BackgroundAlthough papillary thyroid microcarcinoma (PTMC) is diagnosed with increasing frequency, the best therapeutic option and follow-up protocol have not been established yet, especially in the case of incidental diagnosis. We reviewed our series of patients with PTMC to determine risk factors for recurrence in an area where there is a high prevalence of goiter.MethodsThe medical records of all patients who underwent thyroidectomy with a final pathology report of PTMC between October 2002 and June 2007 were reviewed. PTMC was defined as a papillary thyroid carcinoma 10 mm or less in diameter. Follow-up evaluation was obtained by outpatient consultation and/or telephone interview.ResultsIn a series of 2,220 patients who underwent thyroidectomy for a thyroid carcinoma, 933 had a PTMC. Diagnosis was incidental in 704 patients (75.5%). Upon multivariate analysis, tumor size, nonincidental diagnosis, and neck node metastases at diagnosis were independent risk factors for extracapsular spread (ECS), while ECS, multifocal disease, and number of removed lymph nodes were independent risk factors for lymph node metastases at diagnosis. Follow-up evaluation was completed in 287 patients, 9 (3.1%) of whom experienced recurrence. The number of removed and metastasized nodes at first operation and the length of the follow-up were independent risk factors for recurrent disease.ConclusionsIncidental diagnosis of PTMC is frequent in a high prevalence of goiter area. PTMC shows a variable degree of aggressiveness. Management protocols should be based on patient- and tumor-related prognostic factors, as for larger tumors.

Papillary thyroid microcarcinoma: extrathyroidal extension, lymph node metastases and risk factors for recurrence in a high prevalence of goiter area

ObjectiveThe objective of this study was to investigate the correlation between dual-energy computed tomography (DECT)–based iodine quantitation and fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) imaging for response evaluation of lung cancers to

Dual-Energy Computed Tomography-Based Iodine Quantitation for Response Evaluation of Lung Cancers to Chemoradiotherapy/Radiotherapy: A Comparison With Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography-Based Positron Emission Tomography/Computed Tomography Response Evaluation Criterion in Solid Tumors.

BACKGROUND/AIMS The Positron Emission Tomography Response Criteria in Solid Tumors (PERCIST) or European Organization for Research and Treatment of Cancer (EORTC) criteria are used to assess metabolic tumor responses. However, tumor responses have shown considerable discrepancies between the morphologic criteria (Response Evaluation Criteria in Solid Tumors [RECIST]) and metabolic criteria. We performed this pooled study to compare the RECIST and metabolic criteria in the assessment of tumor responses. METHODS Electronic databases were searched for eligible articles with the terms "RECIST," "PERCIST," or "EORTC criteria." The level of concordance in the tumor responses between the two criteria was estimated using κ statistics. RESULTS A total of 216 patients were collected from eight studies comparing the RECIST and EORTC criteria. The agreement of tumor responses between the two criteria was moderate (κ = 0.447). Eighty-six patients (39.8%) showed disagreement: tumor response was upgraded in 70 patients and downgraded in 16 when adopting the EORTC criteria. The EORTC criteria significantly increased the overall response rate (53% vs. 28%, p < 0.0001). The agreement of tumor responses between the RECIST and PERCIST was deemed fair (κ = 0.389). Of 407 patients from nine studies, 181 (44.5%) showed a discrepancy: using the PERCIST, tumor response were upgraded in 151 patients and downgraded in 30. When adopting the PERCIST, the overall response rate was also significantly increased from 30% to 55% (p < 0.0001). CONCLUSION This pooled analysis demonstrates that the concordance of tumor responses between the morphologic criteria and metabolic criteria is not excellent. When adopting the metabolic criteria instead of the RECIST, overall response rates were significantly increased.

/pdf/comparison-of-the-morphologic-criteria-recist-and-metabolic-3anxbbjr42.pdf

Comparison of the morphologic criteria (RECIST) and metabolic criteria (EORTC and PERCIST) in tumor response assessments: a pooled analysis.

