Objective: The aim of this study is to investigate the roles of pre- and post- treatment quantita... more Objective: The aim of this study is to investigate the roles of pre- and post- treatment quantitative fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and their rate of change in predicting pathological complete response (pCR) in patients with local and locally advanced invasive breast cancer receiving neoadjuvant chemotherapy (NAC). Subjects and methods: Ninety-eight patients who received NAC after being diagnosed with local and locally advanced invasive breast cancer between January 2017 and September 2021 were retrospectively included in our study. Molecular subtypes of all patients were determined. Maximum SUV, MTV, TLG, percent change in SUVmax (ΔSUVmax), ΔMTV, and ΔTLG obtained from PET/CT scans performed before and after NAC were calculated. The cut-off, AUC, sensitivity, and specificity values of these parameters in predicting pCR were calculated using receiver operating characteristic (ROC) curves. Results: ΔTMTV (cut-off 94.01%, AUC: 0.846), ΔTTLG (cut-off 97.36%, AUC: 0.870), B2MTV (cut-off<1.75, AUC: 0.764), B2TLG (cut-off<2.11, AUC: 0.764), B2SUVmax (cut-off<1.58, AUC: 0.767), ΔBMTV (cut-off 93.67%, AUC: 0.851), ΔBTLG (cut-off 97.22%, AUC: 0.870), ΔBSUVmax (cut-off 84.99%, AUC: 0.846) calculated using ROC curves were found to significantly predict pCR with high sensitivity and specificity. Conclusion: We concluded that metabolic and volumetric PET/CT parameters, the rates of their change, and metabolic response during NAC may be important variables in predicting pCR in patients with breast cancer.
Objective: The aim of this study was to evaluate the association between thyroid function abnorma... more Objective: The aim of this study was to evaluate the association between thyroid function abnormalities and breast cancer and, in particular, the prognostic markers of breast cancer.. Subjects and methods: Baseline levels of thyrotropin, free triiodothyronine, free thyroxine and thyroid autoantibodies were measured in 97 women with primary breast cancer, 27 women with benign breast disease, and 4 women with atypical ductal hyperplasia. Their baseline levels were compared with those in 48 healthy women with a normal mammography in the last 2 years. Results: There were no significant associations between history of thyroid disease and breast cancer (p = 0.33). The mean baseline levels of triiodothyronine and thyrotropin did not differ significantly between the compared groups. The mean baseline levels of free thyroxine were found to be significantly higher in the breast cancer group, even after adjusting for thyroid replacement therapy. The presence of thyroid antibodies did not differ significantly between the compared groups. In a subgroup analysis, breast cancer cases with thyroid disease and particularly hypothyroidism had a significantly lower incidence of lymph node metastases compared with breast cancer cases without thyroid disease. Conclusions: Our data confirmed the proliferative effect of thyroid hormones on breast cells, which had previously been shown in vitro. Additionally, thyroid disease and particularly hypothyroid function appeared to be associated with a lower incidence of lymph node metastases. Further studies to determine the prognostic role of thyroid hormones in breast cancer are warranted.
A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18 flo... more A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18 flourine-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for staging. The tumor was located in the superior external quadrant of the right breast, and did not exhibit pathological uptake in 18 F-FDG PET/CT. Later, gallium-68 (68 Ga) fibroblast activation protein-specific inhibitor (FAPI)-04 PET/ CT imaging was performed and the primary tumor showed intense radiotracer accumulation. This presumes that 68 Ga-FAPI PET/CT imaging is superior to 18 F-FDG imaging in detecting the primary tumor in breast cancer, thereby suggesting the replacement of FAPI by 18 F-FDG in breastcancer staging in the future.
We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of prim... more We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of primary tumor and metastases in primary and recurrent breast cancer. Twenty female patients with histopathologically confirmed primary and recurrent breast cancer were included in the prospective study. All patients underwent FDG and FAPI PET/CT imaging in the same week. The number of primary and metastatic lesions, SUVmax values, and tumor-to-background ratios (TBR) were recorded from both scans. Data obtained were statistically compared. FAPI PET/CT was superior to FDG in detecting breast lesions, as well as hepatic, bone, lymph node, and cerebral metastases in terms of patient- and lesion-based assessments. The sensitivity and specificity of FAPI in detecting primary breast lesions were 100% and 95.6%, respectively, while the sensitivity and specificity of FDG were 78.2% and 100%, respectively. The SUVmax values of primary breast tumors, lymph nodes, lung metastases, and bone metastases were significantly higher on FAPI imaging than FDG imaging (p < 0.05). However, SUVmax values of hepatic metastases did not exhibit a statistically significant difference between two imaging techniques (p > 0.05). Also, FAPI imaging yielded significantly higher TBR in breast lesions as well as hepatic, bone, brain and lung metastases compared to FDG (p < 0.05). 68 Ga-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in detecting the primary tumor in patients with breast cancer with its high sensitivity, high SUVmax, and high TBR. 68 Ga-FAPI-04 PET/CT is also superior to 18F-FDG PET/CT in detecting lymph node, hepatic, bone, and cerebral metastases because it has lower background activity and higher uptake in subcentimetric lesions.
