. 44.8 %) and negative predictive value (57.9 % vs. 45.8 %) with lower false negativity rate (16 vs. 32) than Method 1. pCR rate was higher in Her2-positive and triple negative tumors. Despite the significant differences detected between the biological subtypes regarding changes in primary tumor SUVmax (p = 0.007) and size (p = 0.015), the subtypes only had significant impact on response evaluation with Method 2 and not with Method 1. In our study, neither clinical nor pathological CR were predictors of longer progression-free survival. CONCLUSIONS: Our results suggest that combined PET/CT criteria are more predictive of pCR. The effect of biological subtypes is significant on pCR rate as well as on the changes in FDG-uptake and morphological tumor response. Response evaluation with combined criteria was also able to reflect the differences between the biological behavior of breast tumor subtypes.

Impact of 3T multiparametric MRI and FDG-PET-CT in the evaluation of occult primary cancer with cervical node metastasis.

BACKGROUND: This study aimed to determine the ability of multimodal evaluation with multiparametric 3T-MRI (MPMRI) and positron emission tomography - computed tomography (PET/CT) to detect cancer of unknown primary origin (CUP) with neck lymph node (LN) metastasis. METHODS: The study group comprised 38 retrospectively analysed consecutive patients with LN metastasis in the head and neck (HN) region without known primary tumours (PTs). Statistical values of 3T-MRI and of FDG-PET/CT scans were evaluated. RESULTS: Of the 38 CUPs, conventional native T1-, T2-weighted and STIR sequences detected 6 PTs. Native sequences plus diffusion-weighted imaging (DWI) found 14-, and with fat suppression contrast-enhanced T1-weighted measurement as well as with the complex MPMRI found 15 primaries and with PET/CT 17 CUPs could be evaluated, respectively. The detection rates were 15.8, 36.8, 39.5, 39.5 and 44.7 % for conventional native MRI, native plus DWI, native with contrast-enhanced MRI (CE-MRI), for MPMRI, and for PET/CT, respectively. The overall detection rate proved by histology was 47.4 %. PET/CT provided the highest sensitivity (Sv: 94.4 %) but a lower specificity (Sp: 65.0 %), using MPMRI (Sv: 88.2 %) the specificity increased to 71.4 %. DWIincreased specificity of the native sequences (Sp: 76.2 %). Conventional native sequences plus DWI as well as 3T-MPMRI and PET/CT were same accurate (Acc: 79.0 %) and had similar likelihood ratio (LR: 3.42, 3.03 and 2.62) in detecting unknown PT sites. CONCLUSIONS: The accuracy of FDG-PET/CT and MPMRI in case of CUP in finding the primary cancer in the neck regions is identical. While using PET/CT whole body information can be obtained in one examination. MPMRI shows the local soft tissue status more accurately. In cases of CUP PET/CT should be the first method of choice if it is available. MPMRI can clarify the exact primary tumor stage, and it can be advantageous in clarifying the prognostic factors, which is necessary in case of advanced tumor stage and when surgery is under consideration. In case low N stage is likely after the clinical examination and wait and see policy can be considered, MPMRI is recommended, and in this case the significance the of radiation free MPMRI is increasing.

[Use of imaging methods in the current screening, diagnostics and treatment of breast cancer - Professional guidelines. 3rd Breast Cancer Consensus Meeting]. / A képalkotó vizsgálómódszerek alkalmazása az emlõdaganatok korszerû szûrésében, diagnosztikájában és ellátásában - Szakmai útmutató a III. Emlõrák Konszenzus Konferencia alapján.

Breast radiologists and nuclear medical specialists have refreshed their previous statement text during the 3rd Hungarian Breast Cancer Consensus Meeting. They suggest taking into consideration this actual protocol for the screening, diagnostics and treatment of breast tumors, from now on. This recommendation includes the description of the newest technologies, the recent results of scientific research, as well as the role of imaging methods in the therapeutic processes and the follow-up. Suggestions for improvement of the Hungarian current practice and other related issues as forensic medicine, media connections, regulations, and reimbursement are also detailed. The statement text has been cross-checked with the related medical disciplines.

Complexity of Response Evaluation During Primary Systemic Therapy of Breast Cancer: Scoring Systems and Beyond-Preliminary Results.