Purpose: The aim of the present study was to show the protective effect of pulsed magnetic field (PMF) application and melatonin administration on damage in testis in a one-sided torsion detorsion induced rat model using testicular scintigraphy with 99m Tc pertechnetate, PET/CT with 18 F-FDG and histopathological methods. Materials and Methods: Sixty male rats were used in the study; 30 rats were randomly divided into five groups for one day applications of sham control, torsion, melatonin, pulsed magnetic field (PMF) and melatonin plus PMF. Similarly, for one week group, the other 30 rats were divided into the same five group (n=6), but the animals were sacrificed after one week. Rats were exposed to 50 Hz, 1 mT PMF for two hours. PET/CT with 37 MBq 18 F-FDG and testicular scintigraphy with and 37 MBq 99m Tc pertechnetate examinations were carried out, and testicular tissue was examined using histopathological methods. Results: In one day treatment, melatonin administration significantly increased perfusion and glucose metabolism compared to torsion group (p<0.01). Perfusion and glucose metabolism was also higher in the PMF and melatonin plus PMF groups than torsion group (p<0.01). In one week treatment, melatonin administration resulted in a significant higher perfusion rate and glucose metabolism rate compared to torsion group (p<0.01 and p<0.001, respectively). In addition, perfusion and glucose metabolism significantly increased in PMF and melatonin plus PMF groups compared to torsion group (p<0.01 and p<0.001, respectively). Furthermore, caspase-3 immunoreactivity and pathological changes increased in the torsion group (p<0.05). Melatonin and melatonin plus PMF treatment reduced the rate of immunoreactivity and pathological findings compared to the torsion group (p<0.05). Conclusion: According to these results it can be concluded that PMF application had a therapeutic benefit as effective as melatonin administering. In addition, it was indicated that PET/CT with 18 F-FDG and testicular scintigraphy with 99m Tc pertechnetate could be efficiently used in determining the treatment efficiency in testicular torsion.

/pdf/the-protective-effects-of-pulsed-magnetic-field-and-35bzs1jfxx.pdf

The Protective Effects of Pulsed Magnetic Field and Melatonin on Testis Torsion and Detorsion Induced Rats Indicated by Scintigraphy, Positron Emission Tomography/Computed Tomography and Histopathological Methods

Objectives: 18 Fluorine-fluorodeoxyglucose ( 18 F-FDG) positron emission tomography/ computed tomography (PET/CT) is commonly used for diagnosis, staging and re-staging of cancers and for determining the effectiveness of treatment. Because of renal, ureteral and urinary involvement of 18 F-FDG radiopharmaceutical after its injection, patients subject to radioactivity during its effective half-life. The aim of the present study was to determine the degree of association between effective dose levels of patients and bladder emptying of patients having PET/CT scans. Methods: The present retrospective study included 108 patients (43 females and 65 males, average age: 60.9 ± 12.7 years). Effective dose level as mSv/h was determined from a distance of 1 m in all patients before and after bladder emptying at the first hour following 18 F-FDG injection. Radioactivity excretion amounts were compared based on gender, age, body mass index, fasting blood sugar level and clinical diagnosis. Results: Amount of radioactivity decreased by 22.75% ± 14.77% after bladder emptying. No association was found between urinary excretion level and age, gender, fasting blood sugar and body mass index ( p > 0.05). Conclusions: Active emptying of bladder in patients having PET/CT scans where 18 F-FDG radiopharmaceutical is involved is an effective method for the radiation safety of both health workers and patients.

