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Gjorup CA, Woodford R, Li I, Carlino MS, Ch'ng S, Chung D, Hsiao E, Lo SN, London K, Long GV, Menzies AM, Nieweg OE, Pennington TE, Rtshiladze MA, Saw RPM, Scolyer RA, Shannon KF, Spillane AJ, Stretch JR, Thompson JF, Varey AHR, van Akkooi ACJ. ASO Visual Abstract: Role of Concurrent Ultrasound Surveillance of Sentinel Node-Positive Node Fields in Melanoma Patients Having Routine Cross-Sectional Imaging. Ann Surg Oncol 2024; 31:1882-1883. [PMID: 38117390 DOI: 10.1245/s10434-023-14665-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Affiliation(s)
- Caroline A Gjorup
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Isabel Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Blacktown Hospital, Blacktown, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
| | - David Chung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Edward Hsiao
- Mater Imaging, Mater Hospital, North Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kevin London
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia
- Department of Medical Oncology, Mater Hospital, North Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael A Rtshiladze
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- NSW Health Pathology, Sydney, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, St Leonards, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Westmead Hospital, Westmead, Australia
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia.
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Gjorup CA, Woodford R, Li I, Carlino MS, Ch'ng S, Chung D, Hsiao E, Lo SN, London K, Long GV, Menzies AM, Nieweg OE, Pennington TE, Rtshiladze MA, Saw RPM, Scolyer RA, Shannon KF, Spillane AJ, Stretch JR, Thompson JF, Varey AHR, van Akkooi ACJ. Role of Concurrent Ultrasound Surveillance of Sentinel Node-Positive Node Fields in Melanoma Patients Having Routine Cross-Sectional Imaging. Ann Surg Oncol 2024; 31:1857-1864. [PMID: 37966706 PMCID: PMC10838221 DOI: 10.1245/s10434-023-14526-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/17/2023] [Indexed: 11/16/2023]
Abstract
PURPOSE In sentinel node-positive (SN+ve) melanoma patients, active surveillance with regular ultrasound examination of the node field has become standard, rather than completion lymph node dissection (CLND). A proportion of these patients now receive adjuvant systemic therapy and have routine cross-sectional imaging (computed tomography [CT] or positron emission tomography [PET]/CT). The role of concurrent ultrasound (US) surveillance in these patients is unclear. The purpose of our study was to describe the modality of detection of nodal recurrence in SN+ve node fields. METHODS SN+ve melanoma patients who did not undergo CLND treated at a single institution from January 1, 2016 to December 31, 2020 were included. RESULTS A total of 225 SN+ve patients with a median follow-up of 23 months were included. Of these, 119 (53%) received adjuvant systemic therapy. Eighty (36%) developed a recurrence at any site; 24 (11%) recurred first in the SN+ve field, of which 12 (5%) were confirmed node field recurrence only at 2 months follow-up. The nodal recurrences were first detected by ultrasound in seven (3%), CT in seven (3%), and PET/CT in seven (3%) patients. All nodal recurrences evident on US were also evident on PET/CT and vice versa. CONCLUSIONS The high rate of recurrences outside the node field and the identification of all US-detected nodal recurrences on concurrent cross-sectional imaging modalities suggest that routine concurrent ultrasound surveillance of the node-positive field may be unnecessary for SN+ve melanoma patients having routine cross-sectional imaging.
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Affiliation(s)
- Caroline A Gjorup
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Rachel Woodford
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, Australia
| | - Isabel Li
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Matteo S Carlino
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Medical Oncology, Westmead Hospital, Westmead, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Blacktown Hospital, Blacktown, Australia
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Royal Prince Alfred Hospital, Camperdown, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
| | - David Chung
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Edward Hsiao
- Mater Imaging, Mater Hospital, North Sydney, Australia
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Kevin London
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Alfred Nuclear Medicine and Ultrasound, Newtown, Australia
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Westmead, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Medical Oncology, Royal North Shore Hospital, St Leonards, Australia
- Department of Medical Oncology, Mater Hospital, North Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Omgo E Nieweg
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Thomas E Pennington
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael A Rtshiladze
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Charles Perkin Centre, The University of Sydney, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- NSW Health Pathology, Sydney, Australia
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Chris O'Brien Lifehouse Cancer Centre, Head and Neck Service, Camperdown, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andrew J Spillane
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
- Breast and Melanoma Surgery Unit, Royal North Shore Hospital, St Leonards, Australia
| | - Jonathan R Stretch
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia
- Department of Surgery, Mater Hospital, North Sydney, Australia
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Plastic Surgery, Westmead Hospital, Westmead, Australia
| | - Alexander C J van Akkooi
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia.
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
- Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, Australia.
