Seong Jang Kim

Metabolic tumor volume by positron emission tomography/computed tomography as a clinical parameter to determine therapeutic modality for early stage Hodgkin's lymphoma

Recent studies have shown that metabolic tumor volume (MTV) by positron emission tomography/computed tomography (PET/CT) is an important prognostic parameter in patients with non‐Hodgkins lymphoma. However, it is unknown whether doxorubicin, bleomycin, vinblastine, dacarbazine (ABVD) alone in early stage Hodgkins lymphoma would lead to similar disease control as combined modality therapy (CMT) using MTV by PET/CT. One hundred and twenty‐seven patients with early stage Hodgkins lymphoma who underwent PET/CT at diagnosis were enrolled. The MTV was delineated on PET/CT by the area ≥SUVmax, 2.5 (standardized uptake value [SUV]). Sixty‐six patients received six cycles of ABVD only. The other 61 patients received CMT (involved‐field radiotherapy after 4–6 cycles of ABVD). The calculated MTV cut‐off value was 198 cm3. Clinical outcomes were compared according to several prognostic factors (i.e. age ≥50 years, male, performance status ≥2, stage II, B symptoms, ≥4 involved sites, extranodal site, large mediastinal mass, CMT, elevated erythrocyte sedimentation rate and high MTV). Older age (progression‐free survival [PFS], P = 0.003; overall survival [OS], P = 0.007), B symptoms (PFS, P = 0.006; OS, P = 0.036) and high MTV (PFS, P = 0.008; OS, P = 0.007) were significant independent prognostic factors. Survival of two high MTV groups treated with ABVD only and CMT were lower than the low MTV groups (PFS, P < 0.012; OS, P < 0.045). ABVD alone was sufficient to control disease in those with low MTV status. However, survival was poor, even if the CMT was assigned a high MTV status. The MTV would be helpful for deciding the therapeutic modality in patients with early stage Hodgkins lymphoma.

Protein-losing enteropathy detected on Tc-99m HSA and Tc-99m MDP scintigraphy

The authors describe a patient with protein-losing enteropathy in whom abnormal intestinal accumulation of tracer occurred during Tc-99m human serum albumin scintigraphy. Abnormal leakage of the radiotracer was observed in the left upper abdomen and was confirmed by Tc-99m MDP scintigraphy. Both Tc-99m HSA scintigraphy and Tc-99m MDP scintigraphy are useful in the detection of protein-losing enteropathy.

Tc-99m MIBI, Tc-99m tetrofosmin, and Tc-99m (V) DMSA accumulation in recurrent malignant thymoma.

Thymoma is the most common primary tumor of the anterior mediastinum, accounting for 20% to 30% of all mediastinal tumors. The recurrence rate after total resection of the thymoma ranges from 8% to 18%. The authors describe a patient with recurrent malignant thymoma imaged with Tc-99m MIBI, Tc-99m tetrofosmin, and Tc-99m (V) DMSA. Early and delayed Tc-99m MIBI and Tc-99m tetrofosmin scintigraphy showed increased uptake in the mediastinal area, as did Tc-99m (V) DMSA scintigraphy. Coronal SPECT images obtained with Tc-99m MIBI, Tc-99m tetrofosmin, and Tc-99m (V) DMSA showed increased uptake in the mediastinal lesion seen on a computed tomograph of the chest. However, the normal blood-pool activity of the heart and great vessels imaged with Tc-99m (V) DMSA obscured the recurrent malignant thymoma. Although Tc-99m (V) DMSA is a useful tumor-seeking agent, Tc-99m MIBI and Tc-99m tetrofosmin SPECT are preferred to Tc-99m (V) DMSA to detect primary and recurrent malignant thymoma.

Detection of plasma BRAF(V600E) mutation is associated with lung metastasis in papillary thyroid carcinomas.

Purpose The BRAFV600E mutation represents a novel indicator of the progression and aggressiveness of papillary thyroid carcinoma (PTC). The purpose of this study was to determine the clinical significance of free circulating mutant BRAFV600E in predicting the advanced disease of PTC. Materials and Methods Seventy seven matched tumor and plasma samples obtained from patients with both benign and PTC were analyzed for BRAFV600E mutation using a peptide nucleic acid (PNA) clamp real-time polymerase chain reaction (PCR). Results The BRAFV600E mutation was absent in tumor DNA samples obtained from patients with benign follicular adenomas or adenomatous goiter. In contrast, 49 of 72 (68.1%) PTC tumors were positive for the BRAFV600E mutation. Among them, 3 (6.1%) patients with PTC were positive for BRAFV600E mutation in plasma and tumor. However, all 3 patients (100%) had lateral lymph node and lung metastasis. Conclusion These findings suggest that the BRAFV600E mutation can be detected using a PNA clamp real-time PCR in the blood of PTC patients with lung metastasis. Future studies are warranted to determine clinical significance of serum BRAFV600E mutation in large prospective studies.