Background: There have been different biodistribution of Ga-68 PMSA in normal organs. Methods : S... more Background: There have been different biodistribution of Ga-68 PMSA in normal organs. Methods : SUVmax and SUVmean values was evuluated of 66 patients who underwent Ga-68 PSMA, without radical prostatectomy, relapse in the prostate gland, extensive metastasis, or metastasis in the target. Results: The SUVmax and SUVmean values of the patients included in the study were determined to range from high to low as bladder, kidney, submandibular gland, parotid salivary gland, duodenum 3 rd part, jejunum, spleen, liver and lachrymal gland. The highest uptake was observed in the bladder, kidneys and salivary gland. Conclusions: High PSMA expressions were observed in the kidney, salivary glands and duodenum 3 rd part, medium PSMA expressions were observed in the liver and lachrymal glands, low PSMA expressions were observed in normal prostate tissue, stomach, ileum and pancreas and no PSMA expression was observed in cerebral and cerebellar cortexes. The bladder should be emptied before exami...
Purpose: To investigate the caregiver burden and quality of life (QoL) of patients with metastati... more Purpose: To investigate the caregiver burden and quality of life (QoL) of patients with metastatic prostate cancer. The relationship between questionnaire results and medical, socioeconomic, disease and treatment related factors of the patients were evaluated. Methods: One hundred twenty one metastatic prostate cancer patients and caregivers were enrolled in this cross-sectional study. Short Form 36 (SF-36) questionnaires and Zarit caregiver burden interviews (ZCBI) were conducted with patients and their caregivers seperately. Patients’ comorbidities, presence of bone and visceral metastases, bone related events, palliative radiotherapy needs, ECOG scores, being under active chemotherapy, socioeconomic factors such as public transportation need, residential factors and caregiver related factors such as comorbidities and kinships were recorded respectively. Results: Patients’ comorbidities, ECOG score, presence and quantity of bone or visceral metastasis, bone related events, receivi...
Objective To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole ... more Objective To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole body Gallium68-prostatespecific membrane antigen-HBED-CC [(68 Ga)PSMA 11] Positron Emission Tomography/Computed Tomography (PET/ CT) images to 1st hour imaging in patients with prostate cancer (PCa). Materials and methods A total of 63 patients diagnosed with PCa who underwent (68 Ga)PSMA 11 PET/CT between April 2019 and June 2019 and who had 5th minute and 1st and 2nd hour images were included in the study. Early (5th minute) pelvic region and 1st and 2nd hour full body images were obtained from all patients. The regions of interest (ROI) were drawn from the background tissues and the physiological uptake sites in a way to include the same lesions from primary and metastatic lesions in all three imagings, and SUVmax values, and tumor-background ratio (TBR) were calculated. Results The mean age of the patients was 69.81 ± 8.78 (min/max: 51/91) years. In the 5th minute images, prostate gland and bed were easier to evaluate, because of low bladder activity. However, lymph node evaluation was more difficult due to high vascular activity. In the prostate gland, lymph nodes and bone metastases, both SUVmax values and TBR rates increased with time from the 5th minute (p < 0.001). At the 2nd hour, some lesions became more visible, while decreased activity was observed in some lesions. However, none of the patients required a change in the stage or treatment. Conclusion In conclusion, the 5th minute pelvic images in (68 Ga)PSMA 11 PET/CT were helpful in visual evaluation of the prostate gland and bed, while 2nd hour images showed high SUVmax and TBR rates in malignant lesions. As the SUVmax values of benign lesions were found to be lower in the 2nd hour, when compared to the 1st hour, it was thought that the 2nd hour imaging could be used in the additional imaging for suspicious lesions without the need for very long waiting times.
To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with... more To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with biochemical and histopathological parameters. One hundred twenty-one prostate cancer patients who underwent 68Ga-PSMA PET/CT between January 2018 and December 2019 were included. Imaging was conducted for staging upon new diagnosis with moderate- and high-risk disease and for confirming the progression of castration resistance. The relationships between the Wbv 68Ga-PSMA PET/CT parameters and prostate-specific antigen (PSA) levels, PSA doubling time and Gleason score (GS) were evaluated. The median GS and mean PSA levels were similar between the castration-naive and resistant patients. The PSA levels were positively correlated with MTVwb (p: 0.009, r: 0.286) and TLPwb (p: 0.002, r: 0.344). Gleason scores were positively correlated with MTVwb (p: 0.050, r: 0.216), TLPwb (p: 0.007, r: 0.296) and highest standard uptake value (HSUV) max (p: 0.047, r: 0.220). In the castration-naive group, Gleason scores (from p < 0.001 to p = 0.04 and r = 0.331 to 0.549) and PSA levels (from p = 0.002 to p = 0.045 and from r = 0.323 to 0.473) correlated with all 68Ga-PSMA-PET/CT parameters. PSA doubling time was negatively correlated with whole-body metabolic tumour volume (MTVwb) (p: 0.050, r: 0.232) and whole-body total lesion PSMA (TLPwb) (p: 0.026, r: 0.262). The MTVwb, TLPwb and HSUVpeak values of the patients with biochemical recurrence (BR) of 0–6 months (n = 18) were higher than those with BR > 2 years (n = 35) (p = 0.046, 0.047 and 0.042, respectively). Wbv 68Ga-PSMA PET/CT results were correlated with PSA levels and Gleason scores. The correlation was relatively stronger in the castration-naive group. The prognostic accuracy of PSA in the resistant group may be weaker than in the naive group. The difference in volumetric parameters of patients with short BR compared to long BR supports the idea that 68Ga-PSMA PET/CT can distinguish patients with rapid relapse from others.
