Clinical value of 18F-PSMA-1007 PET/MRI in primary staging of patients with intermediate- to high-risk prostate cancer.

OBJECTIVE: To assess the utility of 18F-PSMA-1007 PET/MRI in initial staging of intermediate- to high-risk prostate cancer (HRPCa). METHODS: A total of 46 patients with pathologically verified intermediate and/or HRPCa who underwent 18F-PSMA-1007 PET/MRI with dedicated pelvic high-resolution multiparametric MRI (mpMRI) were included. RESULTS: PET/MRI showed 100% sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV), and accuracy in detecting seminal vesicle (SV) and rectal invasion, versus 87.5%, 100%, 100% 93.8%, 95.7% and 50%, 100%,100%, 95.5%, and 95.7% for mpMRI respectively. However, PET/MRI had poor SN (40% and 0%) but high SP (94.4% and 100%) in detection of UB and neurovascular bundle (NV) invasion compared to 100% SN and SP for mpMRI. PET/MRI demonstrated stronger TNM staging agreement with the gold standard than mpMRI-WBMRI. It demonstrated concordance with T, N, and M stages in 40, 41, and 36 patients (k 0.84, 0.60, and 0.68, respectively) versus 29, 33, and 31 patients (k 0.54, 0.22, and 0.50) with accurate over all staging of 38/46 patients versus 30/46 patients (K 0.52 versus 0.22). CONCLUSION: 18F-PSMA-1007 PET/MRI is a promising imaging modality with high diagnostic accuracy in staging intermediate- and HRPCa; it improves local tumour evaluation and provides precise TNM staging. ADVANCES IN KNOWLEDGE: 18F-PSMA-1007 PET/MRI could have high diagnostic accuracy as shown in the current study for staging HRPCa patients that is crucial for treatment selection. We think that our study will contribute to the body of knowledge and improve the literature surrounding the clinical uses of integrated 18F-PSMA-1007 PET/MRI.

Phyllodes Tumors of the Breast (the Egyptian Experience).

Phyllodes tumors (PT) are rare fibroepithelial lesions, about 0.3-0.5% of all breast tumors. This study is an evaluation of patient characteristics, clinicopathologic features, diagnostic tools, therapeutic options, risk factors for recurrence, and distant metastasis and follow-up findings in patients with PTs. One hundred twenty-seven patients with pathologically proved PTs in the National Cancer Institute, Cairo University, Egypt, from January 2011 to January 2016 were reviewed and analyzed. Sixty patients presented with benign PTs (47.2%), 34 had borderline PTs (26.8%), and 33 had malignant PTs (26%). The mean follow-up period was approximately 36 months; local recurrence occurred in 34 patients, 9 benign cases (14.5%), 11 borderlines (32.4%), and 14 malignant PTs (42.4%). Mastectomy was the most commonly used surgery in recurrent cases (61.4%). Axillary staging was performed in 31 cases (24.4%); only 2 cases showed positive nodal metastasis (6.5%) and were of the malignant subtype. Distant metastasis occurred in 12 patients, 4 with borderline PTs, and 8 with malignant PTs. The most common site for metastasis was the lungs and bones. Adjuvant radiotherapy was applied in 9 patients, 2 in borderline phyllodes, and 7 in malignant phyllodes; post-radiotherapy recurrence occurred in 5 malignant phyllodes patients. Chemotherapy was employed in 10 metastatic patients (4 with borderline and 6 with malignant phyllodes); excision with clear margins is important to reduce the local recurrence. Routine axillary staging should not be done. The adjuvant radiation therapy is still controversial. Local recurrence can develop even after appropriate surgery. Therefore, close follow-up is mandatory.

Retrospective Study of Tc-99m Thyroid Scan in Patients with Graves' Disease: Is There Significant Difference in Lobar Activity?