Pulmonary tumor embolism derived from stomach cancer observation with serial 18F-FDG PET/CT.

Stomach cancer is one of malignancies that may result in pulmonary tumor embolism. Pulmonary tumor embolism commonly presents with dyspnea and cor pulmonale signs. We report serial observations of pulmonary tumor embolism with 18F-FDG PET/CT. 18F-FDG PET/CT scan showed chronological changes of FDG uptake in both lung fields.

The Effectiveness of Recombinant Human Thyroid-Stimulating Hormone versus Thyroid Hormone Withdrawal Prior to Radioiodine Remnant Ablation in Thyroid Cancer: A Meta-Analysis of Randomized Controlled Trials

We evaluated the efficacy of recombinant human thyroid-stimulating hormone (rhTSH) versus thyroid hormone withdrawal (THW) prior to radioiodine remnant ablation (RRA) in thyroid cancer. A systematic search of MEDLINE, EMBASE, the Cochrane Library, and SCOPUS was performed. Randomized controlled trials that compared ablation success between rhTSH and THW at 6 to 12 months following RRA were included in this study. Six trials with a total of 1,660 patients were included. When ablation success was defined as a thyroglobulin (Tg) cutoff of 1 ng/mL (risk ratio, 0.99; 95% confidence interval, 0.96-1.03) or a Tg cutoff of 1 ng/mL plus imaging modality (RR 0.97; 0.90-1.05), the results of rhTSH and THW were similar. There were no significant differences when ablation success was defined as a Tg cutoff of 2 ng/mL (RR 1.03; 0.95-1.11) or a Tg cutoff of 2 ng/mL plus imaging modality (RR 1.02; 0.95-1.09). When a negative 131I-whole body scan was used solely as the definition of ablation success, the effects of rhTSH and THW were not significantly different (RR 0.97; 0.93-1.02). Therefore, ablation success rates are comparable when RRA is prepared by either rhTSH or THW.

Technetium-99m-Tetrofosmin Scintimammography in Suspected Breast Cancer Patients: A Comparison with Technetium-99m-MIBI

Objective: To investigate the diagnostic role of 99mTc-tetrofosmin in the detection of primary breast cancer and axillary lymph node metastasis and to compare the findings with those of 99mTc-MIBI. Methods: Forty-eight patients with clinically palpable masses or abnormal radiologic findings had 99mTc-MIBI and 99mTc-tetrofosmin scintimammographies (SMMs) after intravenous injections of 925 MBq of radiopharmaceuticals. The SMMs were correlated with histopathologic findings. Results: Thirty-three patients were diagnosed with breast cancer and 15 patients with benign breast diseases. The number of true positive, true negative, false positive, and false negative cases of 99mTc-tetrofosmin SMM were 31, 10, 5, and 2, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of 99mTc-tetrofosmin SMM were 93.9, 66.7, 86.1 and 73.3%, respectively. The number of true positive, true negative, false positive, and false negative cases of 99mTc-MIBI SMM was 29, 10, 5, and 4, respectively. The sensitivity, specificity, positive predictive value, and negative predictive value of 99mTc-MIBI SMM were 87.8, 66.7, 85.3 and 73.3%, respectively. In assessment of axillary lymph node involvement, 99mTc tetrofosmin SMM demonstrated 31.8, 100, 100, and 42.3% sensitivity, specificity, positive and negative predictive values, respectively. The sensitivity and specificity of 99mTc-MIBI SMM was 22.7 and 100%. Positive and negative predictive values were 100 and 39.3%, respectively. One patient was false negative in both 99mTc-MIBI and 99mTc-tetrofosmin SMMs with a tumor size of 0.5 cm. Conclusion:99mTc-tetrofosmin and 99mTc-MIBI SMMs were noninvasive and useful in the detection of primary breast cancer and 99mTc tetrofosmin was comparable to 99mTc-MIBI in the detection of primary breast cancer. However, both radiopharmaceuticals had limited values in the assessment of axillary lymph node involvement.