Objective In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT... more Objective In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison. Materials and method Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically. Results 68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%. Conclusion 68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition), 2022
Abstract Objective This study aimed to determine the prognostic role of baseline maximum standard... more Abstract Objective This study aimed to determine the prognostic role of baseline maximum standardized uptake value (SUVmax) obtained by pretreatment PET/CT and the change in SUVmax (ΔSUVmax [%]) in patients with axillary lymph node–positive breast cancer receiving neoadjuvant chemotherapy (NAC). Methods One hundred and eighty patients with baseline SUVmax and 121 patients with SUVmax measurement after treatment were evaluated in the study. The baseline SUVmax value of the breast (SUVmaxBI) and axilla (SUVmaxAI) and the change in the SUVmax of the breast (ΔSUVmaxB) and axilla (ΔSUVmaxA) were measured. The optimal cut-off value of SUVmax and ΔSUVmax were determined by ROC curve analysis. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan–Meier curves. Results ΔSUVmaxB, pCRB, pCRA, and pCR parameters were found to be associated with relapse (P Conclusion The results showed that ΔSUVmaxB was an independent prognostic factor for relapse and mortality in patients with axillary lymph node–positive breast cancer who received NAC.
Objective: To investigate the caregiver burden and quality of life (QoL) of patients with metasta... more Objective: To investigate the caregiver burden and quality of life (QoL) of patients with metastatic prostate cancer and, to evaluate the relationship between questionnaire results and medical, socioeconomic, disease and treatment related factors of the patients. Methods: One hundred twenty one metastatic prostate cancer patients, and caregivers were enrolled in this cross-sectional study. Patients with metastatic prostate cancer who had at least one bone, lymph node or visceral metastasis who had undergone androgen deprivation or chemotherapy treatments for at least 3 months were included. Short Form 36 (SF-36) questionnaires and Zarit caregiver burden interviews (ZCBI) were conducted with patients and their caregivers seperately. Patients' disease, treatment, socioeconomic and caregiver related factors were recorded respectively. Results: Patients' comorbidities, ECOG score, presence and quantity of bone or visceral metastasis, bone related events, receiving palliative radiotherapy and chemotherapy, using public transportation resulted in lower SF-36 and higher ZCBI results (p<0.001-p=0.049). Obligation to live in rented houses were correlated with lower SF-36 physical function results (p=0.043). Condition of the caregiver being from distant relatives resulted in a lower SF-36 score (p=0.01-p=0.043). Moderate to strong negative correlation was detected between ZCBI and all SF-36 results (p<0.001, r:-646 to-749). In ZCBI, score over 47 resulted with 69.57% sensitivity and 65.52% specificity (AUC =0.671, p =0.008). Conclusion: QoL was directly related to caregiver burden. Factors such as patient comorbidities, bone metastasis and related situations, ECOG score, presence of visceral metastasis, undergoing chemotherapy, low socioeconomic status negatively affect the quality of life of patients and caregiver burden. If these factors can be monitored, the care and quality of life of these patients can be improved.
OBJECTIVE The aim of the present study was to compare the surgical results with contrast-enhanced... more OBJECTIVE The aim of the present study was to compare the surgical results with contrast-enhanced [99mTc]methoxyisobutylisonitrile ([99mTc]MIBI) single-photon emission computed tomography (SPECT)/computed tomography (CT) results by adding the simultaneous single phase contrast to the [99mTc]MIBI SPECT/CT examination. METHOD Between November 2016 and January 2018, 24 (21 female, 3 male) patients who underwent an operation after preoperative contrast-enhanced [99mTc]MIBI SPECT/CT, and 49 asymptomatic patients (42 female, 7 male), who did not undergo surgery, were included in the study. RESULTS Sensitivity and specificity rates of contrast enhanced [99mTc]MIBI SPECT/CT were 100% and 100% when evaluated together with surgical results. The rate of detection in asymptomatic patients was found to be 93.8%. CONCLUSIONS With the contrast-enhanced [99mTc]MIBI SPECT/CT imaging, both high sensitivity and specificity values were achieved in the preoperative localization of parathyroid adenomas (...