BACKGROUND: Precise and standardized response evaluation enables clinicians to tailor primary systemic therapy (PST). PATIENTS AND METHODS: Breast cancer patients underwent (18)F-fluoro-deoxy-glucose positron emission tomography and computerized tomography (FDG-PET/CT) before and after PST. Response was assessed by maximal Standardized Uptake Value (SUVmax); morphological changes and Ki-67 labeling index (LI). In parallel response assessment was performed by European Organization for Research and Treatment of Cancer (EORTC); PET Response Criteria in Solid Tumors (PERCIST); World Health Organization (WHO); Response Evaluation Criteria in Solid Tumors (RECIST); Chevallier and Sataloff classifications, and by a novel Ki-67 score. Accuracy of different scoring systems was evaluated. RESULTS: In the 42 enrolled patients, SUVmax, size, and Ki-67 LI decreased significantly on PST. Significant differences between patients with versus those without pathological complete response were observed for pre-treatment Ki-67 LI and SUVmax and for post-treatment Ki-67 LI, SUVmax and size. Change in Ki-67 LI was the best predictor of pathological complete response. Correlation patterns of the directly measured metabolic, morphological, and proliferation responses differed from those determined by scoring methods. CONCLUSION: During PST, FDG-PET/CT enables for robust assessment of treatment efficacy, but more reliable scoring systems are still needed for more precise response evaluation.

[Role of 18FDG-PET/CT in the management and gross tumor volume definition for radiotherapy of head and neck cancer; single institution experiences based on long-term follow-up]. / 18FDG-PET/CT szerepe fej-nyak daganatok kezelésében és a sugárterápiás tumortérfogat meghatározásában - Az SZTE Onkoterápiás Klinika eredményeinek értékelése.

The purpose of our work is evaluation of the impact of 18FDG-PET/CT on the complex management of locoregionally advanced (T3-4N1-3) head and neck squamous cell cancer (LAHNSC), and on the target definition for 3D conformal (3DCRT) and intensity-modulated radiotherapy (IMRT). 18FDG-PET/CT were performed on 185 patients with LAHNSC prior to radiotherapy/chemoradiation in the treatment position between 2006 and 2011. Prior to it 91 patients received induction chemotherapy (in 20 cases of these, baseline PET/CT was also available). The independently delineated CT-based gross tumor volume (GTVct) and PET/CT based ones (GTVpet) were compared. Impact of PET/CT on the treatment strategy, on tumor response evaluation to ICT, on GTV definition furthermore on overall and disease-specific survival (OS, DSS) was analysed. PET/CT revealed 10 head and neck, 2 lung cancers for 15 patients with carcinoma of unknown primary (CUP) while 3 remained unknown. Second tumors were detected in 8 (4.4%), distant metastasis in 15 (8.2%) cases. The difference between GTVct and GTVpet was significant (p=0.001). In 16 patients (14%) the GTVpet were larger than GTVct due to multifocal manifestations in the laryngo-pharyngeal regions (4 cases) or lymph node metastases (12 cases). In the majority of the cases (82 pts, 72%) PET/CT-based conturing resulted in remarkable decrease in the volume (15-20%: 4 cases, 20-50%: 46 cases, >50%: 32 cases). On the basis of the initial and post-ICT PET/CT comparison in 15/20 patients more than 50% volume reduction and in 6/20 cases complete response were achieved. After an average of 6.4 years of follow-up the OS (median: 18.3±2.6 months) and DSS (median: 25.0±4.0 months) exhibited close correlation (p=0.0001) to the GTVpet. In cases with GTVpet <10 cm3 prior to RT, DSS did not reach the median, the mean is 82.1±6.1 months, while in cases with GTVpet 10-40 cm3 the median of the DSS was 28.8±4.9 months (HR = 3.57; 95% CI: 1.5-8.3), and in those with GTVpet >40 cm3 the median DSS was 8.4±0.96 months (HR= 11.48; 95% CI: 5.3-24.9). Our results suggest that 18FDG-PET/CT plays an important role for patient with LAHNSC, by modifying the treatment concept and improving the target definition for selective RT modalities. Volumetric PET/CT-based assessment of the tumor response after ICT gives valuable contribution to further therapy planning.

Response evaluation after primary systemic therapy of Her2 positive breast cancer ­ an observational cross-sectional study.

