2022 Vol. 46, No. 8
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2022, 46(8): 457-463.
doi: 10.3760/cma.j.cn121381-202108021-00209
Abstract:
Objective To investigate the correlation between the proliferation index of proliferating nuclear antigen Ki-67 (called Ki-67) in different pathological subtypes of non-small cell lung cancer (NSCLC) and the metabolic parameters of 18F-fluorodeoxyglucose (FDG) PET/CT. Methods The clinical data of 134 patients with NSCLC diagnosed by histopathological examination in Renmin Hospital of Wuhan University from March 2018 to August 2020 were retrospectively analyzed. The patients included 86 males and 48 females, aged 39–85 (63.9±9.1) years old. All patients underwent 18F-FDG PET/CT and high-resolution CT (HRCT) imaging before surgery. Metabolic parameters, including maximum standardized uptake value (SUVmax), tumor metabolic volume (MTV), and total lesion glycolysis (TLG), were extracted from the PET/CT images. Tumor size and CT morphological features were obtained from the HRCT images. Mann-Whitney U and Kruskal-Wallis tests were used to compare the differences in PET/CT metabolic parameters and Ki-67 proliferation indexes among different clinicopathological features. Pearson and Spearman correlation analysis were used to correlate PET/CT metabolic parameters with Ki-67 proliferation index in different pathological subtypes. Results Significant differences were found in Ki-67 proliferation index, SUVmax, MTV, and TLG among the 134 NSCLC patients in terms of tumor stage, tumor size, pathological type, lymph node metastasis, and CT morphological features (Z=2.634–84.842, all P<0.001). The Ki-67 proliferation index in all patients was positively correlated with SUVmax, MTV, and TLG (r=0.787, 0.309, 0.651; all P<0.001). The Ki-67 proliferation index of poorly differentiated adenocarcinoma (solid + micropapillary predominant type) was correlated with SUVmax, MTV, and TLG (r=0.492, 0.652, 0.603; all P<0.05). However, the SUVmax and TLG in the well-differentiated adenocarcinoma group (adenocarcinoma predominantly adherent) and the SUVmax in the moderately differentiated adenocarcinoma group (acinar+papillary predominant adenocarcinoma) were correlated linearly with the Ki-67 proliferation index (r=0.568, 0.567, 0.671; all P<0.05). Conclusions The Ki-67 proliferation index of NSCLC was correlated with 18F-FDG PET/CT metabolic parameters SUVmax, MTV, and TLG. The highest correlation was obtained with SUVmax. The correlation degree of Ki-67 proliferation index with different 18F-FDG PET/CT metabolic parameters varied in different NSCLC pathological subtypes.
2022, 46(8): 464-470.
doi: 10.3760/cma.j.cn121381-202110016-00210
Abstract:
Objective To compare dosimetry between volumetric modulated arc therapy (VMAT) and intensity-modulated radiation therapy (IMRT) for protecting the hippocampus in the radiotherapy of children with central nervous system (CNS) germ cell tumors (GCT). Methods Retrospective analysis was conducted on the imaging data of 12 children with GCT who received craniospinal irradiation in the 900th Hospital of the Joint Logistics Support Force of PLA from June 2020 to June 2021. The participants included 4 males and 8 females aged 7 to 14 years, with a median age of 11 years. VMAT and IMRT plans were designed after completing the delineation of the target area and the corresponding organs at risk. The prescribed dose was 30 Gy with 10 fractions. Dose-volume histogram was used to obtain various dosimetry parameters. The parameters were then analyzed using paired t-test to compare dosimetry between the target area and the corresponding organs at risk and evaluate the implementation efficiency based on machine monitor unit and treatment time. Results VMAT and IMRT plans both achieve better target dose distribution. VMAT is slightly better than IMRT in terms of the uniformity of the target area. The homogeneity index values for VMAT and IMRT are 0.11±0.02 and 0.14±0.01, respectively, and the difference is statistically significant (t=−5.392, P<0.001). The maximum doses of the left hippocampus in VMAT and IMRT are (15.99±0.70) and (21.21±1.07) Gy, and those of the right hippocampus are (16.13±0.58) and (21.35±0.69) Gy, respectively; the differences are statistically significant (t=−17.622, −21.628; both P<0.001). VMAT meets the dose limit for hippocampal protection and has obvious advantages over IMRT in protecting organs at risk. VMAT is significantly better than IMRT in protecting the eye lens, thyroid, and kidney, and the differences are statistically significant (t=−8.198 to −2.231, all P<0.05). In terms of treatment efficiency, VMAT is also superior to IMRT. The machine monitor unit of VMAT is 1749±95 and the treatment time is (354±31) s, which are about 40% of those of IMRT, and the differences are statistically significant (t=−20.883, −22.790; both P<0.001). Conclusion In the radiotherapy of childhood CNS GCT, VMAT can achieve better target uniformity while protecting the hippocampus and has obvious advantages in terms of protection of the corresponding organs at risk and treatment efficiency than IMRT.