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Vanderniet JA, Tsinas D, Wall CL, Girgis CM, London K, Keane C, Briody J, Hibbert S, Poon M, Padhye B, Biggin A, Dalla-Pozza L, Gray RJ, Munns CF. Surgical Management and Denosumab for Aneurysmal Bone Cysts of the Spine in an Australian Tertiary Paediatric Centre. Calcif Tissue Int 2023; 112:592-602. [PMID: 36810677 DOI: 10.1007/s00223-023-01068-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/30/2023] [Indexed: 02/23/2023]
Abstract
Aneurysmal bone cysts (ABC) are rare osteolytic, benign but often locally aggressive tumours of the long bones or vertebrae. For spinal ABC, surgical management, embolisation or sclerotherapy alone often carry high morbidity and/or high recurrence rates. Interruption of receptor activator of nuclear factor-kappa B ligand (RANKL) signalling holds promise as an effective therapeutic strategy for these tumours. We aimed to review the approach to surgical management and evaluate the efficacy and safety of denosumab for ABC of the spine in children. Retrospective review of 7 patients treated with denosumab using a standardised protocol for ABC of the spine in a tertiary paediatric centre. Surgical intervention was only conducted if there was spinal instability or significant neurological impairment. Denosumab 70 mg/m2 was given 4-weekly for at least 6 months, followed by 2 doses of zoledronate 0.025 mg/kg, aiming to prevent rebound hypercalcaemia. All patients achieved stability of the spine and resolution of neurological impairment, if present. Six patients achieved metabolic remission and have ceased denosumab without recurrence to date; the other showed clinical and radiological improvement without complete metabolic remission. Three patients developed symptomatic hypercalcaemia 5-7 months after cessation of denosumab, requiring additional bisphosphonate treatment. We present our algorithm for the surgical and medical management of paediatric spinal ABC. Denosumab produced a radiological and metabolic response in all patients, with complete remission in most. Follow-up time was not long enough to evaluate the endurance of response after cessation in some patients. Incidence of rebound hypercalcaemia in this paediatric cohort was high, prompting a change to our protocol.
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Affiliation(s)
- Joel A Vanderniet
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
| | - Dionysios Tsinas
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Christie-Lee Wall
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
| | - Christian M Girgis
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal North Shore Hospital, Sydney, NSW, Australia
- Department of Diabetes and Endocrinology, Westmead Hospital, Sydney, NSW, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Corinne Keane
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sally Hibbert
- Department of Dentistry, The Children's Hospital at Westmead, Sydney, NSW, Australia
- Department of Paediatric Dentistry, Westmead Centre for Oral Health, Sydney, NSW, Australia
| | - Myra Poon
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
| | - Bhavna Padhye
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Randolph J Gray
- Department of Orthopaedics, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Craig F Munns
- Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia
- Mayne Academy of Paediatrics, The University of Queensland, Brisbane, QLD, Australia
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Li AT, Miin Yip J, Choksi H, London K, Potter AJ, Lo SN, Saw RPM, Shannon KF, Pires da Silva I, Varey AHR, Menzies AM, Long GV, Shivalingam B, Scolyer RA, Thompson JF, Ch'ng S. Lack of association between anatomical sites of scalp melanomas and brain metastases does not support direct vascular spread. Melanoma Res 2022; 32:260-268. [PMID: 35579680 DOI: 10.1097/cmr.0000000000000827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary scalp melanomas are associated with a higher rate of brain metastasis than primary cutaneous melanomas occurring at other head and neck and body sites, but the reason is unclear. Spread to brain parenchyma via emissary veins draining from the scalp to dural sinuses has been suggested. We sought to examine the locations of metastases from primary scalp and nonscalp head and neck melanomas to determine whether there was anatomical evidence supporting direct venous spread to the brain. Data from patients who developed distant metastases from cutaneous head and neck melanomas (CHNMs) between 2000 and 2018 were analyzed. Anatomical sites of primary scalp melanomas and their respective intracranial metastases were compared. Times to first brain and nonbrain metastases were investigated for scalp and nonscalp primary CHNMs. Of 693 patients with CHNMs, 244 developed brain metastases: 109 (44.7%) had scalp primaries and 135 (55.3%) had nonscalp primaries. There was no significant association between anatomical sites of scalp primary melanomas and brain metastases (Cramer's V = 0.21; Chi-square P = 0.63). Compared with nonscalp CHNMs, scalp melanomas had no greater propensity for the brain as the first distant metastatic site ( P = 0.52) but had a shorter time to both brain metastasis (76.3 vs. 168.5 months; P < 0.001) and nonbrain metastasis (22.6 vs. 35.8 months; P < 0.001). No evidence was found to support a direct vascular pathway for metastatic spread of scalp melanomas to the brain. The increased incidence of brain metastases from scalp melanomas is probably driven by aggressive biological mechanisms.
