Correct staging is the most crucial for the treatment outcome in cancer management. Molecular imaging with 18F-fluoroestradiol (FES) positron emission tomography-computed tomography (PET-CT) targets estrogen receptor (ER) and may have a higher incremental value in diagnosis by aiding specificity. We enrolled 12 female breast cancer patients prospectively and did 18F-FES PET-CT and 18F-fluorodeoxyglucose (FDG) PET-CT within 1 week interval time. Lesion detection sensitivity was compared for a total number of lesions and for nonhepatic lesions only by McNemar test. 18F-FES PET-CT was taken as reference in case of indeterminate lesions. The incremental value reported by identifying 18F-FES exclusive lesions and by characterization of 18F-FDG indeterminate lesions. Spearman rank test was used to correlate ER expression and maximum standardized uptake value (SUVmax). Two ER-negative patients with no 18F-FES uptake were excluded. Ten ER-positive patients with 154 disease lesions were finally analyzed. 18F-FDG picked-up 142 lesions (sensitivity 92.21%), whereas 18F-FES picked-up 116 lesions (sensitivity 75.32%) and this difference was statistically significant. For nonhepatic lesions (n = 136) detectability, 18F-FDG picked-up 124 (sensitivity 91.18%), whereas 18F-FES picked-up 116 (sensitivity 85.29%) lesions and this difference was not statistically significant. Beside 12 exclusive lesions, 18F-FES characterized 41 (27.5%) 18F-FDG indeterminate lesions. Overall 18F-FES impacted 20% patient management. The positive trend was also seen with 18F-FES SUVmax with ER expression and negative with 18F-FDG SUVmax. We conclude, 18F-FDG has overall better sensitivity than 18F-FES PET-CT, however for nonhepatic metastasis difference was not significant. 18F-FES PET-CT better-characterized lesions and impacted 20% patient management. Therefore, 18F-FES PET-CT should be used with 18F-FDG PET-CT in strongly ER expressing patients for better specificity.
clinical presenTaTion of differenTiaTed Thyroid cancer Majority of thyroid cancer patients present with a solitary thyroid nodule which is detected most of the time incidentally. The thyroid nodule can be associated with lymph nodes in the neck. Rarely, it may present as hoarseness of voice or symptoms of distant metastasis at presentation. 1 The first investigation is the ultrasound (USG) of neck which can characterize the solitary nodule as cystic, solid or indeterminate. In addition, the vascularity of the nodule can also be assessed with ultrasonography or scintigraphy. USG is capable of detecting other non-palpable nodules which will also help to ascertain the probability of a benign or malignant outcome. 2-7 iniTial TreaTmenT of differenTiaTed Thyroid cancer Differentiated thyroid cancer (DTC) are the tumors arising from the cells lining the thyroid follicles which includes papillary (PTC), follicular (FTC) and Hurthle cell carcinoma (HTC). It generally excludes the tumors arising from para follicular cells. DTC are the commonest type of thyroid malignancy. In recent years, the incidence of these tumors seems to be rising. 8 While surgical resection has remained the gold-standard for their initial treatment, controversies still exist regarding the extent of surgery because of indolent nature of majority of these tumors. 9-16 The study of various prognostic factors has enabled the endocrine surgeons to develop a risk stratification system in order to arrive at
Molecular imaging has high potential to link target identification with therapy and thus to personalize it. It also has a very high potential for in-vivo tissue characterization, to improve prediction, prognostication, road map for biopsy and monitoring of therapy.
In chronic liver disease, high uric acid levels are independently associated with severe disease and poor prognosis. However, studies regarding the relation of uric acid levels with different parameters of liver dysfunction are rare from India. Our aim was to study uric acid (UA) levels in chronic liver disease and find any association of UA with different blood parameters and prognosis. We selected patients of chronic liver disease of any etiology. We did the serum UA test along with full liver function tests. Child Turcot Pugh (CTP) score was calculated for each patient. Then by suitable statistical tests, any association or correlation was studied. We had total of 52 patients with 31 % female. 19 (36.5 %) of the cases had liver disease secondary to alcoholism followed by 15 cases of non alcoholic fatty liver disease. 69.2 % of the patients were in CTP class B or C. Serum UA levels were significantly higher in chronic viral hepatitis cases (p<0.001). UA levels showed significant correlation with serum bilirubin (r=0.567), SGOT (r=0.464) and mortality. The UA levels showed significant correlation with severe disease and mortality. However, whether UA can be included in risk stratification of chronic liver disease can only be determined by larger randomized trials.
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