Bone marrow examination (BMex) in staging of SCLC after implementation of PET/CT scan.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e20014-e20014
Author(s):  
Karin Holmskov Hansen ◽  
Mette Boes Eriksen ◽  
Tine Schytte ◽  
Olfred Hansen
Keyword(s):  
Decision Making ◽  
Ct Scan ◽  
Bone Metastases ◽  
Bone Lesions ◽  
Therapeutic Decision ◽  
Therapeutic Decisions ◽  
Pet Ct ◽  
Therapeutic Decision Making ◽  
The Impact ◽  
Pet Ct Scan

e20014 Background: Correct staging of small cell lung cancer (SCLC) in limited disease (LD) or extensive disease (ED) is crucial as it has an impact on the therapeutic decision-making. The staging procedures in SCLC in the late 1990s included chest X-ray, blood samples, abdominal ultrasonography (UL), and iliac crest BMex. The aim of this study was to evaluate the continued eligibility of performing BMex in patients (ptt) with SCLC as a routine staging procedure, and to see how often therapeutic decisions were influenced by a positive BM before and after the PET/CT scan era. Methods: All diagnostic and staging procedures were registered in ptt with SCLC referred to our department from 1995 to 1999 in cohort 1 (C1). Cohort 2 (C2) included SCLC patients referred from 2009 to 2013. In C2 results of PET/CT in terms of bone metastases were related to results of BMex. Results: In C1 194 ptt was referred with 136 (70%) having ED. BMex was omitted in 32 (17%) fragile ptt having known ED while all LD ptt underwent BMex. BM involvement was seen in 37 (23%) of all 162 BMex and 36% of the 104 ED ptt examined. When BM was negative the staging of ED was due to other imaging. The BM had an impact on therapeutic decision-making in 5 (4%) of 136 having ED and 5 (3%) of 162 BMex. In C2 211 ptt of 292 (72%) had ED and 203 (70%) of all ptt underwent BMex. BM biopsy was done in 137 (65 %) ED and in 66 (69 %) LD. Of 137 ED ptt BM involvement was found in 31 (23 %) cases. A PET/CT scan was performed in 13 (42 %) of these ptt of which bone metastases was found in 12 (92 %). One patient (8%) had a PET/CT without bone lesions. Bone metastases were seen at PET/CT scan in 61 ptt in C2, of these 22 (36%) had negative BM, whereas 12 (20%) had BM involvement and in 3 ptt (5%) BMex were inconclusive. No BMex was performed in 24 ptt (39%). BMex had an impact on therapeutic decision-making in 3 (1.4%) of 211 having ED and 5 (2.5%) of 203 BMex. Conclusions: Due to staging by PET/CT and CT scan in SCLC ptt the impact of BMex in the therapeutic decision-making has decreased and fewer ptt are undergoing BMex. Though a negative PET/CT cannot exclude BM involvement BMex may be considered omitted.

Accuracy of NaF PET/CT scan to detect bone metastases in CRPC.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 186-186
Author(s):  
Modar Alom ◽  
Ilija Aleksic ◽  
Brian Ruhle ◽  
Peter Iannotta ◽  
Colin Okeefe ◽  
...  
Keyword(s):  
Ct Scan ◽  
Bone Metastases ◽  
Bone Scintigraphy ◽  
Metastatic Disease ◽  
Bone Lesions ◽  
Castration Resistant Prostate Cancer ◽  
Current Standard ◽  
Pet Ct ◽  
Feasible Option ◽  
Pet Ct Scan

186 Background: The current standard for imaging Castration Resistant Prostate Cancer (CRPC) is aimed at detecting metastatic lesions to the bones. However, discovery, validation, and implementation of new imaging modalities have fallen considerably behind that of new therapies for this population. Recent studies have shown the NaF PET/CT Scans are significantly more sensitive and accurate in detecting bone lesions than conventionally used Bone Scintigraphy with Technetium-99 (Tc-99). This study conducted retrospective analysis to compare the competence of these two methods for identifying bone metastases. Methods: We conducted a charts review of 613 patients being currently treated with androgen deprivation therapy (ADT) and identified 55 patients who obtained a Na18F PET/CT Scan. Results: The median age was 75.5 years with a range of 52-89, for our cohort. Of these 55 patients, 5 (11.9%) were determined to have metastasis with Tc-99 Bone Scintigraphy alone while 27 (49.1%) were determined to have metastases with NaF Scan (p<0.005). 8 (19%) patients had equivocal findings on Tc-99 Bone Scintigraphy. Therefore, for all of them we performed NaF scan to define a bone metastatic disease that demonstrated in 5 (62.5%) cases of these as having no bone involvement and 3(37.5%) as positive for bone lesions (Table). However, data of NaF scan also indicated 5(9%) patients as having equivocal findings for metastatic disease. Conclusions: According to our data, NaF is more sensitive for detecting bone lesions (11.9 vs. 49.1%). It was also able to delineating equivocal TC-99 Bone Scintigraphy findings, where it deemed 62.5% as negative and 37.5% as positive for bone lesions. NaF PET scan is a feasible option for CRPC for detecting bone metastases, early in disease progression. With coverage of this procedure by Medicare patients have more sensitive and specific tool for early diagnosis and monitoring of treatment of CRPC. [Table: see text]

Does 68Ga-DOTA-NOC-PET/CT impact staging and therapeutic decision making in pulmonary carcinoid tumors?