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Affiliation(s)
- Andrew T Li
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Faculty of Medicine and Health, The University of Sydney
| | - Jia Miin Yip
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
| | - Harsham Choksi
- Faculty of Medicine and Health, The University of Sydney
| | - Kevin London
- Faculty of Medicine and Health, The University of Sydney
- Alfred Nuclear Medicine and Ultrasound, Sydney
- Westmead Hospital, Westmead
| | - Alison J Potter
- Melanoma Institute Australia, The University of Sydney, North Sydney
- NSW Health Pathology
- Charles Perkins Centre, The University of Sydney
- Faculty of Medicine, University of New South Wales, Sydney
| | - Serigne N Lo
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Faculty of Medicine and Health, The University of Sydney
| | - Robyn P M Saw
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Faculty of Medicine and Health, The University of Sydney
| | - Kerwin F Shannon
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Chris O'Brien Lifehouse, Camperdown
| | - Ines Pires da Silva
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Blacktown Hospital, Blacktown
| | - Alexander H R Varey
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Faculty of Medicine and Health, The University of Sydney
- Westmead Hospital, Westmead
| | - Alexander M Menzies
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Georgina V Long
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Faculty of Medicine and Health, The University of Sydney
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Brindha Shivalingam
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Chris O'Brien Lifehouse, Camperdown
| | - Richard A Scolyer
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Faculty of Medicine and Health, The University of Sydney
- NSW Health Pathology
- Charles Perkins Centre, The University of Sydney
| | - John F Thompson
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Faculty of Medicine and Health, The University of Sydney
| | - Sydney Ch'ng
- Melanoma Institute Australia, The University of Sydney, North Sydney
- Royal Prince Alfred Hospital, Camperdown
- Faculty of Medicine and Health, The University of Sydney
- Chris O'Brien Lifehouse, Camperdown
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Vanderniet JA, Wall CL, Mullins A, London K, Lim L, Hibbert S, Briody J, Padhye B, Poon M, Biggin A, Dalla-Pozza L, Munns CF. Denosumab for central giant cell granuloma in an Australian tertiary paediatric centre. Bone 2022; 159:116395. [PMID: 35331976 DOI: 10.1016/j.bone.2022.116395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/26/2022] [Accepted: 03/17/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Central giant cell granulomas (CGCG) are rare osteolytic, benign but often locally aggressive tumours of bone. Surgical curettage may not be possible in extensive lesions and resection carries high morbidity, especially in growing children, and previous medical therapies have had variable efficacy and high recurrence rates. Interruption of receptor activator of nuclear factor-kappa B ligand (RANKL) signalling holds promise as an effective therapeutic strategy for these tumours. AIMS To evaluate the efficacy and safety of our protocol for denosumab treatment of CGCG in children. METHODS Retrospective review of 4 patients treated with denosumab using a standardised protocol for CGCG in a tertiary paediatric centre. Denosumab 70 mg/m2 was given 4-weekly, followed by 2 doses of zoledronate 0.025 mg/kg, aimed at preventing rebound hypercalcaemia. RESULTS Treatment of CGCG resulted in metabolic remission in all patients, but recurrence, detected by positron emission tomography (PET), occurred at 6 months in three patients and 12 months in one patient. Three patients developed symptomatic hypercalcaemia 4-5 months and one patient asymptomatic hypercalcaemia 7 months after cessation of denosumab, with 3 requiring additional bisphosphonate treatment. CONCLUSIONS Denosumab produced a radiological and metabolic response in our patients, but metabolic recurrence occurred in all patients. PET imaging was effective for monitoring treatment response and early detection of recurrence. Incidence of rebound hypercalcaemia in this paediatric cohort was high. We present proposed changes to our protocol with the aim of producing sustained remission and preventing rebound hypercalcaemia.
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Affiliation(s)
- Joel A Vanderniet
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia.
| | - Christie-Lee Wall
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Anna Mullins
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Lydia Lim
- Department of Oral and Maxillofacial Surgery, Westmead Hospital, Sydney, NSW, Australia; Department of Paediatric Dentistry and Oral and Maxillofacial Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sally Hibbert
- Department of Paediatric Dentistry and Oral and Maxillofacial Surgery, The Children's Hospital at Westmead, Sydney, NSW, Australia; Department of Paediatric Dentistry, Westmead Centre for Oral Health, Sydney, NSW, Australia
| | - Julie Briody
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bhavna Padhye
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Myra Poon
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Andrew Biggin
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Luciano Dalla-Pozza
- Cancer Centre for Children, The Children's Hospital at Westmead, Sydney, NSW, Australia; Discipline of Paediatrics and Child Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Craig F Munns
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia; Child Health Research Centre, The University of Queensland, Brisbane, QLD, Australia; Department of Endocrinology and Diabetes, Queensland Children's Hospital, Brisbane, QLD, Australia
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Elberts S, Bateman R, Koutsoubis A, London K, White J, Fields J. 196 The Impact of COVID-19 on the Specificity of D-Dimer for Pulmonary Embolism. Ann Emerg Med 2021. [PMCID: PMC8536292 DOI: 10.1016/j.annemergmed.2021.09.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kertész H, Beyer T, London K, Saleh H, Chung D, Rausch I, Cal-Gonzalez J, Kitsos T, Kench PL. Reducing Radiation Exposure to Paediatric Patients Undergoing [18F]FDG-PET/CT Imaging. Mol Imaging Biol 2021; 23:775-786. [PMID: 33846898 PMCID: PMC8410733 DOI: 10.1007/s11307-021-01601-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/19/2021] [Accepted: 03/29/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the possibility of reducing the injected activity for whole-body [18F]FDG-PET/CT studies of paediatric oncology patients and to assess the usefulness of time-of-flight (TOF) acquisition on PET image quality at reduced count levels. PROCEDURES Twenty-nine paediatric oncology patients (12F/17M, 3-18 years old (median age 13y), weight 45±20 kg, BMI 19±4 kg/m2), who underwent routine whole-body PET/CT examinations on a Siemens Biograph mCT TrueV system with TOF capability (555ps) were included in this study. The mean injected activity was 156 ± 45 MBq (3.8 ± 0.8 kg/MBq) and scaled to patient weight. The raw data was collected in listmode (LM) format and pre-processed to simulate reduced levels of [18F]FDG activity (75, 50, 35, 20 and 10% of the original counts) by randomly removing events from the original LM data. All data were reconstructed using the vendor-specific e7-tools with standard OSEM only, with OSEM plus resolution recovery (PSF). The reconstructions were repeated with added TOF (TOF) and PSF+TOF. The benefit of TOF together with the reduced count levels was evaluated by calculating the gains in signal-to-noise ratio (SNR) in the liver and contrast-to-noise ratio (CNR) in all PET-positive lesions before and after TOF employed at every simulated reduced count level. Finally, the PSF+TOF images at 50, 75 and 100% of counts were evaluated clinically on a 5-point scale by three nuclear medicine physicians. RESULTS The visual inspection of the reconstructed images did not reveal significant differences in image quality between 75 and 100% count levels for PSF+TOF. The improvements in SNR and CNR were the greatest for TOF reconstruction and PSF combined. Both SNR and CNR gains did increase linearly with the patients BMI for both OSEM only and PSF reconstruction. These benefits were observed until reducing the counts to 50 and 35% for SNR and CNR, respectively. CONCLUSIONS The benefit of using TOF was noticeable when using 50% or greater of the counts when evaluating the CNR and SNR. For [18F]FDG-PET/CT, whole-body paediatric imaging the injected activity can be reduced to 75% of the original dose without compromising PET image quality.