Objective(s): The aim of this study was to determine metastasis rate in patients with well-differ... more Objective(s): The aim of this study was to determine metastasis rate in patients with well-differentiated grade1 (G1) and grade 2 (G2) gastroenteropancreatic neuroendocrine tumors (GEP NETs) using the gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT). This study was also targeted toward investigating the relationship of maximum standardized uptake value (SUVmax) with mitotic count, histological grade, and Ki-67 index. Methods: This retrospective study included 38 patients (i.e., 17 males and 21 females) with G1 or G2 GEP NETs who underwent 68Ga-DOTATATE PET/CT in Diyarbakir Gazi Yasargil training and research hospital between November 2014 and March 2018. The patients had at least one positive lesion that was approved by two nuclear medicine specialists with a minimum of 10 years of experience. Results: The median age of the patients was 50 years (age range: 27-80 years), and their mean age was 52±15 years. Out of 38 patients, 1 (2.6%), 2 (5...
OBJECTIVE The present study compared metabolic and volumetric fluorine-18-fluorodeoxyglucose (18F... more OBJECTIVE The present study compared metabolic and volumetric fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters [metabolic tumour volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax)] with carbohydrate antigen (CA) 19-9 tumour marker levels and haemogram parameters [(neutrophil-lymphocyte ratio, mean platelet volume (MPV), and platelet-lymphocyte ratio] as prognostic and diagnostic markers of pancreatic cancer. MATERIAL AND METHODS A total of 66 patients who underwent 18F-FDG PET/CT in our nuclear medicine clinic between February 2017 and March 2019, and had a diagnosis of pancreatic adenocarcinoma, were included in this retrospective study. The enrolled patients had not been administered steroids or operated on. Among these patients, whose haemogram parameters and tumour markers could not be assessed by PET/CT within the same week were excluded. The MTV, TLG, and SUVmax values were ca...
Objective. The aim of this study is to investigate the uptake of 68Ga-FAPI-04 in normal tissues a... more Objective. The aim of this study is to investigate the uptake of 68Ga-FAPI-04 in normal tissues and calculate standardized uptake values (SUVs) for various organs in the body. Methods. A total of 49 patients who underwent 68Ga-FAPI-04 PET/CT were included in our study. The following organs were identified on CT images: brain, parotid, and submandibular glands, palatine tonsils, thyroid, lymph nodes (if present), breasts, lungs, thymus, left ventricle walls, mediastinal blood pool, vertebral bone marrow, liver, spleen, pancreas, stomach, small and large intestines, adrenal glands, kidneys, uterus, testes, and prostate. Median, minimum, and maximum values (max) and average (avg) values of standard uptake value (SUV) of tissues and organs were calculated. Results. The accumulation of 68Ga-FAPI in normal organs showed variations. The cerebral/cerebellar cortex exhibited no 68Ga-FAPI uptake, while the scalp showed low uptake. Low uptake was also observed in the lung parenchyma, esophagus...
We present the case of a 75-year-old man with osteosarcoma of the sternum in whom Ga-prostate-spe... more We present the case of a 75-year-old man with osteosarcoma of the sternum in whom Ga-prostate-specific membrane antigen (PSMA) PET/CT showed high radiotracer activity in the primary tumor and metastatic lesions than F-FDG PET/CT. The present case shows that Ga-PSMA PET/CT is very useful for staging of osteosarcoma due to in vivo expression of PSMA. Ga-PSMA PET/CT can have potential effects on prognosis and in response assessment following treatment in osteosarcoma. The use of PSMA-targeted radioligand treatments may be beneficial especially in metastatic chemorefractory osteosarcoma.
Objective: The aim of this study is to investigate the roles of pre- and post- treatment quantita... more Objective: The aim of this study is to investigate the roles of pre- and post- treatment quantitative fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters including maximum standardized uptake value (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) and their rate of change in predicting pathological complete response (pCR) in patients with local and locally advanced invasive breast cancer receiving neoadjuvant chemotherapy (NAC). Subjects and methods: Ninety-eight patients who received NAC after being diagnosed with local and locally advanced invasive breast cancer between January 2017 and September 2021 were retrospectively included in our study. Molecular subtypes of all patients were determined. Maximum SUV, MTV, TLG, percent change in SUVmax (ΔSUVmax), ΔMTV, and ΔTLG obtained from PET/CT scans performed before and after NAC were calculated. The cut-off, AUC, sensitivity, and specificity values of these parameters in predicting pCR were calculated using receiver operating characteristic (ROC) curves. Results: ΔTMTV (cut-off 94.01%, AUC: 0.846), ΔTTLG (cut-off 97.36%, AUC: 0.870), B2MTV (cut-off<1.75, AUC: 0.764), B2TLG (cut-off<2.11, AUC: 0.764), B2SUVmax (cut-off<1.58, AUC: 0.767), ΔBMTV (cut-off 93.67%, AUC: 0.851), ΔBTLG (cut-off 97.22%, AUC: 0.870), ΔBSUVmax (cut-off 84.99%, AUC: 0.846) calculated using ROC curves were found to significantly predict pCR with high sensitivity and specificity. Conclusion: We concluded that metabolic and volumetric PET/CT parameters, the rates of their change, and metabolic response during NAC may be important variables in predicting pCR in patients with breast cancer.