AIM: To evaluate (I) trastuzumab-containing primary systemic therapy (PST) in human epidermal growth factor receptor 2 (Her2) overexpressing breast carcinomas.; (II) compare the patients who achieved and those who did not achieve pathological complete remission (pCR), and (III) analyze the accuracy of different clinical-imaging modalities in tumor response monitoring. METHODS: 188 patients who received PST between 2008 and 2014 were reviewed and 43 Her2 overexpressing breast cancer patients (28 Luminal B/Her2-positive and 15 Her2-positive) were enrolled. 26 patients received mostly taxane-based PST without trastuzumab (Group 1) and 17 patients received trastuzumab-containing PST (Group 2). We compared the concordance between pCR and complete remission (CR) defined by breast-ultrasound, CR defined by standard 18F-fluoro-deoxy-glucose positron emission tomography and computerized tomography (FDG-PET/CT) criteria (Method 1) and CR defined by a novel, breast cancer specific FDG-PET/CT criteria (Method 2). Sensitivity (sens), specificity (spec), and positive (PPV) and negative predictive values (NPV) were calculated. RESULTS: Ten patients (38.5%) in Group 1 and eight (47%) in Group 2 achieved pCR. pCR was significantly more frequent in Her2-positive than in Luminal B/Her2-positive tumors in both Group 1: (P=0.043) and Group 2: (P=0.029). PET/CT evaluated by the breast cancer specific criteria (Method 2) differentiated pCR from non-pCR more accurately in both groups (Group 1: sens=77.8%, spec=%, PPV=100%, NPV=71.4%; Group 2: sens=87.5%, spec=62.5%, PPV=70%, NPV=83.3%) than standard PET/CT criteria (Method 1) (Group 1: sens=22.2% spec=100% PPV=100% NPV=41.7%; in Group 2: sens=37.5%, spec=87.5%, PPV=75% NPV=58.3%) or breast ultrasound (Group 1, sens=83.3% spec=25% PPV=62.5% NPV=50%; Group 2, sens=100% spec=12.5% PPV=41.6% NPV=100%). CONCLUSION: The benefit of targeted treatment with trastuzumab-containing PST in Her2 overexpressing breast cancer was defined in terms of pCR rate. Luminal B/Her2-positive subtype needs further subdivision to identify patients who would benefit from PST. Combined evaluation of tumor response by our novel, breast cancer specific FDG-PET/CT criteria accurately differentiated pCR from non-pCR patients.

Correlation of the value of 18F-FDG uptake, described by SUVmax, SUVavg, metabolic tumour volume and total lesion glycolysis, to clinicopathological prognostic factors and biological subtypes in breast cancer.

OBJECTIVE: The aim of this study was to observe the relationships between different metabolic parameters and clinicopathological features (CPFs) or immunohistochemically defined biological subtypes (IHC-BS) in breast cancer. MATERIALS AND METHODS: Eighty-two women (83 lesions, tumour size>15 mm) underwent PET/computed tomography imaging after a core biopsy. Maximum and average standardized uptake values (SUVmax, SUVavg), metabolic tumour volume (MTV) and total lesion glycolysis (TLG) in the primary tumour were calculated and compared with CPFs and IHC-BS. Tumours with oestrogen receptor (ER) positivity were separately investigated in relation to their progesterone receptor (PR) status. RESULTS: Significant correlation was found between all metabolic parameters and high nuclear grade or ER status or IHC-BS. All parameters were higher in PR(-) and triple-negative cases than in PR(+) and non-triple-negative tumours, and the correlation was significant for most of the metabolic parameters (except for SUVavg in the case of PR status and MTV in the case of triple negativity). Significant correlation was found only for SUVmax regarding the human epidermal growth factor receptor 2 (HER2) status. There was moderate correlation between the Ki67 expression and the SUVmax or SUVavg. All metabolic parameters were higher in ER(+)/PR(-)/HER2(-) lesions compared with ER(+)/PR(+)/HER2(-) cancers. However, ER(+)/PR(-)/HER2(+) tumours had lower SUVmax and SUVavg compared with ER(+)/PR(+)/HER2(+) lesions. CONCLUSION: Our study confirms that the fluorine-18 fluorodeoxyglucose uptake in primary tumour is associated with distinct CPFs or IHC-BS in breast cancer. SUVmax may reflect tumour metabolism more reliably compared with SUVavg, MTV or total lesion glycolysis. Our preliminary results suggest different biological properties in ER(+) tumours with different PR statuses.

[Salvage 125I brachytherapy of locally recurrent prostate cancer]. / Prosztatadaganat sugárkezelését követo helyi kiújulás "salvage" kezelése 125I brachyterápiával.

