In this clinical case we analyzed the need for a correct algorithm for examining patients with liver tumors when making a primary diagnosis, thus it significantly affects the prognosis and course of the disease. We demonstrate capabilities of various diagnostic methods in the differential diagnosis of focal liver lesions. Our clinical case confirms the need for optimal routing schemes for patients to specialized centers that have all necessary resources to perform all types of diagnostic methods, including nuclear medicine diagnosis, as well as the presence of a multidisciplinary team of specialists. The article is illustrated with original images of nuclear medicine studies, CT and MRI images.

Introduction. Oral squamous cell carcinoma is associated with a high risk of regional metastasis even in early stages (T1–2N0M0). Morphological examination reveals concealed metastases in 20 % of removed clinically unaffected lymph nodes.Objective – to evaluate the effectiveness of flow cytometry for detection of concealed metastases in sentinel lymph nodes as an indication for cervical lymph node dissection in patients with stage сT1–2N0M0 oral squamous cell carcinoma.Materials and methods. This study included 27 patients, including 13 patients (48.1 %) with stage T1N0M0 cancer and 14 patients with stage T2N0M0 cancer (51.9 %). At the first stage, all participants underwent primary tumor removal and cervical lymph node dissection with sentinel lymph node examination. After mobilization, half of these lymph nodes was used for routine morphological examination followed by immunohistochemical examination, while the second half of them was analyzed using flow cytometry. Then we compared the results obtained.Results. We examined 46 removed sentinel lymph nodes from 27 patients. Conventional histological examination revealed 4 concealed metastases (8.7 %). Polymerase chain reaction allowed us to detect another 16 metastases (37.8 %). Levels I, II, and III lymph nodes were most frequently affected. Flow cytometry demonstrated that 20 % of patients with a <4 mm invasion had concealed metastases, whereas patients with a 4 to 8 mm invasion had concealed metastases in 60 % of cases. Median follow-up time was 20.4 ± 11.7 months (range: 2.2 to 42.5 months; median 19.5 months). All participants were alive during this time. Seventeen out of 27 patients with stage T1–2N0M0 disease (63 %) were found to have concealed metastases, while the remaining ten patients (37 %) had no metastasis. One patient with stage T1N0M0 oral floor squamous cell carcinoma underwent the removal of the primary tumor and sentinel lymph node. Morphological examination and flow cytometry showed no metastatic lesions. After 14.8 months, the patient developed ipsilateral regional CN3 metastasis. The three-year progression-free survival rate was 94.7 ± 5.1 %.Conclusion. Highly sensible and rapid flow cytometry can become the method of choice in the diagnosis of metastases and deciding on cervical lymph node dissection in patients with cN0 disease. The study is still ongoing.

Purpose of the study. To determine and compare the diagnostic efficacy of planar scintigraphy, SPECT (including SPECT/CT) and intraoperative gamma probe radiometry in the detection of sentinel lymph nodes (SLN) in patients with breast cancer.Material and methods. The study included 200 patients with diagnosed breast cancer who underwent SLN biopsy in the period 2020–2021. To identify SLN s, all patients underwent lymphoscintigraphy with a 99mtc-labeled colloidal radiopharmaceutical one day before surgery. Planar lymphoscintigraphy was performed on 200 patients included into the study, 181 underwent examination in the volume of SPECT or SPECT/CT (147 and 34 studies, respectively). The SLN was detected intraoperatively using a portable gamma probe (n=200). Subsequent histological examination determined the presence of lymphoid tissue and the status of the removed SLN.Results. SLN were detected in a comprehensive study (planar and tomographic studies) in all 200 patients studied (100 %), while planar scintigraphy did not visualize any SLN in 6 (3 %) cases, but they were determined during examination in tomographic mode. Also, in some cases, additional SLN were determined during tomography, which were not considered in the planar study. In 95 % of cases, SLN were localized in the axillary region. All non-axillary slns were identified on tomograms. The sensitivity of SPECT for SLN detection was 100 % (ci 98.0–100 %), which was higher than the sensitivity of planar scintigraphy and gamma probe (97.0 %, ci 96.5–97.4 % and 97.0 %, ci 96.1–97.4 %, respectively). The PPV values were also high (99.5 %, ci 99.0–100 % for planar scintigraphy, 99.5 %, ci 98.6–100 % for gamma probe and 98.3 %, ci 95.2–99.7 % for SPECT.Conclusion. Nuclear medicine imaging of sln with lymphotropic radiopharmaceuticals in patients with breast cancer is an effective and reliable method of navigation during surgery to perform a biopsy. SPECT and SPECT/CT can identify more lymph nodes than planar scintigraphy, improving their anatomical localization, and reducing the false negative rate. The diagnostic performance of SPECT/CT and SPECT is believed to be superior to that of planar lymphoscintigraphy and intraoperative navigation in detecting SLN.

