Luca Nicosia

Molecular Imaging of Stem Cell Transplantation for Liver Diseases: Monitoring, Clinical Translation, and Theranostics

Stem cell transplantation has been investigated to rescue experimental liver failure and is promising to offer an alternative therapy to liver transplantation for liver diseases treatment. Several clinical studies in this field have been carried out, but the therapeutic benefit of this treatment is still controversial. A major obstacle to developing stem cell therapies in clinic is being able to visualize the cells in vivo. Imaging modalities allow optimization of delivery, detecting cell survival and functionality by in vivo monitoring these transplanted graft cells. Moreover, theranostic imaging is a brand new field that utilizes nanometer-scale materials to glean diagnostic insight for simultaneous treatment, which is very promising to improve stem cell-based therapy for treatment of liver diseases. The aim of this review was to summarize the various imaging tools that have been explored with advanced molecular imaging probes. We also outline some recent progress of preclinical and clinical studies of liver stem cells transplantation. Finally, we discuss theranostic imaging for stem cells transplantation for liver dysfunction and future opportunities afforded by theranostic imaging.

Atypical ductal hyperplasia: Our experience in the management and long term clinical follow-up in 71 patients

INTRODUCTION Atypical ductal hyperplasia (ADH) is a high-risk benign lesion found in approximately 1-10% of breast biopsies and associated with a variable incidence of carcinoma after surgical excision. The main goal of our study is to present our experience in the management and long-term follow-up of 71 patients with ADH diagnosed on breast biopsy. MATERIALS AND METHODS Results of 3808 breast biopsy specimens from 1 January 2000 to 31 December 2005 were analyzed to identify all biopsies which resulted in a diagnosis of ADH. The histopathological results of the 45 patients who underwent surgery were analyzed. Long-term follow-up for the remaining patients was carried out. RESULTS 45 of 71 (63.4%) patients with histological diagnosis of ADH on breast biopsy underwent surgery. Definitive histological results revealed invasive carcinoma in 7 cases (15.6%), high grade Ductal Carcinoma in situ (DCIS) in 10 (22.2%) patients, Lobular Carcinoma in situ (LCIS) in 4 cases (8.9%) and benign findings in 24 cases (53.3%). 12 of 71 (16.9%) patients underwent only long term follow-up; one (8,3%) of these developed invasive breast carcinoma after 6 years. CONCLUSION Atypical ductal hyperplasia diagnosed on breast biopsy is associated with a relatively high incidence of invasive carcinoma and high grade ductal carcinoma in situ at the time of surgical excision. Certain radiological and cytological criteria can be used to help determine which patients should forgo surgery and be followed up with good results. Long term follow-up is always crucial for patients who have not undergone surgery.

Unusual tumour ablations: report of difficult and interesting cases

Image-guided ablations are nowadays applied in the treatment of a wide group of diseases and in different organs and regions, and every day interventional radiologists have to face more difficult and unusual cases of tumour ablation. In the present case review, we report four difficult and unusual cases, reporting some tips and tricks for a successful image-guided treatment.

Percutaneous laser ablation for thyroid benign and malignant diseases

Minimally invasive image-guided thermal ablation is becoming increasingly common as an alternative to surgery for the treatment of benign thyroid nodules. Among the various techniques for thermal ablation, laser ablation (LA) is the least invasive, using the smallest applicators available on the market and enabling extremely precise energy deposition. However, in some cases, multiple laser fibers must be used simultaneously for the treatment of large nodules. In this review, the LA technique is described, and its main clinical applications and results are discussed and illustrated.

Minimally invasive treatment of postsurgical biliary complications: the role of interventional radiology

