FDG PET for the routine follow-up in NHL: First prospective evaluation

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 7569-7569
Author(s):  
G. Jerusalem ◽  
R. Silvestre ◽  
Y. Beguin ◽  
R. Hustinx ◽  
M. Fassotte ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Clinical Symptoms ◽  
False Negative ◽  
B Cell Lymphoma ◽  
High Rate ◽  
Time Interval ◽  
Low Grade ◽  
Clinical Relapse

7569 Background: We have shown that FDG PET is able to detect preclinical relapses in patients with Hodgkin’s disease but the high rate of false-positivity (55%) was a problem (Jerusalem et al, Ann Oncol, 2003; 14 : 123–130). The aim of this study was to determine the accuracy of PET during follow-up after treatment in non-Hodgkin’s lymphoma (NHL). Methods: Patients were eligible if they had a positive baseline FDG PET and a negative end of treatment work-up including a negative PET study. They underwent FDG PET every 4–6 months until 3 years after diagnosis. Forty-five aggressive NHL (diffuse large B-cell lymphoma : 34, other : 11) and eighteen low grade NHL (follicular lymphoma : 16, other : 2) were recruited prospectively between 5/94 and 12/01. Results: A total of 197 FDG PET studies were realized. Six patients relapsed (aggressive NHL : 4, low grade NHL : 2) and 3 patients died (aggressive NHL : 2, pancreatic cancer : 1) during the time interval of the study protocol. Four asymptomatic relapses (aggressive NHL : 2, low grade NHL : 2) and one symptomatic relapse (aggressive NHL) was detected by FDG PET. Disease recurrence became symptomatic or clinically detectable a week, 3 months (both aggressive NHL), 12 and 17 months (both low grade NHL) after the first positive PET study. The latter had 4 positive FDG PET studies before biopsy-proven relapse. The time interval between the only false-negative PET and clinical relapse was 5 months in a patient with aggressive NHL. We observed for the whole study population a sensitivity of 89% (8/9), a specificity of 93% (174/188), a positive predictive value of 36% (8/22), a negative predictive value (NPV) of 99% (174/175) and an accuracy of 92% (182/197). In low grade NHL PET had a sensitivity of 100% (5/5), a specificity of 93% (50/54), a PPV of 56% (5/9), a NPV of 100% (50/50) and an accuracy of 93% (55/59). In aggressive NHL, PET had a sensitivity of 75% (3/4), a specificity of 93% (124/134), a PPV 23% (3/13), a NPV of 99% (124/125) and an accuracy of 92% (127/138). Conclusions: In aggressive NHL, routine follow-up by FDG PET is not very useful and we stopped it now in unselected aggressive NHL. In contrast, FDG PET can detect a relapse several months before the development of clinical symptoms in low grade NHL suggesting further evaluation of the role of PET in the routine follow-up of these patients. No significant financial relationships to disclose.

PET/CT a New Marker of Response in Waldenstrom Macroglobulinemia (WM).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1937-1937
Author(s):  
Xavier Leleu ◽  
Renee Leduc ◽  
Meghan Rourke ◽  
Brianna Harris ◽  
Aldo M. Roccaro ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Low Grade ◽  
Minor Response ◽  
Female Ratio ◽  
Probability Of Survival ◽  
Pet Ct ◽  
Before And After ◽  
Pet Scans

