Wolf-Gunter Franke

Prognostic value of positron emission tomography in the evaluation of post‐treatment residual mass in patients with Hodgkin's disease and non‐Hodgkin's lymphoma

The prognostic value of 18F‐fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of post‐treatment residual masses in patients with Hodgkins disease (HD) or non‐Hodgkins lymphomas (NHL) was evaluated. We prospectively studied 58 patients with HD (n = 43) or NHL (n = 15) who had post‐therapeutic complete remission with residual masses (CRu) indicated by computerized tomography. Analysis of 62 residual locations by FDG‐PET was performed separately for HD and NHL. Patients with a PET‐positive residual mass [standardized uptake value (SUV) > 3] had a recurrence rate of 62·5% (5/8 patients), whereas patients with PET‐negative residual mass (SUV ≤ 3·0) showed a recurrence rate of 4% (2/50 patients, P = 0·004). A positive FDG‐PET study correlated with a significantly poorer progression‐free survival (P < 0·00001). No recurrence occurred in any of the 39 HD patients with a negative PET scan (negative predictive value, 100%). Four out of four NHL patients with a positive PET study relapsed (positive predictive value, 100%). In conclusion, FDG‐PET is a suitable non‐invasive method with a high degree of accuracy in the prediction of early recurrence in lymphoma patients with CRu.

A high-sensitivity enzyme-linked immunosorbent assay for serum thyroglobulin.

A sensitive enzyme-linked immunosorbent assay (ELISA) for measuring serum thyroglobulin (Tg) is described. The assay has a functional sensitivity of 0.03 ng/mL and values obtained in sera from patients with treated differentiated thyroid cancer (DTC; n = 24, 17 of whom showed some evidence of recurrence) and from healthy blood donors (n = 48) were in agreement with those obtained by Tg immunoradiometric assay (IRMA) (functional sensitivity = 0.6 ng/ml) (r = 0.99 and 0.98 for the two groups, respectively). The Tg levels measured by ELISA in 47 of the healthy blood donor sera ranged from 2.3 to 139 ng/ml with 1 serum giving a value of 0.03 ng/mL. The mean +/- standard deviation (SD) Tg concentration for the healthy blood donors was 20.3+/-23 ng/mL. Studies with a recovery test suggest that Tg measurements by ELISA were not always reliable when Tg autoantibodies were present. Analysis of samples from 167 patients treated successfully for DTC (papillary carcinoma, 94; follicular carcinoma, 73) showed that 139 were negative for Tg autoantibodies and of these 106 (76%) had Tg levels measurable by ELISA (0.03 ng/mL or greater). In contrast, only 7 (5%) of these 139 sera had Tg levels measurable by IRMA (0.6 ng/mL or greater). It is possible that this ability to measure Tg simply and easily in most treated DTC patients will have significant advantages for patient care. In particular, the Tg level after initial ablative treatment will usually be measurable rather than undetectable. Furthermore, any increases in serum Tg levels which may herald relapse will be detectable earlier.

