N. Özlem Küçük

Is thyroglobulin the stronger indicator for progressive disease than the other conventional factors in same age patient groups with differentiated thyroid cancer

AimTo determine the thyroglobulin cut-off value as an indicator for progressive disease and to research relationships between sex, histological type, extra-capsular invasion and progressive disease in differentiated thyroid cancer. MethodsFour hundred and eight patients were evaluated retrospectively. One hundred and fifty-eight patients (group 1) treated for progressive disease and 166 patients (group 2) that were ablated for thyroid remnant were included in our study. Sex, age, histological type, presence of extra-capsular invasion at the diagnosis and L-thyroxine off thyroglobulin values (6–12 months after the ablation) were obtained. Data were analysed by statistical methods. ResultsThere was no statistically significant difference for ages (group 1, 45.3±16.1 years; group 2, 47±12 years, P>0.05). The chi-squared test revealed statistically significant differences for histological type (P>0.05) and extra-capsular invasion (P<0.001) but not for sex (P>0.05). Feasible cut-off level, sensitivity and specificity were found as a 10 ng·ml−1 thyroglobulin value, 79% and 97%, respectively. However, sensitivity and specificity were 80%, 92% for 5 ng·ml−1 and 82% for 2 ng·ml−1 thyroglobulin levels. Multivariate analysis showed that a 10 ng·ml−1 thyroglobulin cut-off value and extra-capsular invasion were independent prognostic factors. ConclusionIncreased thyroglobulin level, extra-capsular invasion and follicular type were poor prognostic factors but sex was not, whereas only extra-capsular invasion and increased thyroglobulin level were independent prognostic indicators for our groups. A 10 ng·ml−1 thyroglobulin level was a feasible cut-off and seemed to be a stronger factor than other indicators to predict progressive disease.

Lymphoscintigraphy in detection of the regional lymph node involvement in gastric cancer

INTRODUCTION Involvement of regional lymph node is a critical sign in prognosis of gastric cancer. Radiological techniques are commonly used to evaluate the extension of gastric cancer. But their sensitivity and specificity are low especially in the early stage. Our aim was to assess the value of gastric lymphoscintigraphy in identifying regional lymph node involvement in patients with gastric cancer, as compared to the abdominal ultrasonography, computed tomography and postoperative histopathological evaluation. PATIENTS AND METHODS 50 patients (12 females) with a median age of 61 years (range, 35-73 years) were included in the study. Pre-operative staging in all cases included upper gastrointestinal endoscopy and biopsy, followed by ultrasound, computed tomography and lymphoscintigraphy. 148 MBq Technetium-99m lymphoscint was injected around the tumour during endoscopy and immediately after injection, anterior, lateral and posterior images were taken in 5-min intervals using a gamma camera. Findings were compared to the findings of other tests. The sensitivity, specificity, positive predictive value, and negative predictive value of each test were calculated and compared. RESULTS Histologically, 68% of cases (34/50) had metastasis in regional lymph nodes and all cases were accurately diagnosed by lymphoscintigraphy. Lymphoscintigraphy was significantly more sensitive for detecting lymph node involvement (P < 0.01). Both abdominal ultrasonography and CT had very low sensitivity in identifying lymph nodes. CONCLUSIONS Lymphoscintigraphy is a promising test in the identification of regional lymph nodes pre-operatively in patients with gastric cancer. It might help the surgeon to plan the extent of dissection before surgery which may decrease postoperative complications related to unnecessary extensive lymph node dissection.

Uncommon extent involvement of sarcoidosis in 18F-FDG PET/CT.

1. Uehlinger E, Wurm K. Sarcoidosis of the skeleton: review of the literature and case report. Rofo 1976;125:111–22. 2. Nguyen BD. F-18 FDG PET imaging of disseminated sarcoidosis. Clin Nucl Med 2007;32:53–4. 3. Kobayashi A, Shinozaki T, Shinjyo Y, Kato K, Oriuchi N, Watanabe H, Takagishi K. FDG PET in the clinical evaluation of sarcoidosis with bone lesions. Ann Nucl Med 2000;14:311–3. 4. Cheng CY, HuangWS, Shen DH, Fan YM, Hsu HH, Cherng SC, Lee SC. FDG PET/CT demonstrated rapid progression of mediastinal lymphadenopathy in sarcoidosis. Clin Nucl Med 2007;32: 117–21. 5. Kaira K, Ishizuka T, Yanagitani N, Sunaga N, Hisada T, Mori M. Value of FDG positron emission tomography in monitoring the effects of therapy in progressive pulmonary sarcoidosis. Clin Nucl Med 2007; 32:114–6. Eur J Nucl Med Mol Imaging (2007) 34:2151 DOI 10.1007/s00259-007-0555-6

Ocular Involvement in Mantle Cell Lymphoma Detected by F 18 FDG PET/CT.

Mantle Cell Lymphoma (MCL) is an uncommon but aggressive form of non-Hodgkin’s lymphoma. The extranodal involvement is not unusual especially in bone marrow, spleen, gastrointestinal tract and Waldeyer’s ring. Ocular involvement is very exceptional and the most commonly affected site is the orbit (90%), followed by the lacrimal gland (50%) and the eyelids (50%). Today, PET/CT is widely used in non-Hodgkin’s lenfoma especially in staging and evaluation of treatment response. Authors report MCL with ocular involvement that was detected on PET/CT scan. Conflict of interest:None declared.