You have accessJournal of UrologyCME1 May 2022MP02-17 MOLECULAR ANALYSIS OF CETYLPYRIDINIUM CHLORIDE FOR USE IN BLADDER INSTILLATION THERAPY IN THE ADVANCED MANAGEMENT OF RECURRENT URINARY TRACT INFECTIONS Samuel Chang, Namrata Sawant, William Warner, Philippe Zimmern, and Nicole De Nisco Samuel ChangSamuel Chang More articles by this author , Namrata SawantNamrata Sawant More articles by this author , William WarnerWilliam Warner More articles by this author , Philippe ZimmernPhilippe Zimmern More articles by this author , and Nicole De NiscoNicole De Nisco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Treatment of recurrent urinary tract infections (rUTI) has become increasingly difficult due to the rise of antibiotic resistance among uropathogens. Alternative uses of existing antimicrobials, such as antimicrobial bladder instillations, have become the subject of increased attention. Cetylpyridinium chloride (CPC), a cationic detergent, may be a promising candidate for use in bladder instillations. A preliminary trial reported mild symptoms of bladder irritation in women with antibiotic refractory rUTI, who underwent bladder instillation using 0.05% CPC. The aim of this study was to identify the minimum inhibitory and bactericidal concentrations (MIC/MBCs) of CPC against diverse uropathogenic bacteria to design an optimal CPC instillation strategy for women with rUTI. METHODS: Following IRB approval, uropathogenic Escherichia coli (UPEC), Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa were isolated from urine collected from postmenopausal women with active rUTI. Serial two-fold dilutions of CPC were placed into a microtiter plate. Overnight cultures grown in Mueller Hinton (MH) broth were normalized to an OD600 of 0.05 and were inoculated into each well. Following overnight static incubation at 37°C, growth was measured. The MIC was recorded as the lowest concentration of CPC for which no growth was visible. 10 μL from wells with no growth was spotted onto MH Agar (MHA). The concentration for which no growth occurred on MHA was recorded as the MBC. RESULTS: The MIC and MBC of CPC ranged from 0.0008% to 0.0016% for UPEC and from 0.0016% to 0.0063% for K. pneumoniae. P. mirabilis had an MIC of 0.0063% and MBC of 0.0125%. The MIC and MBC of CPC for P. aeruginosa were both 0.0125%. A CPC concentration as low as 0.0125% exhibited bactericidal activity against all tested uropathogens. CONCLUSIONS: This study determined that 0.0125% CPC shows bactericidal activity against diverse uropathogens. Future bladder instillation trials using 0.0125% CPC could potentially alleviate reported symptoms of bladder irritation. Continued work will focus on studying the cytotoxic effects of CPC against bladder epithelial cells and the pharmacodynamics of CPC through a time-kill kinetic assay. Source of Funding: The Felecia and John Cain Distinguished Chair in Women’s Health, in Honor of Philippe Zimmern, M.D. © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e16 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Samuel Chang More articles by this author Namrata Sawant More articles by this author William Warner More articles by this author Philippe Zimmern More articles by this author Nicole De Nisco More articles by this author Expand All Advertisement PDF DownloadLoading ...