Purpose: To develop a method for evaluation of the radiation dose of an embryo/fetus during lymphoscintigraphy (sentinel lymph node mapping) in pregnant patients with breast cancer.Material and methods: Two pregnant women (aged 43 and 30) with breast cancer stage IIA (T2N0M0), during the second trimester of pregnancy. We used a lymphotropic colloidal radiopharmaceutical labeled with 99mTc. To evaluate the radiation dose of an embryo, each patient had 6 individual dosimeters, which were placed around the abdomen using an elastic bandage at equal distances around the abdomen. Additionally, we placed the 7th dosimeter, it was placed near the injection site (under the mammary gland). After installing individual dosimeters, radiocolloid was injected into the affected mammary gland at four points (periareolar). The administered activity of radiopharmaceutical was 32.5 MBq, and 51.5 MBq. Lymphoscintigraphy was performed 1 hour after injection. First patient underwent sector resection of the left breast with SLN biopsy. The second patient underwent right mastectomy with SLN biopsy and breast reconstruction surgery using a tissue expander.Results: Based on the results of the study, the dose rate was calculated, on the basis of which the fetal radiation doses were calculated in both patients. Comparison of the mathematical data of both patients shows that, the calculated and experimental values of radiation exposure to the fetus during the radionuclide study of sentinel lymph nodes practically coincide. The obtained data shows that during pregnancy (280 days) the embryo/fetus will accumulate a natural radiation background dose of 1960 μSv, which is 2 times higher than the dose from the radionuclide study of sentinel lymph nodes. Thus these results verify the safety of SLN biopsy technology in pregnancy.Conclusion: 1. Radionuclide diagnostic studies of pregnant women determine radiation doses to the embryo/fetus that do not cause any radiation-induced effects in the prenatal period, and the probability of the occurrence of stochastic radiation-induced effects is several times lower than the incidence of endogenous cancers. 2. Radionuclide examination of sentinel lymph nodes appears to be safe for the fetus when conducted in pregnant women diagnosed with breast cancer. 3. In Russian Federation this method is used for the first time in pregnant women with diagnosed breast cancer. This technology has not been previously described in Russian literature.

he disease incidence of neuroendocrine tumors (NET) is increasing every year. Neuroendocrine tumors Grade 1 and 2 have a more favorable prognosis than Grade 3. When we are talking about NET with non-detected initial focus, the 10-year survival rate is 22 % [1]. Therefore, it is necessary to make every effort and use all technical abilities to localize the primary tumor, even in the presence of metastases, because resection of the primary tumor(s) can increase disease-free and overall survival rate. Also, the choice of chemotherapy drug or the appointment of biotherapy may depend on this. Finding tumor localization remains challenging and must involve a combination of radiological, nuclear medicine and endoscopic imaging techniques. There are many different myths about the purpose of nuclear medicine examinations and interpretation of the results in NET patients. And in this article we will try to debunk some of them, using examples from our experience in our center. We choose 111 patients with NET (histologically confimed). All patients underwent scintigraphy of neuroendocrine tumors with 99mTc-EDDA/HYNICTOC (99mTc-Tektrotyd) in the «whole body» mode and additional SPECT or SPECT/CT examination of the chest,abdomen and pelvis.