We read with great interest the paper by Adolfo CuendisVelázquez et al. entitled “Minimally invasive approach (robotic and laparoscopic) to biliary-enteric fistula secondary to cholecystectomy bile duct injury” recently published in the Journal of Robotic Surgery [1]. In this paper, authors reported on the robotic/laparoscopic treatment of postsurgical biliary damage to minimize the invasiveness of treatment. This novel technique represent a very interesting further step toward the minimization of invasiveness of surgical treatment in patients with postsurgical biliary complications. However, when dealing with such frail patients, multidisciplinary discussion might be useful, as other non-surgical options should be taken into account and offered to the patient, to further minimize the invasiveness of the treatment [2]. Particularly, endoscopic and interventional radiological procedures should be considered and discussed, as they might provide relevant advantages to patients with postsurgical biliary complications with minimal invasiveness. In case of postsurgical biliary complications, endoscopic management is actually often proposed as the first strategy when feasible. When endoscopy cannot be performed, percutaneous radiological treatments can be evaluated to provide effective treatment avoiding surgical reoperation [3, 4]. Several different radiological procedures can be offered to patients with postsurgical biliary complications. In case of presence of a postoperative biliary fistula, percutaneous biliary drainage (PTBD) might be used to divert the bile from the site of the fistula and to promote its spontaneous healing, with the minimal invasiveness of a small percutaneous drainage. When PTBD positioning is not enough, placement of an occlusion balloon proximal to the site of the fistula might further improve the healing process by completely interrupting the bile flow at the level of the fistula [5, 6]. Another interventional option in the treatment of postoperative biliary fistulas is represented by percutaneous injection of glue at the level of the fistula. This approach has been reported to be successful in cases not responsive to standard PTBD, and effective in avoiding major surgical reoperation [7, 8]. Another critical biliary complication that might determine major morbidity and require reoperation is represented by the onset of a post-surgical biliary stricture. Also in this occurrence, percutaneous interventions can be successfully performed for cases in which endoscopic management fails or cannot be performed [2, 3]. PTBD and bilioplasty are the most widely used percutaneous techniques in the treatment of postsurgical biliary strictures, and can be performed with minimal invasiveness and limited complications rate [9]. However, rate of restenosis after those approaches is still quite elevated, and patients often need to carry an external drainage for long periods. To overcome this limitation, and to improve not only the technical result but particularly the benefit for the patients [10], the percutaneous insertion of biodegradable biliary stents has recently been proposed and validated in multicentric trials [11, 12]. With this technique, it is possible to achieve the sustained resolution of a postsurgical biliary stenosis without the need for the patients to carry for long time an external drainage catheter, with a fast return to the normal every-day activities. In conclusion, efforts to minimize the invasiveness of surgical re-interventions in patients with biliary complications Valerio Ferrara and Luca Nicosia contributed equally to this work.

Which needle in the treatment of thyroid nodules

Thyroid nodules are a common finding in general population, with a prevalence of 20% to 70% at ultrasound (US) examination. Many of them are benign but treatment can be necessary to relief compressive symptoms. In the last years, percutaneous ablations have achieved amazing development in the treatment of thyroid nodules as they provide a minimally invasive but effective approach. We aimed to summarize the main aspects related to treatment of thyroid nodules with radiofrequency ablation (RFA), focusing on the use of different types of needles. A narrative review was performed and all papers analyzed reported good results in terms of nodules size reduction and symptoms relief. No major complications have been reported, even though needles of bigger size seemed related with major risks of post-procedural local edema. Thus, thinner internally cooled multi tined needles [18-19 Gauge (G)] rather than larger needles (14 G) seem to have better results and less complications.

Treatment of non-healing post-surgical fistula: a challenge for interventional radiologist

in the management of post-surgical complications [3, 4]. Thus, these results might be difficult to extend to general practice. Furthermore, glue injection into the peritoneal cavity and inside bowel lumen might be difficult to control: undesired leakage of glue might determine adherence of undesired structures. Also, the wide range of dilution of the material reported (from 1:2 to 1:5) makes the technique quite variable and difficult to standardize. Over the past two decades, interventional radiologists assumed an increasingly important role in the minimally invasive management of post-surgical complications. However, the experiences are still quite sparse, and different practices occur among different centers, depending on the availability of a dedicated interventional radiology service and the experience of the operators. Until now percutaneous injection of glues to treat postsurgical fistulae has been used only in series with limited number of patients. Even if it may seem to be a good alternative to surgical reoperation in management of patient with non-healing enteric fistulae, we want to underline how the technique is still not well defined. Therefore, this treatment should be still considered as an option after failure of standard treatments and should be performed only by experienced operator. Further studies on the topic would be highly beneficial to better understand the role of this technique in the future.

Solitary thyroid metastasis from colon cancer: a rare case report

Malignant metastases to the thyroid are rare and are even rarer from a colorectal primary. As these metastases are often asymptomatic, they are usually discovered incidentally on imaging performed as follow-up for the primary tumour. In this report, we present a case of metastatic sigmoid adenocarcinoma to the thyroid diagnosed and treated at our institution.