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Affiliation(s)
- Hunor Kertész
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Thomas Beyer
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Hamda Saleh
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - David Chung
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Ivo Rausch
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Jacobo Cal-Gonzalez
- QIMP Team, Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.,Ion Beam Applications, Protontherapy Center Quironsalud, Madrid, Spain
| | - Theo Kitsos
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Peter L Kench
- Discipline of Medical Imaging Science and Brain and Mind Centre, Faculty Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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Fois AF, Chang FC, Barnett R, London K, Mahant N, Ha A, Aldaajani Z, Cruse B, Morales-Briceno H, Ma KK, Farlow D, Fung VS. Rest tremor correlates with reduced contralateral striatal dopamine transporter binding in Parkinson's disease. Parkinsonism Relat Disord 2021; 85:102-108. [PMID: 33799200 DOI: 10.1016/j.parkreldis.2021.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In vivo dopamine transporter imaging is a useful tool for distinguishing nigrostriatal pathologies (e.g. Parkinson's disease) from other causes of tremor. However, while many of the motoric features of Parkinson's disease (e.g. bradykinesia, rigidity, hypomimia) correlate well with reduced striatal dopamine transporter binding, the same relationship has not been demonstrated for tremor. We investigated the relationship between striatal dopamine transporter binding and quantitative measures of tremor. METHODS 23 participants with Parkinson's disease underwent standardised clinical assessment including structured, videotaped clinical examination, tremor neurophysiology study of both upper limbs using accelerometry and surface EMG, and Technitium-99 m TRODAT-1 brain SPECT imaging. Normalised striatal uptake values were calculated. Tremor EMG and accelerometry time series were processed with Fourier transformation to identify peak tremor power within a window of 3-10Hz and to calculate the tremor stability index (TSI). RESULTS Spearman correlation analyses revealed an association between tremor power and contralaterally reduced striatal uptake in a number of recording conditions. This association was strongest for rest tremor, followed by postural tremor, with the weakest association observed for kinetic tremor. Lower TSI was also associated with lower contralateral striatal uptake in a number of rest and postural conditions. CONCLUSION These data suggest a relationship between Parkinsonian rest tremor and contralateral reduction in striatal dopamine binding. Use of quantitative neurophysiology techniques may allow the demonstration of clinico-pathophysiological relationships in tremor that have remained occult to previous studies.
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Affiliation(s)
- Alessandro F Fois
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Florence Cf Chang
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Robert Barnett
- Department of Medical Physics, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, Australia; Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, NSW, 2006, Australia
| | - Neil Mahant
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Ainhi Ha
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Zakiyah Aldaajani
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Present Address: Neurology Unit, King Fahad Medical Military Complex, Dhahran, Saudi Arabia
| | - Belinda Cruse
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Hugo Morales-Briceno
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia
| | - Kit Kwan Ma
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - David Farlow
- Department of Nuclear Medicine, PET, and Ultrasound, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia
| | - Victor Sc Fung
- Movement Disorders Unit, Westmead Hospital, Cnr Hawkesbury and Darcy Road, Westmead, NSW, 2145, Australia; Sydney Medical School, The University of Sydney, NSW, 2006, Australia.
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Nijhuis A, Chung D, London K, Uren R, Thompson J, Nieweg O. Ultrasound Examination of the Lymphatic Drainage Area and Regional Lymph Nodes in Melanoma Patients with In-Transit Metastases. Ann Surg Oncol 2020; 28:1625-1631. [PMID: 33108596 DOI: 10.1245/s10434-020-09240-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 08/24/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND In-transit metastases (ITMs) are cutaneous or subcutaneous regional metastases that may occur in patients with melanoma. ITMs are often multiple and new lesions tend to appear over time. Ultrasonography can detect impalpable subcutaneous tumors. OBJECTIVE The aim of this study was to assess the value of ultrasound examination in detecting additional, non-palpable ITMs and to determine their relevance. METHODS Melanoma patients with ITMs who underwent regional ultrasound examination of the skin and subcutaneous tissue between the wide excision scar of the primary melanoma and the regional lymph node field were identified. In most, ultrasound assessment also included the regional lymph node field. Relevant data were collected and analyzed. RESULTS Twenty-eight patients presenting with a total of 40 ITMs were included. Ultrasound examination identified additional ITMs in 15 patients (54%). No nodal recurrences were detected. Most additional lesions were found closer to the regional lymph nodes than the original ITMs. Management was influenced by the ultrasound findings in nine patients (32%), five of whom had more extensive surgery, three received systemic drug therapy instead of surgery, and in one patient surgery was delayed and follow-up intensified. In one patient, only subcutaneous fat was found in the excised specimen and the ultrasound was classified as false-positive. CONCLUSION In melanoma patients with ITMs, ultrasonography of the lymphatic drainage area provided valuable information, as additional ITMs were identified in more than half of these patients and management was influenced in one-third.
