The value of lymph node ultrasound and whole body PET/CT in stage IIB/C patients prior to SLNB.

e22079 Background: Stage IIB/IIC (pT3b-T4N0) patients are known to have high-risk primary tumors, even higher risk than some stage IIIA/B melanomas (AJCC Staging System 8th edition), however they follow the same routine to sentinel lymph node biopsy (SLNB) as more low-risk tumors. A priori the risk of finding SLNB or other metastases is much higher for these thick and/or ulcerated primary melanomas compared to the thinner ones. Guidelines are not conclusive regarding the use of preoperative imaging in these cases. Recently, a trend to more frequently use cross-sectional imaging has been noticed. However, others have previously shown that preoperative ultrasound was the most sensitive. The aim of this pilot study was to assess the value of ultrasound (US) and Positron Emission Tomography/Computerized Tomography (PET/CT) prior to SLNB for stage IIB/C (pT3b-T4N0) melanoma patients. Methods: Starting 2019-04, all patients with a pT3b melanoma or higher (8th AJCC) were included. All patients underwent US and PET/CT before their planned lymphoscintigraphy and routine SLNB. Suspected metastases were confirmed with cytologic puncture. Results: A total of 20 patients were screened. Seven patients (35%) had metastases detected by imaging: one by PET/CT, three by US and three by both imaging modalities. Three of these metastases were detected by US as well as PET/CT. All metastases were nodal. For all seven patients treatment was altered to lymph node dissection with adjuvant therapy. Of the 13 patients in whom no metastases were identified by imaging, six (46%) still had a positive sentinel node (SN). Conclusions: This study showed that this select group of patients had a high risk of metastases prior to SLNB and that all recurrences except one, were detected by ultrasound. This suggests that nodal staging with US is sufficient and can replace the need for SLNB when metastases is proven with cytology. Despite negative imaging, SLNB cannot be foregone for pT3b-pT4N0 melanoma patients, as many still have an involved SN. Cross-sectional imaging can be reserved for patients after positive cytology or SN to confirm the absence of distant visceral metastases.

Download Full-text

The role of pre-biopsy mpMRI in lymph node staging for prostate cancer

Urologia Journal ◽

10.1177/03915603211016805 ◽

2021 ◽

pp. 039156032110168

Author(s):

Nassib Abou Heidar ◽

Robert El-Doueihi ◽

Ali Merhe ◽

Paul Ramia ◽

Gerges Bustros ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

High Risk ◽

Gleason Score ◽

Gold Standard ◽

Cross Sectional ◽

Significant Difference ◽

Cross Sectional Imaging ◽

Sectional Imaging ◽

Kappa Agreement

Introduction: Prostate cancer (PCa) staging is an integral part in the management of prostate cancer. The gold standard for diagnosing lymph node invasion is a surgical lymphadenectomy, with no superior imaging modality available at the clinician’s disposal. Our aim in this study is to identify if a pre-biopsy multiparametric MRI (mpMRI) can provide enough information about pelvic lymph nodes in intermediate and high risk PCa patients, and whether it can substitute further cross sectional imaging (CSI) modalities of the abdomen and pelvis in these risk categories. Methods: Patients with intermediate and high risk prostate cancer were collected between January 2015 and June 2019, while excluding patients who did not undergo a pre-biopsy mpMRI or a CSI. Date regarding biopsy result, PSA, MRI results, CSI imaging results were collected. Using Statistical Package for the Social Sciences (SPSS) version 24.0, statistical analysis was conducted using the Cohen’s Kappa agreement for comparison of mpMRI with CSI. McNemar’s test and receiver operator curve (ROC) curve were used for comparison of sensitivity of both tests when comparing to the gold standard of lymphadenectomy. Results: A total of 143 patients fit the inclusion criteria. We further stratified our patients into according to PSA level and Gleason score. Overall, agreement between mpMRI and all CSI was 0.857. When stratifying patients based on Gleason score and PSA, the higher the grade or PSA, the higher agreement between mpMRI and CSI. The sensitivity of mpMRI (73.7%) is similar to CSI (68.4%). When comparing CSI sensitivity to that of mpMRI, no significant difference was present by utilizing the McNemar test and very similar receiver operating characteristic curve. Conclusion: A pre-biopsy mpMRI can potentially substitute further cross sectional imaging in our cohort of patients. However, larger prospective studies are needed to confirm our findings.

Download Full-text

Comparison of 68 Ga-PSMA ligand PET/CT versus conventional cross-sectional imaging for target volume delineation for metastasis-directed radiotherapy for metachronous lymph node metastases from prostate cancer

Strahlentherapie und Onkologie ◽

10.1007/s00066-018-1417-9 ◽

2019 ◽

Vol 195 (5) ◽

pp. 420-429 ◽

Cited By ~ 6

Author(s):

Daniel Walacides ◽

Astrid Meier ◽

Anne Caroline Knöchelmann ◽

Daniele Meinecke ◽

Thorsten Derlin ◽

...

