Journal of Medical Imaging and Radiation Oncology最新文献

Background

Hookwire localisation (HWL) is the most established method of localising impalpable breast lesions. Previous cross-sectional study of Australian and New Zealand surgeons in 2016 found HWL to be the most widely used breast lesion localisation technique (LLT). Many non-wire techniques have subsequently been developed to address the limitations of HWL. The aim of this study is to assess current trends in the use of breast LLTs in Australia and New Zealand and to compare results with previous findings of a prior study.

Methods

Attendees of a national Breast Conference were invited to participate in an online survey between 25 March and 21 April 2023.

Results

100 complete responses were received. The number of respondents using each LLT was: HWL 95, Magseed 30, Carbon-track 26, SCOUT 19, IOUS 13, ROLLIS 9, ROLL 4, MOLLI 2. Considering the LLTs they used the most, 73 respondents stated HWL, 14 Magseed, 6 carbon-track and 4 ROLLIS. Magseed and ROLLIS were more likely to be the most used LLT of respondents in public practice, and HWL was more likely to be the most used LLT in private practice (p = 0.010). Since 2016, the use of radioguided techniques has increased (4%–13%, p = 0.036).

Conclusion

HWL remains the most used LLT; however, non-wire LLTs are being used more frequently. Although non-wire LLTs have many advantages, familiarity and cost likely also influence the choice of technique.

Aim

To identify the pattern of growth of true renal artery aneurysms (RAA) in a multicentre cohort and to propose an algorithm for the follow-up of asymptomatic RAA.

Methods

A retrospective review of all patients identified to have true RAA with subsequent follow-up cross-sectional imaging at three centres over a 15-year period was performed. Aneurysm maximal diameter was measured on initial and latest imaging and growth pattern assessed by two radiologists in consensus.

Results

In total, 155 patients with 171 aneurysms were identified with follow-up imaging. Mean initial aneurysm size was 1.27 cm (range 0.3–3.4 cm) with a mean follow-up time of 61.08 months (range 12–182.5 months). 159 (93%) aneurysms remained stable in size over time. Overall mean growth rate was 0.015 cm/y. RAA ≤ 1.5 cm at diagnosis were associated with significantly lower mean growth rates (0.01 cm/year; p = 0.0059). No RAA rupture occurred during the follow-up period.

Conclusion

The present study demonstrates an indolent course of RAA with no ruptures reported and stability over time demonstrated in 93% of a multicentre cohort. These findings are in agreement with multiple other published studies. A positive impact on cost, equity of resources, and cumulative radiation exposure with rationalisation of RAA surveillance warrants its consideration, particularly in low risk cohorts.

Introduction

This study aims to describe and quantify the normal physiologic zonal variation of PSMA expression within the prostate gland on 18F-DCFPyL-PSMA-PET imaging with histopathologic correlation, to aid in the accurate diagnosis of central zone (CZ) lesions. We also aim to quantify a normal range of CZ avidity and identify normal cut-off values below which CZ uptake can be safely considered physiologic.

Method

Prostate MR and 18F-DCFPyL-PSMA-PET imaging studies were assessed along with the review of histopathology for 93 consecutive patients who underwent radical prostatectomy for prostate cancer. Prostate MR and PSMA PET data sets were fused with standardised volumes of interest (VOI) placed on each zone (CZ, PZ & TZ) bilaterally based on MR T2 sequence prostate zonal anatomy. SUVmax and SUVmean values for each VOI were measured. Semi-quantitative histopathological correlation was performed for ten selected cases. The CZ, TZ and PZ in each sample were assessed for PSMA receptor density and graded by staining intensity and the percentage of cells staining with this level of intensity.

Results

A higher intensity of PSMA uptake was seen with respect to both SUVmax and SUVmean in the CZ compared to both the PZ and TZ. Histological analysis also provided concordant results, providing direct cellular surface correlation to the imaging findings.

Conclusion

Increased physiological PSMA expression (and thus molecular PSMA intensity) on PET/CT was seen in the CZ. This knowledge will improve confidence during interpretation of intra-prostatic findings on staging or restaging PSMA PET/CT studies.

Introduction

Fine needle aspiration (FNA) from parotid tumour is inadequate and nondiagnostic in 8% and FNA/biopsy from deep lobe is technically challenging; hence, our first objective was to evaluate MRI findings which best predict the benign and malignant nature of parotid tumour. Our second objective was to develop MRI signatures for parotid tumour histopathologies including grades of carcinoma, to help in decision making regarding elective neck dissection.

Methods

Two head and neck radiologists retrospectively evaluated and developed signatures of common benign and malignant parotid tumours using morphology and signal intensity–related variables for 98 patients on MRI available in PACS from 01 January 2016 to 26 December 2022. T1 weighted image (WI), T2WI, short tau inversion recovery, diffusion WI/apparent diffusion coefficient and postcontrast T1WI sequences were evaluated. The developed MRI signatures were then validated by a blinded third radiologist.

Results

Sensitivity, specificity, accuracy, positive and negative predictive values using MRI signatures were 92.31%, 100%, 94.23%, 100% and 81.25%, respectively, for benign and malignant nature of parotid tumours with a highly significant p-value (< 1e-04). Developed MRI signatures also showed high statistical performance and significant p-value for parotid tumour histopathologies and grades of mucoepidermoid carcinoma (MEC). T2 signal intensity and enhancement patterns can help identify low-grade MEC, impacting management decisions regarding elective neck dissection.

Conclusions

MRI can predict the benign and malignant nature, parotid tumour histopathologies and grades of MEC when typical signatures are present, impacting management decisions.