Abstract Abstract 1937 Poster Board I-960 Background. Waldenstrom's macroglobulinemia is a rare B cell neoplasm characterized by the production of a monoclonal IgM protein and a lymphoplasmacytic infiltrate in the bone marrow. The clinical manifestations related to tumor infiltration include hepatomegaly (20%), splenomegaly (15%) and lymphadenopathy (15%). Organomegaly was associated with adverse prognosis in a large series of WM. More sensitive tools of tumor burden and prognosis are needed in these patients. The use of FDG-PET has not been previously studied in WM but has proved an effective diagnostic and prognostic tool in other in low-grade lymphomas. Therefore the objective of this study was to determine whether FDG-PET was an effective tool in evaluating pts with WM. Methods. We prospectively studied PET/CT in 39 WM patients homogeneously treated with bortezomib-rituximab (given IV bortezomib 1.6mg/m2 at days 1, 8, 15 q 28 days × 6 cycles and rituxan 375 mg/m2 at days 1, 8, 15, 22 on cycles 1 and 4) on a phase II clinical trial, at diagnosis (N=12) and with relapsed/refractory disease (N=27). All pts underwent staging evaluation by FDG-PET in combination with CT scan before and after therapy. PET results were analyzed as positive or negative. Response (ORR) was assessed after cycle 3, confirmed with 2 consecutive values and included minor response or better. Overall (OS) and treatment free survivals (TFS) were calculated from start of treatment to date of last follow up and time of next treatment, respectively. Results. The median age of the population was 62 years (range, 43-78), Male/Female ratio 1.64, WM-International staging score breakdown was 46% low, 23% intermediate, 31% high. Serum M-spike was 2.5g/L (0.41-4.62) with 8% patients >= 4g/L. The overall response rate was 89.7% with minor response in 13 pts and major response in 22 pts. With a median (+/-se) follow-up of 15 months (+/-1.22), death occurred in 2 patients, and the median OS was not reached with a 3-year probability of survival of 89%. The median TFS was 21 months (+/-2.09). Twenty-five (64.1%) and 13 (37.1%) patients had a positive PET before and after treatment, respectively. 11 (45.8%) patients had a negative post treatment PET which was positive before treatment, 1 (4.8%) had a positive PET after treatment while initially negative and all other patients had no change. Patients with positive PET before treatment had no clinical-biological difference (age, gender, hemoglobin level, serum beta 2-microglobulin value, platelet count, IgM spike and ISS-WM score) with other patients. A positive PET before treatment had no influence on either OS or TFS or ORR or MR. However, a normal PET after treatment, including a negative PET after treatment which initially was positive before treatment, correlated with response (p=0.04). The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for a normal PET after treatment and for a negative PET after treatment while initially positive before treatment in predicting ORR were 68.7%, 100%, 100%, 23% and 52.4%, 100%, 100%, 23.1%, respectively. Although the number of deaths is low in this series, a positive PET after treatment was an adverse prognostic factor for OS. The median survival and the 2-year probability of survival was not reached and 100% for patients with a normal (negative) PET after treatment (number of death/number of pts in the group, O/N=0/22) while it was 20 months and 46% for patients with a positive PET after treatment (O/N=2/13 ), respectively (p=0.019). Conclusion: Over 60% of WM pts demonstrated FDG-avid disease when using FDG-PET scans with the majority showing negative imaging after therapy. PET positive scans after therapy correlated with poor prognosis. FDG-PET scans may prove an effective tool in the diagnosis and prognosis in WM. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical relevance of 18F-FDG PET/CT in the postoperative follow-up of patients with history of medullary thyroid cancer

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jelena Saponjski ◽  
Djuro Macut ◽  
Dragana Sobic Saranovic ◽  
Branislava Radovic ◽  
Vera Artiko
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Somatostatin Receptor ◽  
False Negative ◽  
Standardized Uptake Value ◽  
True Negative ◽  
Medullary Thyroid ◽  
Pet Ct ◽  
Fdg Pet Ct