/pdf/effect-of-urinary-excretion-on-radiation-dose-in-patients-je3lsx2kts.pdf

Effect of urinary excretion on radiation dose in patients having PET/CT scans

Objective The aim of the present study was to evaluate the response to treatment by histopathologic type in patients with lung cancer and under follow-up with 18F-fluoro-2deoxy-glucose-positron emission tomography/computed tomography (18F-FDG PET/CT) imaging by using Response Evaluation Criteria in Solid Tumors (RECIST) and European Organisation for Research and Treatment of Cancer (EORTC) criteria that evaluate morphologic and metabolic parameters. Methods On two separate (pre- and post-treatment) 18F-FDG PET/CT images, the longest dimension of primary tumor as well as of secondary lesions were measured and sum of these two measurements was recorded as the total dimension in 40 patients. PET parameters such as standardized uptake value (SUVmax), metabolic volume and total lesion glycolysis (TLG) were also recorded for these target lesions on two separate 18F-FDG PET/CT images. The percent (%) change was calculated for all these parameters. Morphologic evaluation was based on RECIST 1.1 and the metabolic evaluation was based on EORTC. Results When evaluated before and after treatment, in spite of the statistically significant change (p 0.05). In histopathologic typing, when we compare the post-treatment phase change with the treatment responses of RECIST 1.1 and EORTC criteria; for RECIST 1.1 in squamous cell lung cancer group, progression was observed in sixteen patients (57%), stability in seven patients (25%), partial response in five patients (18%); and for EORTC progression was detected in four patients (14%), stability in thirteen patients (47%), partial response in eleven patients (39%), in 12 of these patients an increase in stage (43%), in 4 of them a decrease in stage (14%), and in 12 of them stability in stage (43%) were determined. But in adenocancer patients (n=7), for RECIST 1.1, progression was determined in four patients (57%), stability in two patients (29%), partial response in one patient (14%); for EORTC, progression in one patient (14%), stability in four patients (57%), partial response in two patients (29%) were observed and in these patients, an increase in stage was detected in 3 of them (43%), while 4 of them remained stable. According to histopathologic diagnosis, between squamous cell cancer and adenocancer cases, no significant difference was determined in terms of SUVmax (p>0.05). Post-treatment SUVmax was significantly different in primary tumor but was not significantly different in nodal involvement and metastatic lesions for squamous cell carcinoma patients as compared to the pre-treatment SUVmax measurements. Similarly, there was no significant difference between primary tumor and nodal involvement for adenocarcinoma patients. Conclusion Whether metabolic or morphologic changes are more accurate in evaluating treatment response in lung cancer remains unknown, and there is no gold standard diagnostic method on this issue yet. The most reliable results can only be achieved by survival curve parameters. However, we believe SUVmax seems to provide more easy and practical data for the evaluation of treatment response.

Morphologic and Metabolic Comparison of Treatment Responsiveness with 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography According to Lung Cancer Type.

Objective: The aim of the present study was to evaluate the response to treatment by histopathologic type in patients with lung cancer and under follow-up with 18F-fluoro-2deoxy-glucose-positron emission tomography/computed tomography (18F-FDG PET/CT) imaging by using Response Evaluation Criteria in Solid Tumors (RECIST) and European Organisation for Research and Treatment of Cancer (EORTC) criteria that evaluate morphologic and metabolic parameters. Methods: On two separate (pre- and post-treatment) 18F-FDG PET/CT images, the longest dimension of primary tumor as well as of secondary lesions were measured and sum of these two measurements was recorded as the total dimension in 40 patients. PET parameters such as standardized uptake value (SUVmax), metabolic volume and total lesion glycolysis (TLG) were also recorded for these target lesions on two separate 18F-FDG PET/CT images. The percent (%) change was calculated for all these parameters. Morphologic evaluation was based on RECIST 1.1 and the metabolic evaluation was based on EORTC. Results: When evaluated before and after treatment, in spite of the statistically significant change (p 0.05). In histopathologic typing, when we compare the post-treatment phase change with the treatment responses of RECIST 1.1 and EORTC criteria; for RECIST 1.1 in squamous cell lung cancer group, progression was observed in sixteen patients (57%), stability in seven patients (25%), partial response in five patients (18%); and for EORTC progression was detected in four patients (14%), stability in thirteen patients (47%), partial response in eleven patients (39%), in 12 of these patients an increase in stage (43%), in 4 of them a decrease in stage (14%), and in 12 of them stability in stage (43%) were determined. But in adenocancer patients (n=7), for RECIST 1.1, progression was determined in four patients (57%), stability in two patients (29%), partial response in one patient (14%); for EORTC, progression in one patient (14%), stability in four patients (57%), partial response in two patients (29%) were observed and in these patients, an increase in stage was detected in 3 of them (43%), while 4 of them remained stable. According to histopathologic diagnosis, between squamous cell cancer and adenocancer cases, no significant difference was determined in terms of SUVmax (p>0.05). Post-treatment SUVmax was significantly different in primary tumor but was not significantly different in nodal involvement and metastatic lesions for squamous cell carcinoma patients as compared to the pre-treatment SUVmax measurements. Similarly, there was no significant difference between primary tumor and nodal involvement for adenocarcinoma patients. Conclusion: Whether metabolic or morphologic changes are more accurate in evaluating treatment response in lung cancer remains unknown, and there is no gold standard diagnostic method on this issue yet. The most reliable results can only be

Morphologic and Metabolic Comparison of Treatment Responsiveness with 18 Fludeoxyglucose-Positron Emission Tomography/Computed Tomography According to Lung Cancer Type Akciğer Kanseri Tipine Göre 18 Florodeoksiglikoz-Pozitron Emisyon Tomografisi/Bilgisayarli Tomografi ile Tedavi Yanitinin Morfolojik ve Metabolik Karşilaştirilmasi

Objective: In this study, we aimed to evaluate the tumor size for proximal and distant metastases when the new and old TNM classification is taken into account in differentiated thyroid cancers.

