The Role of Somatostatin in Vasogenic Meningioma Associated Brain Edema

Many tumors, including meningiomas, express somatostatin receptors, suggesting the application of somatostatin analogues for therapy and diagnosis. Sixty percent of meningiomas are associated with perilesional edema, whose development seems to be related to the vascular endothelial growth factor, although it requires an efficient pial blood supply. However, in several neoplastic models, other mediators seem to cooperate with vascular endothelial growth factor in regulating angiogenesis. We evaluated somatostatin receptors (sst2) in relation to the possibility that somatostatin analogues may influence vascular endothelial growth factor production with reduction of edema. Of 35 studied meningiomas, 21 presented peritumoural edema. Vascular endothelial growth factor, microvascular density and pial blood supply were significantly related to the edema (P = 0.0001, P = 0.0001, P = 0.0005). Similarly, a relation was found between sst2 and microvascular density (r = 0.58, P <0.001) and between sst2 and vascular endothelial growth factor expression (P = 0.03). This suggests that somatostatin analogues may be relevant for the treatment of meningiomas.

Accessory Spleen Mimicking a Pancreatic Neuroendocrine Tumor

A 60-year-old man underwent computed tomography as part of colorectal cancer follow-up. A hypervascular nodule was found within the pancreatic tail and subsequently proved to be positive on [111In] DTPA-octreotide scan. A neuroendocrine tumor of the pancreas was supposed and a distal pancreatectomy performed. Heterotopic splenic tissue was finally proved by pathological examination. The present case suggests that intrapancreatic accessory spleen be considered in the differential diagnosis of pancreatic lesions positive on [111In] DTPA-octreotide scan.

Multi-field-of-view SPECT is superior to whole-body scanning for assessing metastatic bone disease in patients with prostate cancer

Aim

The aim of this study was to compare the diagnostic performance of whole-body bone scintigraphy (WBS) and multi-field-of-view single photon emission tomography (multi-FOV SPECT) with 99mTc-oxidronate (99mTc-HDP) in patients with prostate cancer (PCa).

Methods

In a prospective study, WBS and SPECT acquisitions were performed in194 patients with histologically confirmed PCa and serum prostate-specific antigen (PSA) levels above 10 ng/mL. Scans obtained using the two modalities were interpreted separately. Clinical and biochemical follow-up, radiological studies and biopsies served as benchmarks for the assessments. The impact of PSA level on WBS and SPECT results was also evaluated.

Results

The patient-based sensitivity, specificity, accuracy, PPV and NPV values of SPECT examinations were higher than those of WBS, especially in patients with serum PSA levels ≶40 ng/mL.

Conclusion

Multi-FOV SPECT proved to be more sensitive and specific than WBS in detecting bone metastases in PCa patients.

Major phenolic and volatile compounds and their influence on sensorial aspects in stem-contact fermentation winemaking of Primitivo red wines

In red winemaking de-stemming is crucial since the stems contain polymeric phenolic compounds responsible for the astringency of wine. Wine such as Primitivo has low phenolic constituents and tannins and stems affect aroma, taste body and olfactory characteristics. The aim of the study was to evaluate the effects of presence of stems during fermentation on polyphenolic, volatile compounds and sensory characteristics of wine. Primitivo grapes vinified in presence of different percentage of stems: 100 % de-stemmed (D100), 75 % de-stemmed (D75) and 50 % de-stemmed (D50). Results confirmed that the wines vinified in presence of stems were higher in tannins, flavans, to vanillin and proanthocyanidins, colour intensity with lower anthocyanins. The presence of stems during fermentation conferred more structure and flavour to wines. They facilitated must aeration thus promoting synthesis of higher alcohols and ethyl esters by yeast. In particular, a higher content of hexan-1-ol, hex-3-en-1-ol and 2-phenyl ethanol in D50 and D75 gave the wines that suggest green grass, herb and floral. Wine from D75 seemed to be better than D50 in terms of volatile compounds as well as fruity, floral and balsamic components preserved, without any unpleasant taste of long chain fatty acids found in D50.