AbstractBackgroundThe aim of the study was evaluation of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography with computed tomography (PET/CT) in the detection of active disease in the patients with suspected recurrence of the medullary thyroid carcinoma (MTC).Patients and methods18F-FDG PET/CT investigation was performed in 67 patients, investigated from 2010 to 2019. _ Follow up was performed from 6 to 116 months after surgery (median 16.5 months, x± SD = 29±28.9 months). Twenty five of 67 patients underwent 99mTc-dimercaptosuccinic acid (99mTc-DMSA) scintigraphy, 11 underwent somatostatin receptor scintigraphy (SRS) with 99mTc-HYNIC TOC while 11 123I-metaiodobenzylguanidine (MIBG) scintigraphy.ResultsFrom 67 patients, 35 (52.2%) had true positive 18F-FDG PET/CT findings (TP). Average maximal standardized uptake value (SUVmax) for all TP lesions was 5.01+3.6. In 25 (37.3%) patients findings were true negative (TN). Four (6%) patients had false positive (FP) findings while three (4.5%) were false negative (FN). Thus, sensitivity of the 18F-FDG PET/ CT was 92.11%, specificity 86.21%, positive predictive value 89.74%, negative predictive value 89.29% and accuracy 89.55%. In 27 patients (40%) 18F-FDG PET/CT finding influenced further management of the patient.Conclusions18F-FDG PET/CT has high accuracy in the detection of metastases/recurrences of MTC in patients after thyroidectomy as well as in evaluation and the appropriate choice of the therapy.

Prognostic value of FDG-PET in Hodgkin lymphoma for posttreatment evaluation. Long-term follow-up results

2009 ◽  
Vol 150 (47) ◽  
pp. 2133-2138
Author(s):  
Zsuzsa Molnár ◽  
Zsófia Simon ◽  
Zita Borbényi ◽  
Beáta Deák ◽  
LászLÓ Galuska ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Predictive Value ◽  
False Positive ◽  
Fdg Pet ◽  
Clinical Stage ◽  
False Negative ◽  
True Negative ◽  
Significant Difference ◽  
The Difference

In the past few decades Hodgkin lymphoma (HL) has become a highly curable malignant disease, as a result of using modern polychemotherapy and irradiation. Differentiation of active tumor from fibrosis or necrosis within residual radiographic masses represents a problem of interpretation. Aims: The aim of this retrospective study is to assess the value of FDG-PET for prediction of remission or relapse in HL. Patients and methods: Data of 128 patients, who had residual masses on CT after completion of their planned treatment, have been analyzed. FDG-PET was performed between January 1995 and February 2005. Results: The median duration of the follow-up from PET was 75.5 months (range: 20–180 months). 89 (70%) patients had negative and 39 (30%) patients had positive FDG-PET results. The numbers of true-positive, true-negative, false-positive and false-negative subjects were 29, 83, 10 and 6, respectively. Sensitivity of post-treatment FDG-PET was 83%, specificity 93%, positive predictive value 74%, negative predictive value 93%, and accuracy 88%. The difference between the event free survival of PET positive and negative cases is highly significant (p = 0.0000), according to the Mantel-Cox test. Conclusion: Our results, in accordance with literature, clearly indicate that patients with negative FDG-PET results are unlikely to progress or relapse during a long follow-up. However, false positive uptake is a problem. We have investigated the effect of age, histological subtype, clinical stage and the type of treatment on the accuracy, but on the basis of these facts we could not find any significant difference. However, the date of the investigation influenced the results: before 2000 the number of false results was significantly higher than after that time, which shows the importance of investigators’ experience.

Immunoglobulin G Fc Receptor Polymorphisms and Clinical Course in Follicular Lymphoma Patients.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 3250-3250
Author(s):  
Wen-Kai Weng ◽  
Abby Rosenberg ◽  
Ronald Levy
Keyword(s):  
Follicular Lymphoma ◽  
Predictive Value ◽  
Clinical Course ◽  
Antibody Therapy ◽  
B Cell Lymphoma ◽  
Fc Receptor ◽  
Time Interval ◽  
Low Grade ◽  
Response To Chemotherapy ◽  
Anti Cd20

