Sabri Zincirkeser

Reliability of positron emission tomography-computed tomography in identification of mediastinal lymph node status in patients with non-small cell lung cancer

OBJECTIVE The involvement of mediastinal lymph nodes is a very important prognostic factor in patients with potentially resectable non-small cell lung cancer. Our aim in this study was to investigate the value of positron emission tomographic-computed tomographic scanning in staging lung cancer, especially for mediastinal lymph node evaluation, and to determine whether this could decrease the need for mediastinoscopy. METHODS Seventy-eight patients with non-small cell lung cancer who were potential candidates for surgical resection and admitted to the thoracic surgery unit of our hospital from March 2006 to June 2008 joined this prospective study. Positron emission tomographic-computed tomographic scanning was performed as part of the prospective studies used to diagnose or stage the tumors. All 78 patients underwent tissue sampling of mediastinal lymph nodes to compare these with imaging results. The diagnostic efficacy of the computed tomographic and positron emission tomographic-computed tomographic scans compared with histopathologic findings were calculated with sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS Final histology was available on 397 lymph node stations (N1, N2, and N3) sampled from 78 patients during mediastinoscopy or surgical intervention. Sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing thoracic computed tomographic scanning were 45.4%, 80.5%, 27.7%, and 90%, respectively. The accuracy of computed tomographic scanning was 75.6%. The sensitivity, specificity, and positive and negative predictive values of mediastinal lymph node involvement in patients undergoing positron emission tomographic-computed tomographic scanning were 81.8%, 89.5%, 56.2%, and 96.7%, respectively. CONCLUSION There is a need for mediastinoscopy in positron emission tomographic-computed tomographic scanning-positive mediastinal lymph nodes, but it might not be necessary for positron emission tomographic-computed tomographic scanning-negative lymph nodes.

FDG PET-CT in cervical cancer: relationship between primary tumor FDG uptake and metastatic potential.

ObjectiveWe retrospectively evaluated the relationships between primary tumor 18F-fluorodeoxyglucose (FDG) uptake measured as the maximum standardized uptake value (SUVmax) and local extension, and nodal or distant metastasis in patients with cervical cancer on pretreatment FDG positron emission tomography–computed tomography (PET-CT). MethodsForty-three patients (mean age, 55.14 years; range, 34–90 years) with cervical cancer who underwent FDG PET-CT scans for staging before the initiation of treatment were included in the study. Primary tumor SUVmax was calculated; clinical tumor stages, presence of local extension, sites of lymph node and distant organ metastases were recorded. The patients were divided into low and high SUV groups by using the median primary tumor SUVmax. The low SUV group consisted of 21 patients with SUVmax less than 13.5, the high SUV group consisted of 22 patients with SUVmax ≥13.5. Their data were compared statistically. ResultsThe average SUVmax was 9.6±2.6 and 19.9±4.9 in the low and high SUV groups, respectively. In the low SUV group, six patients (29%) had a local extension, eight (38%) had pelvic and/or para-aortic lymph node metastasis, and one had distant organ metastasis (4.7%). In the high SUV group, 10 patients (45%) had a local extension, 16 (73%) had pelvic and/or para-aortic lymph node metastasis, and two (9%) had distant organ metastases. There was a significant difference in the lymph node metastasis rate between the two groups (P<0.05), but differences in local extension and distant organ metastasis were not statistically significant (P>0.05). In addition, there was a moderate correlation between SUVmax and clinical tumor stages (r=0.40, P=0.0075). ConclusionHigher primary tumor FDG uptake predicts higher nodal metastatic potential in cervical cancer patients. Patients with higher SUVmax in cervical tumor may need a close follow-up because of their higher metastatic potential.

Primary synovial sarcoma of the kidney: use of PET/CT in diagnosis and follow-up

Primary renal synovial sarcoma is a rarely seen renal neoplasm. An experienced uropathologist is needed to make the pathological diagnosis. A patient, operated on with a prediagnosis of renal cell carcinoma, the pathology of which was reported as synovial sarcoma, is presented in this article. 18F-fluoro-deoxyglucose positron emission tomography and computed tomography were performed preoperatively and in the postoperative follow-up to detect the primary tumor and lymph node metastases.

FDG uptake in abdominal mesh implant on FDG PET/CT.

A 50-year-old man with peritoneal angiosarcoma underwent total tumor excision along with removal of the total right rectus and medial part of the left rectus muscles 1 year earlier. F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) was performed for suspected recurrence. In the anterior abdominal wall extensive subcutaneous FDG uptake showing linear hypermetabolic zone on PET slices was noted. The patient had a history of a dual mesh implant, which consists of polypropylene and polyvinylidene fluoride for the reinforcement of the abdominal wall during the operation. PET/CT fusion image demonstrated that the finding was due to the dual mesh implant in the anterior abdominal wall most likely representing a foreign body reaction.

A Different Concept in the Application of Dacryoscintigraphy

Purpose Current dacryoscintigraphy methods have several potential pitfalls, the most important of which is the outflow of tears. Another is the difficulty in fixing the head with the patient seated. To overcome these difficulties, a new method was applied. Materials and Methods The study included 77 persons: 43 controls and 34 patients with epiphora. Two methods were applied to the two groups. In the first, protocol 1 (the current conventional protocol), the patient was seated in front of a gamma camera and one drop (50 &mgr;l) Tc-99m pertechnetate containing 50 to 100 &mgr;Ci radioactivity was instilled in the inferior fornix or outer canthus of the eye and dynamic and static images were obtained for approximately 15 to 20 minutes. In the other, protocol 2 (our protocol), 100 &mgr;Ci (10 &mgr;l) Tc-99m pertechnetate was instilled in the outer canthus of the eye using a micropipette with the patient in the supine position under the gamma camera. Dynamic images were taken for only 5 minutes. Conclusion The pitfalls and difficulties seen with protocol 1 were lessened to a great degree in protocol 2.

Coexistence of the monostatic Paget’s disease, sensorimotor neuropathy and elderly onset rheumatoid arthritis

Paget’s disease is a chronic focal disease of the skeleton that affects up to 2–3% of the population over the age of 60. Polymyalgia rheumatica (PMR) is an inflammatory condition of unknown etiology characterized by aching and stiffness in the shoulder, pelvic girdle and the neck. There are two incompletely overlapping subsets of RA that have been recognized: one exhibits the classical RA clinical picture, while the other has a PMR-like onset in later ages of life. We reported a rare case of monostatic Paget’s disease, sensorimotor neuropathy and elderly onset rheumatoid arthritis in an elderly women.

Bilateral symmetrically increased Tc-99m MDP cranial uptake in Hurler syndrome.

The authors describe a bone scan of a 9-year-old boy with Hurler syndrome (mucopolysaccharidosis, type I). Bilateral and symmetrically increased activity of Tc-99m MDP was seen in both maxillae and supraorbital regions of the frontal bone. The anterior image of the cranium was interesting and unusual, with a moustache and eyebrow like appearances. The scintigraphic findings may be secondary to the deposition of mucopolysaccharides and new bone formation in these regions.