Giant hepatic hemangioma treatment with transcatheter arterial embolisation and transcatheter arterial chemoembolisation; Comparative results

Background/aim: Treatment of hepatic hemangiomas is a controversial topic, and traditional treatment is surgical excision. Transcatheter arterial embolisation (TAE) and transcatheter arterial chemoembolisation (TACE) have been reported as minimally invasive treatment methods. To the best of our knowledge, there are no studies comparing use of TACE and TAE for hepatic hemangioma treatment. The aim of the study is to compare symptom resolution, size reducing effects, and complications of TACE and TAE for the treatment of giant hepatic hemangiomas. Materials and methods: A total of 104 patients underwent TACE using bleomycin, and 108 patients underwent TAE. The patients were followed-up for 2 year and follow-up images at 6 months, 12 months, and 24 months were acquired. Lesion volumes in both follow-up images were calculated. The patients were examined for any possible procedure related complications as well as the status of their initial symptoms. Results: The shrinkage period was determined to have ended after 12. month in both groups. The results of the two-way mixed ANOVA showed that there was significant main effect of procedure type (p ≤ 0.001) on hemangioma volumes. Similarly, there was a significant interaction between procedure and time (p ≤ 0.001). Conclusion: Both methods are effective in symptomatic relief in properly selected patients. However, TACE causes greater volume reduction with less pain and, therefore, is the better endovascular treatment option.

Breast diseases in children: the spectrum of radiologic findings in a cohort study.

PURPOSE: We aimed to investigate the spectrum of radiologic findings and referral reasons for breast diseases in children considering age-appropriate presentation. METHODS: Our retrospective cohort study included 348 consecutive pediatric patients aged <19 years (median, 13 years) referred to radiology with a clinical presentation between 2005 and 2016. Radiologic findings were reviewed in four age ranges (0-2 years, 2-8 years, 8-15 years, >15 years). RESULTS: Of 348 patients, 257 had a referral reason. The most frequent referral reason was a palpable mass (35%). Developmental abnormalities accounted for 48% of all radiologic findings in 348 patients. We did not detect any breast malignancy. According to age groups, the most common radiologic findings were neonatal hypertrophy (0-2 years), early breast development (2-8 years), developmental abnormalities by a majority of gynecomastia (8-15 years), and normal findings or developmental abnormalities (>15 years). Interestingly, the frequency of gynecomastia was only 4% in neonatal period or early childhood. Fibroadenomas and fibroadenoma-like solid masses were seen after 8 years and constituted the majority of solid masses (65%). Cysts were seen at a rate of 7% and majority of them were of simple type, which tends to resolve in time. CONCLUSION: In our study, the most common referral reason to radiology was a palpable breast mass. Neonatal hypertrophy and early breast development in younger children, and developmental abnormalities in older children may be kept in mind as the most common radiologic findings. Our study confirms the substantial absence of malignancies in children as well as a widely different disease spectrum in comparison with the adult population.

Evaluation of factors affecting tumor response and survival in patients with primary and metastatic liver cancer treated with microspheres.

OBJECTIVE: Radioembolization with the yttrium-90 (Y-90) microspheres is being used increasingly more often in the treatment of patients with primary or metastatic liver cancer. Although technetium-99m macroaggregated albumin (Tc-99m MAA) scintigraphy performed following diagnostic angiography has an important role in predicting the effectiveness of treatment and in dose estimation, the number of studies using quantitative assessment of Tc-99m MAA scintigraphy is limited in this field. In the present study, the aim was to assess whether a tumor dose is required to obtain objective tumor response and to check whether this threshold value is predictive in terms of tumor response, survival, and liver toxicity by using Tc-99m MAA single-photon emission computed tomography (SPECT) images. MATERIALS AND METHODS: Overall, 54 patients (20 women and 34 men; median age: 60 years) who underwent Y-90 Resin (SIR-Spheres) and Glass (TheraSphere) microsphere treatment with a diagnosis of unresectable liver cancer between August 2010 and April 2013 were included in the study. The mean doses to normal liver and tumor were estimated for each patient using Tc-99m MAA SPECT images and the medical internal radiation dosimetry method. The responses were assessed according to Response Evaluation Criteria In Solid Tumors (RECIST) and European Organisation for Research and Treatment of Cancer (EORTC) criteria. Kaplan-Meier survival curves and univariate Cox regression analysis were used in survival analysis. The relationship between treatment response and other parameters included was assessed using logistic regression analysis. The variables with a P value less than 0.01 in univariate analysis were assessed with multivariate analysis. RESULTS: Fifty-four Y-90 microsphere treatments (eight by using a Y-90 glass microsphere and 46 by using a Y-90 resin microsphere) were performed. In the multivariate analysis, the only parameter related to response was tumor dose (P<0.01). With a tumor dose of 280 Gy or higher, objective tumor response was observed in 59 and 77% of the patients according to RECIST and EORTC criteria, respectively, and the tumor control rate was found to be 95% according to both criteria. In addition, it was found that only tumor dose was correlated with progression-free survival (PFS) (P<0.001) and overall survival (OS) (P=0.018). When the tumor dose was 280 Gy or higher, median PFS increased from 2 to 10.7 months (P<0.001), whereas median OS increased from 9 to 17.6 months (P=0.018). However, reversible ≥ G2 liver toxicity was observed in 3.7% (2/54) of the patients within 3 months after radioembolization with a median normal liver dose of 40 Gy (10-102 Gy). There was reversible ≥ G3 liver toxicity in 3.7% (2/54) of patients, but no G4 liver toxicity was observed. Clinical radiation hepatitis and treatment-induced liver failure were not observed in any of these patients. CONCLUSION: Tc-99m MAA SPECT has a predictive value in terms of response to radioembolization, PFS, and OS. Dosimetry based on Tc-99m MAA SPECT images can be used in the selection of patients and, in particular, to adaptation of treatment plan in selected patients.

Follow-up versus tissue diagnosis in BI-RADS category 3 solid breast lesions at US: a cost-consequence analysis.

PURPOSE: The aim of this study was to compare the economic effect of a proposed follow-up strategy for managing category 3 breast masses. The strategy incorporated direct tissue diagnosis at the patient's discretion for masses that had been assessed only based on ultrasonography (US) and for which mammography made no diagnostic contribution. MATERIALS AND METHODS: This prospective cohort study was conducted between 2003 and 2006 and included 174 patients. We used a two-year short-term follow-up protocol composed of five steps. A biopsy was recommended for masses that were increasing in size and changing in nature. The long-term results were available at the end of 2010. The mean and total costs were calculated for the women who preferred our follow-up protocol and for those who preferred direct tissue diagnosis. The cost savings were calculated by comparing the costs of the current study protocol to the costs of two different scenarios. RESULTS: Two malignancies were found among the 18 women who underwent tissue diagnosis on the recommendation of the radiologist during follow-up. Thirteen of these women underwent biopsy at the request of the patient or surgeon, and these biopsies all revealed benign tumors. The overall negative predictive value was 99.2% (95% confidence interval, 98.46%-100%). There was a statistically significant difference between the mean costs for the women who chose our follow- up regimen (147.57±106.7 TL) and those who preferred direct tissue diagnosis (426.89±149.8 TL) (P = 0.0001). The use of our follow-up protocol decreased the cost of diagnosis by 60% compared with the cost of using direct tissue diagnosis as the initial procedure. CONCLUSION: Our long-term results indicate that following-up solid category 3 masses detected only by US for at least two years at short intervals is a cost-effective alternative to direct breast biopsy.