Objective: The aim of this study was to evaluate the association between thyroid function abnorma... more Objective: The aim of this study was to evaluate the association between thyroid function abnormalities and breast cancer and, in particular, the prognostic markers of breast cancer.. Subjects and methods: Baseline levels of thyrotropin, free triiodothyronine, free thyroxine and thyroid autoantibodies were measured in 97 women with primary breast cancer, 27 women with benign breast disease, and 4 women with atypical ductal hyperplasia. Their baseline levels were compared with those in 48 healthy women with a normal mammography in the last 2 years. Results: There were no significant associations between history of thyroid disease and breast cancer (p = 0.33). The mean baseline levels of triiodothyronine and thyrotropin did not differ significantly between the compared groups. The mean baseline levels of free thyroxine were found to be significantly higher in the breast cancer group, even after adjusting for thyroid replacement therapy. The presence of thyroid antibodies did not differ significantly between the compared groups. In a subgroup analysis, breast cancer cases with thyroid disease and particularly hypothyroidism had a significantly lower incidence of lymph node metastases compared with breast cancer cases without thyroid disease. Conclusions: Our data confirmed the proliferative effect of thyroid hormones on breast cells, which had previously been shown in vitro. Additionally, thyroid disease and particularly hypothyroid function appeared to be associated with a lower incidence of lymph node metastases. Further studies to determine the prognostic role of thyroid hormones in breast cancer are warranted.
A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18 flo... more A female patient diagnosed of infiltrative breast carcinoma using tru-cut biopsy underwent 18 flourine-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) for staging. The tumor was located in the superior external quadrant of the right breast, and did not exhibit pathological uptake in 18 F-FDG PET/CT. Later, gallium-68 (68 Ga) fibroblast activation protein-specific inhibitor (FAPI)-04 PET/ CT imaging was performed and the primary tumor showed intense radiotracer accumulation. This presumes that 68 Ga-FAPI PET/CT imaging is superior to 18 F-FDG imaging in detecting the primary tumor in breast cancer, thereby suggesting the replacement of FAPI by 18 F-FDG in breastcancer staging in the future.
We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of prim... more We aimed to compare the roles of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the evaluation of primary tumor and metastases in primary and recurrent breast cancer. Twenty female patients with histopathologically confirmed primary and recurrent breast cancer were included in the prospective study. All patients underwent FDG and FAPI PET/CT imaging in the same week. The number of primary and metastatic lesions, SUVmax values, and tumor-to-background ratios (TBR) were recorded from both scans. Data obtained were statistically compared. FAPI PET/CT was superior to FDG in detecting breast lesions, as well as hepatic, bone, lymph node, and cerebral metastases in terms of patient- and lesion-based assessments. The sensitivity and specificity of FAPI in detecting primary breast lesions were 100% and 95.6%, respectively, while the sensitivity and specificity of FDG were 78.2% and 100%, respectively. The SUVmax values of primary breast tumors, lymph nodes, lung metastases, and bone metastases were significantly higher on FAPI imaging than FDG imaging (p < 0.05). However, SUVmax values of hepatic metastases did not exhibit a statistically significant difference between two imaging techniques (p > 0.05). Also, FAPI imaging yielded significantly higher TBR in breast lesions as well as hepatic, bone, brain and lung metastases compared to FDG (p < 0.05). 68 Ga-FAPI-04 PET/CT is superior to 18F-FDG PET/CT in detecting the primary tumor in patients with breast cancer with its high sensitivity, high SUVmax, and high TBR. 68 Ga-FAPI-04 PET/CT is also superior to 18F-FDG PET/CT in detecting lymph node, hepatic, bone, and cerebral metastases because it has lower background activity and higher uptake in subcentimetric lesions.
Background: There have been different biodistribution of Ga-68 PMSA in normal organs. Methods : S... more Background: There have been different biodistribution of Ga-68 PMSA in normal organs. Methods : SUVmax and SUVmean values was evuluated of 66 patients who underwent Ga-68 PSMA, without radical prostatectomy, relapse in the prostate gland, extensive metastasis, or metastasis in the target. Results: The SUVmax and SUVmean values of the patients included in the study were determined to range from high to low as bladder, kidney, submandibular gland, parotid salivary gland, duodenum 3 rd part, jejunum, spleen, liver and lachrymal gland. The highest uptake was observed in the bladder, kidneys and salivary gland. Conclusions: High PSMA expressions were observed in the kidney, salivary glands and duodenum 3 rd part, medium PSMA expressions were observed in the liver and lachrymal glands, low PSMA expressions were observed in normal prostate tissue, stomach, ileum and pancreas and no PSMA expression was observed in cerebral and cerebellar cortexes. The bladder should be emptied before exami...