Abstract Objectives To determine the benefit of performing transperineal prostate mapping biopsy (TPMB) following multiparametric magnetic resonance imaging (mpMRI) to increase the identification of clinically significant prostate cancer (csPCa) with Gleason grade group (GG) ≥ 2 and their locations outside of the PI‐RADS v2 3–5 category lesions. Methods mpMRI was performed in 80 men prior TPMB from two institutions. The mpMRI was considered clinically significant (csMRI) if it contained one or more PI‐RADS 3–5 category lesion. mpMRI findings were compared against csPCa diagnosed by TPMB, performed between 16 November 2010, and 13 September 2019, for the entire gland, both lobes and to the right and left anterior and right and left posterior quadrants (RA, LA, RP and LP). Sensitivity, specificity, positive and negative predictive values (PPV, NPV), accuracy and the area under curve (AUC) were determined. Thirteen men also underwent radical prostatectomy and had comparison of TPMB pathology to prostatectomy specimen grading. Results TPMB was positive in 60/80 (75%) of which 32 (53.3%) were csPCa. csPCa was present in the RA in 9 (11.3%), LA in 11 (13.8%), RP in 25 (31.3%) and LP in 27 (33.8%) and involved 1 quadrant in 7 (21.9%), 2 quadrants in 12 (37.5%), 3 quadrants in 11 (34.4%) and all 4 quadrants in 2 (6.3%) patients; 57/80 (71.3%) men had a mpMRIs with lesions designated as PI‐RADS 3 in 24 (30%), 4 in 25 (31.3%) and 5 in 8 (10%). A csMRI was present in the RA in 7 (8.8%), LA in 8 (10%), RP in 31 (38.8%) and in the LP in 29 (36.3%), which were limited to one quadrant in 39 (68.4%), 2 quadrants in 16 (28.1%), and 3 quadrants in 2 (3.5%). Sensitivity, specificity, PPV, and NPV were determined from the results of the TPMB and were for the entire gland 81.3%, 35.4%, 45.6% and 73.9%. There were 31 csMRIs involving the right posterior of the gland but only 25 csPCa by TPMB of which 12/31 (38.7%) were concordant for high grade disease. There were 29 men who have a csMRI in the left posterior quadrant, and 14 (48.3%) were concordant with csPCa from the TPMB. Conclusions MpMRI should be supplemented with TPMB to correctly identify the regions of the prostate that would require ablation in men considering focal therapy.

You have accessJournal of UrologyProstate Cancer: Detection & Screening II (MP20)1 Apr 2020MP20-02 ACCURACY OF MPMRI IN IDENTIFYING CLINICALLY SIGNIFICANT PROSTATE CANCER BY QUADRANT WHEN COMPARED TO TRANSPERINEAL MAPPING BIOPSY Nelson N. Stone*, Vassilios Skouteris, E. David Crawford, Paul Arangua, M. Scott Lucia, Francisco G. La Rosa, Paul D. Maroni, Nayana Patel, Samuel Chang, Adrie van Bokhoven, and Priya N. Werahera Nelson N. Stone*Nelson N. Stone* More articles by this author , Vassilios SkouterisVassilios Skouteris More articles by this author , E. David CrawfordE. David Crawford More articles by this author , Paul AranguaPaul Arangua More articles by this author , M. Scott LuciaM. Scott Lucia More articles by this author , Francisco G. La RosaFrancisco G. La Rosa More articles by this author , Paul D. MaroniPaul D. Maroni More articles by this author , Nayana PatelNayana Patel More articles by this author , Samuel ChangSamuel Chang More articles by this author , Adrie van BokhovenAdrie van Bokhoven More articles by this author , and Priya N. WeraheraPriya N. Werahera More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000853.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: mpMRI is known to miss clinically significant prostate cancer (csPC) in up to 30% of men. These lesions are usually smaller than 1 cc and are not easily identified when 12-core systematic biopsy is added to fusion biopsy. A previously study has shown that a comprehensive transperineal mapping biopsy (TPMB) missed only 1/64 (1.6%) of clinically significant lesions when compared to prostatectomy specimens (Crawford et al. Prostate 2013; 73:778). We sought to analyze the performance characteristics of mpMRI when TPMB is performed. METHODS: 81 men had mpMRI followed by TPMB which was performed under anesthesia through a template with biopsies taken every 5 mm. The prostate was divided 4 quadrants (Qs): right and left anterior and right and left posterior. The results of the TPMB were compared to the mpMRI findings with a PIRADS-2 score where 4-5 considered clinically significant (csPIRADS). For the TPMB, Gleason grade group (GG) > 2 was considered as csPC. Sensitivity (SN), specificity (SP) and the negative predictive values (NPV) were determined for entire gland and the 4 Qs. Associations for csPCa and csPIRADS was tested by ANOVA (bootstrap) and chi-square analysis. The number of men with a PSAD ≤ 0.15 was compared to csPC and csPIRADS. ROC curves were calculated for csPC vs. csPIRADS. RESULTS: Median age, PSA and PSAD was 64 years, 6.0 ng/ml and 0.125, respectively. Of the 81 men, 33 (40.8%) had csPIRADS vs 32 (39.1%) with csPCa of which 13/48 (27.1%) were in men with negPIRADS. (p=0.006, OR 1.8). Neither elevated PSA or PSAD were associated csPIRADS or csPC. 19/54 (35.2%) of csPC and 14/26 (53.8%) of csPIRADS had PSAD ≤ 0.15. 5/28 (17.9%) of men with negPIRADS and PSAD ≤ 0.15 also had csPC. SN, SP and NPV are shown in the table. The AUC for csPC vs. csPIRADS was 0.654. CONCLUSIONS: When a thorough TPMB is done, mpMRI has AUC for csPCa of 64%. Men with a negative MRI also had a 27.1% risk of harboring csPC, which is similar to prostatectomy data. A negative mpMRI and a PSAD < 0.15 should not exclude men from further evaluation. The sensitivity for csPC is poor when MRI is analyzed by quadrant, suggesting that selection of men for focal therapy utilizing MRI alone may be inadequate without TPBM to screen for such cancer. Source of Funding: This study was supported in parts by Schramm Foundation and Bingham Foundation © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e307-e307 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nelson N. Stone* More articles by this author Vassilios Skouteris More articles by this author E. David Crawford More articles by this author Paul Arangua More articles by this author M. Scott Lucia More articles by this author Francisco G. La Rosa More articles by this author Paul D. Maroni More articles by this author Nayana Patel More articles by this author Samuel Chang More articles by this author Adrie van Bokhoven More articles by this author Priya N. Werahera More articles by this author Expand All Advertisement PDF downloadLoading ...

