Eva Radecka

Complications associated with percutaneous nephrostomies : A retrospective study

Purpose: To determine the morbidity and mortality associated with radiologically guided percutaneous nephrostomy (PCN). Material and Methods: A retrospective analysis of 401 patients treated with 569 PCN over a 5‐year period was performed. Using the Seldinger technique, the catheters (6–10 F) were placed under fluoroscopic, ultrasonographic, or CT guidance. Data on underlying disease, complications, subsequent management, and long‐term management were collected. Results: PCN was successful in 558 of the 569 attempts (98%). There were 22 major complications (4%) in 569 procedures, including cardiac arrest, bleeding requiring transfusion or embolization, septicemia, hydrothorax or pneumothorax. There were 38% minor complications, including urinary tract infection, catheter dislodgement, catheter obstruction by debris, urinary leakage, and inflammation of the skin at the site of insertion of the percutaneous catheter. Seventy‐seven (14%) of the procedures were followed by urinary tract infection during the PCN treatment. Seventy‐nine (14%) catheters slipped out unintentionally. Conclusion: Percutaneous nephrostomy is a gentle procedure associated with high technical success and low morbidity. However, the risk of the procedure has to be weighed against the expected benefit.

Survival time and period of catheterization in patients treated with percutaneous nephrostomy for urinary obstruction due to malignancy

Purpose: To assess patient mortality and survival time, period of catheterization, and indications for percutaneous nephrostomy (PCN) withdrawal in patients treated with PCN for urinary obstruction due to malignancy. Material and Methods: A retrospective analysis of 151 patients treated with 257 PCNs in a 5-year period was performed. Data on survival time, duration of catheterization, and clinical end-points for PCN treatment were collected. Results: The median survival time of the patients was 255 days, while median catheterization time was 62 days. The majority of patients (84) died with the catheter. Indications for PCN withdrawal were surgery, stent treatment, catheter displacement, and response to medical treatment. Conclusion: The majority of patients with malignancy treated with PCN have advanced disease and short life expectancy. Factors such as diagnosis, prognosis, economy, and the patients preference influence the choice of urinary diversion method. However, PCN should be considered in patients with malignancy on grounds of safety and low cost.

[11C]Acetate positron emission tomography-computed tomography imaging of prostate cancer lymph-node metastases correlated with histopathological findings after extended lymphadenectomy.

Abstract Objective.The aim of this study was to determine the efficacy of combined [11C]acetate positron emission tomography and computed tomography ([11C]acetate-PET/CT) in regional lymph-node staging in patients with prostate cancer (PCa). Material and methods. [11C]Acetate-PET/CT was performed in 19 PCa patients who subsequently underwent extended pelvic lymph-node dissection (ePLND). The [11C]acetate-PET/CT results were compared with the surgical and histopathological findings from 13 defined lymph-node regions. Results.[11C]Acetate-PET/CT was true-positive for lymph-node metastases in nine patients, false-positive in three, false-negative in one patient and true-negative in six. The patient-by-patient-based sensitivity was 90% and the specificity 67%, the positive predictive value (PPV) was 75% and the negative predictive value (NPV) 86%. From a total of 114 nodal regions (mean 5.9 regions per patient), 484 lymph nodes (mean 25.5 nodes per patient) were removed and evaluated histopathologically. Forty-six lymph nodes from 24 out of 114 (21%) nodal regions were positive for PCa metastasis. The nodal-region-based sensitivity of [11C]acetate-PET/CT was 62%, specificity was 89%, PPV 62% and NPV 89%. Conclusion. [11C]Acetate-PET/CT detects PCa lymph-node metastases with high patient-by-patient-based sensitivity but low specificity, and low nodal-region-based sensitivity but high specificity. Its limited ability to detect microscopic lymph-node involvement makes ePLND essential in all patients diagnosed with positive nodes on [11C]acetate-PET/CT.

An unusual case of tumor thrombus in the inferior vena cava. A case report.

Adrenal cortical carcinoma (ACC) is a rare malignancy. Patients present either with a functional tumor or secondary to mass effect. In non-functioning tumors, the tumor size often exceeds 5 cm by the time of diagnosis, and tumor thrombus can occur. We report on a case of a small non-functioning ACC causing a large tumor thrombus in the inferior vena cava.