Rhenium-188-HEDP in the Palliative Treatment of Bone Metastases

INTRODUCTION Rhenium-188-HEDP (188Re-HEDP) is a new and attractive radiopharmaceutical for the treatment of bone pain due to metastases. As a product of a 188W/188Re generator it is convenient for clinical use. With a short physical half life of 16.9 hours and a maximal beta-energy of 2.1 MeV, it is suitable for therapy. METHODS We investigated the influence of 188Re-HEDP on pain relief, analgesic intake and impairment of bone marrow function in 15 patients. All patients were interviewed using standardized questions before, and 1, 2, 3, 4, 8, and 12 weeks after therapy. Blood samples were drawn weekly for 12 weeks, and a blood count was performed. Patients underwent gamma camera imaging to determine the radionuclide accumulation 4, 20, and 28 hours after therapy. The patients were treated with 1600 to 3459 MBq of 188Re-HEDP. RESULTS Patients showed an improvement of the Karnofsky performance index from 74 +/- 8% to 84 +/- 11% 12 weeks after therapy. This improvement was statistically significant (p = 0.001). Eighty percent of the patients described pain relief and reduction of analgesics. Twenty percent of the patients could discontinue their analgesics. Mean platelet count decreased from (284 +/- 84)*10(3)/microliter to (205 +/- 62)*10(3)/microliter, and mean leukocyte count from (7.5 +/- 1.5)*10(3)/microliter to (5.9 +/- 2.1)*10(3)/microliter after therapy. The maximal differences between the values of platelets and leukocytes before and after therapy were not statistically significant (p = 0.021 and p = 0.094). Prostate specific antigen decreased from 95 +/- 83 ng/ml to 41 +/- 21 ng/ml, the difference was not statistically significant (p = 0.443). The bone accumulation 4, 20, and 28 hours after therapy was 1.3 +/- 0.5%, 0.6 +/- 0.3%, and 0.45 +/- 0.2% of the injected dose of a single metastasis, and 57 +/- 17%, 15.5 +/- 2% and 11 +/- 3% in the whole body, respectively. The effective half-life of 188Re-HEDP was 15.3 +/- 3.0 hours in the bone metastases, and 11.4 +/- 2.8 hours in the whole body. This corresponds to a residence time of 0.22 +/- 0.25 hours in the bone metastases, and of 10.54 +/- 2.59 hours in the whole body. CONCLUSION In a small patient population, 188Re-HEDP therapy for bone pain palliation was effective and was associated with minimal toxicity.

FDG-PET in the pretherapeutic evaluation of primary squamous cell carcinoma of the oral cavity and the involvement of cervical lymph nodes.

PURPOSE The diagnostic role of positron emission tomography (PET) with 2-deoxy-2-[18F]fluoro-D-glucose (FDG) in squamous cell carcinoma of the oral cavity is evaluated. PROCEDURES In 38 patients, the results of FDG-PET, magnetic resonance imaging (MRI), computed tomography (CT), and ultrasound were compared. The standard uptake values (SUV) of FDG-PET were correlated to histopathological grading and DNA-image cytometry. RESULTS In the case of lymph node metastases, the sensitivity of FDG-PET (93%) was higher than the sensitivity for the compared methods. The specificity was best for CT. SUVs of diploid tumor cell lines seemed to be lower than in non-diploid tumor cell lines. CONCLUSIONS The high sensitivity and the high negative predictive value of PET may lead to more restrictive therapeutic regimens regarding lymph node metastases. Studies are necessary regarding possible relationships between glucose metabolism and tumor grading.

18F-FDG for the staging of patients with differentiated thyroid cancer: Comparison of a dual-head coincidence gamma camera with dedicated PET

Coincidence imaging with a dual-head gamma camera may offer a cost-effective alternative to dedicated PET. The aim of this study was to compare the diagnostic accuracy of coincidence imaging and PET in patients with differentiated thyroid cancer.Thirty-one patients were studied after thyroidectomy and radioiodine ablation. They were injected with a single dose of 300 MBq18F-FDG. Scanning was performed on a dedicated PET system after 1 hr, and on a coincidence gamma camera after 4 hrs.Based on a lesion-by-lesion comparison, coincidence imaging and PET concurred in 69% of 118 lesions. Based on lesion size, concurrence was 96% in lesions larger than 1.5 cm, and 62% in those between 1 and 1.5 cm. Lesions smaller than 1 cm could not be identified with coincidence imaging.Identical staging was obtained with coincidence imaging and PET in 26/31 patients (84%). In four patients FDG accumulating lesions were shown by both the coincidence camera and the dedicated scanner, but not detectable with any other imaging means and were confirmed histologically on surgery.Although a coincidence camera is technically inferior to a dedicated PET scanner, it may provide clinically useful results in situations were a lesion of sufficient size and FDG uptake is to be expected, e.g. when evaluating a known lesion for malignancy.