Purpose To retrospectively compare the diagnostic performance of different noninvasive diagnostic criteria of HCC including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, KLCSG-NCC. Materials and methods We reviewed the medical records of 3,491 pathologically examined liver lesions from January-2011 to January-2015 in our institution. 195 lesions in 133 patients (M:F = 100:33) with chronic hepatitis B/C and/or cirrhosis for any etiology were finally included in our study, with 98 lesions ≥ 2 cm, 72 lesions between 1–2 cm, and 25 lesions < 1 cm. The main comparison was made with the largest nodules of each patient (n = 133). The lesions were retrospectively evaluated for the diagnosis of HCC on DCE-CT or MR using different noninvasive diagnostic criteria including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLCSG-NCC. With pathological evaluation serving as a gold-standard, sensitivity, specificity, PPV and NPV as well as accuracy of the diagnostic criteria were calculated. Results There was no statistically significant differences in diagnostic accuracy among noninvasive diagnostic criteria. For 133 lesions of the largest lesion per patient, the overall accuracy was highest with LI-RADS criteria (89.3%) and the overall sensitivity was highest with LI-RADS, AASLD, NCCN criteria (all 89.5%). For 1–2 cm lesions, sensitivity decreased for all criteria in the following order: EASL-EORTC (59.1%), KLCSG-NCC (58.3%), LI-RADS, AASLD, NCCN (all 56.5%), and OPTN-UNOS (22.7%) criteria. OPTN-UNOS had the highest specificity in cirrhotic livers, 91.7%. Conclusions The current noninvasive diagnostic criteria of HCC have no statistically significant difference in diagnostic accuracy. Overall, LI-RADS had the highest sensitivity and accuracy among the guidelines. OPTN had the highest specificity for cirrhotic livers.