2022, 46(8): 471-477.
doi: 10.3760/cma.j.cn121381-202201015-00211
Abstract:
Objective To analyze the level and distribution characteristics of chromosome aberration rate and micronucleus rate in the pre-job occupational health examination of radiation workers in Shenzhen from 2015 to 2020 and to provide scientific basis for strengthening the radiation protection and occupational health management among radiation workers. Methods A cross-sectional study was conducted among 2 777 radiation workers who received pre-job occupational health examinations in the Shenzhen Prevention and Treatment Center for Occupational Disease from 2015 to 2020, including 2 210 males and 567 females with age range of 17–69 (27.6±6.8) years. The subjects were divided into five groups by age (17–20, 21–30, 31–40, 41–50, and 51–69 years old). The lymphocyte micronuclei and chromosomes of the subjects were prepared by whole-blood microculture method. Chromosomal aberrations, including dicentric, rings, and acentric segments, in the chromosomal metaphases of 100 lymphocytes of each subject were scored by the automatic chromosome analysis system. The differences in chromosome aberrations and micronuclei were compared between different age groups and subjects of different genders in the same age group. The measurement data that conformed to the normal distribution were compared between groups by analysis of variance. The distribution of chromosome aberrations and micronuclei obeyed the Poisson distribution, and nonparametric test was used. Comparison between two groups was performed using Mann-Whitney U test, and comparison between multiple groups was performed using Kruskal-Wallis rank-sum test. Spearman rank correlation analysis was used to analyze the correlation between subjects' age and chromosome aberration and micronucleus rates. Results The chromosome aberration (dicentric + ring + acentric segment) rate of 2 777 subjects was (0.072±0.005)%, and the dicentric + ring aberration rate was (0.016±0.002)%, the chromosome aberration cell rate was (0.068±0.005)%, the micronucleus rate was (0.43±0.01)‰, the micronucleated cell rate was (0.40±0.01)‰, and the lymphocyte transformation rate was (85.07±3.16)%. All of the above results were within the background level range of healthy people reported in domestic literature. No statistical difference was found in the chromosome aberration rate, dicentric + ring aberration rate, and chromosome aberration cell rate among different age groups, as well as the chromosome aberration rate and chromosome aberration cell rate among different genders in each age group (χ2=1.193, 0.931, 0.691; Z=−0.929 to −0.059; all P>0.05). Compared with the 17–20-year-old age group, the micronucleus rate and micronucleated cell rate of the subjects in the other age groups were higher, and the lymphocyte transformation rate was lower, and the differences were statistically significant (Z=−6.981 to −2.510, F=4.922–52.860, all P<0.05). The micronuclei rate and micronucleated cell rate of the subjects were positively correlated with age (r=0.166, 0.168; both P<0.001), whereas the lymphocyte transformation rate was negatively correlated with age (r=−0.197, P<0.001). The micronuclei rate, micronucleated cell rate, and lymphocyte transformation rate of female subjects in the 17–20- and 21–30-year-old age groups was significantly higher than those of the male subjects in the same age group, and the differences were statistically significant (Z=−4.826 to −3.516; F=6.947, 14.563; all P<0.01). Conclusions The chromosome aberration rate and micronucleus rate in the pre-job occupational health examination of radiation workers in Shenzhen from 2015 to 2020 did not exceed the background level range of healthy people reported in domestic literature, but they tended to increase with age. The results of this study suggested that attention should be paid to strengthening the radiation protection and occupational health management of radiation workers.
