Imaging for the Initial Staging and Post-Treatment Surveillance of Penile Squamous Cell Carcinoma

Although relatively rare in the United States, penile squamous cell carcinoma is encountered worldwide at a higher rate. Initial diagnosis is often made on clinical exam, as almost all of these lesions are externally visible and amenable to biopsy. In distinction to other types of malignancies, penile cancer relies heavily on clinical nodal staging of the inguinal lymph node chains. As with all cancers, imaging plays a role in the initial staging, restaging, and surveillance of these patients. The aim of this manuscript is to highlight the applications, advantages, and limitations of different imaging modalities in the evaluation of penile cancer, including ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography.

Additional Value of PET Radiomic Features for the Initial Staging of Prostate Cancer: A Systematic Review from the Literature

We performed a systematic review of the literature to provide an overview of the application of PET radiomics for the prediction of the initial staging of prostate cancer (PCa), and to discuss the additional value of radiomic features over clinical data. The most relevant databases and web sources were interrogated by using the query “prostate AND radiomic* AND PET”. English-language original articles published before July 2021 were considered. A total of 28 studies were screened for eligibility and 6 of them met the inclusion criteria and were, therefore, included for further analysis. All studies were based on human patients. The average number of patients included in the studies was 72 (range 52–101), and the average number of high-order features calculated per study was 167 (range 50–480). The radiotracers used were [68Ga]Ga-PSMA-11 (in four out of six studies), [18F]DCFPyL (one out of six studies), and [11C]Choline (one out of six studies). Considering the imaging modality, three out of six studies used a PET/CT scanner and the other half a PET/MRI tomograph. Heterogeneous results were reported regarding radiomic methods (e.g., segmentation modality) and considered features. The studies reported several predictive markers including first-, second-, and high-order features, such as “kurtosis”, “grey-level uniformity”, and “HLL wavelet mean”, respectively, as well as PET-based metabolic parameters. The strengths and weaknesses of PET radiomics in this setting of disease will be largely discussed and a critical analysis of the available data will be reported. In our review, radiomic analysis proved to add useful information for lesion detection and the prediction of tumor grading of prostatic lesions, even when they were missed at visual qualitative assessment due to their small size; furthermore, PET radiomics could play a synergistic role with the mpMRI radiomic features in lesion evaluation. The most common limitations of the studies were the small sample size, retrospective design, lack of validation on external datasets, and unavailability of univocal cut-off values for the selected radiomic features.

Additional MRI for initial M-staging in pancreatic cancer: a cost-effectiveness analysis

Objective Pancreatic cancer is portrayed to become the second leading cause of cancer-related death within the next years. Potentially complicating surgical resection emphasizes the importance of an accurate TNM classification. In particular, the failure to detect features for non-resectability has profound consequences on patient outcomes and economic costs due to incorrect indication for resection. In the detection of liver metastases, contrast-enhanced MRI showed high sensitivity and specificity; however, the cost-effectiveness compared to the standard of care imaging remains unclear. The aim of this study was to analyze whether additional MRI of the liver is a cost-effective approach compared to routinely acquired contrast-enhanced computed tomography (CE-CT) in the initial staging of pancreatic cancer. Methods A decision model based on Markov simulation was developed to estimate the quality-adjusted life-years (QALYs) and lifetime costs of the diagnostic modalities. Model input parameters were assessed based on evidence from recent literature. The willingness-to-pay (WTP) was set to $100,000/QALY. To evaluate model uncertainty, deterministic and probabilistic sensitivity analyses were performed. Results In the base-case analysis, the model yielded a total cost of $185,597 and an effectiveness of 2.347 QALYs for CE-MR/CT and $187,601 and 2.337 QALYs for CE-CT respectively. With a net monetary benefit (NMB) of $49,133, CE-MR/CT is shown to be dominant over CE-CT with a NMB of $46,117. Deterministic and probabilistic survival analysis showed model robustness for varying input parameters. Conclusion Based on our results, combined CE-MR/CT can be regarded as a cost-effective imaging strategy for the staging of pancreatic cancer. Key Points • Additional MRI of the liver for initial staging of pancreatic cancer results in lower total costs and higher effectiveness. • The economic model showed high robustness for varying input parameters.