Keyword(s):

Prostate Cancer ◽

Lymph Node ◽

Target Volume ◽

Cross Sectional ◽

Target Volume Delineation ◽

Volume Delineation ◽

Pet Ct ◽

Cross Sectional Imaging ◽

Node Metastases ◽

Sectional Imaging

Download Full-text

Real Life Use of Imaging in the Management of Newly Diagnosed Patients with Myeloma- Practical Perspectives from a UK Hospital

Blood ◽

10.1182/blood-2019-121504 ◽

2019 ◽

Vol 134 (Supplement_1) ◽

pp. 5513-5513

Author(s):

Ke Xu ◽

Lucy Fowkes ◽

Fenella Willis ◽

Yasmin Reyal

Keyword(s):

Data Collection ◽

Whole Body ◽

Lytic Lesion ◽

Newly Diagnosed ◽

Cross Sectional ◽

Pet Ct ◽

Data Collection Period ◽

Cross Sectional Imaging ◽

Collection Period ◽

Sectional Imaging

Background: The role of imaging in myeloma has gained increasing importance over the past few years. Cross‐sectional imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI) and 18fluoro‐deoxyglucose (18F‐FDG) positron emission tomography (PET/CT) have increased sensitivity of detection of myeloma bone lesions compared to skeletal plain radiographs. However, there is huge variation in practice both within the United Kingdom and internationally, as to the choice of modality due to differences in access to the techniques and the subtleties of the information gained from each type of imaging. At present whole body (WB) diffusion weighted (DW) MRI is not yet available in our hospital. Aim: To review compliance of our current practice with the 2017 British Society for Haematology (BSH) guideline "Use of imaging in the management of patients with myeloma". To review the number of imaging modalities performed in newly diagnosed myeloma patients. Audit Standard Criteria range: 100%, or if not achieved, there is documentation in the case notes that explains the variance. • Patient with suspected myeloma underwent whole body MRI (WB-MRI) or CT (unless excluded due to unsuitability of procedure for the patient). • Patient without established myeloma defining event (MDE) but with bone marrow plasma cells 10-60% and/or M-protein >30g/l underwent WB-MRI, WB-CT or PET/CT. • WB/DW-MRI or PET/CT performed in the assessment of oligosecretory myeloma. • Whole spine MRI performed and reported within 24 hours of suspected cord compression in myeloma. • PET/CT or WB/DW-MRI performed in the diagnostic assessment of possible solitary plasmacytoma. Method: Data collection period was between 1st July 2017 to 30th June 2018. We included all adult patients (age at least18 years) who were newly diagnosed with myeloma or plasmacytoma in our Trust during the data collection period, and had their diagnostic imaging in our Trust.Data were retrospectively collected from multidisciplinary meeting lists, chemotherapy list, radiology department data and electronic patient record (EPR). Results: Forty patients were included in the audit, which included 31 myeloma patients, 8 smouldering myeloma patients, one plasmacytoma patient. There were no non-secretory or oligosecretory myeloma cases and there were no newly diagnosed myeloma patients presenting with suspected cord compression in our Trust during the data collection period. All patients (100%) with suspected myeloma underwent cross-sectional imaging at diagnosis. Twenty nine (73%) patients had low dose (LD) WB-CT, four (10%) had PET/CT and one (2%) had WB-MRI. Eleven (27%) had CT chest abdomen pelvis (CT-CAP) ; this latter group of patients came through the suspected cancer referral pathway. No skeletal surveys were performed for patients with newly diagnosed myeloma or plasmacytoma during the data collection period. All smouldering myeloma patients underwent LDWB-CT. All solitary plasmacytoma patients had PET/CT or WB/DW-MRI. Twenty out of 40 (50%) patients had more than one imaging modality. For the majority of these patients this comprised a CT and MRI whole spine/pelvis (40%) and 10% had a CT and PET-CT. Two patients had three modes of imaging. The main reasons for requesting MRI spine/pelvis were back pain, CT showed lytic lesion or mass in spine, CT showed equivocal lytic lesion or abnormal marrow signal in spine, CT showed no lytic lesion but clinically strongly suspected lytic lesion in spine. The main reasons for requesting PET/CT were CT showed equivocal lytic lesion, and suspected cancer. Conclusion: Our Trust has excellent compliance with the BSH guideline as all new myeloma patients underwent cross-sectional imaging with a CT. However, for half of these patients CT alone was inadequate to fully assess their bone disease, requiring an additional modality. Discussion: Patients with suspected myeloma are referred to the haematology department through different pathways, most commonly suspected myeloma and back pain (73%), and suspected cancer (27%). The route of referral often determines first imaging modality. For many patients more than one modality is required to accurately assess their bone disease, eg presence of focal lesions, active lesions, spinal cord compromise. This causes delay of making diagnosis and increased cost. Access to WB-DWI/MRI may address some if not all these issues. Disclosures No relevant conflicts of interest to declare.

Download Full-text