Planar 99m Tc-PSMA Imaging of Prostate Cancer in a Low-Resource Setting: A Series Report.

Objective Technetium-99m labeled prostate-specific membrane antigen (PSMA) single-photon emission computed tomography/computed tomography (SPECT/CT) is a suitable alternative to prostate-specific membrane antigen-positron emission tomography (PSMA-PET) imaging. However, the availability of SPECT/CT in many developing countries is limited. Materials and Methods To evaluate the utility of planar 99m Tc-PSMA in the absence of SPECT/CT, we compared planar 99m Tc-PSMA and routine bone scan imaging in low-, intermediate-, and high-risk prostate cancer in five patients with histologically confirmed prostate cancer who had both scans within a period of less than 4 days. The mean age of patients was 66.8 ± 5.24, and the median prostate-specific antigen level was 175 ng/mL (range: 0-778 ng/mL). Results Planar 99m Tc-PSMA scan provided no additional benefit over bone scans in the low-risk prostate cancer cases. In the cases with intermediate-risk prostate cancers, planar 99m Tc-PSMA indicated complete and partial response to treatment in oligometastatic and widespread metastatic disease, respectively. In one patient with high-risk prostate cancer, planar 99m Tc-PSMA detected additional skeletal lesions that were not seen on bone scan. Conclusion In the absence of SPECT/CT, planar 99m Tc-PSMA was useful for confirming extent of disease in treated intermediate- and high-risk prostate cancer. It showed little value in low-risk prostate cancer, especially when bone scan is normal. It was particularly useful for treatment response assessment in oligometastatic disease, and its utility should be further explored.

Bone Scintigraphy in Breast Cancer Patients in Ibadan, Nigeria.

BACKGROUND: The bone is the commonest site of metastases from breast carcinoma. Radionuclide isotope scanning is a sensitive scanning procedure for the demonstration of bone pathology. In May 2006, a gamma camera was introduced into clinical use for skeletal scintigraphy at the University College Hospital, Ibadan, Nigeria. OBJECTIVE: To review the first five years findings of skeletal scintigraphy in our breast cancer patients. METHODS: We retrospectively reviewed the clinical data and scintigraphic bone studies of patients with histology proven breast carcinoma managed in the Surgical Oncology Division, University College Hospital, Ibadan, Nigeria between May 2006 and April 2011. RESULTS: Within the period, a total of 597 breast cancer patients had skeletal scintigraphy (SS). Of the 594 (99.5%) SS reports available for review, scintigraphic evidence of bone metastases was found in 232 (39.1%) patients. Correlation of bone involvement and clinical stage showed that a large majority of the patients had stage IV (83.3%) and III (15.7%) disease. Most patients (71.6%) had multiple bone lesions. The bone lesions were osteoblastic in 88.9% of the patients; only 1.8% had purely osteolytic lesions with the remainder being a mix of both. CONCLUSION: There was scintigraphic evidence of bone metastasis in most of our patients with stage four breast cancer and in some with locally advanced disease. Multiple bone lesions were found in many of them and almost all the lesions were osteoblastic. Moreover, both the truncal and axial skeletal bones were involved in similar proportions.

Stitch abscess masquerading as recurrent thyroid cancer.

Recurrent thyroid cancer after remnant ablation is a known entity in follow up of differentiated thyroid cancer. It is however unusual for a stitch abscess to present as a recurrent thyroid cancer. We highlight the diagnostic dilemma of a stitch abscess masquerading as a recurrent thyroid cancer in a young female adult in the setting of financial constraint.

High default rate in thyroid cancer management in Ibadan, Nigeria: a need for health insurance.

BACKGROUND: Differentiated thyroid cancer is a potentially curable disease provided there is early diagnosis and full compliance with management modalities. This however becomes a problem in a resource poor environment where most patients pay out of pocket resulting in poor compliance and inability to access standard care due to poverty. This retrospective study was carried out to evaluate the percentage of patients that could afford the cost of care in a premier nuclear medicine facility of a tertiary centre. PATIENTS, MATERIAL AND METHOD: A total 56 patients with differentiated thyroid cancer managed since the inception of the Nuclear Medicine Department, University College Hospital from June 2006 to March 2010 were included in the study. Socioeconomic status of the patients and the affordability of the nuclear medicine procedure for differentiated thyroid cancer post thyroidectomy were evaluated. RESULT: A total of 20 out of 56 (35.7%) patients had total thyroidectomy at presentation, while, 36 had subtotal thyroidectomy. The commonest type of thyroid malignancy was papillary thyroid cancer (51.8%), while follicular cancer accounted for 41.1%. Medullary and Anaplastic thyroid cancers were the least common. Majority of the patients evaluated were within the income bracket of 10,000-30,000 naira ($67- $200) per month). The average cost of management of thyroid cancer post total thyroidectomy was $2500 (N375 000.00) at this centre. Twenty one out of 56 patients (37.5%) could afford the $300 cost of diagnostic whole body iodine scan while only 16 patients out 21 (28.6%) could afford the ($1200) cost of radioactive iodine treatment. CONCLUSION: With average cost of management of management of thyroid cancer beyond the yearly income of majority of the patients studied, there is need for a comprehensive health insurance policy to make accessibility of care of this potentially curable disease available to most Nigerians.

Radioactive iodine ablation therapy: a viable option in the management of Graves' disease in Nigeria.

BACKGROUND: Graves' disease is an autoimmune disorder characterized by hyperthyroidism and associated features. Management of this disease condition for many decades has been largely by surgical and medical intervention. Usage of anti thyroid medication ameliorates the symptoms and effects of excessive production of thyroid hormones. Recently in Nigeria, Nuclear medicine facility became available with the option radioiodine ablative therapy for the management of Graves disease. This study highlights the benefits of radioiodine therapy against the background of equally viable medical and surgical practice. PATIENTS MATERIAL AND METHOD: All the 36 patients seen from the inception of Nuclear Medicine facility at the University College Hospital from June 2006 to May 2010 were included in this study. Sources of referral were compiled. All the patients were on anti thyroid medication at presentation. Thyroid scan was performed by Siemens E- cam gamma camera 20 minutes after intravenous injection of 3-5 mCi of Tc-99m-Pertechnetate. The patients with "diffuse toxic goiter" on thyroid scan were given 10 mCi of Iodine-131 orally and discharged home with radiosafety precautions. Most of the patients were treated 5 days post discontinuation of antithyroid medication. The patients were followed-up monthly with thyroid function tests to determine commencement of replacement therapy. RESULT: Peak incidence of Graves' disease was at 6th decade (38.9%) of all patients studied. This disease was commoner in women with a ratio of 8 to 1. Ten (27.8%) patients became hypothyroid at the 3rd month post radioactive iodine-131 treatment, while the remaining 20 (55.6%) patients became hypothyroid at the 5th month. Six patients were lost to follow up. There was no recurrence of hyperthyroidism in all patients treated. Twenty eight (93.3%) patients were maintained on 100 mcg of levo-thyroxine daily, while 2 (6.7%) patients had more than 100 mcg of levo- thyroxine daily as maintenance dose. CONCLUSION: Radioactive iodine therapy presents a safe and effective alternative to the older conventional mode of management of Graves' disease