Purpose: To investigate the caregiver burden and quality of life (QoL) of patients with metastati... more Purpose: To investigate the caregiver burden and quality of life (QoL) of patients with metastatic prostate cancer. The relationship between questionnaire results and medical, socioeconomic, disease and treatment related factors of the patients were evaluated. Methods: One hundred twenty one metastatic prostate cancer patients and caregivers were enrolled in this cross-sectional study. Short Form 36 (SF-36) questionnaires and Zarit caregiver burden interviews (ZCBI) were conducted with patients and their caregivers seperately. Patients’ comorbidities, presence of bone and visceral metastases, bone related events, palliative radiotherapy needs, ECOG scores, being under active chemotherapy, socioeconomic factors such as public transportation need, residential factors and caregiver related factors such as comorbidities and kinships were recorded respectively. Results: Patients’ comorbidities, ECOG score, presence and quantity of bone or visceral metastasis, bone related events, receivi...
Objective To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole ... more Objective To investigate the superiority or contribution of 5th minute pelvic and 2nd hour whole body Gallium68-prostatespecific membrane antigen-HBED-CC [(68 Ga)PSMA 11] Positron Emission Tomography/Computed Tomography (PET/ CT) images to 1st hour imaging in patients with prostate cancer (PCa). Materials and methods A total of 63 patients diagnosed with PCa who underwent (68 Ga)PSMA 11 PET/CT between April 2019 and June 2019 and who had 5th minute and 1st and 2nd hour images were included in the study. Early (5th minute) pelvic region and 1st and 2nd hour full body images were obtained from all patients. The regions of interest (ROI) were drawn from the background tissues and the physiological uptake sites in a way to include the same lesions from primary and metastatic lesions in all three imagings, and SUVmax values, and tumor-background ratio (TBR) were calculated. Results The mean age of the patients was 69.81 ± 8.78 (min/max: 51/91) years. In the 5th minute images, prostate gland and bed were easier to evaluate, because of low bladder activity. However, lymph node evaluation was more difficult due to high vascular activity. In the prostate gland, lymph nodes and bone metastases, both SUVmax values and TBR rates increased with time from the 5th minute (p < 0.001). At the 2nd hour, some lesions became more visible, while decreased activity was observed in some lesions. However, none of the patients required a change in the stage or treatment. Conclusion In conclusion, the 5th minute pelvic images in (68 Ga)PSMA 11 PET/CT were helpful in visual evaluation of the prostate gland and bed, while 2nd hour images showed high SUVmax and TBR rates in malignant lesions. As the SUVmax values of benign lesions were found to be lower in the 2nd hour, when compared to the 1st hour, it was thought that the 2nd hour imaging could be used in the additional imaging for suspicious lesions without the need for very long waiting times.
To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with... more To evaluate the relationship between whole body volumetric (Wbv) results of 68Ga-PSMA PET/CT with biochemical and histopathological parameters. One hundred twenty-one prostate cancer patients who underwent 68Ga-PSMA PET/CT between January 2018 and December 2019 were included. Imaging was conducted for staging upon new diagnosis with moderate- and high-risk disease and for confirming the progression of castration resistance. The relationships between the Wbv 68Ga-PSMA PET/CT parameters and prostate-specific antigen (PSA) levels, PSA doubling time and Gleason score (GS) were evaluated. The median GS and mean PSA levels were similar between the castration-naive and resistant patients. The PSA levels were positively correlated with MTVwb (p: 0.009, r: 0.286) and TLPwb (p: 0.002, r: 0.344). Gleason scores were positively correlated with MTVwb (p: 0.050, r: 0.216), TLPwb (p: 0.007, r: 0.296) and highest standard uptake value (HSUV) max (p: 0.047, r: 0.220). In the castration-naive group, Gleason scores (from p < 0.001 to p = 0.04 and r = 0.331 to 0.549) and PSA levels (from p = 0.002 to p = 0.045 and from r = 0.323 to 0.473) correlated with all 68Ga-PSMA-PET/CT parameters. PSA doubling time was negatively correlated with whole-body metabolic tumour volume (MTVwb) (p: 0.050, r: 0.232) and whole-body total lesion PSMA (TLPwb) (p: 0.026, r: 0.262). The MTVwb, TLPwb and HSUVpeak values of the patients with biochemical recurrence (BR) of 0–6 months (n = 18) were higher than those with BR > 2 years (n = 35) (p = 0.046, 0.047 and 0.042, respectively). Wbv 68Ga-PSMA PET/CT results were correlated with PSA levels and Gleason scores. The correlation was relatively stronger in the castration-naive group. The prognostic accuracy of PSA in the resistant group may be weaker than in the naive group. The difference in volumetric parameters of patients with short BR compared to long BR supports the idea that 68Ga-PSMA PET/CT can distinguish patients with rapid relapse from others.