Prevalence of goiter and iodine deficiency in Saxony is less than previously assumed. A study 6 years after discontinuation of general iodization of table salt

ZusammenfassungHintergrund: Deutschland ist ein Strumaendemiegebiet. In den neuen Bundesländern, der früheren DDR, wurde die landesweite Jodierung von Paketspeisesalz 1985 eingeführt und bestand bis zur Wiedervereinigung 1990. Aufklärungskampagnen konzentrieren sich seitdem auf die Verwendung von jodiertem Speisesalz in den Produkten von Bäckern und Fleischern und in Fertignahrungsmitteln. In der Literatur werden Angaben zur Strumaprävalenz (zwischen 13 und 69%) gemacht, die in sich widersprüchlich sind und auch unserer klinischen Erfahrung (etwa 30%) nicht entsprechen. Methode: Wir führten 1996 und 1997 jeweils eine prospektive Querschnittsstudie mit einer nicht randomisiert selektierten Studienpopulation (Beschäftigte von Handwerksbetrieben) durch, die das Gebiet des Freistaates Sachsen abdeckte. 1 129 bzw. 1 594 Erwachsene wurden durch Fragebogen, Sonographie und Bestimmung der Jodausscheidung im Urin (nur 1996) untersucht. Ergebnisse: Unsere Ergebnisse bei Männern/Frauen waren 1996: Schilddrüsenvolumen 23,0±1,3/17,1±1,5 ml; Strumaprävalenz 32,1/31,3%; Prävalenz von Schilddrüsenknoten 21,1/23%; Jodausscheidung im Urin (bezogen auf Kreatinin) 86,4±1,3/104±24,1 nmol/mmol (97,1±1,4/117±27,1 μg/g). Im Jahre 1997 fanden wir: Volumen 20,9±1,2/15,7±2,1 ml; Struma 25,6/23,6%; Knoten 16,4/19,8%. Schlussfolgerung: Obwohl Struma und Jodmangel in Sachen immer noch endemisch sind, ist es trotz der Abschaffung der generellen Speisesalzjodierung zu einer Verbesserung beider Parameter gekommen.AbstractBackground: Germany is a known area of goitre endemicity. In East Germany (former German Democratic Republic), iodization of pre-packed table salt was introduced in 1985 and was only abolished after German reunification in 1990. Public awareness campaigns have concentrated on the use of iodized salt in the products of bakers and butchers as well as canned and frozen food since. Reports in the literature give figures of goitre prevalence (13 to 69%) inconsistent with each other and with our own clinical experience (about 30%). Method: We undertook a prospective cross-sectional study with a non randomly selected population (craftsmen and -women) covering Saxony in 1996. 1,129 and 1,594 adults were examined in 1996 and 1997, respectively, using a questionnaire, ultrasound, and measurement of urinary iodine excretion (1996 only). Results: We found the following (mean) results in men/women in 1996: thyroid volume 23.0±1.3/17.1±1.5 ml, prevalence of goitre 32.1/31.3%, prevalence of thyroid nodules 21.1/23.0%, urinary iodine excretion (per creatinine) 86.4±1.3/104±24.1 nmol/mmol (97.1±1.4/117±27.1 μg/g). In 1997 the results were as follows: thyroid volume 20.9±1.2/15.7±2.1, prevalence of goitre 25.6/23.6%, prevalence of thyroid nodules 16.4/19.8%. Conclusion: Whilst goitre and iodine deficiency are still endemic in Saxony, both have been improving despite the abolition of general table salt iodization.BACKGROUND Germany is a known area of goitre endemicity. In East Germany (former German Democratic Republic), iodization of pre-packed table salt was introduced in 1985 and was only abolished after German reunification in 1990. Public awareness campaigns have concentrated on the use of iodized salt in the products of bakers and butchers as well as canned and frozen food since. Reports in the literature give figures of goitre prevalence (13 to 69%) inconsistent with each other and with our own clinical experience (about 30%). METHOD We undertook a prospective cross-sectional study with a non randomly selected population (craftsmen and -women) covering Saxony in 1996, 1,129 and 1,594 adults were examined in 1996 and 1997, respectively, using a questionnaire, ultrasound, and measurement of urinary iodine excretion (1996 only). RESULTS We found the following (mean) results in men/women in 1996: thyroid volume 23.0 +/- 1.3/17.1 +/- 1.5 ml, prevalence of goitre 32.1/31.3%, prevalence of thyroid nodules 21.1/23.0%, urinary iodine excretion (per creatinine) 86.4 +/- 1.3/104 +/- 24.1 nmol/mmol (97.1 +/- 1.4/117 +/- 27.1 micrograms/g). In 1997 the results were as follows: thyroid volume 20.9 +/- 1.2/15.7 +/- 2.1 ml, prevalence of goitre 25.6/23.6%, prevalence of thyroid nodules 16.4/19.8%. CONCLUSION Whilst goitre and iodine deficiency are still endemic in Saxony, both have been improving despite the abolition of general table salt iodization.