Pilot study of adoptive immunotherapy with sentinel node-derived T cells in muscle-invasive urinary bladder cancer

Abstract Objective: The aim of this study was to determine by computed tomography (CT) whether treatment with tumor-draining lymph-node-derived expanded autologous T lymphocytes results in objective responses and/or improved survival in patients with metastatic urinary bladder cancer (UBC) and to record the toxicity of the treatment. Materials and methods: Eighteen patients with metastatic UBC were prospectively selected from two centers. The preoperative staging was T2–T4bN1–2 and/or M0–M1 or MX. Tumor-draining lymph nodes were harvested at intended cystectomy for the extraction of T lymphocytes. This was followed by expansion of the T lymphocytes in a cell culture, and subsequent reinfusion of these autologous tumor-specific T lymphocytes. Responses to therapy were evaluated by CT scans according to Response Evaluation Criteria In Solid Tumors (RECIST) and clinical follow-up, according to the research protocol. Results: Nine out of 18 patients were treated. Treatment was feasible and safe. In two out of nine immunologically treated patients, objective responses were detected in terms of diminished or obliterated nodal metastases. When excluding three patients with disseminated osseous metastases plus one with a T4b tumor left in situ, a success rate of two out of six treated patients was seen. The two responders had survival times of 35 and 11 months, respectively. No toxicity was recorded. Conclusions: Infusion of expanded autologous tumor-specific T lymphocytes is feasible and safe, and objective responses according to RECIST were recorded. One objective responder to immunotherapy displayed notably long overall survival.

An Unusual Case Of Tumor Thrombus In The Inferior Vena Cava

Adrenal cortical carcinoma (ACC) is a rare malignancy. Patients present either with a functional tumor or secondary to mass effect. In non-functioning tumors, the tumor size often exceeds 5 cm by the time of diagnosis, and tumor thrombus can occur. We report on a case of a small non-functioning ACC causing a large tumor thrombus in the inferior vena cava.

Diagnostic accuracy of computed tomography urography and visual assessment during ureterorenoscopy in upper tract urothelial carcinoma.

To investigate diagnostic accuracy of multiphase computed tomography urography (MCTU) and visual assessment at ureterorenoscopy (URS) for detection of upper tract urothelial carcinoma (UTUC).

242 11C-ACETATE PET/CT IMAGING OF PROSTATE CANCER LYMPH NODE METASTASES AND CORRELATION WITH LYMPHADENECTOMY AND HISTOPATHOLOGY FINDINGS

INTRODUCTION AND OBJECTIVES: The choice of treatment in patients with prostate cancer (PCa) is often determined by the existence of tumor spread to regional lymph nodes. In this study, we evaluated the accuracy of PET/CT with 11C-acetate to detect regional lymph node metastases with strict correlation to surgical defined locations and histopathological results. METHODS: A total of 19 PCa patients staged with 11C-acetate-PET/CT imaging were included. All cases underwent extended pelvic lymph node dissection (ePLND) with lymph node sampling according to side and localisation. Group A: 10 patients with biochemical recurrence after RP and positive lymph nodes on 11C-acetate PET/CT Imaging underwent ePLND. Group B: 8 patients had an ePLND at RP and 1 subject an ePLND before curative radiotherapy. Median pre-operative PSA was for Group A (n 10): 0.83 ng/ml (range: 0.1-1.6) and Group B (n 9): 26.2 ng/ml (range: 6.1-130). We collected an average of 6.2 PLND sites per patient (range: 4 8).The tissue samples from each PLND site were sent for histopathological examination in separate test-tubes and analysed separately. Accordingly we had a total of 118 sites for histopathological analyses to compare with the PET/CT images. A postoperative PET/CT was scheduled 3 months after surgery in all patients. RESULTS: For each patient a mean of 25 (range 8-50) lymph nodes were obtained at surgery. Ten patients were positive for lymph node metastases on histopathology. A total of 484 lymph-nodes were examined by the pathologists and 44 of these were positive for malignancy. Good correlation between 11C-acetate-PET/CT report and histopathology was seen in 15 cases resulting in 90% sensitivity and 67% specificity. Postoperative control 11C-acetate-PET/CT imaging was suspicious for progression in 4 patients. CONCLUSIONS: 11C-acetate PET/CT imaging in this limited material had a high sensitivity but lower specificity. Further clinical research on the use of 11C-acetate-PET/CT with optimizing scanning time and equipment may allow further improvement.