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Affiliation(s)
- Amanda Nijhuis
- Melanoma Institute Australia, Sydney, NSW, Australia. .,Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - David Chung
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Alfred Nuclear Medicine and Ultrasound, The University of Sydney, Sydney, NSW, Australia
| | - Kevin London
- Alfred Nuclear Medicine and Ultrasound, The University of Sydney, Sydney, NSW, Australia.,Department of Nuclear Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Roger Uren
- Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Alfred Nuclear Medicine and Ultrasound, The University of Sydney, Sydney, NSW, Australia
| | - John Thompson
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Omgo Nieweg
- Melanoma Institute Australia, Sydney, NSW, Australia.,Sydney Medical School, The University of Sydney, Sydney, NSW, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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10
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Thompson JF, London K, Uren RF, Pennington TE, Saw RPM, Lo SN. Same-day or next-day sentinel node biopsy after lymphoscintigraphy for melanoma using 99m Tc-labelled antimony sulphide colloid. Br J Surg 2020; 107:1773-1779. [PMID: 32820818 DOI: 10.1002/bjs.11844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/31/2020] [Accepted: 05/31/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Two recent publications have reported that a shorter interval between preoperative lymphoscintigraphy and sentinel node biopsy (SNB) is associated with improved survival of patients with primary cutaneous melanoma. The aims of this study were to analyse prospectively collected survival data for patients who had SNB on the same day as lymphoscintigraphy or the day after; and to assess tracer migration from sentinel nodes to second-tier nodes after lymphoscintigraphy on the previous day. METHODS Outcome data were obtained for patients who had lymphoscintigraphy and SNB on the same day (time interval less than 8 h) or the next day (interval more than 16 h). In a separate prospective cohort, same-day and next-day lymphoscintigraphic images of sentinel nodes and second-tier nodes were compared. RESULTS Following lymphoscintigraphy, 2848 patients had same-day and 3328 had next-day SNB. Survival outcomes did not differ between these groups. In a prospectively studied cohort of 30 patients, none had significant tracer migration from sentinel nodes to second-tier nodes on imaging the following day. CONCLUSION No difference in survival after same- or next-day sentinel node biopsy is seen when 99m Tc-labelled antimony sulphide colloid is used. This may be because of less tracer migration to second-tier nodes.
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Affiliation(s)
- J F Thompson
- Melanoma Institute Australia, Sydney, Australia.,Faculty of Medicine and Health, the University of Sydney, Sydney, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - K London
- Faculty of Medicine and Health, the University of Sydney, Sydney, Australia.,Alfred Nuclear Medicine and Ultrasound, Royal Prince Alfred Hospital Medical Centre, Sydney, Australia
| | - R F Uren
- Melanoma Institute Australia, Sydney, Australia.,Faculty of Medicine and Health, the University of Sydney, Sydney, Australia.,Alfred Nuclear Medicine and Ultrasound, Royal Prince Alfred Hospital Medical Centre, Sydney, Australia
| | - T E Pennington
- Melanoma Institute Australia, Sydney, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - R P M Saw
- Melanoma Institute Australia, Sydney, Australia.,Faculty of Medicine and Health, the University of Sydney, Sydney, Australia.,Department of Melanoma and Surgical Oncology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - S N Lo
- Melanoma Institute Australia, Sydney, Australia.,Faculty of Medicine and Health, the University of Sydney, Sydney, Australia
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London K, Watson H, Kwok S, Nanan R, Liu A. Oral sucrose for analgesia in children aged between 3 months and 3 years undergoing transurethral bladder catheterisation: A randomised, double-blinded, clinical trial. J Paediatr Child Health 2020; 56:207-214. [PMID: 31317627 DOI: 10.1111/jpc.14559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 03/08/2019] [Accepted: 06/13/2019] [Indexed: 11/27/2022]
Abstract
AIM Many children admitted to hospital undergo invasive, painful and stressful procedures, including children who are not toilet trained undergoing transurethral bladder catheterisation (TUBC). Oral sucrose is commonly given to children to reduce procedural pain. In this study, we evaluated the effectiveness of oral sucrose in reducing procedural pain in children aged between 3 months and 3 years undergoing TUBC. METHODS This study was a randomised, double-blind, placebo-controlled study conducted at Nepean Hospital, Sydney, Australia from June 2005 to June 2010. A total of 40 participants requiring TUBC for diagnostic evaluation were included. The participants were randomly assigned to receive 4 mL of 75% oral sucrose (n = 20) or a placebo (sterilised water) (n = 20). The primary outcomes were changes in two paediatric pain scale scores (the FLACC pain scale and the OUCHER pain scale), assessed by the parent/guardian(s), the doctor performing the TUBC and the nurse assisting. The secondary outcomes were physiological (changes in heart rate) and behavioural pain (crying) indicators. RESULTS Of the outcome measures, 65% favoured the oral sucrose group, 31% favoured the placebo group, and 4% found no difference between the oral sucrose and placebo groups. CONCLUSION While the trends favouring the sucrose group in this study were encouraging, as the results were not statistically significant, there was insufficient evidence to demonstrate the effectiveness of oral sucrose in reducing procedural pain in children aged between 3 months and 3 years undergoing TUBC.