PURPOSE: Graves' disease (GD) is the most common cause of hyperthyroidism. It was reported that the right thyroid lobe is generally larger, and it is more likely to be affected by thyroid disorders. The aim of the current study is to verify preferential affection of one of the thyroid lobes and incidence of higher activity of either thyroid lobe in patients with GD through analysis of quantitative data of Tc-99m thyroid scan and possible relation of different thyroid lobar activity to gender, age, and total thyroid uptake (TTU) level. MATERIALS AND METHODS: Retrospective analysis of quantitative data of Tc-99m thyroid scan in patients with GD was done. Total and lobar thyroid uptake levels were analyzed and correlated with age, gender, and TTU. RESULTS: GD was reported in 222 patients, representing 76.6% of those with hyperthyroidism, women represent 70.3% of patients. The right thyroid lobe uptake (RLU) figures were significantly higher compared to the left in the whole group as well as in women and in young patients (<40 years). This significance was lost in men and in old patients. Equal lobar uptake was found in 11 patients. 138 patients (62.2%) had higher RLU, while the remaining 73 patients (32.8%) had higher left thyroid lobe uptake, with statistically significant difference. This significant difference was found in women and in young patients and was absent in men and old patients. There is an increase in the incidence of patients with higher RLU in association with an increase in TTU. All women with TTU >30% had higher RLU figures. CONCLUSION: There is significant preferential thyroid lobar affection in favor of the right thyroid lobe in patients with GD, with significantly higher RLU figures and significantly more incidence of patients with higher right lobar activity. This significance is maintained in women and in young patients and lost in men and old patients. The incidence of higher right thyroid lobe activity also increases in association with increase in TTU. Our results emphasize the value of Tc99m thyroid scan in patients with GD, especially when surgery is the treatment of choice, helping to tailor suitable surgical procedure for each individual patient.

Measurement of cumulative radiation exposure to children and adolescents in contact with outpatients treated with low dose radioactive iodine (131I).

BACKGROUND: Radiation exposure from patients treated with radioactive iodine (131I) represents a radiation hazard to children and adolescents, representing the most vulnerable group of household contacts. Our aim was to calculate the cumulative radiation exposure (CRE) figures to children and adolescents sharing the same home with outpatients treated with low-dose 131I. The secondary aim was to study the demographic and educational factors that may significantly affect radiation exposure to them. RESULTS: The whole number of household contacts less than 18 years was 99, out of them 49 ≤ 12 years. CRE level to children and adolescents ranged from 79 to 934 uSv. The mean, median, and 75th percentile figures were 284 ± 178 uSv, 215 uSv, and 334 uSv, respectively. The compliance of this group of contacts to radiation exposure constraint (1 mSv) was 100%. All CRE values were below this figure with 75% of them below half of this constraint. Thirteen adolescents from 12 to 18 years and 17 mothers of 23 household contacts ≤ 12 years got radiation safety instructions (RSI) directly from a radiation safety officer (RSO). This group had a significantly lower mean CRE value (184 ± 93 uSv) compared to those who got RSI from the patient or from other family members (298 ± 185 uSv) with a significant p value. CONCLUSION: The compliance of adolescents and children to the 1-mSv radiation exposure constraint is 100%. It is advised for adolescents and mothers of children in contact with 131I-treated patients to get direct RSI from the RSO, which is the only factor associated with significantly lower radiation exposure figures.

Long-term scintigraphic and clinical follow up in patients with differentiated thyroid cancer and iodine avid bone metastases.

AIM: The aim of this study was to evaluate the long-term overall therapy outcomes and clinicopathological risk factors in patients with differentiated thyroid cancer (DTC) and iodine avid bone metastases. METHODS: Our study included 93 patients [female to male ratio (2:1)]. All patients were subjected to clinical examination, laboratory assessment, I-131 whole body scan, and neck ultrasound. Iodine avid metastases were treated with successive radioactive iodine-131 (RAI-131) doses. The overall response was defined as complete response (CR), incomplete response (IR) [partial response (PR) and stable disease (SD)], and progressive disease (PD). RESULTS: Fifty-four patients had follicular carcinoma and 39 with papillary type. Isolated bone metastases, bone and lung metastases, and multi-organ metastases were found in 45, 34, and 14 patients, respectively. The overall CR, PR, SD, and PD were found in 8.6%, 28%, 46.2%, and 17.2% patients, respectively. Adjunctive radiotherapy resulted in more CR, IR, and low PD rates compared to RAI-131 therapy (9.0%, 78.3%, 12.7% vs. 7.9%, 56.8%, and 23.7%, respectively) (P = 0.03). The overall survival rate was 88.2% and median follow-up period was 123 months. Female patients, papillary carcinoma, and single focal lesion had better overall response rate. Males, extrathyroidal extension, vascular invasion, and lymph nodes metastases had increased PD and decreased global response rates. CONCLUSION: Despite of low CR rate (8.6%), most patients with DTC and iodine avid bone metastases had SD (46.2%) and long lived (88.2%). Adjunctive radiotherapy reduced PD and improved outcome. Males, extra thyroid extension and vascular invasion were bad prognostic factors.