Abstract Patients with low-grade B cell lymphoma, such as follicular lymphoma usually have an indolent clinical course. In most of the cases, patients do not require therapy at the time of diagnosis. Instead, patients can be monitored from months to years before the need for therapy. However, the time interval from diagnosis to the first therapy in these patients can vary significantly. In addition, the overall clinical course is heterogeneous in these patients with variable length of survival after diagnosis. The pathobiological basis of this hetergenisity is not known. We have recently found that IgG Fc receptor (FcγR) polymorphisms correlated with clinical outcome after immunotherapies in patients with follicular lymphoma. In one case, FcγRIIIa 158 V/F and FcγRIIa 131 H/R polymorphisms predicted the response to anti-CD20 antibody, rituximab therapy probably due to their role in the antibody-dependent cellular cytotoxicity. One question is whether the FcγR polymorphisms are correlated with the general clinical course of follicular lymphoma due toq their role in innate immunity. We therefore tested if FcγRIIIa 158 V/F, FcγRIIa 131 H/R and FcγRIIb 232 I/T polymorphisms predict clinical course of a group of 307 patients with follicular lymphoma. None of the three FcγR polymorphisms tested correlated with the time interval from diagnosis to first therapy, or with overall survival in this group of patients. We then tested whether FcγR polymorphisms have predictive value on clinical response to chemotherapy. Of 307 patients, only 158 patients received chemotherapy alone as first therapy, while the rest of the patients have received additional idiotype vaccination or rituximab. In the analysis of these 158 patients, there was no correlation between the FcγR polymorphisms and response rate to chemotherapy or time to progression after chemotherapy. Our results did not find any association between the three FcγR polymorphisms tested and clinical course of disease or response to chemotherapy in patients with follicular lymphoma, suggesting that the predictive value of FcγR polymorphisms on the clinical responses to rituximab is specific to the monoclonal antibody therapy.

Lack Of Benefit From Surveillance PET-CT In Transformed Indolent Lymphoma (TrIL) In Complete Metabolic Remission (CMR) Following Therapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 1796-1796
Author(s):  
Chan Y Cheah ◽  
Michael J. Dickinson ◽  
Anupkumar George ◽  
Michael S Hofman ◽  
Kate Burbury ◽  
...  
Keyword(s):  
Predictive Value ◽  
False Positive ◽  
Clinical Symptoms ◽  
Ct Scans ◽  
Low Grade ◽  
Primary Therapy ◽  
Pet Ct ◽  
Positive Scan ◽  
Relapsed Lymphoma

Abstract Background Patients (pts) with TrIL have inferior outcomes compared with de novo diffuse large B-cell lymphoma (DLBCL), and their optimum follow up is not well defined. We sought to determine the utility of surveillance PET-CT in pts with TrIL achieving CMR after primary therapy and identify patterns of relapse. Methods We performed a retrospective analysis of pts with TrIL treated at Peter MacCallum Cancer Centre between 2002 and 2012 who achieved CMR after primary therapy who had ³1 subsequent surveillance PET-CT. In the period analysed, departmental protocol recommended 6-monthly scans for pts in CMR for the first 2 years, then annually until 5 years after completion of therapy, if there was intention to intervene on detection of subclinical relapse. A positive scan suggested relapsed lymphoma, with true positive results requiring either biopsy confirmation or unequivocal scan progression. A false positive scan was refuted by biopsy and/or follow up showing resolution of areas of increased FDG uptake. A negative scan was interpreted as negative for relapsed lymphoma: true negatives had no clinical relapse and false negatives manifest relapse within three months from the date of the scan. Indeterminate scans were recorded if determination could not be made. Results The cohort included 55 pts with TrIL: 38 underwent stem cell transplant (autologous, n= 37; allogeneic, n=1) as consolidation; 17 did not. (Table 1). After a median follow-up of 34 (range 3 – 101) months, the actuarial 3-year progression free (PFS) and overall survival (OS) were 77% (95% CI 62 – 86%) and 88% (75 – 94%) respectively. Multiple potential prognostic factors including IPI, stage, serum LDH, timing of transformation (simultaneous diagnosis of transformation versus delayed) and type of indolent histology were not predictive of PFS. Of 180 surveillance PET-CT scans, there were 153 true negatives, 4 false positives, 1 false negative, 7 indeterminate and 15 true positives (Table 2). Considering indeterminate scans as false positives, the specificity of PET-CT for detecting relapse was 93%, sensitivity 93%, positive predictive value 54% and negative predictive value 99%. Of the 15 pts who experienced disease relapse, 7 (47%) were subclinical (i.e. detected by surveillance PET-CT scans) whilst 8 (53%) were suspected on the basis of clinical symptoms. Although 5% of scans in the first 2 years detected a subclinical relapse, all of these were either biopsy or clinically shown to be low-grade lymphoma. All 8 symptomatic relapses (at 2 – 42 months), in contrast were DLBCL. Conclusion In pts with TrIL achieving CMR, PET-CT detects subclinical relapses of low-grade histology with high sensitivity but with a moderate false-positive rate. This is of limited clinical benefit as the initiation of further therapy in these circumstances is rarely based on imaging findings alone. In contrast, all DLBCL relapses in our cohort were accompanied by clinical symptoms. Thus, surveillance imaging of pts with TrIL achieving CMR is not indicated. PET-CT should be reserved for evaluation of suspected relapse only. Disclosures: No relevant conflicts of interest to declare.