Purpose: The purpose of this study was to evaluate the response of retinoic acid (RA) in radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC). Methods: Systematic searches of MEDLINE (from inception to December 2016) and of EMBASE (from inception to December 2016) were performed for English-language publications on thyroid cancer treated with RA. Studies were classified according to the response criteria used: (1) 123I or 131I whole body scintigraphy (WBS), (2) serum thyroglobulin (Tg) level, (3) the response evaluation criteria in solid tumors (RECIST) version 1.0, and (4) World Health Organization (WHO) criteria. Results: Disease response rates as determined by WBS ranged widely between 6.2% and 46.1% with a pooled disease response rate of 27.6% (95% confidence interval: 21.7-34.0%). Response rates as determined by Tg level ranged from 56.6% to 83.3% (pooled response rate 61.3% (51.0-70.9%)), RECIST response rates from 0% to 45.5% (pooled response rate 17.0% (1.4-44.5%)), and according to WHO criteria, the pooled response rate was 30.8% (12.7-52.7%). Conclusions: A minority of patients with RAI-refractory DTC respond to RA treatment.

OBJECTIVE:To determine the most reliable predictor of radiofrequency (RF) ablation zone volume among three-dimensional (3D) volumetric colour Doppler vascular indices in an in vitro blood-perfused bovine liver model.METHODS:3D colour Doppler volume data of the local hepatic parenchyma were acquired from 37 areas of 13 bovine livers connected to an in vitro oxygenated blood perfusion system. Doppler vascular indices of vascularization index (VI), flow index (FI) and vascularization flow index (VFI) were obtained from the volume data using 3D volume analysis software. 37 RF ablations were performed at the same locations where the ultrasound data were obtained from. The relationship of these vascular indices and the ablation zone volumes measured from gross specimens were analyzed using a general linear mixed model fit with random effect for liver and backward stepwise regression analysis.RESULTS:FI was significantly associated with ablation zone volumes measured on gross specimens (p = 0.0047), but explained little of the variance (Rβ2 = 0.21). Ablation zone volume decreased by 0.23 cm3 (95% confidence interval: -0.38, -0.08) for every 1 increase in FI. Neither VI nor VFI was significantly associated with ablation zone volumes (p > 0.05).CONCLUSION:Although FI was associated with ablation zone volumes, it could not sufficiently explain their variability, limiting its clinical applicability. VI, FI and VFI are not clinically useful in the prediction of RF ablation zone volume in the liver. Advances in knowledge: Despite a significant association of FI with ablation zone volumes, VI, FI and VFI cannot be used for their prediction. Different Doppler vascular indices need to be investigated for clinical use.

OBJECTIVE:This study was aimed to define the predictive values of preoperative Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18 FDG PET/CT) parameters and compared to define effective parameters for prediction of overall survival (OS) and recurrent free survival (RFS) in locally advanced esophageal cancer (LAEC).MATERIALS AND METHODS:This study included 44 patients with LAEC who received F-18 FDG PET/CT. Univariate and multivariate analyses were used to calculate survival, and the survival curves were estimated by clinical factors and F-18 FDG PET/CT-derived parameters.RESULTS:Higher values of F-18 FDG PET/CT parameters (SUVmax, SUVmean, metabolic tumor volume [MTV], total lesion glycolysis [TLG]) and advanced tumor-node-metastasis (TNM) staging showed higher mortality. The Cox proportional hazard regression model demonstrated advanced TNM stage and high MTV as poor OS factors. The early TNM stage, lower MTV, lower TLG, lymph node (LN) (-), and lower heterogeneity factor (HF) were also associated with better RFS. The MTV was the potent predictor for RFS.CONCLUSIONS:In conclusion, although the newly described parameter of HF measured by F-18 FDG PET/CT could be a prognostic factor, the MTV is the most potent prognostic predictor in LAEC.