Material and Methods: Two hundred sixty eight patients diagnosed with thyroid carcinoma, undergoing bilateral total or subtotal thyroidectomy treated with high doses of I-131 were examined retrospectively. The data of these patients were compared after classification, according to tumor size <1 cm and <2 cm, lymph node metastases thyroid and tumor capsule invasion at the time of diagnosis, and accumulation of abnormal activity in post I-131 treatment whole-body scan. I-131 uptakes besides physiological and thyroid bed were considered as abnormal activity uptakes.

Results: A total of 268 patients with average age of 19-82 yrs (mean: 47.0±13.8 yrs) were included in the study. At postoperative histopathological evaluation, 228 (85.1%) of patients were reported as papillary, 13 (4.9%) as follicular, 23 (8.6%) as well differentiated tumor of unknown malignant potential, 2 (0.7%) as insular and 2 (0.7%) as Hurthle-cell carcinoma. In patients with known tumor size, 96 of 207 (46.4%) patients' tumor size was 1 cm. In the same group, according to the revised TNM classification, in 149 of 207 patients (72%) the tumor size was 2 cm. Of 187 patients with negative lymph nodes, 15 (8%) showed abnormal activity accumulation in the first post I-131 treatment whole-body scan and 10 (40% of 25 patients) positive lymph node (p<0.05) involvement.

Conclusion: Since the treatment of patients with microcarcinoma is controversial, tumor size should not be the only factor considered in patients with differentiated thyroid cancer Tissue tumor invasion, age, gender and multifocality should also be taken into account.

Conflict of interest:None declared.

The Evaluation of Microcarcinoma in Differentiated Thyroid Cancers According to Old and New TNM Classification.

Ozet Kemik sintigrafisi aktif kemik hastaliginin saptanmasinda hassasiyeti cok yuksek bir goruntuleme yontemidir. En sik kullanilan endikasyonu kemik metastazlarinin tespit ve takibidir. Kemige ozgu radyofarmasotigin kemik dokuda yuksek oranda tutulumu sonucu kemik sintigrafisinde normalde kemik yapilar ve atilimi sirasinda bobrek ve mesane gorulmekte, ancak bazen iskelet-disi yumusak dokularda da tutulum bildirilmektedir. Tc-99m MDP ile yapilan tum vucut kemik sintigrafisinde skrotal herni veya hidroselin goruntulenmesi yine nadir ve ilginc bir bulgudur. Bu raporumuzda literatur gozden gecirilerek, klinigimizde kemik sintigrafisi esnasinda tesadufen goruntulenen skrotal lezyon saptanmis uc olgu sunulmaktadir. Anahtar sozcukler: Kemik sintigrafisi, skrotal herni, hidrosel, Tc-99m MDP Abstract Bone scintigraphy is a very sensitive imaging technique in detecting active bone diseases. Primary indication is diagnosis and follow-up of metastatic bone disease. Bone specific radiopharmaceuticals have quite a high skeletal uptake, thus osseous structures can readily be seen in bone scintigraphy, along with kidneys and bladder during their excretion. However, extra-skeletal uptake in soft-tissue structures on bone scans has been reported occasionally. Imaging of scrotal hernia and of testicular hydrocele during Tc-99m- MDP bone scintigraphy are rare and interesting findings. In our paper, we presented three cases with scrotal lesions, detected incidentally during bone scintigraphy in our clinic together with a review of the literature on the subject. Keywords: Bone scingtigraphy, scrotal hernia, hydrocele, Tc-99m MDP

/pdf/kemik-sintigrafisi-esnasinda-skrotal-lezyonlarin-4an3uddyrn.pdf

Mehmet Fatih Börksüz

Papers

Morphologic and Metabolic Comparison of Treatment Responsiveness with 18Fludeoxyglucose-Positron Emission Tomography/Computed Tomography According to Lung Cancer Type.

The Evaluation of Microcarcinoma in Differentiated Thyroid Cancers According to Old and New TNM Classification.

Kemik sintigrafisi esnasında skrotal lezyonların görüntülenmesi