Bülent Aksel

The Role of 18F-FDG PET/CT in the Primary Staging of Gastric Cancer.

Objective: The aim of this study is to explore the role of 18F-FDG PET/CT in the primary staging of gastric cancer in the comparison of ceCT as routine staging method and evaluate influencing parameters of 18F-FDG uptake. Methods: Thirty-one patients (mean age: 58.9±12.6) who underwent 18F-FDG PET/CT for primary staging of gastric cancer between June 2011 and June 2012 were included to the study. 18F-FDG PET/CT findings were compared with pathological reports in patients who underwent surgery following PET/CT. 18F-FDG PET/CT findings of primary lesions, lymph nodes and adjacent organs were compared with ceCT findings and pathological reports. Since 6 patients were accepted as inoperable according to 18F-FDG PET/CT and/or ceCT and/or laparotomy and/or laparoscopy findings, pathological confirmation could not be possible. Results: In the postoperative TNM staging of patients, while 1 (4%), 1 (4%), 4 (16%), 2 (8%), 12 (48%) and 5 (20%) patients were staged as T0, Tis, T1, T2, T3 and T4, respectively, 8 (32%), 6 (24%), 6 (24%) and 5 (20%) patients were N0, N1, N2 and N3 respectively. 18F-FDG PET/CT was totally normal in 2 patients. While primary tumors were FDG avid in 27 patients, in 17 and 6 patients FDG uptake was observed in perigastric lymph nodes and distant organs, respectively. Mean SUVmax of FDG avid tumors was calculated as 13.49±9.29 (3.00-44.60). However, SUVmax of lymph nodes was computed as 9.28±6.92 (2.80-29.10). According to sub-analysis of histopathological subtypes of primary tumors, SUVmax of adenocarsinomas was calculated as 15.16 (3.00-44.60), of signet ring cells as 9.90 (5.50-17.70), of adenocarcinomas with signet ring cell component as 11.27 (6.20-13.90) (p=0.721). In the comparison with histopathological examination while ceCT was TP, TN, FN in 23, 1 and 1 patients, 18F-FDG PET/CT was TP, FP, FN in 20, 1 and 4 patients, respectively. Sensitivity, specificity, accuracy, PPD and NPV of ceCT in the detection of lymph node metastasis was calculated as 83.3%, 75%, 80%, 87.5% and 66.6%, respectively. These parameters for 18F-FDG PET/CT were 64.7%, 100%, 76%, 100% and 57.1%. Conclusion: Despite lower sensitivity than ceCT, diagnostic power of 18F-FDG PET/CT in the preoperative staging of gastric cancer is acceptable. Because of its high PPV, it might be beneficial in the evaluation of patients with suspected lymph nodes. The role of 18F-FDG PET/CT seems to be limited in the early stage and signet ring cell carcinomas due to lower 18F-FDG uptake.

Primer meme kanserinin lokal kontrolünde radyofrekans ablasyon bir seçenek olabilir mi

Meme kanseri tedavisi icin radyofrekans ablasyon gorece yeni bir tekniktir. Radyofrekans ablasyon uygulama- lari konusunda literaturde her gun artan yayinlara karsin meme kanserinde uygulamalardaki deneyim sinirli bu- lunmaktadir. Sinirli sayidaki klinik calismanin sonuclarina bakildiginda bu yontem, tumor boyutu kucuk olan (T1) lokalize olgularda tercih edilebilir minimal invaziv bir yontem gibi gorunmektedir. Doku harabiyeti nedeniy- le ablasyon sonrasi histopatolojik degerlendirmenin yapilamamasi ve hastalarin takibinde belirli bir standardi- zasyonun olmayisi bu islemin cozum bekleyen onemli sorunlaridir. Radyofrekans ablasyonun ameliyat edilebi- lir meme kanserinde bir tedavi secenegi olabilmesi icin, literaturdeki hasta sayisi dusuk olan az sayidaki hete- rojen calismalara eklenmis, uzun takip sureli ve genis serili klinik calismalara ihtiyac vardir.

To What Extent Peritonitis Carcinomatosa Can Foreseeable in Digestive System Tumors

Introduction: Peritoneal dissemination may develop in many digestive system and gynecological cancers. Despite advances in imaging technologies, it is difficult to diagnose PC induced by digestive system tumors before surgery. Methods: In this study, staging tests used in patients with PC that unidentified preoperatively were reviewed retrospectively. Eighty-two patients were evaluated in between January 2012 and November 2015. Results Forty-five (54.8%) patients had been operated with stomach cancer, 24 patients (29.2%) with colorectal, and 13 patients (15.8%), pancreas and biliary tract cancers. Computerized Tomography (CT) was taken to all patients for staging, 26 patients were also evaluated with abdominal ultrasonography (USG) and 4 patients with magnetic resonance imaging (MRI). Positron Emission Tomography (PET-CT) was applied to eight patients. While 40 (48.7%) patients underwent surgical bypass and other palliative procedures, no additional surgical procedures were performed in 42 patients. In our series of patients who all have undergone laparotomy, all patients were evaluated with preoperative CT and suspicious findings identified in 10 patients were interpreted as not being specific to quit laparotomy. The most suspicious findings were reported in PC patients with gastric cancer (8/45). In our study, the PET/CT findings of 4 out of 8 patients evaluated were interpreted as suspicious, but they were not strong enough to exclude PC. Conclusion: It is still difficult to diagnose PC before surgery with conventional radiological imaging techniques. Combined use of different imaging modalities together can increase the success rate. It should be known that the probability of PC is especially high in patients with tumor marker elevation and locally advanced and borderline resectable disease findings. If palliative interventions are not planned in these patients, staging laparoscopy emerges as a suitable alternative.

Mide kanseri cerrahisinde fast-track ve geleneksel yöntemlerin karşılaştırılması

GIRIŞ Mide kanseri sik karsilasilan bir hastaliktir. Dunyada her yil yaklasik bir milyon yeni olgu teshis edilmektedir (1). Billroth tarafindan ilk basarili gastrektominin yapildigi 1881 yilindan bu yana cerrahi mide kanserinin kuratif tedavisinde hala tek umuttur. Geleneksel elektif gastrik rezeksiyon %10-45 komplikasyon orani ve 8-13 gunluk postoperatif hastanede yatis suresiyle uygulanmaktadir (2-5) . Mide kanser cerrahisinde fasttrack cerrahi (FTC) uygulamalarla ilgili, literaturde cok az veri bulunmaktadir. Tek prospektif randomize calisma Wang ve ark. (6) ait olup FTC’nin mide kanser cerrahisine guvenle uygulanabilecegi rapor edilmistir.