Multi-field-of-view SPECT is superior to whole-body scanning for assessing metastatic bone disease in patients with prostate cancer

AIM

The aim of this study was to compare the diagnostic performance of whole-body bone scintigraphy (WBS) and multi-field-of-view single photon emission tomography (multi-FOV SPECT) with 99mTc-oxidronate (99mTc-HDP) in patients with prostate cancer (PCa).

METHODS

In a prospective study, WBS and SPECT acquisitions were performed in 194 patients with histologically confirmed PCa and serum prostate-specific antigen (PSA) levels above 10 ng/mL. Scans obtained using the two modalities were interpreted separately. Clinical and biochemical follow-up, radiological studies and biopsies served as benchmarks for the assessments. The impact of PSA level on WBS and SPECT results was also evaluated.

RESULTS

The patient-based sensitivity, specificity, accuracy, PPV and NPV values of SPECT examinations were higher than those of WBS, especially in patients with serum PSA levels <40 ng/mL.

CONCLUSION

Multi-FOV SPECT proved to be more sensitive and specific than WBS in detecting bone metastases in PCa patients.

Accessory spleen mimicking a pancreatic neuroendocrine tumor

A 60-year-old man underwent computed tomography as part of colorectal cancer follow-up. A hypervascular nodule was found within the pancreatic tail and subsequently proved to be positive on [111In] DTPA-octreotide scan. A neuroendocrine tumor of the pancreas was supposed and a distal pancreatectomy performed. Heterotopic splenic tissue was finally proved by pathological examination. The present case suggests that intrapancreatic accessory spleen be considered in the differential diagnosis of pancreatic lesions positive on [111In] DTPA-octreotide scan.

Lymph node thyroglobulin measurement in diagnosis of neck metastases of differentiated thyroid carcinoma

Aim. Enlarged cervical lymph nodes (LNs) in patients with thyroid cancer are usually assessed by fine-needle aspiration cytology (FNAC). Thyroglobulin (Tg) is frequently elevated in malignant FNAC needle wash specimens (FNAC-Tg). The objectives of the study were to (1) determine an appropriate diagnostic cut-off for FNAC-Tg levels (2) compare FNAC and FNAC-Tg results in a group of 108 patients affected by differentiated thyroid carcinoma (DTC). Methods. A total of 126 consecutive FNACs were performed on enlarged LNs and the final diagnosis was confirmed by surgical pathology examination or clinical follow-up. The best FNAC-Tg cut-off level was selected by receiver operating curve analysis, and diagnostic performances of FNAC and FNAC-Tg were compared. Results. The rate of FNAC samples adequate for cytological examination was 77% in contrast FNAC-Tg available in 100% of aspirates (P < .01). The sensitivity, specificity, and accuracy of FNAC were 71%, 80%, 74%, 100%, 80%, and 94%, respectively. The most appropriate cut-off value for the diagnosis of thyroid cancer metastatic LN was 1.1 ng/mL (sensitivity 100%, specificity 100%). Conclusions. The diagnostic performance of needle washout FNAC-Tg measurement with a cut-off of 1.1 ng/mL compared favorably with cytology in detecting DTC node metastases.

18FDG-positron emission tomography/computed tomography (PET/CT) scanning in thyroid nodules with nondiagnostic cytology

OBJECTIVE

To assess the role of positron emission tomography/computed tomography (PET/CT) scans with (18) FDG ((18)FDG-PET/CT) in the evaluation of thyroid nodules with nondiagnostic cytology.

SUBJECTS AND METHODS

Eighty-eight patients with a single euthyroid nodule and repeatedly nondiagnostic ultrasound-guided fine-needle cytology (US-FNC) were enrolled in the present study. Nodules concentrating (18)FDG were considered positive (i.e. suspicious for malignancy). Histological findings were obtained after surgery in all patients.