Objective In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT... more Objective In this study, we aimed to evaluate the diagnostic sensitivities of 68Ga-FAPI-04 PET/CT and 18F-FDG PET/CT in the primary tumor, and nodal, peritoneal and distant organ metastases of primary and recurrent gastric adenocarcinoma (GAc) with patient and lesion-based comparison. Materials and method Twenty-one patients with histopathologically proven newly diagnosed or recurrent GAc who underwent 18F-FDG and 68Ga-FAPI-04 imaging were included in the study. Both imaging techniques were evaluated visually according to the intensity of organ-based uptake. SUVmax and tumor-to-background ratio (TBR) values obtained from primary tumor/relapse and metastatic organs were compared statistically. Results 68Ga-FAPI-04 uptake was positive in all 15 newly diagnosed patients, while two patients among them who had mucinous and signet ring cell carcinoma did not exhibit 18F-FDG uptake. The sensitivity and specificity of 68Ga-FAPI-04 PET/CT in detecting primary gastric were 100%, while the sensitivity and specificity of 18F-FDG were 86.6 and 100%, respectively. 68Ga-FAPI-04 imaging revealed diffuse stomach uptake in seven patients, while 18F-FDG could only show two of them. The sensitivity and specificity of in-patient-based detection of lymph node metastases were 100 and 95.2%, respectively, while these values were 71.4 and 93.7%, respectively, for 18F-FDG. For peritoneal involvement 68Ga-FAPI-04 had a sensitivity and specificity of 100%, whereas 18F-FDG had a sensitivity of 40% and a specificity of 100%. Conclusion 68Ga-FAPI-04 PET/CT is an imaging modality with the potential of yielding more sensitive and specific findings 18F-FDG PET/CT. This modality may help avoid invasive diagnostic procedures that may be frequently required in GAc.
Revista Española de Medicina Nuclear e Imagen Molecular (English Edition), 2022
Abstract Objective This study aimed to determine the prognostic role of baseline maximum standard... more Abstract Objective This study aimed to determine the prognostic role of baseline maximum standardized uptake value (SUVmax) obtained by pretreatment PET/CT and the change in SUVmax (ΔSUVmax [%]) in patients with axillary lymph node–positive breast cancer receiving neoadjuvant chemotherapy (NAC). Methods One hundred and eighty patients with baseline SUVmax and 121 patients with SUVmax measurement after treatment were evaluated in the study. The baseline SUVmax value of the breast (SUVmaxBI) and axilla (SUVmaxAI) and the change in the SUVmax of the breast (ΔSUVmaxB) and axilla (ΔSUVmaxA) were measured. The optimal cut-off value of SUVmax and ΔSUVmax were determined by ROC curve analysis. Disease-free survival (DFS) and overall survival (OS) were calculated using Kaplan–Meier curves. Results ΔSUVmaxB, pCRB, pCRA, and pCR parameters were found to be associated with relapse (P Conclusion The results showed that ΔSUVmaxB was an independent prognostic factor for relapse and mortality in patients with axillary lymph node–positive breast cancer who received NAC.
Objective: To investigate the caregiver burden and quality of life (QoL) of patients with metasta... more Objective: To investigate the caregiver burden and quality of life (QoL) of patients with metastatic prostate cancer and, to evaluate the relationship between questionnaire results and medical, socioeconomic, disease and treatment related factors of the patients. Methods: One hundred twenty one metastatic prostate cancer patients, and caregivers were enrolled in this cross-sectional study. Patients with metastatic prostate cancer who had at least one bone, lymph node or visceral metastasis who had undergone androgen deprivation or chemotherapy treatments for at least 3 months were included. Short Form 36 (SF-36) questionnaires and Zarit caregiver burden interviews (ZCBI) were conducted with patients and their caregivers seperately. Patients' disease, treatment, socioeconomic and caregiver related factors were recorded respectively. Results: Patients' comorbidities, ECOG score, presence and quantity of bone or visceral metastasis, bone related events, receiving palliative radiotherapy and chemotherapy, using public transportation resulted in lower SF-36 and higher ZCBI results (p<0.001-p=0.049). Obligation to live in rented houses were correlated with lower SF-36 physical function results (p=0.043). Condition of the caregiver being from distant relatives resulted in a lower SF-36 score (p=0.01-p=0.043). Moderate to strong negative correlation was detected between ZCBI and all SF-36 results (p<0.001, r:-646 to-749). In ZCBI, score over 47 resulted with 69.57% sensitivity and 65.52% specificity (AUC =0.671, p =0.008). Conclusion: QoL was directly related to caregiver burden. Factors such as patient comorbidities, bone metastasis and related situations, ECOG score, presence of visceral metastasis, undergoing chemotherapy, low socioeconomic status negatively affect the quality of life of patients and caregiver burden. If these factors can be monitored, the care and quality of life of these patients can be improved.
