Initial experience in staging primary oesophageal/gastro-oesophageal cancer with 18F-FDG PET/MRI

Background 18F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high-contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for staging oesophageal/gastro-oesophageal cancer. Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastro-oesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324 ± 28 MBq 18F-FDG administration and 60-min uptake, PET/CT was performed, immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians and PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%. Results Out of 26 participants, 22 (20 males; mean ± SD age 68.8 ± 8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p > 0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10). Conclusion In this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.

The Uro-Oncology Multi-disciplinary team (MDT) Clinic – Clinical and Patient-Reported Outcomes From Implementing a New Model of Care

Introduction A multi-disciplinary approach has often been advocated to improve the delivery of oncological care, as compared to a mono-disciplinary and linear approach. Our study elucidates the clinical and patient-reported outcomes from a urologic-oncology multi-disciplinary team (MDT) clinic in a regional general hospital. Materials and Methods Patients who attended a uro-oncology MDT clinic which was started in January 2019 were identified. This service was specifically catered to patients who were histologically diagnosed with urological cancers. The MDT service comprised a multi-disciplinary tumour board followed by outpatient clinical consults with representatives from urology, medical and radiation oncology. Demographic variables, disease characteristics and treatment rendered were analysed. A survey was administered to assess patient satisfaction. Results Fifty patients with a median age of 70 years with complete case records were identified. The cancer types included prostate cancers (46%), urothelial cancers (26%) and renal cell carcinoma (12%) as the most frequent urological cancers. The median time from MDT to therapy initiation was 8 days. Among those with prostate, urothelial, renal and testicular malignancies, 71% (32/45) of our patients received treatment that were in accordance to guideline recommendations. A post-clinic survey showed that patients were satisfied with the information provided during the clinic and this also facilitated decision and time to initiation of therapy. Conclusion A multi-disciplinary service comprising a tumour board followed by a one-stop clinic provides patients with multi-disciplinary care, improved access to subsequent therapy, better time efficiency and high patient satisfaction scores. More studies are warranted to demonstrate its oncological outcomes.

Initial Experience in Staging Primary Oesophageal/Gastroesophageal Cancer with 18F-FDG PET/MRI

Background18F-Fluorodesoxyglucose Positron-emission tomography magnetic resonance imaging (18F-FDG PET/MRI) may improve cancer staging by combining sensitive cancer detection with high contrast resolution and detail. We compared the diagnostic performance of 18F-FDG PET/MRI to 18F-Fluorodesoxyglucose Positron-emission tomography computed tomography (18F-FDG PET/CT )for staging oesophageal/gastroesophageal cancer.Following ethical approval and informed consent, participants with newly diagnosed primary oesophageal/gastroesophageal cancer were enrolled. Exclusions included prior/concurrent malignancy. Following 324±28 MBq 18F-FDG administration and 60-minute uptake, PET/CT was performed; immediately followed by integrated PET/MRI from skull base to mid-thigh. PET/CT was interpreted by two dual-accredited nuclear medicine physicians; PET/MRI by a dual-accredited nuclear medicine physician/radiologist and cancer radiologist in consensus. Per-participant staging was compared with the tumour board consensus staging using the McNemar test, with statistical significance at 5%. Results 22/26 participants (20 male; mean±SD age 68.8±8.7 years) completed 18F-FDG PET/CT and PET/MRI. Compared to the tumour board, the primary tumour was staged concordantly in 55% (12/22) with PET/MRI and 36% (8/22) with PET/CT; the nodal stage was concordant in 45% (10/22) with PET/MRI and 50% (11/22) with PET/CT. There was no statistical difference in PET/CT and PET/MRI staging performance (p>0.05, for T and N staging). The staging of distant metastases was concordant with the tumour board in 95% (21/22) with both PET/MRI and PET/CT. Of participants with distant metastatic disease, PET/MRI detected additional metastases in 30% (3/10). ConclusionIn this preliminary study, compared to 18F-FDG PET/CT, 18F-FDG PET/MRI showed non-significant higher concordance with T-staging, but no difference with N or M-staging. Additional metastases detected by 18F-FDG PET/MRI may be of additive clinical value.

‘We will take care of you’: Identity categorisation markers in intercultural medical encounters

Ethnomethodology research has systematically investigated discursive practices of categorisation, looking at the various ways by which social actors ascribe both themselves and others to identity categories to accomplish various kinds of social actions. Drawing on a data corpus of oncological visits collected in an Italian hospital, involving both native and non-native patients, the present work analyses how participants in these intercultural medical encounters invoke and make relevant social identity categories by the marking of collective pronouns in their talk. Our results showed that whilst institutional identities (e.g. those of the doctors, the local hospital or the Tumour Board) prevailed, categorial formulations related to cultural or linguistic identities were rarely displayed in interactions with non-native patients. Conversational participants made very little of their linguistical or cultural background and when they did so, their cultural and linguistic identities were deployed for rhetorical and pragmatical aims, such as testing and negotiating common knowledge and epistemic authority. This study shows how even speakers’ minimal lexical choices, such as marked pronouns, impact the negotiation of meanings and activities in life-saving sites such as oncological visits.

Synchronous breast and colon cancer in a young female: a single stage surgery

Synchronous breast and colon cancers are rare, particularly in the absence of family history. Synchronous tumors should always be kept in mind during the staging workup for the primary malignancy. There are no definitive guidelines for the management of synchronous tumors, thus the involvement of tumour board multidisciplinary team is essential. We present a case of a young female patient who was diagnosed with synchronous breast and colon cancer. A handful of synchronous breast and colon cancer cases have been reported and operated at intervals, but up to our knowledge this is the first case operated simultaneously in a single stage surgery.

Leptomeningeal metastases from solid tumours

SummaryLeptomeningeal metastases from solid tumours are increasingly being diagnosed and require a careful assessment by an interdisciplinary neuro-oncological tumour board for adequate diagnosis, therapy planning and optimal care of the affected patients.