RESULTS

None of 41 patients with negative (18)FDG-PET/CT scan had a final histological diagnosis of malignancy (i.e. no false-negative results). Twenty-nine patients with final histological diagnosis of thyroid cancer had positive (18)FDG-PET/CT scan. Eighteen patients with final histological diagnosis of benign lesions (including four with follicular adenomas) also had positive (18)FDG-PET/CT scans. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) were 100%, 69%, 79%, 62% and 100%, respectively.

CONCLUSIONS

A negative (18)FDG-PET/CT scan accurately excludes malignancy in thyroid nodules with non-diagnostic US-FNC procedures. Histology is still necessary to distinguish benign from malignant disease in (18)FDG-PET/CT-positive nodules, but unnecessary surgery could have been reduced from 88 to 41 cases (46%) in our series.

Evaluation of serum parathyroid hormone-related peptide in hyperthyroid patients

BACKGROUND

Hypercalcemia occurs in 10-20% of patients with hyperthyroidism, but its pathogenesis is still unclear.

AIM

To evaluate changes in parathyroid hormone-related peptide (PTH-rP) concentration in hyperthyroid patients compared with healthy controls.

METHODS

We studied PTH-rP, parathormone (PTH) and ionized calcium levels in 153 hyperthyroid patients, and 89 control subjects. These variables were revaluated after attainment of euthyroidism with the antithyroid drug carbimazole for 6 months in a subgroup of 47 patients.

RESULTS

Pretreatment PTH-rP and ionized calcium level were significantly higher in hyperthyroid patients than in controls, whereas an opposite trend occurred for PTH. All parameters normalized after carbimazole therapy.

CONCLUSION

Untreated hyperthyroid patients exhibited a significant elevation in serum ionized calcium and PTH-rP and a significant reduction in serum PTH levels when compared with healthy controls. Our data favoured the hypothesis of a direct involvement of PTH-rP in the pathogenesis of hypercalcemia in hyperthyroid patients.

(99m)Tc-sestamibi scanning in thyroid nodules with nondiagnostic cytology

BACKGROUND

Our aim in this study was to assess the relevance of (99m)Tc-sestaMIBI (MIBI) scan in the diagnostic evaluation of thyroid nodules with nondiagnostic cytology.

METHODS

In all, 74 patients with a single nodule and repeatedly nondiagnostic ultrasound-guided fine-needle aspiration cytology (US-FNAC) were enrolled. In all cases thyroid nodules were cold in (99m)Tc-pertechnetate (Tc) scans. Thyroid scans were also acquired 30 and 120 minutes after intravenous administration of MIBI. Nodules that concentrate MIBI were considered as positive (ie, suspicious for malignancy). Histologic findings were obtained after surgery in all patients.

RESULTS

No differences occurred in early and late MIBI images. None of 63 patients with a negative MIBI scan had a final histologic diagnosis of malignancy (ie, no false-negative results). Two patients with a final histologic diagnosis of papillary thyroid carcinoma (PTC) and 1 with follicular thyroid carcinoma (FTC) had a positive MIBI scan. Eight patients with a final histologic diagnosis of benign lesions (3 with follicular adenomas) also had MIBI-positive scans. The sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were, respectively, 100%, 88%, 89%, 27%, and 100%.

CONCLUSIONS

A negative MIBI scan in a cold nodule accurately excludes malignancy when US-FNAC is reported as nondiagnostic. This avoids the need for more invasive diagnostic procedures (ie, surgery) and positively influences the cost-effectiveness profile. A MIBI scan may be performed by acquiring images 30 minutes after tracer administration alone. Histology is still necessary to distinguish benign from malignant disease in a MIBI-positive nodule but unnecessary surgery could have been reduced from 71 to 8 cases in our series.

Thyroglobulin measurement before rhTSH-aided 131I ablation in detecting metastases from differentiated thyroid carcinoma

AIM

Thyroidectomy followed by administration of large activities of 131-iodine ((131)I) is the treatment of choice for differentiated thyroid carcinoma (DTC). The serum thyroglobulin (Tg) measurement during hypothyroidism (offT4-Tg), just before radioiodine thyroid ablation, has proved to be effective for predicting persistent/recurrent disease. However, the Tg measurement cannot be used as a corresponding value for pre-ablative offT4-Tg when recombinant human TSH (rhTSH) is used as stimulus before treatment. The present study was undertaken to evaluate if post-thyroidectomy Tg values, measured before rhTSH-stimulated radioiodine ablation is of prognostic value in patients affected by DTC.