OBJECTIVE The aim of the present study was to compare the surgical results with contrast-enhanced... more OBJECTIVE The aim of the present study was to compare the surgical results with contrast-enhanced [99mTc]methoxyisobutylisonitrile ([99mTc]MIBI) single-photon emission computed tomography (SPECT)/computed tomography (CT) results by adding the simultaneous single phase contrast to the [99mTc]MIBI SPECT/CT examination. METHOD Between November 2016 and January 2018, 24 (21 female, 3 male) patients who underwent an operation after preoperative contrast-enhanced [99mTc]MIBI SPECT/CT, and 49 asymptomatic patients (42 female, 7 male), who did not undergo surgery, were included in the study. RESULTS Sensitivity and specificity rates of contrast enhanced [99mTc]MIBI SPECT/CT were 100% and 100% when evaluated together with surgical results. The rate of detection in asymptomatic patients was found to be 93.8%. CONCLUSIONS With the contrast-enhanced [99mTc]MIBI SPECT/CT imaging, both high sensitivity and specificity values were achieved in the preoperative localization of parathyroid adenomas (...
Objective(s): The aim of this study was to determine metastasis rate in patients with well-differ... more Objective(s): The aim of this study was to determine metastasis rate in patients with well-differentiated grade1 (G1) and grade 2 (G2) gastroenteropancreatic neuroendocrine tumors (GEP NETs) using the gallium-68 DOTATATE positron emission tomography/computed tomography (68Ga-DOTATATE PET/CT). This study was also targeted toward investigating the relationship of maximum standardized uptake value (SUVmax) with mitotic count, histological grade, and Ki-67 index. Methods: This retrospective study included 38 patients (i.e., 17 males and 21 females) with G1 or G2 GEP NETs who underwent 68Ga-DOTATATE PET/CT in Diyarbakir Gazi Yasargil training and research hospital between November 2014 and March 2018. The patients had at least one positive lesion that was approved by two nuclear medicine specialists with a minimum of 10 years of experience. Results: The median age of the patients was 50 years (age range: 27-80 years), and their mean age was 52±15 years. Out of 38 patients, 1 (2.6%), 2 (5...
OBJECTIVE The present study compared metabolic and volumetric fluorine-18-fluorodeoxyglucose (18F... more OBJECTIVE The present study compared metabolic and volumetric fluorine-18-fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) parameters [metabolic tumour volume (MTV), total lesion glycolysis (TLG), and maximum standardized uptake value (SUVmax)] with carbohydrate antigen (CA) 19-9 tumour marker levels and haemogram parameters [(neutrophil-lymphocyte ratio, mean platelet volume (MPV), and platelet-lymphocyte ratio] as prognostic and diagnostic markers of pancreatic cancer. MATERIAL AND METHODS A total of 66 patients who underwent 18F-FDG PET/CT in our nuclear medicine clinic between February 2017 and March 2019, and had a diagnosis of pancreatic adenocarcinoma, were included in this retrospective study. The enrolled patients had not been administered steroids or operated on. Among these patients, whose haemogram parameters and tumour markers could not be assessed by PET/CT within the same week were excluded. The MTV, TLG, and SUVmax values were ca...
Objective. The aim of this study is to investigate the uptake of 68Ga-FAPI-04 in normal tissues a... more Objective. The aim of this study is to investigate the uptake of 68Ga-FAPI-04 in normal tissues and calculate standardized uptake values (SUVs) for various organs in the body. Methods. A total of 49 patients who underwent 68Ga-FAPI-04 PET/CT were included in our study. The following organs were identified on CT images: brain, parotid, and submandibular glands, palatine tonsils, thyroid, lymph nodes (if present), breasts, lungs, thymus, left ventricle walls, mediastinal blood pool, vertebral bone marrow, liver, spleen, pancreas, stomach, small and large intestines, adrenal glands, kidneys, uterus, testes, and prostate. Median, minimum, and maximum values (max) and average (avg) values of standard uptake value (SUV) of tissues and organs were calculated. Results. The accumulation of 68Ga-FAPI in normal organs showed variations. The cerebral/cerebellar cortex exhibited no 68Ga-FAPI uptake, while the scalp showed low uptake. Low uptake was also observed in the lung parenchyma, esophagus...
We present the case of a 75-year-old man with osteosarcoma of the sternum in whom Ga-prostate-spe... more We present the case of a 75-year-old man with osteosarcoma of the sternum in whom Ga-prostate-specific membrane antigen (PSMA) PET/CT showed high radiotracer activity in the primary tumor and metastatic lesions than F-FDG PET/CT. The present case shows that Ga-PSMA PET/CT is very useful for staging of osteosarcoma due to in vivo expression of PSMA. Ga-PSMA PET/CT can have potential effects on prognosis and in response assessment following treatment in osteosarcoma. The use of PSMA-targeted radioligand treatments may be beneficial especially in metastatic chemorefractory osteosarcoma.
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