Introduction

Pelvic examination is a routine component of post-treatment surveillance for endometrial cancer, supported by global guidelines. However, there is no evidence of oncological or quality-of-life benefit, with data suggesting associated discomfort and potential psychological harm. We evaluate the value of routine pelvic examination in follow-up protocols after adjuvant radiation therapy.

Methods

We retrospectively reviewed all patients receiving adjuvant radiation therapy for endometrial carcinoma across two combined cancer services between January 2017 and December 2022. All stages and histological subtypes were eligible. At least 12 months of documented follow-up was required. Patients were stratified by FIGO stage (2009 and 2023) and ESGO/ESTRO risk group.

Results

Two hundred and sixty-four of 395 patients met inclusion criteria, with a median follow-up of 34 months. Whilst demographics were widely distributed, the most common features included endometrioid histology (76.5%), FIGO 2023 stage II (48.5%) and ESGO/ESTRO high-risk (36.7%).

Disease recurrence was identified in 41 patients (15.5%). Only four patients had isolated local recurrence, with most also having distant disease at detection. Only three patients had asymptomatic recurrence found on examination (1.1% of cohort), with only one proceeding to salvage therapy (0.4% of cohort). As expected, higher-risk groups were associated with worse overall survival (p < 0.001).

Conclusions

We found routine pelvic examination following adjuvant radiation therapy for endometrial cancer results in low recurrence detection rates, with salvageable local recurrences being rare. We advocate for the omission of routine pelvic examination from follow-up protocols for patients receiving adjuvant radiation therapy, with either clinic-based or telephone-based follow-up being offered on a risk-stratified basis.

Introduction

This study aimed to compare the outcomes and complications following radical radiotherapy between very elderly patients aged ≥ 90 years and non-very elderly patients using pairwise matching analysis.

Methods

Data of patients who underwent radical radiotherapy at our hospital between January 2013 and March 2024 and those who were aged ≥ 90 years at the start of radical radiotherapy were extracted. Data of control patients were extracted by pairwise matching from patients aged < 90 years who underwent radical radiotherapy during the same period. Pairwise matching was performed using the following criteria: (i) cancer type, (ii) TNM classification, (iii) histological type, (iv) concurrent chemotherapy, (v) prescribed biological effective dose, (vi) performance status, (vii) sex and (viii) ability to walk. The local control (LC), cancer-specific survival (CSS) and overall survival (OS) rates were calculated from the date of completion of radiotherapy.

Results

Forty patients from each group were analysed. There were no significant differences in LC, CSS or OS rates between the two groups. The completion rate of radiotherapy and the incidence rate of adverse events were not significantly different between the two groups.

Conclusion

In this study, there was no difference in the outcomes of radiotherapy between very elderly and non-very elderly patients. Our findings may aid clinicians in the treatment of nonagenarian patients.

Purpose

To investigate the timing, type, and severity of complications following percutaneous, image-guided renal biopsy and to determine if the current observation period of 4 h can be safely reduced.

Methods

Consecutive image-guided percutaneous renal biopsies performed between 2017 and 2022 in adult patients by radiology medical staff were included. The RIS-PACS imaging systems and electronic medical records (EMR) were accessed to obtain relevant patient information and procedural reports. A retrospective analysis of the type and timing of complications was performed against patient demographics and biopsy-related variables. Probabilities were calculated for a range of observation periods to assess the proportion of complications identified by shortening the observation period from 4 h.

Results

Three hundred and thirty-two percutaneous renal biopsies were included, and 44 (13%) complications were identified within the 4 h observation. Twenty-nine complications were post-operative bleeding, of which 2 developed macroscopic haematuria, 25 peri-nephric haematoma and 2 had haemodynamic instability with either haematuria or peri-nephric haematoma. 64% of all complications occurred within the first hour, and 86% occurred within 2 h. Of the six complications occurring after 2 h, two were post-operative bleeding in non-targeted renal biopsies requiring admission, and the other four did not require additional observation/procedures.

Conclusion

The vast majority of complications after targeted and non-targeted renal biopsies tend to occur within the first 2 h of observation. Complications that occurred after 2 h observation were often pain related, something that can be overcome with a standardised post-operative analgesic regime. It may be possible to safely reduce observation times following image-guided targeted renal biopsies.

Background

Mepitel film decreases the severity of radiation dermatitis in breast cancer patients, but its application is resource-intensive. Many departments therefore use StrataXRT, a gel that patients apply themselves. We compared the protective effects of Mepitel film and StrataXRT on radiation dermatitis during and immediately after radiation therapy.

Methods

This phase III multicentre randomised intra-patient-controlled clinical trial recruited breast cancer patients receiving radiation therapy following mastectomy in three New Zealand Hospitals. Lateral and medial aspects of the chest wall were randomised to either Mepitel film or StrataXRT. Overall skin reaction severity was measured using RISRAS and RTOG once a week during treatment and for 4 weeks after treatment completion. The primary outcome was moist desquamation (with a non-inferiority margin of 7.5%); secondary outcomes were overall skin reaction severity, patient tolerability, satisfaction and cost.

Results

Between June 2021 and May 2024, 93 patients were recruited, and 80 patients completed the trial. The absolute difference in moist desquamation rates was 6% lower under Mepitel film (p = 0.413, 95% CI -5%, 18%). Overall skin reaction severity was significantly lower for Mepitel film (Researcher RISRAS: p = 0.022; RTOG: p = 0.011). Mepitel film was cheaper to apply but was less well tolerated, with poor skin adherence being an issue for many patients.

Conclusion

The study did not show non-inferiority for StrataXRT; overall skin reaction severity and costs were significantly lower under Mepitel film; however, StrataXRT was better tolerated.

Trial Registration: ACTRN12621000124831