INTRODUCTION:The goal of the present study was to investigate the predictive and prognostic values of interim fluorine-18 (18F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) parameters for the prediction of a complete pathologic response (pCR) in patients with locally advanced rectal cancer (LARC) who had received preoperative chemoradiotherapy (PCRT).PATIENTS AND METHODS:A total 103 patients with LARC were included in the present study. All the patients were evaluated by 18F FDG PET/CT before and after 45 Gy of radiotherapy with concurrent oral capecitabine chemotherapy. The quantitative, volumetric parameters and their percentage of change (Δ%) were used to predict the pCR and calculate the overall survival (OS). The predictive value for a pCR of 18F FDG PET/CT cutoff values were determined by receiver operating characteristic analysis. The prognostic significance was assessed using Kaplan-Meier analysis.RESULTS:A pCR occurred in 22 patients (21.4%). Univariate and multivariate analyses demonstrated that the post-PCRT maximum standardized uptake value (SUVmax2) and change in the SUVmax (ΔSUVmax) as significant factors for the prediction of pCR, with a sensitivity of 68.2% and specificity of 87.7% and sensitivity of 90.9% and specificity of 80.3%, respectively. Kaplan-Meier analysis showed that a low SUVmax2 (< 2.5) and high ΔSUVmax (≥ 62.2%) were potent predictors for OS.CONCLUSION:The present study has shown the capability of interim 18F FDG PET/CT parameters to predict the achievement of pCR after PCRT in patients with LARC. Of the parameters, SUVmax2 and ΔSUVmax were potent predictors for pCR and well associated with OS.

The authors aimed to assess the risk of recurrence in patients with nonsmall-cell lung cancer after surgery with no evidence of disease (NED) demonstrated on (18)F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). A total of 140 subjects with adenocarcinoma or squamous cell carcinoma of the lung were included in this study. Patients had FDG PET/CT scans within a year after surgery between January 2007 and December 2014. Patients with PET/CT scans with NED were included. Following an NED PET/CT scan, recurrence or metastasis was found in 14 patients (10.0%), and deaths in 4 (2.9%) during a median follow-up of 636 days. Although the rates of recurrence or metastasis were very low, the risk for recurrence continuously increased after 600 days up to 0.03%. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV. In conclusion, according to the smoothed hazard functions, there was a very low risk of recurrence until 600 days after normal (18)F-FDG PET scans. The risk was higher in patients with positive margin at surgery, lymphovascular invasion, N2 stage, and TNM stage III/IV.

PURPOSE:The aim of this study was to investigate the value of morphologic, functional, and metabolic biomarkers acquired concurrently at PET/MRI in patients with thymic epithelial tumors.PATIENTS AND METHODS:During 1 year, 9 patients with suspected thymic epithelial tumors at contrast-enhanced chest CT were prospectively enrolled and underwent preoperative 18F-FDG PET/MRI. Two chest radiologists prospectively reviewed the CT and MRI scans of PET/MRI in consensus, and 2 nuclear physicians reviewed the PET images. Visual assessment of the tumor morphology, functional biomarkers such as apparent diffusion coefficient from diffusion-weighted images, and metabolic biomarkers (including SUVmax, metabolic tumor volume, total lesion glycolysis, and heterogeneity index) were recorded. All patients underwent operation, and their pathologic reports served as the reference standard.RESULTS:Thymic epithelial tumors were demonstrated in all 9 patients at pathologic examination. Tumor contour (P = 0.012) and shape (P = 0.033) had an association with the World Health Organization subtype, and the presence of septum (P = 0.048) on MRI scans had an association with the Masaoka stage. In terms of functional and metabolic biomarkers, SUVmax (ρ = 0.683, P = 0.042) and SUV/apparent diffusion coefficient (ρ = 0.703, P = 0.035) correlated with the Masaoka stage. Metabolic tumor volume (P = 0.024), heterogeneity index (P = 0.024), and total lesion glycolysis (P = 0.048) were useful for classification between low- and high-risk thymic epithelial tumors.CONCLUSIONS:Although limited by the small number of patients enrolled, morphologic, functional, and metabolic biomarkers derived from PET/MRI scans were useful for the stratification of thymic epithelial tumors.