Outcome prediction with the revised American joint committee on cancer staging system and American thyroid association guidelines for thyroid cancer

BackgroundSeveral staging systems have been developed to predict the risk of mortality in patients with differentiated thyroid cancer (DTC). However, none of them have been shown to be clearly superior to the other.MethodsWe compared the patient outcome predictability of recently revised staging systems predictability of patient outcome using data from The Cancer Genome Atlas. To set a comparison among American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) staging 7th, 8th editions, American Thyroid Association guidelines 2009 and 2015, concordance index (c-index), Akaike information criterion (AIC), Bayesian information criterion (BIC), and Brier score were applied to quantify the predictive ability of a survival model, to select the statistical model, and to measure the accuracy of probabilistic predictions.ResultsA total of 457 patients with papillary thyroid cancer having a mean age of 45.9 years were included in this study (120 males, 337 females). Among these patients, 43 (9.4%) experienced recurrence/progression during the follow-up (591.2 ± 833.5 months). Among the models used, the AJCC/UICC 8th edition, which showed the highest c-index and lowest AIC, BIC, and Brier score, was identified as the best among the models used.ConclusionAJCC/UICC 8th edition predicted patient outcome more accurately than the other staging systems.

Tumor Heterogeneity Assessed by 18F-FDG PET/CT Is Not Significantly Associated with Nodal Metastasis in Breast Cancer Patients

Introduction: The purpose of this study was to evaluate the association of tumor heterogeneity as assessed by positron emission tomography/computed tomography (PET/CT) with pathological factors of breast cancer, and the prediction of nodal metastasis through tumor heterogeneity. Methods: From January 2013 to December 2013, 102 patients with invasive ductal carcinoma of the breast were enrolled into this study. [18F]Fluorodeoxyglucose PET/CT was performed before surgery. The metabolic tumor volume (MTV) of each lesion was calculated and a series of standardized uptake value (SUV) thresholds (e.g. 40%, 50%, 60%, 70%, and 80% of SUVmax) was obtained. A threshold-volume (dV/dT) curve was acquired by plotting thresholds to MTV values automatically calculated with these thresholds. Tumor heterogeneity was calculated from the slope of the threshold-volume curve and defined as heterogeneity factor (HF). Results: HF differed significantly according to T stage (p < 0.0001), N stage (p = 0.0131) and American Joint Committee on Cancer (AJCC) stage (p = 0.0006). Among the pathological parameters, dermal lymphatic involvement (p = 0.0039) showed the significant correlations with HF. Lymphovascular invasion (p = 0.0005) was the only independent factor for predicting nodal metastasis. Conclusions: Tumor heterogeneity measured by 18F-FDG PET/CT is significantly associated with dermal lymphatic involvement. However, PET might not be able to predict nodal metastasis in breast cancer.

Neck circumference correlates with tumor size and lateral lymph node metastasis in men with small papillary thyroid carcinoma

Background/Aims Obesity is correlated with numerous diseases, including thyroid cancer, but the clinical significance of obesity with regard to the clinical characteristics of thyroid cancer remains unclear. Neck circumference is an index of upper-body adipose tissue distribution. Methods In total, 401 patients with papillary thyroid carcinoma (PTC) measuring ≤ 2 cm were included. Neck circumference was measured horizontally at the level just below the thyroid cartilage on preoperative neck computed tomographic images. Results Neck circumference correlated significantly with tumor size in men (p = 0.001) but not in women (p = 0.930). Body mass index (BMI) did not significantly correlate with tumor size in either sex. Neck circumference was significantly larger in men with lateral lymph node (LN) metastasis than in those without (p = 0.004). Neck circumference and BMI did not differ significantly in women according to other factors such as tumor size, multifocality, extrathyroid extension, and LN metastasis. Tumor size and the prevalence of lateral LN metastasis in men tended to increase in the middle/large neck circumference subgroup compared with those in the low neck circumference subgroup. Multivariate logistic regression analysis revealed that neck circumference (p = 0.009) was a predictor for the presence of lateral LN metastasis in men. BMI was not a predictive factor for lateral LN involvement in either sex. Conclusions Neck circumference, an indicator of central or visceral obesity but not BMI, may be associated with some prognostic factors in men with small PTC.