The purpose of the study is to report a case of salvage low dose rate (LDR) prostate brachytherapy in a patient with locally recurrent prostate cancer, four years after his first treatment with combined external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. A 61-year-old man was treated with 1x10 Gy HDR brachytherapy and a total of 60 Gy EBRT for an organ confined intermediate risk carcinoma of the prostate in 2009. The patient's tumor had been in regression with the lowest PSA level of 0.09 ng/ml, till the end of 2013. After slow but continuous elevation, his PSA level had reached 1.46 ng/ml by February 2014. Pelvis MRI and whole body acetate PET/CT showed recurrent tumor in the dorsal-right region of the prostate. Bone scan was negative. After discussing the possible salvage treatment options with the patient, he chose LDR brachytherapy. In 2014, in spinal anesthesia 21 125I "seeds" were implanted with transrectal ultrasound guidance into the prostate. The prescribed dose to the whole prostate was 100 Gy, to the volume of the recurrent tumor was 140 Gy. The patient tolerated the salvage brachytherapy well. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. PSA level decreased from the pre-salvage value of 1.46 ng/ml to 0.42 ng/ml by one month and 0.18 ng/ml by two months after the brachytherapy. No gastrointestinal side effects appeared, the patient's urination became slightly more frequent. In selected patients, salvage LDR brachytherapy can be a good choice for curative treatment of locally recurrent prostate cancer, after primary radiation therapy. Multiparametric MRI is fundamental, acetate PET/CT can play an important role when defining the localization of the recurrent tumor.

[Is ceCT necessary beyond FDG-PET/CT for primary staging in Hodgkin lymphoma?]. / Szükséges-e Hodgkin-limfóma primer stádium-megállapításához FDG-PET/CT mellett iv. ka. CT elvégzése is?

INTRODUCTION: Several study supported that 18F-Fluoro-deoxy-glucose (FDG) positron emission tomography/computer tomography with low dose CT (standard PET/CT) is more accurate than contrast-enhanced CT (ceCT) in the primary staging of Hodgkin disease. AIM: The authors compared the accuracy of these examinations with this indication in their practice, and analysed the added value of ceCT which was performed as a supplement to standard PET/CT. METHOD: Twenty-eight patients were categorized based on ceCT, single standard PET/CT and standard PET/CT with ceCT. RESULTS: Twenty-four patients were in the same disease-stage based on all methods. Disease was upstaged by standard PET/CT compared to ceCT in 4 patients. There was no change in stage when comparing standard PET/CT and standard PET/CT with ceCT. CONCLUSIONS: Standard PET/CT is more accurate than ceCT in the primary staging of Hodgkin disease. The authors established that it is not reasonable to supplement standard PET/CT with ceCT in this indication.

Port-site metastasis after laparoscopic removal of an isolated adrenal metastasis in a patient with breast cancer detected with FDG PET/CT.

Adrenal metastasis from breast cancer rarely occurs in the course of this disease. Laparoscopic surgery has increased in the therapy for malignant tumors because of its lower morbidity and mortality compared with conventional surgical methods. However, complications such as the appearance of a port-site metastasis may also occur. Clinical examination and conventional cross-sectional imaging usually reveal this only at advanced stage. The authors reported on a case with abdominal wall port-site metastasis detected with F-FDG PET/CT 33 months after the laparoscopic removal of a late-onset, PET/CT-verified adrenal metastasis from lobular breast cancer.

Comparison of the International Harmonization Project, London and Gallamini criteria in the interpretation of 18F-FDG PET/CT examinations after first-line treatment in Hodgkin's lymphoma.

OBJECTIVE: Fluorine 18-fluorodeoxyglucose (F-FDG) PET/computed tomography (CT) has been reported to have a wide-ranging positive predictive value (PPV) in the literary data on Hodgkin's lymphoma after first-line therapy. This study was carried out to compare the usefulness of the International Harmonization Project, London and Gallamini criteria in the interpretation of F-FDG PET/CT examinations for this indication. METHODS: Data from 66 patients with a median follow-up care of 54 months were evaluated. The initial stage had been I-II in the case of 45 patients and III-IV in the case of 21 patients. RESULTS: The analysis based on the International Harmonization Project criteria resulted in a negative predictive value (NPV) of 98.0% and a PPV of 62.5%. Using mediastinal blood pool and liver activity as the thresholds for the London criteria, the NPV and PPV were 98.0 and 62.5% and 98.1 and 71.4%, respectively. Considering only those lesions with F-FDG uptake that was markedly higher than liver uptake as positive, the NPV and PPV were 94.7 and 88.9%, respectively. The analysis based on the Gallamini criteria resulted in an NPV of 96.2% and a PPV of 69.2%. CONCLUSION: Using the London criteria with liver activity as the threshold seems to be a good approach for the interpretation of post-treatment F-FDG PET/CT studies because of its high accuracy and simplicity.