Aims: The present study was aimed to investigate whether volumetric parameters measured by sequential F-18 fluoro-D-glucose (F-18 FDG) positron emission tomography/computed tomography (PET/CT) could be used as prognostic factors in patients with locally advanced esophageal cancer (LAEC) who received preoperative chemoradiotherapy (CRT). Methods: A total of 61 patients with LAEC were included in the current study. All patients were evaluated by F-18 FDG PET/CT before and after 46 Gy of radiotherapy with a concurrent cisplatin-based chemotherapy. Initial, second, and percent changes (Δ, %) of semiquantitative and volumetric parameters were used to calculate recurrence-free survival (RFS) and overall survival (OS). The median values of each parameter were used as cutoff values. The prognostic significance was assessed using univariate and multivariate Cox proportional hazard regression analyses. Results: Cox proportional hazard regression analyses revealed that change in total lesion glycolysis (ΔTLG) was a potent predictor of RFS and OS. Kaplan-Meier survival curves showed better prognosis in higher ΔTLG. Conclusion: Our data suggest that ΔTLG measured by sequential F-18 FDG PET/CT after preoperative CRT could provide prognostic information in LAEC patients.

OBJECTIVE:We aimed to investigate whether the standardized uptake values, volumetric parameters and intratumoral heterogeneity of fluorine-18-fludeoxyglucose ((18)F-FDG) uptake could predict regional lymph node (rLN) metastasis in oesophageal cancer.METHODS:51 patients with surgically resected oesophageal cancer were included in the present study. The (18)F-FDG positron emission tomography (PET)/CT findings and rLN metastasis were compared with the histopathological results. The intratumoral metabolic heterogeneity was represented by the heterogeneity factor (HF), which was determined for each patient. Univariate and multivariate analyses were used to analyse the associations between the rLN metastasis and clinical findings, standardized uptake values, metabolic tumour volume (MTV), total lesion glycolysis (TLG) and HF.RESULTS:The rLN(+) group showed statistically significant higher values of MTV (median, 13.59 vs 6.6; p = 0.0085), TLG (median, 119.18 vs 35.96; p = 0.0072) and HF (median, 3.07 vs 2.384; p = 0.0002) than the rLN(-) group. Univariate analysis showed that maximum standardized uptake value, mean standardized uptake value, MTV, TLG and HF were significantly associated with pathologic rLN involvement. However, in multivariate analysis, the HF was a potent associated factor for the prediction of pathologic rLN metastasis in oesophageal cancer.CONCLUSION:In conclusion, (18)F-FDG PET/CT parameters such as maximum standardized uptake value, mean standardized uptake value, MTV, TLG and HF were useful for the prediction of pathologic rLN status in patients with oesophageal cancer. However, HF might be the most powerful predictor of rLN metastasis of patients with oesophageal cancer.ADVANCES IN KNOWLEDGE:Assessment of intratumoral heterogeneity of (18)F-FDG PET/CT may be a useful adjunct for rLN staging of oesophageal cancer.

The goal of the current study was to investigate the predictive and prognostic values of repeated F-18 FDG PET/CT parameter changes for prediction of complete pathologic response (pCR) in patients with adenocarcinoma of locally advanced esophageal cancer (LAEC) who received preoperative concurrent chemoradiotherapy (PCRT).

