Vani Vijayakumar

Can Prostate-specific Antigen Levels Predict Bone Scan Evidence of Metastases in Newly Diagnosed Prostate Cancer?

Staging in prostate cancer, as in any other cancer has significant ramifications in management. Currently, prostate-specific antigen (PSA) determination and the bone scan are two important procedures in the pretreatment staging workup of prostate cancer. PSA is a very useful serum tumor marker in the management of prostate cancer patients. We retrospectively evaluated 90 patients at the time of initial diagnosis of prostate cancer, all of whom had initial PSA levels measured, as well as bone scans obtained. In addition to the PSA level, we considered clinical stage and pathologic grade in the prediction of bone scan for metastases, at the time of initial diagnosis of prostate cancer. Negative predictive value for PSA values < 10 ng/ml (27 patients), clinical stage A (9 patients) and pathologic grade 1 (19 patients) was 100%. The number of patients with bone scan evidence of metastasis with <10 ng/ml and >10 ng/ml PSA levels were 0% (0/27 patients) and 27% (17/63 patients) (p = .0022 [Fishers Exact test]; p = .003 [chi-square test]). In patients with higher stage (p = .688), grade (p = .039), or PSA levels (p = .0001), the incidence of bone metastases increased. However, none of these three parameters can predict reliably bone scan evidence of metastases (i.e., positive predictive value). The negative predictive values did not improve when a combination of the two or three of the above parameters were used.

A critical review of variables affecting the accuracy and false-negative rate of sentinel node biopsy procedures in early breast cancer

Radionuclide sentinel lymph node localization and biopsy is a staging procedure that is being increasingly used to evaluate patients with invasive breast cancer who have clinically normal axillary nodes. The most important prognostic indicator in patients with invasive breast cancer is the axillary node status, which must also be known for correct staging, and influences the selection of adjuvant therapies. The accuracy of sentinel lymph node localization depends on a number of factors, including the injection method, the operating surgeons experience and the hospital setting. The efficacy of sentinel lymph node mapping can be determined by two measures: the sentinel lymph node identification rate and the false-negative rate. Of these, the false-negative rate is the most important, based on a review of 92 studies. As sentinel lymph node procedures vary widely, nuclear medicine physicians and radiologists must be acquainted with the advantages and disadvantages of the various techniques. In this review, the factors that influence the success of different techniques are examined, and studies which have investigated false-negative rates and/or sentinel lymph node identification rates are summarized.

Recent developments in nuclear medicine in the management of bone metastases: a review and perspective.

Objective:To review recent developments and to examine the role of nuclear medicine-based radionuclide therapy in the management of bone metastases. Methods:Recent developments in the use of radionuclides were broadly reviewed in the context of treatment paradigms, radionuclide toxicity, cost, and overall outcomes, and an impression of the use of radionuclides in metastatic bone disease was derived. Results:Through a number of studies, radionuclide therapy has been shown to be an efficacious and cost-effective means of alleviating bone pain in metastatic disease. Moreover, its early use in pain therapy may limit cancer progression by inhibiting oligometastases. Thus, radionuclides can significantly decrease patient morbidity, increase patient survival, and perhaps attenuate the aggressiveness of cancer. Nonetheless, in comparison with analgesics, external beam radiotherapy, or surgery, it still appears to have lower priority among medical oncologists. Conclusion:Bone pain palliation is critical for cancer patients afflicted with bone metastases, but radionuclides remain underutilized in such treatments. The authors propose that physician education regarding radionuclide therapy be improved and additional investigations to evaluate newer radionuclides and treatment paradigms (eg, higher activities, repetitive or cyclic administration, chemosensitization, or chemosupplementation) be strongly encouraged. A comprehensive and an interdisciplinary clinical approach toward increasing the use of radionuclides in alleviating metastatic bone pain is proposed. Data from clinical collaborations will help optimize radiopharmaceutical therapy for pain palliation, increase its awareness among oncologists, and contribute effectively to patient palliation and quality-of-life improvements.

Widespread Tophaceous Gout Demonstrating AvidF-18 Fluorodeoxyglucose Uptake

Abstract:Gout is a sodium urate crystal-induced deposition disorder that can involve articular cartilage, subchondral bone, synovial tissue, and periarticular soft tissues. Gout can be secondary to increased urate production, decreased renal clearance of urate, or most commonly, idiopathic. Typical

Detection of ectopic parathyroid adenoma by early Tc-99m sestamibi imaging

Localization of Tc-99m sestamibi (MIBI) by parathyroid adenomas (PA) is well known. Typically the radionuclide washes out slowly from the PAs located in the neck. Rapid washout from some PAs has been reported. Various hypotheses have been postulated for slow and rapid clearance of MIBI from PAs, located in the neck. However, the washout of MIBI from ectopic parathyroid adenoma (EPA) in not well reported. We present a case of EPA with rapid washout of MIBI. Hence, early MIBI imaging plays an important role in the evaluation of EPA.