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Affiliation(s)
- Kevin London
- Department of Nuclear Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Hamish Watson
- Department of Nuclear Medicine, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Samson Kwok
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
| | - Ralph Nanan
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
| | - Anthony Liu
- Department of Paediatrics, Nepean Hospital, Sydney, New South Wales, Australia
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12
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Jessop S, Crudgington D, London K, Kellie S, Howman-Giles R. FDG PET-CT in pediatric Langerhans cell histiocytosis. Pediatr Blood Cancer 2020; 67:e28034. [PMID: 31599488 DOI: 10.1002/pbc.28034] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Langerhans cell histiocytosis (LCH) in pediatric patients presents with single-system or multisystem disease. Accurate staging is essential for selecting the most appropriate therapy ranging from local surgery to chemotherapy. METHODS A retrospective review was undertaken of reported fludeoxyglucose (FDG) positron emission tomography - computed tomography (PET-CT) scans performed in children with LCH from June 2006 to February 2017. Findings were compared with a reference standard of biopsy or informed clinical follow-up. RESULTS One hundred nine scans were performed in 33 patients (age 7 weeks to 18 years). Nineteen patients had single-system, bone unifocal disease; seven patients had single-system, bone multifocal disease; four patients had single-system, skin unifocal disease; two patients had multisystem disease; and one patient had single-system, lymph node disease. Twenty-six scans were performed to stage biopsy-proven LCH, and 83 scans were performed during follow-up to assess treatment response or recurrence after therapy completion. At staging, FDG PET-CT detected all sites of biopsy-proven LCH (except where bone unifocal disease had been resected). There was one false-positive thymic finding that resolved without therapy. The per-patient false-positive rate of FDG PET-CT at staging was 4% (1/26). During follow-up, five LCH recurrences and one case of progressive disease on therapy occurred, all positive on FDG PET-CT. During follow-up two patients had FDG PET-CT scans with false-positive findings and one patient with a magnetic resonance imaging false-positive finding. The per-scan false-positive rate of FDG PET-CT during follow-up was 2% (2/83). CONCLUSIONS FDG PET-CT is highly sensitive for the staging and follow-up of pediatric patients with LCH, and has a very low false-positive rate.
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Affiliation(s)
- Sophie Jessop
- Department of Oncology, The Children's Hospital at Westmead, New South Wales, Australia
| | - Donna Crudgington
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia
| | - Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
| | - Stewart Kellie
- Department of Oncology, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia
| | - Robert Howman-Giles
- Department of Nuclear Medicine, The Children's Hospital at Westmead, New South Wales, Australia.,Discipline of Child and Adolescent Health, University of Sydney Medical School, Sydney, Australia.,Discipline of Imaging, University of Sydney Medical School, Sydney, Australia
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13
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Randolph F, Joshi A, Slovis B, Chang A, White J, Aini M, London K, Hollander J. 30 Emergency Department Tele-Intake Is Comparable to In-Person Intake. Ann Emerg Med 2019. [DOI: 10.1016/j.annemergmed.2019.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Morales-Briceño H, Ha AD, London K, Farlow D, Chang FC, Fung VS. Parkinsonism in PGK1 deficiency implicates the glycolytic pathway in nigrostriatal dysfunction. Parkinsonism Relat Disord 2019; 64:319-323. [DOI: 10.1016/j.parkreldis.2019.04.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 03/27/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
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Affiliation(s)
- Alice Faure
- Department of Urology; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
| | - Kevin London
- Department of Nuclear Medicine; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
| | - Grahame H.H. Smith
- Department of Urology; Children's Hospital at Westmead; Paediatrics and Childhealth; University of Sydney; Sydney New South Wales Australia
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London K, Howman-Giles R. Voxel-based analysis of normal cerebral [18F]FDG uptake during childhood using statistical parametric mapping. Neuroimage 2015; 106:264-71. [DOI: 10.1016/j.neuroimage.2014.11.047] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 10/07/2014] [Accepted: 11/22/2014] [Indexed: 01/18/2023] Open
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London K, Stege C, Cross S, Onikul E, Graf N, Kaspers G, Dalla-Pozza L, Howman-Giles R. 18F-FDG PET/CT compared to conventional imaging modalities in pediatric primary bone tumors. Pediatr Radiol 2012; 42:418-30. [PMID: 22134535 DOI: 10.1007/s00247-011-2278-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 07/27/2011] [Accepted: 08/09/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND F-Fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography (PET) is useful in adults with primary bone tumors. Limited published data exist in children. OBJECTIVE To compare hybrid FDG positron emission tomography/computed tomography (PET/CT) with conventional imaging (CI) modalities in detecting malignant lesions, predicting response to chemotherapy and diagnosing physeal involvement in pediatric primary bone tumors. MATERIALS AND METHODS Retrospective analysis of PET/CT and CI reports with histopathology or follow-up > 6 months as reference standard. Response parameters and physeal involvement at diagnosis were compared to histopathology. RESULTS A total of 314 lesions were detected in 86 scans. Excluding lung lesions, PET/CT had higher sensitivity and specificity than CI (83%, 98% and 78%, 97%, respectively). In lung lesions, PET/CT had higher specificity than CI (96% compared to 87%) but lower sensitivity (80% compared to 93%). Higher initial SUV(max) and greater SUV(max) reduction on PET/CT after chemotherapy predicted a good response. Change in tumor size on MRI did not predict response. Both PET/CT and MRI were very sensitive but of low specificity in predicting physeal tumor involvement. CONCLUSION PET/CT appears more accurate than CI in detecting malignant lesions in childhood primary bone tumors, excluding lung lesions. It seems better than MRI at predicting tumor response to chemotherapy.