2020 ◽  
Vol 41 (10) ◽  
pp. 1040-1046
Author(s):  
Nilendu C. Purandare ◽  
Ameya Puranik ◽  
Archi Agrawal ◽  
Sneha Shah ◽  
Rajiv Kumar ◽  
...  
Keyword(s):  
Decision Making ◽  
Carcinoid Tumors ◽  
Therapeutic Decision ◽  
Pulmonary Carcinoid ◽  
Pet Ct ◽  
Therapeutic Decision Making

scholarly journals CBCT influences endodontic therapeutic decision-making in immature traumatized teeth with suspected pulp necrosis: a before-after study

2021 ◽  
pp. 20200594
Author(s):  
Fernando José Mota de Almeida ◽  
Dalya Hassan ◽  
Ghada Nasir Abdulrahman ◽  
Malin Brundin ◽  
Nelly Romani Vestman
Keyword(s):  
Decision Making ◽  
Treatment Plan ◽  
Dental Trauma ◽  
Expectant Management ◽  
Rank Test ◽  
Therapeutic Decision ◽  
Radiographic Findings ◽  
Treatment Plans ◽  
Therapeutic Decision Making ◽  
The Impact

Objective: To evaluate the impact of cone-beam computed tomography (CBCT) in endodontic therapeutic decision-making of immature traumatized teeth with suspected pulp necrosis. Methods: Over two years, consecutive patients with a dental trauma in their front teeth (apex >0.5 mm) and with suspected pulp necrosis based on clinical and radiographic findings were referred to a specialist clinic in Sweden. Fifteen patients aged 6–13 (18 teeth) were included and clinically examined by an endodontist. Intraoral radiographs and CBCT examinations were obtained. Five practitioners, three endodontists and two residents in endodontics, used these examinations to determine the most appropriate treatment for the 18 cases (all central incisors) on two occasions scheduled 19 weeks apart. On the first occasion, the practitioners had access to clinical information and the intraoral radiographs (‘before’ CBCT); on the second occasion, the practitioners had also access to a radiologist report and the CBCT images (‘after’ CBCT). Their treatment plans – no treatment, watchful waiting, endodontic orthograde treatment, or extraction – were made anonymously and independently. Results were analysed using descriptive statistics and Wilcoxon signed-rank test. Results: ‘After’ CBCT, practitioners changed treatment plans in 30% of the 90 assessments, 74% of which were more aggressive (p = 0.028). In 49% of the assessments, practitioners who chose the watchful and waiting treatment plan ‘before’ CBCT changed to a more aggressive therapy such as endodontic orthograde treatment and extraction ‘after’ CBCT (p = 0.005). Conclusion: This study provides evidence that CBCT influences endodontic therapeutic decision-making regarding immature traumatised teeth with suspected pulp necrosis, chiefly when expectant management (i.e., watchful and waiting) was selected before access to CBCT.

scholarly journals Health emergencies and interoceptive sensibility modulate the perception of non-evidence-based drug use: Findings from the COVID-19 outbreak

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0256806
Author(s):  
Gerardo Salvato ◽  
Daniela Ovadia ◽  
Alessandro Messina ◽  
Gabriella Bottini
Keyword(s):  
Decision Making ◽  
Individual Characteristics ◽  
Decision Making Process ◽  
Evidence Based ◽  
Care Providers ◽  
Therapeutic Decision ◽  
Therapeutic Approaches ◽  
Experimental Drugs ◽  
Therapeutic Decisions ◽  
Therapeutic Decision Making

Scientific evidence plays an important role in the therapeutic decision-making process. What happens when physicians are forced to make therapeutic decisions under uncertainty? The absence of scientific guidelines at the beginning of a pandemic due to an unknown virus, such as COVID-19, could influence the perceived legitimacy of the application of non-evidence-based therapeutic approaches. This paper reports on a test of this hypothesis, in which we administered an ad hoc questionnaire to a sample of 64 Italian physicians during the first wave of the COVID-19 pandemic in Italy (April 2020). The questionnaire statements regarding the legitimacy of off-label or experimental drugs were framed according to three different scenarios (Normality, Emergency and COVID-19). Furthermore, as the perception of internal bodily sensations (i.e., interoception) modulates the decision-making process, we tested participants’ interoceptive sensibility using the Multidimensional Assessment of Interoceptive Awareness (MAIA). The results showed that participants were more inclined to legitimate non-evidence-based therapeutic approaches in the COVID-19 and Emergency scenarios than the Normality scenario. We also found that scores on the MAIA Trusting subscale positively predicted this difference. Our findings demonstrate that uncertain medical scenarios, involving a dramatic increase in patient volume and acuity, can increase risk-taking in therapeutic decision-making. Furthermore, individual characteristics of health care providers, such as interoceptive ability, should be taken into account when constructing models to prevent the breakdown of healthcare systems in cases of severe emergency.

18F-Fluciclovine PET/CT in Therapeutic Decision Making for Prostate Cancer

2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Alexandra D. Dreyfuss ◽  
Grace S. Ahn ◽  
Andrew R. Barsky ◽  
Jennifer A. Gillman ◽  
Neha Vapiwala ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Therapeutic Decision ◽  
Pet Ct ◽  
Therapeutic Decision Making
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