A bio-inspired artificial bee colony approach for dynamic independent connectivity patterns in VANET

Vehicular Ad-Hoc Network (VANET) [1] which is a sub-type of the mobile ad-hoc networks provides wireless communication between the vehicles and to the Road Side Units (RSU) [2]. In VANET, the communication between the vehicles is used for various purposes like safety, comfort and entertainment. We use the vehicles as the portable nodes to create the mobile network. The VANET uses all the vehicles in the nearby distance as a wireless router or node to form a network. The vehicles can dynamically come in or drop out of the network as they move. The working of the VANET depends on how the routing of data is done in the network. In the recent years, the number of accidents has been increased to a greater count. In order to eradicate this, the implementation of VANET technology is being used in various modes of transportation. Even though VANET has been proposed to be a successful network model, it has some issues to overcome. The most major issues are the connectivity and the signal fading issue. We can overcome some of the issues in VANET by using the Artificial Bee Colony Algorithm (ABC) [3]. The proposed use of the algorithm in VANET may resolve some of the issues effectively.

Euthyroid Graves' orbitopathy and incidental papillary thyroid microcarcinoma

Euthyroid Graves’ orbitopathy (GO) combined with incidental papillary thyroid microcarcinoma has rarely been reported. CASE REPORT: A 61-year-old caucasian woman initially presented with progressive fatigue, exophthalmos, and thyroid function tests within normal limits. She underwent thyroidectomy, was found to have two incidental papillary thyroid microcarcinomas, and received radioactive iodine ablation to eliminate thyroid antigen. In addition to following her eye disease, TSH-receptor antibodies, thyroid stimulating immunoglobulins, and serum thyroglobulin measurements were recorded, demonstrating no evidence of thyroid cancer at four-year follow-up. At first, she had mild GO, developing into moderate-to-severe GO, and at 4 years she had Hertel measurements of 20 mm in both eyes. CONCLUSION: This report underscores the difficulty of managing GO even when thyroid function is normal(ized) and thyroid antigen exposure has been minimized. In addition, it illustrates why antithyroidal antibodies should be considered in cases of concomitant papillary thyroid cancer, as thyroid cells can be stimulated not only by TSH but also by TSH-receptor stimulating antibodies.

Analysis of Patterns of Gene Expression Variation within and between Ethnic Populations in Pediatric B-ALL:

B-Precursor acute lymphoblastic leukemia (B-ALL) is the most common childhood cancer. Although 80% of B-ALL patients are able to be cured, significant challenges persist. Significant disparities in clinical outcomes and mortality rates exist between racial/ ethnic populations. The objective of this study was to determine whether gene expression levels significantly differ between ethnic populations. We compared gene expression levels between four ethnic populations (Whites, Blacks, Hispanics, and Asians) in the United States. Additionally, we performed network and pathway analysis to identify gene networks and pathways. Gene expression data involved 198 samples distributed as follows: 126 Whites, 51 Hispanics, 13 Blacks, and 8 Asians. We identified 300 highly significantly (P < 0.001) differentially expressed genes between the four ethnic populations. Among the identified genes included the genes PHF6, BRD3, CRLF2, and RNF135 which have been implicated in pediatric B-ALL. We identified key pathways implicated in B-ALL including the PDGF, PI3/AKT, ERBB2-ERBB3, and IL-15 signaling pathways.

A Systematic and Evidence-Based Approach to the Management of Vertebral Metastasis

Diagnosis and management of vertebral metastasis requires a systematic approach to patient identification as well as selection of appropriate therapy. Rapid identification and prompt intervention in the treatment of malignant epidural spinal cord compression (MESCC) is key to maintaining quality of life. This paper provides a series of tools as well as guidance in selecting effective and evidence-based therapy individualized to the specific patient.

Be aware of disseminated sarcoidosis with diffuse subcutaneous nodules on F-18 FDG PET

Sarcoidosis is a multisystem granulomatous disorder of unknown etiology that typically affects young adults. Definitive diagnosis requires compatible clinical and radiologic manifestations and histopathologic detection of noncaseating granulomas. In recent years, F-18 fluorodeoxyglucose (FDG) positron emission tomography (PET) has been proposed to play a role in the diagnosis and management of sarcoidosis. Although disseminated sarcoidosis has been reported in nearly all organs including the skin, subcutaneous sarcoidosis is relatively rare with few reports using F-18 FDG PET. We report a case of disseminated sarcoidosis with diffuse subcutaneous nodules demonstrating avid F-18 FDG uptake on PET.