Response Assessment After Induction Therapy in Diffuse Large B Cell Lymphoma (DLBCL): Role of Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) in Comparison with Computed Tomography (CT).

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4995-4995 ◽  
Author(s):  
Benedetta Puccini ◽  
Luigi Rigacci ◽  
Patrizia Pregno ◽  
Annalisa Chiappella ◽  
Renato Alterini ◽  
...  
Keyword(s):  
Predictive Value ◽  
Fdg Pet ◽  
Hodgkin’S Lymphoma ◽  
False Negative ◽  
Response Assessment ◽  
Hodgkin's Lymphoma ◽  
Bulky Disease ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Abstract Abstract 4995 Background The response evaluation is performed by computed tomography (CT) as a standard tool in DLBCL. The introduction the FDG-PET performed for post treatment response assessment of aggressive Non Hodgkin's Lymphoma (NHL) is advised by the Revised International Workshop Criteria (IWC). We explored the predictive value by FDG-PET scan performed at the end of therapy in patients (pts) with DLBCL treated with rituximab-containing regimens . Patients From 2003 at 2008 were included 86 pts with DLBCL treated with Rituximab and CHOP or CHOP-like regimens. The FDG-PET and CT was mandatory at baseline and at the end of therapy to include pts in the study. We evaluated the progression free survival (PFS) of pts starting from the time of diagnosis to early relapse or disease progression or last follow-up. Results Median age was 60 years (28-78), 40 pts were female and 46 male, 38 pts presented stage I-II and 48 stage III-IV. The International Prognostic Index (IPI) was low in 20% of pts, low-intermediate in 50%, intermediate-high in 28% and high risk in 2%; bulky was reported in 24 pts. Seventy-seven pts attained complete remission (CR) (89%), 8 pts (9%) partial remission (PR) and 1 pts progression disease (2%). The FDG-PET and CT performed at the end of therapy were both negative in 61 pts (71%); both positive in 9 pts (10%). In the remaining pts the FDG-PET and CT scan performed post therapy were discordant in particular in 13 pts (15%) FDG-PET was negative and CT was positive and in 3 pts (4%) FDG-PET was positive and CT was negative. Thus the positive predictive value of a FDG-PET at the end of therapy was 63% and the negative predictive value was 87%. The sensitivity and specificity of FDG-PET at the end of therapy were 41% and 94% respectively. The positive predictive value and the negative predictive value of a CT at the end of therapy were 43% and 87% respectively. The sensitivity of CT at the end of therapy was 53% and the specificity was 83%. Fifthteen out seventy-four patients (20%) with negative FDG-PET progress or relapse within 6 months (median 4 months). Five out twenty (25%) FDG-PET negative bulky disease pts progress or relapse within 6 months moreover four out seventeen (24%) CT negative bulky disease pts progress or relapse. With a median follow-up of 20 months (range 7-83) the overall survival was 86%, and with a median follow-up of 15 months (range 2-78) the PFS was 76%. Conclusions FDG-PET shows an high specificity but a very low sensibility in DLBCL. An high rate of false negative FDG-PET was observed in bulky disease patients. We have observed that pts with negative FDG-PET presented a rapid relapse or progression therefore we can consider that probably in non-Hodgkin's lymphoma PET should be performed after four months from the end of therapy to reduce false negative. Obviously larger study are needed but at the moment CT remain the most sensible instrument to define CR in non-Hodgkin's lymphoma. Disclosures Vitolo: Roche:.

