The role of thallium-201 uptake and retention in intracranial tumors after radiotherapy.

UNLABELLED: This study prospectively assessed the diagnostic accuracy and prognostic value of 201TI uptake and retention in primary and metastatic intracranial tumors treated by conventional radiotherapy and/or radiosurgery. METHODS: An initial 201TI study (early and delayed images), was obtained in 60 postsurgical patients, 6-12 wk after radiotherapy or radiosurgery. Repeat imaging was performed as clinically warranted. Tumor-to-background count ratios and a retention index (RI) were calculated for all lesions. RESULTS: Abnormally increased 201TI uptake was observed in 40 of 60 patients. In all patients with positive results, the diagnosis of residual tumor was confirmed at biopsy or by clinical follow-up. In 20 of 60 patients, no abnormal 201TI uptake was observed, despite findings on CT and/or MRI scans that were suspicious for tumor. Ten of the negative 201TI studies were confirmed as true-negatives by the clinical course and by resolution of CT/MRI abnormalities. The remaining 10 negative SPECT studies ultimately proved to be false-negatives: six of these patients had lesions < 1 cm in maximum diameter, one patient had a large metastatic choriocarcinoma; and three patients had low-grade astrocytomas > 2 cm in minimum diameter. Tumor-to-background ratio of 201TI uptake did not distinguish between tumor type, or predict clinical outcome. The RI of 201TI was significantly higher for metastatic melanoma than for other tumor metastases. It demonstrated reasonably good correlation with clinical outcome: 6/7 patients with eventual tumor regression showed a decrease in RI on follow-up examination, and 4/5 patients with eventual tumor progression had an increase in RI. CONCLUSION: Thallium-201 brain SPECT appears to be a useful noninvasive imaging technique in patients irradiated for intracranial tumors. Thallium-201 scintigraphy has very high specificity (100% in this cohort) for detecting viable residual tumor. False-negative findings may occur. Quantitative analysis of 201TI uptake has limited diagnostic and prognostic significance, but changes in 201TI retention after radiation therapy seems to have prognostic value.

Seminal vesicle biopsy: accuracy and implications for staging of prostate cancer.

OBJECTIVES: Seminal vesicle biopsy (SVB) is a new technique for detecting the spread of prostate cancer to the seminal vesicles. A comparison of findings following SVB in patients undergoing radiation therapy with pathologic findings following radical retropubic prostatectomy (RRP) was made to evaluate the accuracy of this test and its use in the staging of prostate cancer. METHODS: Four hundred nine patients with clinically localized adenocarcinoma of the prostate gland were evaluated for treatment: 222 patients underwent SVB prior to radiation therapy and 187 patients underwent RRP. Clinical stages in patients undergoing SVB included T1a (1 patient), T1b (4), T1c (35), T2a (49), T2b (96), and T2c (37); RRP clinical stages included T1b (3 patients), T1c (48), T2a (57), T2b (66), and T2c (13). The Gleason scores in patients undergoing SVB were 2 to 4 in 50 men, 5 to 6 in 110 men, and 7 and greater in 62 men; the Gleason scores in patients undergoing RRP were 2 to 4 in 53 men, 5 to 6 in 94 men, and 7 and greater in 40 men. Prostate-specific antigen (PSA) values ranged from 1.3 to 190 ng/mL (median 10.75) in men undergoing SVB and ranged from 0.5 to 140.6 ng/mL (median 9.0) in men undergoing RRP. RESULTS: The overall incidence of seminal vesicle involvement as determined by the two techniques was the same. Seminal vesicle involvement was found in 33 of 222 patients (15%) undergoing SVB and in 27 of 187 (14%), of the RRP specimens (P = 0.9). When the two groups were further divided by three prognostic categories (clinical stage, PSA level, and grade), there was no difference in the incidence of seminal vesicle involvement between the two methods, except in the patients with Gleason score of 4 or less. In these patients, 5 of 53 (9%) had seminal vesicle involvement in the RRP group, compared with none of the 50 men in the SVB group (P = 0.02). Disease that was not organ confined was found in 69 of 187 prostatectomy specimens (37%). Of these patients, 27 of 69 (39%) had seminal vesicle involvement. CONCLUSIONS: SVB is an accurate method of detecting seminal vesicle invasion based on comparisons with radical prostatectomy findings. Its importance lies in its ability to detect a large percentage of patients with non-organ-confined disease and in its use in modifying treatment planning accordingly.