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Affiliation(s)
- Kevin London
- Department of Nuclear Medicine, The Children's Hospital at Westmead, Sydney, NSW, Australia.
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Kivlighan DM, London K, Miles JR. Are two heads better than one? The relationship between number of group leaders and group members, and group climate and group member benefit from therapy. ACTA ACUST UNITED AC 2012. [DOI: 10.1037/a0026242] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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London K, Siva J. The role of reflexive capability in relation to intellectual capital on multi international partnerships. International Journal of Project Management 2011. [DOI: 10.1016/j.ijproman.2011.05.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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London K, Howman-Giles R. Methodological issues in the evaluation of FDG PET/CT accuracy in pediatric lymphoma. Eur J Nucl Med Mol Imaging 2010; 37:2200-1. [DOI: 10.1007/s00259-010-1594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 08/02/2010] [Indexed: 11/28/2022]
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Snyman N, Egan JR, London K, Howman-Giles R, Gill D, Gillis J, Scheinberg A. Zolpidem for persistent vegetative state--a placebo-controlled trial in pediatrics. Neuropediatrics 2010; 41:223-7. [PMID: 21210338 DOI: 10.1055/s-0030-1269893] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to determine if zolpidem is associated with improved responsiveness or regional cerebral perfusion in patients with persistent vegetative states. METHODS Following ethics approval, children with persistent vegetative state were enrolled in a prospective, double-blind, placebo-controlled randomised trial. Patients underwent 2 treatments of 4 days, separated by 10 days. Each child received either a daily dose of zolpidem or placebo with a dosage of 0.14-0.2 mg/kg. Responsiveness and regional cerebral perfusion were the outcomes of interest. These were assessed using the Rancho levels of cognitive functioning scale, the coma/near-coma scale and F (18)-FDG positron emission tomography. These were conducted at baseline and after completion of the treatments. RESULTS 3 children were enrolled. The Rancho assessment scales showed no change with treatment. The coma/near-coma scale showed a tendency to increase with zolpidem, suggesting reduced responsiveness - when compared to baseline or placebo. The positron emission tomography scans showed no significant changes between treatments. CONCLUSION Zolpidem was associated with a tendency towards reduced responsiveness in patients with persistent vegetative states. There were no objective changes on positron emission tomography suggestive of an associated increase in cerebral blood flow with zolpidem. It would appear that zolpidem does not offer a beneficial effect in this setting.
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Affiliation(s)
- N Snyman
- Rehabilitation Department, The Children's Hospital at Westmead, Westmead, Sydney, Australia
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London K, Lin M. Clinical and pathological factors related to 18F-FDG-PET positivity in the diagnosis of recurrence and/or metastasis in patients with differentiated thyroid cancer. Ann Surg Oncol 2010; 18:291. [PMID: 20505997 DOI: 10.1245/s10434-010-1102-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Indexed: 11/18/2022]
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Moharir M, London K, Howman-Giles R, North K. Utility of positron emission tomography for tumour surveillance in children with neurofibromatosis type 1. Eur J Nucl Med Mol Imaging 2010; 37:1309-17. [PMID: 20179923 DOI: 10.1007/s00259-010-1386-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2009] [Accepted: 01/05/2010] [Indexed: 01/08/2023]
Abstract
PURPOSE There is little consensus regarding optimal surveillance of optic pathway glioma (OPG) and plexiform neurofibroma (PNF) in childhood neurofibromatosis type 1 (NF1). (18)F-2-Fluoro-2-deoxy-D: -glucose (FDG) positron emission tomography and computed tomography (PET/CT) is employed in the surveillance of adult PNFs; but its utility has neither been specifically studied in children with PNFs nor in children with OPG. METHODS Review of PET/CT studies was performed in NF1 children with OPG or PNF. FDG-avidity of tumours was semi-quantitatively analysed and graded by calculating the maximum standardised uptake value (SUV(max)) [grade 1: <3 (low), grade 2: >3-<4 (intermediate), grade 3: >4 (intense)]. RESULTS Eighteen children (ten girls; median age: 8.5-years) had PET/CT. Nineteen OPGs were imaged. The SUV(max) could be measured in 16. Ten were grade 1 and three each were grade 2 and grade 3. FDG-avidity reduced from grade 3 to grade 1 in two symptomatic OPGs following chemotherapy and this was associated with clinical improvement. PET/CT diagnosed symptomatic OPGs with a sensitivity of 0.625 [95% confidence interval (CI): 0.259-0.897] and specificity of 0.875 (95% CI: 0.466-0.993). Sixteen PNFs were imaged. Twelve were grade 1 and two each were grade 2 and grade 3. The two grade 3 PNFs were confirmed malignant peripheral nerve sheath tumours. PET/CT diagnosed malignant transformation with a sensitivity of 1.0 (95% CI: 0.197-1.0) and specificity of 0.857 (95% CI: 0.561-0.974). CONCLUSION PET/CT may contribute useful information to the surveillance of OPG in childhood NF1-particularly to identify progressive, symptomatic tumours. As in adults, PET/CT is useful for the detection of malignant transformation in PNFs in children with NF1.