The purpose of this study was to assess the efficacy of conventional ultrasound (US) and contrast-enhanced ultrasound (CEUS) in guiding and assessing early therapeutic response to radiofrequency (RF) ablation for hepatocellular carcinomas (HCCs; up to 3 lesions, each <= 3 cm in diameter) and to report the short-term follow-up results. Between September 2011 and January 2013, 63 patients with 78 HCCs (<= 3 cm) underwent conventional US-and CEUS-guided percutaneous RF ablation. CEUS was repeated after 20-30 min to assess therapeutic response, and local efficacy was further confirmed by contrast-enhanced magnetic resonance imaging (MRI) 1 mo after tumor ablation. Patients were followed periodically to look for local tumor or disease progression. Survival probability was estimated with the Kaplan-Meier method. Complete ablation was achieved for 76 (97.4%) of 78 HCCs in one (n = 73) or two (n = 3) sessions. No major complications were observed in any patient. The overall concordance in assessment of therapeutic efficacy of RF ablation between CEUS and MRI was 97.4% (76/78 tumors). The concordance test gave a value of kappa = 0.74 (p < 0.001), indicating that CEUS had a high diagnostic agreement with MRI. During a mean follow-up of 20 mo, the local tumor progression rate was 5.3% (4/76 tumors). The 1-, 1.5- and 2-y cumulative survival rates were 98.4%, 96.1% and 92.6%, respectively. Although CEUS has some intrinsic limitations, the combined use of conventional US and CEUS provides a safe and efficient tool to guide RF ablation for HCCs 3 cm or smaller, with encouraging results in terms of survival rate and minimal complications. Moreover, the immediate post-procedural CEUS can be a reliable alternative to contrast-enhanced MRI for assessing the early therapeutic response to RF ablation. (C) 2015 World Federation for Ultrasound in Medicine & Biology.

The current study was aimed to investigate the clinical value of intratumoral heterogeneity of F-18 FDG uptake for characterization of thyroid nodule (TN) with inconclusive fine-needle aspiration biopsy (FNAB) results. The current study enrolled 200 patients who showed F-18 FDG incidentaloma and were performed FNAB. The intratumoral heterogeneity of F-18 FDG uptake was represented as the heterogeneity factor (HF), defined as the derivative (dV/dT) of a volume-threshold function for a primary tumor. The diagnostic and predictive values of HF and F-18 FDG PET/CT parameters were evaluated for characterization of inconclusive FNAB results. Among F-18 FDG PET/CT parameters, SUVmax, MTV, and TLG of malignant group were statistically higher than those of Bethesda category of suspicious malignant group. However, HF values were not statistically different between the groups of Bethesda categories (Kruskal-Wallis statistics, 9.924; p = 0.0774). In ROC analysis, when HF > 2.751 was used as cut-off value, the sensitivity and specificity for prediction of malignant TN were 100 % (95 % CI 69.2-100 %) and 60 % (95 % CI 42.1-76.1 %), respectively. The AUC was 0.826 (95 % CI 0.684-0.922) and standard error was 0.0648 (p < 0.0001). In conclusion, the intratumoral heterogeneity of F-18 FDG uptake represented by HF could be a predictor for characterization of TN with inconclusive FNAB results. Additional large populationbased prospective studies are needed to validate the diagnostic utility of HF of F-18 FDG PET/CT.

This study was performed to evaluate the efficacy of 177Lu-labelled peptide receptor radionuclide therapy (PRRT) in patients with inoperable or metastatic neuroendocrine tumours (NETs).

Für die Mehrzahl der Patienten mit fortgeschrittenem nichtkleinzelligem Lungenkarzinom (NSCLC) besteht ein großer Bedarf an effektiven, gut verträglichen Behandlungsoptionen die das Gesamtüberleben und die Lebensqualität verbessern. Insbesondere dann, wenn keine EGFRoder ALK-Mutationen vorliegen, wie es bei 80–85% aller Adenokarzinompatienten der Fall ist. Nach der erfolgreichen Einführung von Zytostatika der 3. Generation wie Docetaxel wurde ein Plateau der Wirksamkeit in der Behandlung des fortgeschrittenen NSCLC erreicht – das erst nach fast 10 Jahren durch die Zulassung des 3-fach zielgerichteten Angiokinase-Hemmers Nintedanib übertroffen wurde. Darüber hinaus gibt es weitere zielgerichtete Substanzen, die sich noch in der Erprobung befinden.