2022, 46(8): 478-488.
doi: 10.3760/cma.j.cn121381-202103016-00190
Abstract:
Objective To systematically evaluate the diagnostic efficacy of 18F-fluorodeoxyglucose (FDG) PET/CT in differentiated thyroid cancer (DTC) recurrence patients with positive expression for thyroglobulin (Tg) (referred as Tg-positive) and negative result for 131I whole body imaging (WBS) (referred as 131I-WBS-negative). Methods PubMed, Embase, Cochrane Library, Wanfang Data Knowledge Service Platform, China National Knowledge Internet, VIP Database, and China Biomedical Literature Database were searched for relevant studies on the diagnosis of DTC recurrence by 18F-FDG PET/CT. The search time was from database establishment to December 2020. The literature was screened according to the inclusion and exclusion criteria, the basic characteristics and diagnostic parameters of the studies were extracted. Spearman correlation coefficient was used to analyze whether there was a threshold effect in the literature. Heterogeneity Q test was performed for the included literature, and Deeks linear regression analysis was used to evaluate the publication bias of the literature. The summary receiver operetor characteristic (SROC) curve was drawn, the area under the curve (AUC) was calculated, and the Z test was used to analyze the difference in the diagnostic performance of 18F-FDG in patients undergoing diagnostic whole-body imaging (Dx-WBS) and therapeutic imaging (Rx-WBS). The differences in the diagnostic performance of 18F-FDG PET/CT between thyroid-stimulating hormone (TSH)-stimulated and suppressed states were also analyzed. Results Finally, 16 articles were included, with a total of 1 036 patients with DTC recurrence. The heterogeneity of the included studies was low (I2=47.5%, P=0.018), which may be due to the number of cases (r=1.462, P=0.021), and there was a small publication bias (P=0.070). The combined sensitivity of 18F-FDG PET/CT in diagnosing Tg-positive and 131I-WBS-negative DTC recurrence patients was 0.87(95%CI: 0.82−0.91), the specificity was 0.79(95%CI: 0.68−0.86), and the positive likelihood ratio was 3.76(95%CI: 2.32−6.09), the negative likelihood ratio was 0.20(95%CI: 0.14−0.27), the diagnostic odds ratio was 23.89(95%CI: 13.23−43.12), and the AUC of SROC=0.905 (standard error of 0.022) and Q-index was 0.837 (standard error of 0.023). There was no significant difference in the diagnostic performance of 18F-FDG PET/CT between patients undergoing Dx-WBS and Rx-WBS (Z=0.041, P>0.05); there was no significant difference in the diagnostic performance of 18F-FDG PET/CT between TSH-stimulated and suppressed states undergoing Dx-WBS and Rx-WBS (Z=1.864, 0.525; both P>0.05). Conclusions 18F-FDG PET/CT has high diagnostic efficacy for Tg-positive and 131I-WBS-negative DTC recurrence patients. The diagnostic efficacy of 18F-FDG PET/CT in patients undergoing Dx-WBS and Rx-WBS, in TSH-stimulated and suppressed states is similar.
2022, 46(8): 489-496.
doi: 10.3760/cma.j.cn121381-202110009-00201
Abstract:
The incidence of differentiated thyroid carcinoma (DTC) has kept increasing over the recent decades, and most patients carry a good prognosis and long-term survival through surgery, radioactive iodine therapy, and thyroid-stimulating hormone suppression therapy, while some patients have persistent, recurrent or metastatic disease. Thyroglobulin (Tg) can be regarded as a sensitive and convenient biochemical tumor marker after total or near-total resection of DTC and radioiodine therapy. Regular monitoring of Tg and thyroglobulin antibody (TgAb) in the long-term follow-up of patients is of extreme importance for disease surveillance. However, high serum levels of TgAb can be detected in up to 25% of patients with DTC, which will interfere with the accuracy of Tg assay. During which, the trends of TgAb can be served as a surrogate indicator to reflect the tumor status. A falling TgAb trend over time often indicates the remission or improvement of the disease. On the contrary, a sustained rising TgAb trend may be an early indicator of recurrence or metastases of DTC. Herein, the authors mainly reviewed the possible mechanism TgAb production and its clinical relevance in DTC.