Brain FDG PET for the Etiological Diagnosis of Clinically Uncertain Cognitive Impairment During Delirium in Remission

2020 ◽  
Vol 77 (4) ◽  
pp. 1609-1622
Author(s):  
Franziska Mathies ◽  
Catharina Lange ◽  
Anja Mäurer ◽  
Ivayla Apostolova ◽  
Susanne Klutmann ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Fdg Pet ◽  
False Negative ◽  
Ground Truth ◽  
Etiological Diagnosis ◽  
Geriatric Unit ◽  
Positron Emission ◽  
The Brain ◽  
Hospitalized Geriatric Patients

Background: Positron emission tomography (PET) of the brain with 2-[F-18]-fluoro-2-deoxy-D-glucose (FDG) is widely used for the etiological diagnosis of clinically uncertain cognitive impairment (CUCI). Acute full-blown delirium can cause reversible alterations of FDG uptake that mimic neurodegenerative disease. Objective: This study tested whether delirium in remission affects the performance of FDG PET for differentiation between neurodegenerative and non-neurodegenerative etiology of CUCI. Methods: The study included 88 patients (82.0±5.7 y) with newly detected CUCI during hospitalization in a geriatric unit. Twenty-seven (31%) of the patients were diagnosed with delirium during their current hospital stay, which, however, at time of enrollment was in remission so that delirium was not considered the primary cause of the CUCI. Cases were categorized as neurodegenerative or non-neurodegenerative etiology based on visual inspection of FDG PET. The diagnosis at clinical follow-up after ≥12 months served as ground truth to evaluate the diagnostic performance of FDG PET. Results: FDG PET was categorized as neurodegenerative in 51 (58%) of the patients. Follow-up after 16±3 months was obtained in 68 (77%) of the patients. The clinical follow-up diagnosis confirmed the FDG PET-based categorization in 60 patients (88%, 4 false negative and 4 false positive cases with respect to detection of neurodegeneration). The fraction of correct PET-based categorization did not differ between patients with delirium in remission and patients without delirium (86% versus 89%, p = 0.666). Conclusion: Brain FDG PET is useful for the etiological diagnosis of CUCI in hospitalized geriatric patients, as well as in patients with delirium in remission.

Scoring System for the Diagnosis of COVID-19

2020 ◽  
Vol 13 (1) ◽  
pp. 413-414 ◽  
Author(s):  
Mohamed Farouk Allam
Keyword(s):  
Scoring System ◽  
Clinical Symptoms ◽  
False Negative ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Pcr Assay ◽  
Negative Results ◽  
False Negative Results ◽  
Symptoms And Signs

Due to the international spread of COVID-19, the difficulty of collecting nasopharyngeal swab specimen from all suspected patients, the costs of RT-PCR and CT, and the false negative results of RT-PCR assay in 41% of COVID-19 patients, a scoring system is needed to classify the suspected patients in order to determine the need for follow-up, home isolation, quarantine or the conduction of further investigations. A scoring system is proposed as a diagnostic tool for suspected patients. It includes Epidemiological Evidence of Exposure, Clinical Symptoms and Signs, and Investigations (if available). This scoring system is simple, could be calculated in a few minutes, and incorporates the main possible data/findings of any patient.

