Clinical value of whole body 18F-FDG PET/CT imaging in patients with cutaneous melanoma: A multi-center cohort study.

BACKGROUND: 18F-FDG-PET/CT is a valuable tool in the staging and surveillance of cutaneous melanoma; however, recent studies prompt debate on the clinical significance of imaging patients below the lesser trochanter. This study explored two research questions. In patients with a known primary cutaneous melanoma within the standard field of view (SFOV, between the orbits and lesser trochanter), what is the prevalence of metastasis to sites solely within the lower extremities? and, In patients with a known primary cutaneous melanoma within the SFOV what demographic and clinical factors are associated with sole metastasis to the lower extremities? METHODS: A retrospective, multi-centered, observational study of consecutive case reports was conducted. Subjects included 619 patients who underwent extended field of view (EFOV) 18F-FDG-PET/CT (from vertex to toes) for staging and/or follow-up of cutaneous melanoma. Data was collected at three primary healthcare centers in Canada (Nova Scotia, Alberta, and British Columbia). Inclusion criteria were patients >18 years of age, confirmed primary cutaneous melanoma, and a known location of the primary within the SFOV. Patients with primary cutaneous melanoma lesions in lower extremities and previous other cancers were excluded. To determine the prevalence of lesions located below the lesser trochanter, the proportion of such lesions were computed, and 95% confidence intervals ensured a precise estimation of the proportion. RESULTS: 2512 patient charts were reviewed with 619 meeting the inclusion criteria, 298 of these were females. Six percent had metastases in both the lower extremities and sites within the SFOV. The number of subjects who had no metastasis within their SFOV was 361 (58.3%). The number of subjects who presented with confirmed metastasis in the lower extremities without concurrent metastasis in the SFOV region was one (0.58%). Despite a large initial study sample, the number of patients with metastasis in the lower extremities was insufficient to allow correlation of factors associated with risk of spread to the lower extremities. CONCLUSION: Lower extremity 18F-FDG-PET/CT provided additional, relevant clinical data in a sole patient. This finding supports prior research suggesting the prevalence is rare. Future studies should seek to define demographic and clinical factors that predict such rare occurrences, where follow up would be warranted. This study highlights feasibility challenges associated with such investigation.

First molecular epidemiology study of Mycobacterium tuberculosis in Kiribati.

Tuberculosis incidence rates in Kiribati are among the highest in the Western Pacific Region, however the genetic diversity of circulating Mycobacterium tuberculosis complex strains (MTBC) and transmission dynamics are unknown. Here, we analysed MTBC strains isolated from culture positive pulmonary tuberculosis (TB) cases from the main TB referral centre between November 2007 and October 2009. Strain genotyping (IS6110 typing, spoligotyping, 24-loci MIRU-VNTR and SNP typing) was performed and demographic information collected. Among 73 MTBC strains analysed, we identified seven phylogenetic lineages, dominated by Beijing strains (49%). Beijing strains were further differentiated in two main branches, Beijing-A (n = 8) and -B (n = 28), that show distinct genotyping patterns and are characterized by specific deletion profiles (Beijing A: only RD105, RD207 deleted; Beijing B: RD150 and RD181 additionally deleted). Many Kiribati strains (59% based on IS6110 typing of all strains) occurred in clusters, suggesting ongoing local transmission. Beijing-B strains and over-crowded living conditions were associated with strain clustering (likely recent transmission), however little evidence of anti-tuberculous drug resistance was observed. We suggest enhanced case finding amongst close contacts and continued supervised treatment of all identified cases using standard first-line drugs to reduce TB burden in Kiribati. Beijing strains can be subdivided in different principle branches that might be associated with differential spreading patterns in the population.

The epidemiology of tuberculosis in Pacific Island countries and territories: 2000-2007.

This is a descriptive study of routinely collected tuberculosis (TB) surveillance data from 19 Pacific Island countries and territories. The objectives of the study are to describe (a) the epidemiology of TB during the period 2000-2007 (with a focus on 2007), (b) progress against World Health Organization (WHO) targets, and (c) how TB control can be enhanced in the region. In 2007, there were 1544 cases of TB notified in the Pacific (excluding Papua New Guinea). The case notification rate was 52 per 100 000 population. The case detection rate for sputum smear positive cases in 2007 was 66%, slightly below the WHO target of 70%. The treatment success rate for new sputum smear positive cases in 2006 was 89%, above the WHO target of 85%. It is likely that the regional prevalence and mortality targets will be narrowly missed in 2010. There has been good progress in TB control in the Pacific region, but intensified efforts are needed to further reduce the burden of TB.

Tuberculosis trends in the Pacific: 2000-2006.

The objective in this manuscript is to describe the epidemiology of tuberculosis in 19 Pacific Island countries and territories by analysing routine surveillance data from 2000 to 2006. In addition, progress against World Health Organization targets is described. The setting is National Tuberculosis Programmes in 19 Pacific Island countries and territories served by the Secretariat of the Pacific Community. The study is a descriptive study of routinely collected surveillance data from 19 Pacific Island countries and territories. In 2006 there were 1585 cases of TB notified in the Pacific region. The case notification rate in the Pacific was 54/100,000 population. Almost half (49%) of all TB notifications were in the subregion of Micronesia, with 42% in Melanesia and 9% in Polynesia. Micronesia had the highest rate of TB in the region with a case notification rate of 145/100,000 population. The TB case notification rate in the Pacific increased by 10% between 2000 and 2006, from 49/100,000 to 54/100,000 population. The highest increase in rates has been in Micronesia, where the TB case notification rate rose by 39% between 2000 and 2006. In the Pacific in 2006, 71% of all TB notifications were pulmonary, and just over one third (36%) of all TB notifications were sputum smear positive. One quarter (25%) of sputum smear positive cases were in people aged 15-24 years and slightly more than half of all sputum smear positive cases were in males (52%). In Micronesia this pattern was different; 61% of all sputum smear positive cases were in males. In 2005, the treatment success rate of new sputum smear positive cases in the Pacific was 85%, equivalent to the WHO target. The treatment success rate of sputum smear positive cases rose from 78% in 2000 to 85% in 2005, an increase of 7%. In 2005, 4% of all people with TB died, and of those with sputum smear positive TB, 8% died. In 2005 in Polynesia, 13% of all people with sputum smear positive TB died. Since the year 2000, the rates of TB have increased in the Pacific region, with a relatively large increase in the subregion of Micronesia. Treatment success rates in the same time period have improved and are now at the WHO target of 85%. The conclusion is that to continue to make progress toward TB control in the region, intensified efforts may be needed in the sub-region of Micronesia while support is also maintained at current or increased levels in Melanesia and Polynesia.