Purpose: To evaluate and compare the diagnostic efficacy of the planar lymphoscintigraphy, SPECT (SPECT/CT) and intraoperative detection with handheld gamma-probe in the identification of the sentinel lymph node (SLN) among patients with melanoma. Materia l and methods : 324 patients with cutaneous melanoma who underwent treatment at N.N. Blokhin National Medical Research Center of Oncology between 2018 and 2020, were included in this study. For SLN identification lymphoscintigraphy ( n = 324) and SPECT (SPECT/CT) ( n = 259) images were obtained preoperatively after injection of 99mTc-labeled colloid particles. Lymphatic mapping was implemented with permanent skin marker designating the anatomical landmarks of sentinel node’s location. Additionally, SLN localization was identified by handheld gamma-probe ( n = 294). The status of the remote sentinel lymph node was determined by a histological assessment considered as the gold standard. Results: SPECT (SPECT/CT) provided additional information in 67 patients (25.8 %) with planar lymphoscintigraphy: in 45 cases it revealed more SLN within the same regional lymphatic drainage basin, and in 22 (8.5 %) showed additional (lymphatic drainage) basin or unusual drainage pattern. In 10 patients (3.9 %) SPECT/CT revealed SLN not visible in the planar lymphoscintigraphy (false-negative). False SLN identification results were detected mostly in patients with head and neck melanoma. The overall rate of surgical approach modification in the total group is 10.4 % (10 patients among 259), the additional information provided by SPECT (SPECT/CT) impacted management and surgical planning in 11 (37.9 %) of 29 patients of head and neck melanoma group. Analysis of planar lymphoscintigraphic imaging, tomographic imaging (SPECT and SPECT/CT), and intraoperative detection revealed a sensitivity and PPV of 95.6, 100, 100 % and 98.7, 97.7, 96.9 %, respectively. Conclusion : Radionuclide imaging techniques are reliable and account for the current need for navigating the surgical access when performing a sentinel lymph node biopsy. SPECT and SPECT/CT visualizes more sentinel nodes than conventional images, reduces false-negative rate and improved anatomical location of sentinel nodes. The diagnostic effi of SPECT and SPECT/CT is superior to the static lymphoscintigraphy in sentinel lymph node detection due to the better sensitivity (100 and 95.6 %, respectively) with a similar positive predictive value PPV (97.7 and 98.7 %, respectively). These advantages may lead to a surgical adjustment in a considerable number of patients, especially in the head and neck melanoma.

Relevance: Radionuclide bone scan signs of lesions are not specific and require radiological identification. Hybrid tomographic technology is a combination of spatial distribution of radiopharmaceuticals and its anatomical binding. Thus, makes it possible to accurately identify the affected bone structure and also determine the nature of this changes (radiological anatomy). In cancer patients, SPECT/CT method allows to visualize tumor pathology in the bones, but also keeps to a minimum errors and other excessive examinations.Purpose: To demonstrate the most frequent diseases and conditions that simulate tumor lesions in bones on bone scan.Material and methods: We analyzed the results of examinations of 81 patients with various tumor diseases (2015–2020). Bone scan was performed in the whole body 3 hours later, after intravenous administration of 99mTc-phosphotech on a Symbia E, T2 (Siemens, Germany). SPECT/CT was performed after WB Bone Scan.Results: The most frequent reasons for the focal increased uptake of radiopharmaceutical were: reactive increase in metabolism and as a result additional mineral repair: deforming osteoarthritis, osteophytes; post‑traumatic and postoperative changes; fractures (osteoporosis and stress fractures); inflammatory processes; focal uptake due to the benign neoplasms of bones and dysplasia. Combination of highly sensitive but non-specific scintigraphy with highly specific computed tomography makes it especially useful in anatomically difficult areas.Conclusion: SPECT/CT reveals a direct pater of anatomical and structural abnormalities with changes in bone tissue metabolism in case of different injuries and minimizes a number of ambiguous conclusions. SPECT/CT in oncological practice greatly helps nuclear medicine physician in the differential diagnostic process and reduces time of examination for the patient.

Purpose: To evaluate the prognostic factors in patients with Breslow skin melanoma of various thicknesses that affect the incidence of metastases in the signal lymph nodes (SLN).Material and methods: From November 2018 to November 2020, 324 patients with diagnosed melanoma of the skin of various localization and stages were examined and operated on. We used lymphotropic colloidal radiopharmaceutical (RPh) labeled with 99mTc. RPh with an activity of 150 MBq was administered one day before the operation intradermally around the scar of resected melanoma or peritumorally at 4 points in the case of a primary tumor. Lymphoscintigraphy was performed 1–3 hours after the RP injection on a Symbia E or Symbia E gamma camera (Siemens, Germany). Anteroposterior and lateral static polypositional scintigraphy was performed to determine the topography and mark the SLN. 324 planar studies were performed. In 259 cases, an additional study was performed SPECT (including SPECT / CT) on a Symbia T2 device (Siemens, Germany). Surgical intervention was performed the next day, taking into account the data of intraoperative radiometry using a domestic specialized hand-held gamma detector Radical (Amplituda, Russia).Results: The mean primary melanoma Breslow thickness was 2.77 ± 2.2 mm (range 0.2–13.0 mm). Localization of SLN: axillary (n = 161. 51 %), inguinal (n = 100. 31 %), cervical (n = 16. 5 %), submandibular (n = 9. 3 %), supraclavicular (n = 4. 1 %), more than one basin (n = 34. 9 %). In the group of melanomas <0.75 mm thick, no SLN metastases were found, among 0.75–1 mm melanomas, one positive lymph node with metastasis (SLN+) was found, in the largest group of melanomas of medium thickness (1–3.5 mm) — 25 (17 %). The largest percentage of metastases in SLN is determined in thick melanomas (>3.5 mm) — 17 (28 %), which is consistent with the data of foreign literature, while SLN is most often affected with a Breslow tumor thickness of more than 7 mm.In the group with negative sentinel lymph nodes (SLN–), the average tumor thickness according to Breslow was 2.6 ± 2.0 mm, in the SLN+ group — 4.0 ± 2.9 mm, the differences between the groups are statistically significant, which is confirmed by the result of one-way analysis of variance.The optimal threshold value of tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). An older age of patients (over 35 years old) is also associated with an increased incidence of metastases in the SLN, but this indicator is not statistically significant. Most often, SLN metastases were detected when the primary tumor was localized in the back (more often in men) and lower extremities (more often in women), while they are thicker (> 3.5 mm).Conclusion: 1. According to the ROC-analysis, the optimal threshold value of the tumor thickness according to Breslow for the isolation of patients with a positive prognosis of metastasis in the SLN is 2.0 mm. It is characterized by the maximum levels of sensitivity (79 %) and specificity (59.1 %). 2. Statistically significant prognostic factors of metastasis in SLN: localization of the primary tumor in the back (more often in men) and lower extremities (more often in women); Breslow thickness over 3.5 mm. 3. The absence of the influence of gender and age was noted, with a slight predominance of women in both groups.