Low-Grade Mucosa-Associated Lymphoid Tissue Lymphoma Involving the Kidney: Report of 3 Cases and Review of the Literature

2006 ◽  
Vol 130 (1) ◽  
pp. 86-89 ◽  
Author(s):  
Libo Qiu ◽  
Pamela D. Unger ◽  
Robert W. Dillon ◽  
James A. Strauchen
Keyword(s):  
Lymphoid Tissue ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Lymphoid Cells ◽  
Low Grade ◽  
The Third ◽  
First Case ◽  
Abundant Cytoplasm ◽  
History Of

Abstract Low-grade B-cell lymphoma of mucosa-associated lymphoid tissue involving the kidney is rare. We report a series of 3 cases. The first case occurred in an 83-year-old woman who presented with back pain. The second case was a 53-year-old man with a history of sarcoidosis who was found, in the course of evaluation of sarcoidosis, to have a right renal mass. The third case occurred in a 72-year-old man who had a history of periorbital mucosa–associated lymphoid tissue lymphoma and had been treated with surgery and radiation 1 year prior to this presentation. Histologically, all 3 patients showed infiltrate of uniform small-to-medium–sized lymphocytes with irregular nuclear contours and abundant cytoplasm resembling centrocytes or monocytoid lymphoid cells. The first patient received chemotherapy without complications. The second patient underwent a partial nephrectomy and was asymptomatic at the subsequent follow-up. The third patient developed a pulmonary embolism following nephrectomy, and further follow-up is not available.

Extending the multistage surgical strategy for recurrent initially low-grade gliomas: functional and oncological outcomes in 31 consecutive patients who underwent a third resection under awake mapping

2021 ◽  
pp. 1-10 ◽  
Author(s):  
Noor Hamdan ◽  
Hugues Duffau
Keyword(s):  
High Rate ◽  
Karnofsky Performance Scale ◽  
Consecutive Series ◽  
Low Grade ◽  
Oncological Treatment ◽  
The Third ◽  
Oncological Outcomes ◽  
Group 2 ◽  
Group 1

OBJECTIVE Maximal safe resection is the first treatment in diffuse low-grade glioma (DLGG). Due to frequent tumor recurrence, a second surgery has already been reported, with favorable results. This study assesses the feasibility and functional and oncological outcomes of a third surgery in recurrent DLGG. METHODS Patients with DLGG who underwent a third functional-based resection using awake mapping were consecutively selected. They were classified into group 1 in cases of slow tumor regrowth or group 2 if a radiological enhancement occurred during follow-up. All data regarding clinicoradiological features, histomolecular results, oncological treatment, and survival were collected. RESULTS Thirty-one patients were included, with a median age of 32 years. There were 20 astrocytomas and 11 oligodendrogliomas in these patients. Twenty-one patients had medical oncological treatment before the third surgery, consisting of chemotherapy in 19 cases and radiotherapy in 8 cases. No neurological deficit persisted after the third resection except mild missing words in 1 patient, with 84.6% of the patients returning to work. The median follow-up duration was 13.1 ± 3.4 years since diagnosis, and 3.1 ± 2.9 years since the third surgery. The survival rates at 7 and 10 years were 100% and 89.7%, respectively, with an estimated median overall survival of 17.8 years since diagnosis. A comparison between the groups showed that the Karnofsky Performance Scale score dropped below 80 earlier in group 2 (14.3 vs 17.1 years, p = 0.01). Median residual tumor volume at the third surgery was smaller (2.8 vs 14.4 cm3, p = 0.003) with a greater extent of resection (89% vs 70%, p = 0.003) in group 1. CONCLUSIONS This is the first consecutive series showing evidence that, in select patients with progressive DLGG, a third functional-based surgery can be achieved using awake mapping with low neurological risk and a high rate of total resection, especially when reoperation is performed before malignant transformation.

Sign in / Sign up

Export Citation Format

Share Document