METHODS

We enrolled 126 patients with DTC submitted to total thyroidectomy. T4 treatment was started just after surgery to suppress TSH levels and Tg levels (onT4-Tg) were measured just before rhTSH-aided thyroid ablation by (131)I (3700 MBq). Neck radioiodine uptake (RAIU) was measured just before ablation and a post-treatment whole body scan (PT-WBS) was performed.

RESULTS

A significant relationship was found between thyroid remnants' RAIU and onT4-Tg levels (P < 0.001). The 1.10 ng/ml onT4-Tg threshold selected by ROC curve analysis identifies patients with positive PT-WBS with 83.3% sensitivity, 65.7% specificity, 44.5% positive predictive value (PPV) and 93.6% negative predictive value (NPV). The 0.65 ng/ml cut-off level recognizes metastatic patients with 82.9% sensitivity, 55.2% specificity, 43.3% PPV and 97.8% NPV when compared with 12 months restaging results. Among 63 patients with initially undetectable onT4-Tg (i.e. <or= 0.2 ng/ml) none had positive PT-WBS nor DTC relapse at 12-month restaging (NPV 100%).

CONCLUSIONS

Based on our data we conclude that pre-ablative onT4-Tg is a prognostic marker and should be used instead of pre-ablative TSH-stimulated Tg measurement when rhTSH-aided radioiodine ablation is done.

Radioguided sentinel lymph node biopsy in patients with malignant cutaneous melanoma: the nuclear medicine contribution

As for other solid tumors, malignant cutaneous melanoma drains in a logical way through the lymphatic system, from the first to subsequent levels. Therefore, the first lymph node encountered (the sentinel node) will most likely be the first to be affected by metastasis, and a negative sentinel node makes it highly unlikely that other nodes in the same lymphatic basin are affected. Sentinel lymph node biopsy distinguishes patients without nodal metastases, who can avoid nodal basin dissection with its associated risk of lymphedema, and those with metastatic involvement who might benefit from additional therapy. This procedure represents a significant advantage as a minimally invasive procedure, considering that only an average 20% of melanoma patients with Breslow thickness between 1.5 and 4 mm harbour metastasis in their sentinel node(s) and are therefore candidates to elective lymph node dissection procedures. The cells that originate cutaneous melanomas are located between dermis and epidermis, a zone that drains to the inner lymphatic network in the reticular dermis, in turn to larger collecting lymphatics in subcutis. Therefore, the optimal modality of interstitial administration of radiocolloids for lymphoscintigraphy and subsequent radioguided sentinel lymph node biopsy is through intradermal/subdermal injection. (99m)Tc-labeled colloids in various size ranges are equally adequate for radioguided sentinel lymph node biopsy in patients with cutaneous melanoma, depending on local experience and availability. For melanomas located in the midline area of the head, neck, and trunk, particular consideration should be given to ambiguous lymphatic drainage, which frequently requires interstitial administration virtually all around the tumor or surgical scar from prior excision of the melanoma. Lymphoscintigraphy is an essential part of radioguided sentinel lymph node biopsy because images are used to direct the surgeon to the sites of the node(s). The sentinel lymph node should have a significantly higher count than that of background (at least 10:1 intraoperatively). After removal of the sentinel node, the surgical bed must be reexamined to ensure that all radioactive sites are identified and removed for analysis. The success rate of radioguidance in localizing the sentinel lymph node in melanoma patients is about 98% in institutions where a high number of procedures are performed, approaching 99% when combined with the vital blue dye technique. The procedure is becoming the standard of care for patients with cutaneous melanoma because of its high prognostic value that has led to include the procedure in the most recent version of the TNM staging system.