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Affiliation(s)
- Mahendranath Moharir
- Division of Neurology, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada.
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Howman-Giles R, London K, McCowage G, Graf N, Harvey J. Pulmonary inflammatory myofibroblastic tumor after Hodgkin's lymphoma and application of PET imaging. Pediatr Surg Int 2008; 24:947-51. [PMID: 18528695 DOI: 10.1007/s00383-008-2182-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/15/2008] [Indexed: 10/22/2022]
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare tumor with a particular histological pattern of myofibroblasts and mixed inflammatory infiltrate. IMT has been rarely described in association with malignancy. This case report is of a 16-year-old male who had Hodgkin's disease (stage IVA) and who after chemotherapy and radiotherapy developed IMT, 16 months post completion of therapy. The IMT was in the lung in an area which was previously involved with HD and had undergone radiotherapy. PET imaging with F(18)FDG was used in the initial diagnosis and has been used in follow-up after full surgical resection of the lesion.
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Affiliation(s)
- R Howman-Giles
- Department of Nuclear Medicine, The Children's Hospital at Westmead, University of Sydney, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
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Abstract
The goal of this research was to examine the effect of jury deliberations on juror's propensity to disregard inadmissible evidence. Extant research is inconclusive; some research indicates that jurors do follow judicial instructions to ignore inadmissible evidence, but other research suggests that jurors do not. Two experiments examined whether jurors were affected by inadmissible evidence. The results revealed that although mock jurors were biased by inadmissible evidence prior to deliberations, the bias was tempered following deliberations. In Experiment 1, post deliberation jurors disregarded incriminating evidence that was ruled inadmissible because of due-process concerns. Experiment 2 replicated these results with less incriminating inadmissible evidence and also revealed that jurors did not accurately gauge the impact that the inadmissible evidence had on their verdicts. Theoretical and judicial policy implications are discussed.
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Affiliation(s)
- K London
- Psychology Department, 135 Biological Sciences, University of Wyoming, Laramie, Wyoming 82071, USA.
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Abstract
Whether and when children use information about others' mental states to invent or select persuasive strategies were examined. In Study 1, preschoolers, 3rd-graders, and 6th-graders (ns = 11, 12, and 16, respectively; 17 girls) were told about story characters' persuading parents to buy pets or toys. Children were either given or not given information about story parents' beliefs and asked to invent or select appropriate arguments. Older children, but not preschoolers, used belief information to select arguments. Results were replicated in Study 2 (16 kindergartners, 16 3rd-graders; 19 girls). In Study 3, kindergartners and 1st-graders (N = 16; 6 girls) reasoned well on false-belief tasks but not on persuasion tasks, suggesting that failure to consider mental states in persuasion was not due to lack of a belief concept. Findings suggest that mental state understanding may continue to develop after the preschool years; methodological qualifications are also considered.
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Affiliation(s)
- K Bartsch
- Department of Psychology, University of Wyoming, Laramie 82071, USA.
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Abstract
Whether and when children use information about others' mental states to invent or select persuasive strategies were examined. In Study 1, preschoolers, 3rd-graders, and 6th-graders (ns = 11, 12, and 16, respectively; 17 girls) were told about story characters' persuading parents to buy pets or toys. Children were either given or not given information about story parents' beliefs and asked to invent or select appropriate arguments. Older children, but not preschoolers, used belief information to select arguments. Results were replicated in Study 2 (16 kindergartners, 16 3rd-graders; 19 girls). In Study 3, kindergartners and 1st-graders (N = 16; 6 girls) reasoned well on false-belief tasks but not on persuasion tasks, suggesting that failure to consider mental states in persuasion was not due to lack of a belief concept. Findings suggest that mental state understanding may continue to develop after the preschool years; methodological qualifications are also considered.
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Affiliation(s)
- K Bartsch
- Department of Psychology, University of Wyoming, Laramie 82071, USA.
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Abstract
This study disputes the common notion that many hospitalized patients whose expenses are written off to bad debt are able to pay their bills. By matching 1996 state tax returns to more than 350,000 bad-debt and free-care claims at seven Massachusetts hospitals, we found that most patients involved had incomes below the federal poverty level and thus were presumably eligible for either public programs or hospital-based free care. This suggests that hospitals and public officials need to investigate further why low-income, uninsured patients are not receiving benefits for which they are eligible. Our results also suggest that measurements of indigent care levels in hospitals for purposes of research or regulation should include some portion of bad debt.
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