This article describes a new affordable diagnostic method of neuroendocrine tumors, shows the basic information on it’s conduction and interpretation of the results. Scintigraphy of neuroendocrine tumors with 99m Tc-Tectro-tyd is a new alternative and more affordable diagnostic method that allows you to determine tumor receptor status, assess the prevalence of the tumor process and plan therapy. This study may also be the first step in planning radionuclide therapy for patients with neuroendocrine tumors. Also there is a short review on teranostics.

This article describes a new affordable diagnostic method of neuroendocrine tumors, shows the basic information on it’s conduction and interpretation of the results. Scintigraphy of neuroendocrine tumors with 99m Tc-Tectro-tyd is a new alternative and more affordable diagnostic method that allows you to determine tumor receptor status, assess the prevalence of the tumor process and plan therapy. This study may also be the first step in planning radionuclide therapy for patients with neuroendocrine tumors. Also there is a short review on teranostics.

Purpose : To define the diagnostic capabilities of SPECT/CT in comparison with whole body scintigraphy (WBS) in patients with bone metastases. Material and methods : It was included 67 patients with bone metastases of breast cancer, prostate cancer and other tumors. The evaluation was included WBS and SPECT/CT. Results : Аll patients were divided into 2 groups – those with single and multiple metastases. SPECT/CT showed higher efficiency in detecting bone metastases than WBS. The full detection of bone metastases with WBS ranged from 31 to 56 % compared to SPECT/CT for groups respectively. In some cases (for groups respectively: 4 to 9.5 % depending on the number of metastases and their localization) of WBS was not informative, recorded the absence of lesions. Conclusion : SPECT/CT can improve the diagnosis of bone metastasis.

Purpose: To demonstrate the diagnostic capabilities to control effects of radiotherapy and HIFU treatment in patient with osteosarcoma bone metastases by SPECT/CT method. Material and methods . It was conducted SPECT/CT treatment monitoring of the patient with bone metastases of osteosarcoma after external radiotherapy, ultrasound ablation and cyber knife. Results. It were detected changes in the SPECT/CT-images of treated bones osteosarcoma metastases in short time. The treatment effect induced by ultrasound ablation was manifested after 1 month observation. The SPECT/CT has proven as a reliable method of dynamic control at radiotherapy. The treatment effect all of these methods is to reduce or absence of accumulation bone-tropic radiopharmaceutical labeled with 99mTc. Conclusion . SPECT/CT study is demonstrative method for early determination of pathological metabolism degree at bone metastases of osteosarcoma after radiotherapy and HIFU. SPECT/CT is an effective method of treatment monitoring of bone metastases after radiotherapy and HIFU therapies.

Parathyroid carcinoma (PC) is a rare neoplasm with a prevalence of only 0.005 % of all malignancies, and less than 1 % among patients with primary hyperparathyroidism. The diagnosis can be challenging due to the rarity of the disease, similarity of clinical features to parathyroid adenoma, and lack of reliable morphological signs of the tumor. For metastatic cancer of the parathyroid gland does not exist standard drug therapy due to the rare occurrence of this disease. Chemotherapy and radiotherapy failed to show any significant effect on the course of the disease. We report the case of a 27-year old woman with PC previously misdiagnosed as benign thyroid nodule and multiple lung metastases. After the immunohistochemical study and confirm of diagnosis PC the patient was treatment with multikinase inhibitor sorafenib successfully.