Bone scan appearances in a case of Ollier's disease.

A 63-year-old woman had a large, hard tumor surrounding her left elbow joint. She reported that it had been growing slowly since the 1950s. The tumor was not painful, and there was only a slight restriction of movement. The bone scan showed involvement of the left side of the body, largely confined to the upper limb. Radiographs of the left arm showed multiple radiolucent lesions surrounding the elbow joint. A diagnosis of Olliers disease was made. This comprises enchondromatosis involving predominantly one side of the body. The bone scan clearly documents increased bone metabolism in Olliers disease.

Significant reduction of the mass of bone metastasis 1 year after rhenium-186 HEDP pain palliation therapy.

A 59-year-old man with prostate cancer and pain from multiple bone metastases was treated with 1,424 MBq (38.5 mCi) rhenium-186 hydroxyethylidene diphosphonate (Re-186 HEDP). In addition, he had nonsteroidal antiandrogen, progestagen, and an analog-luteinizing hormone. Neither chemotherapy nor external-beam radiotherapy was administered. Bisphosponate therapy was stopped 4 weeks before the administration of Re-186 HEDP. The Tc-99m HMDP whole-body scan obtained 6 weeks after therapy showed the same results as before therapy. However, 1 year after therapy, a significant reduction of the mass of the metastases was visible on bone scan. The bone scan index decreased from 34 before therapy to 10 after 1 year. The patient described significant pain relief and stopped his analgesic intake 3 weeks after therapy.

Diffuse bone marrow infiltration of a neuroblastoma mimicking the findings of a bone marrow scan on I-123 MIBG scintigraphy

The authors describe a 6-year-old boy with a 4-cm tumor in the right adrenal gland that was shown subsequently to be a neuroblastoma. He was initially referred for I-123 metaiodobenzylguanidine (MIBG) scintigraphy. This showed diffuse uptake in the bone marrow that closely mimicked the image normally obtained with a bone marrow scan. The primary tumor was not visible. A bone scan performed a few days later confirmed bone involvement. Three months later, chemotherapy had produced a nearly complete remission of bone marrow involvement. The primary tumor was clearly visible.

Bone marrow scan using Tc-99m-labeled anti-granulocyte antibody to evaluate hematopoiesis in osteomyelofibrosis.

A 66-year-old woman who had known splenomegaly caused by osteomyelofibrosis for several years was referred for evaluation of hematopoietic bone marrow and extrasplenic hematopoiesis before splenectomy. Bone marrow scanning was performed using a Tc-99m-labeled anti-granulocyte antibody. The most prominent uptake was seen in a grossly enlarged spleen. There was normal uptake in the liver, kidneys, and bladder, but no bone marrow uptake. Despite the known limitations of anti-granulocyte antibodies for evaluating splenic hematopoiesis, the total absence of functioning bone marrow allowed the authors to conclude that any remaining hematopoiesis (a clinical judgment) must be splenic.