P076 Sleep Staging Agreement Between Polysomnography and Sleep Profiler in Isolated REM Sleep Behavior Disorder

Purpose Evaluate the sleep staging agreement between polysomnography (PSG) and Sleep Profiler (SP) in patients with suspected isolated REM-sleep-behavior-disorder. Methods Twenty-six patients with reported dream-enactment-behavior (Site1=16, Site2=10; 27% women; age 64±13 years) underwent a diagnostic PSG with simultaneously recorded SP. A registered sleep-technologist at each site performed PSG-staging, while SP was auto-staged and technically reviewed/edited. Across technicians, the initial staging was blinded. Site1 then performed unblinded restaging of PSG=N3(N2) vs. SP=N2(N3) epochs, while Site2 conducted a blinded, carefully-targeted restaging of N3. Statistics included Cohen’s kappa and Chi-square analyses. Results Agreement between SP and Site1 vs. Site2 were significantly different for Wake (kappa:Site1=0.816;Site2=0.650;combined=0.736), stage N1 (kappa:Site1=0.149;Site2=0.228;combined=0.188), stage N2 (kappa:Site1=0.632;Site2=0.718;combined=0.659), stage N3 (kappa:Site1=0.715;Site2=0.368;combined=0.525) and REM (kappa:Site1=0.827;Site2=0.719;combined=0.766)(all P<0.001). After restaging of N3, the kappa values improved at Site1 (unblinded:N2=0.659/N3=0.883) and Site2 (blinded:N2=0.775/N3=0.736)(combined:N2=0.735/N3=0.851). The proportion of PSG-epochs restaged from N3 to N2 was 17% at Sites1 and 38% at Site2 (P<0.001), while Site1 had fewer remaining PSG=N3 vs. SP=N2 conflicts (5.6% vs. 20.8%, P<0.001). Compared to Site2, Site1 had a superior: REM kappa due to fewer SP=N2 disagreements (8.5% vs. 16.8%, P<0.001), and Wake kappa resulting from fewer SP=N1 (6.6 vs. 15.6%, P<0.001) and SP=N2 conflicts (5.9 vs. 12.0%, P<0.001). Conversely, the Site1 N1 kappa was inferior due to greater SP=wake disagreement (41.6% vs. 19.8%, P<0.001). Discussion N3 was excessively stage by both PSG technicians before restaging. At Site1, Wake, N3, and REM had almost-perfect-agreement with SP, while N2 had substantial-agreement. At Site2 and across-site, substantial-agreement was observed for Wake, N2, N3, and REM.

The Role of Whole- Body Diffusion Imaging with Background Signal Suppression (DWBS) in comparison with PET/CT in assessment of lymphoma patients

Background Malignant lymphomas [Hodgkin lymphomas (HL) and non-Hodgkin lymphoma (NHL)] rank third in incidence, of all childhood cancers, Moreover, in adolescents (aged 15-19 years) the malignant lymphomas are the leading cause of cancer. Furthermore, as with many other cancers, the likelihood of an individual being diagnosed with lymphoma increases markedly with age, with the median age at diagnosis being 67 years. Aim of the Work To compare between F-18-FDG PET-CT and whole-body diffusion-weighted imaging MR protocol (DWIBS) for initial staging and post chemotherapy evaluation in patients with pathologically proven lymphoma (Hodgkin and Non-Hodgkin). Patients and Methods The study is conducted on 32 patients with pathologically proven lymphoma to perform 18-F-FDG PET/CT either for pre-treatment initial staging or for evaluation of response to chemotherapy. A total of 22 had HD (69%) and 10 had NHL (31%). Staging PET/CT and WB-MRI/DWIBS were done at time of diagnosis in 19 of the 32 patients (59.4%), where immediate post-therapy PET/CT and WB-MRI-DWIBS were performed 13 patients (40.6%). Accuracy measures were calculated for PET CT and DWIBS. Results Accuracy measures confirm the higher sensitivity and specificity of PET-CT over DWIBS. Results for F-18 FDG PET/CT were clearly superior with statistically higher sensitivity, specificity, accuracy, PPV & NPV (96.3%, 99.16%, 98.43%, 97.5% and 98.75%) compared to (83.95%, 97.91%, 94.38%, 93.15% and 94.74%) for DWIBS results respectively. Conclusion F-18-FDG PET-CT remains a cornerstone in the evaluation of malignant lymphoma patients; it has significant higher sensitivity, specificity and overall accuracy compared to WB-MRI/DWIBS in HL and NHL patients, either in initial staging or in post therapy evaluation. WB-MRI/DWIBS in HL and NHL patients, either in initial staging or in post therapy evaluation. WB-MRI/DWIBS despite of its relatively longer acquisition time may provide a complementary tool for FDG PET CT.