The incidence of differentiated thyroid carcinoma (DTC) has kept increasing over the recent decades, and most patients carry a good prognosis and long-term survival through surgery, radioactive iodine therapy, and thyroid-stimulating hormone suppression therapy, while some patients have persistent, recurrent or metastatic disease. Thyroglobulin (Tg) can be regarded as a sensitive and convenient biochemical tumor marker after total or near-total resection of DTC and radioiodine therapy. Regular monitoring of Tg and thyroglobulin antibody (TgAb) in the long-term follow-up of patients is of extreme importance for disease surveillance. However, high serum levels of TgAb can be detected in up to 25% of patients with DTC, which will interfere with the accuracy of Tg assay. During which, the trends of TgAb can be served as a surrogate indicator to reflect the tumor status. A falling TgAb trend over time often indicates the remission or improvement of the disease. On the contrary, a sustained rising TgAb trend may be an early indicator of recurrence or metastases of DTC. Herein, the authors mainly reviewed the possible mechanism TgAb production and its clinical relevance in DTC.
2022, 46(8): 497-501.
doi: 10.3760/cma.j.cn121381-202109013-00205
Abstract:
Differentiated thyroid cancer(DTC) has become the most common head and neck tumor, and most DTC patients have a good prognosis after treatment. However, patients with metastasis and loss of differentiation have a poor prognosis and lack of effective diagnosis and treatment. Radiopharmaceuticals targeting prostate specific membrane antigen (PSMA) have been used in imaging and treatment of patients with prostate cancer, but the research on DTC is still at the exploratory stage. In this paper, the application status and prospect of targeted PSMA imaging and treatment of DTC were reviewed, and the future perspectives were also presented.
Differentiated thyroid cancer(DTC) has become the most common head and neck tumor, and most DTC patients have a good prognosis after treatment. However, patients with metastasis and loss of differentiation have a poor prognosis and lack of effective diagnosis and treatment. Radiopharmaceuticals targeting prostate specific membrane antigen (PSMA) have been used in imaging and treatment of patients with prostate cancer, but the research on DTC is still at the exploratory stage. In this paper, the application status and prospect of targeted PSMA imaging and treatment of DTC were reviewed, and the future perspectives were also presented.
2022, 46(8): 502-505.
doi: 10.3760/cma.j.cn121381-202102003-00193
Abstract:
COVID-19 is still the focus of infection prevention and control in the world at present, and has been achieved general basic control under the effective implementation of prevention and control measures in China. However, with the continuous development of the epidemic, there are still small-scale outbreaks. From the perspective of work practice during the COVID-19 epidemic period, the authors preliminarily discussed the management of blood samples from intermediate and high-risk areas in the vitro analysis laboratory of nuclear medicine department in non-designated hospital. The aim of this study is to provide some experience and suggestions for the relevant staff of nuclear medicine laboratories in China, so as to effectively block the transmission route of virus and avoid nosocomial cross infection.
COVID-19 is still the focus of infection prevention and control in the world at present, and has been achieved general basic control under the effective implementation of prevention and control measures in China. However, with the continuous development of the epidemic, there are still small-scale outbreaks. From the perspective of work practice during the COVID-19 epidemic period, the authors preliminarily discussed the management of blood samples from intermediate and high-risk areas in the vitro analysis laboratory of nuclear medicine department in non-designated hospital. The aim of this study is to provide some experience and suggestions for the relevant staff of nuclear medicine laboratories in China, so as to effectively block the transmission route of virus and avoid nosocomial cross infection.
2022, 46(8): 506-512.
doi: 10.3760/cma.j.cn121381-202111008-00203
Abstract:
Radiation-induced skin fibrosis is a late effect of radiation-induced skin injury. It is a common complication of tumor radiotherapy and radioactive nuclear accidents, which seriously affects the life quality of patients. Radiation-induced skin fibrosis is characterized by changes in skin appearance, loss of skin elasticity and contracture, hard skin and difficult to pinch creases, which may be accompanied by capillary dilatation, pain and itching. Some patients may even develop progressive fibrosis and recurrent skin infections. However, the mechanism of radiation-induced skin fibrosis is not completely clear at present, and there are no effective drugs and therapies to prevent or mitigate this disease. Therefore, it is particularly important to explore the mechanism of ionizing radiation-induced skin fibrosis and find more effective prevention and treatment methods. This article reviews the influencing factors, clinical manifestations, mechanism and treatment of radiation-induced skin fibrosis, and prospects its development, aiming to provide a reference for the research of radiation-induced skin fibrosis.
Radiation-induced skin fibrosis is a late effect of radiation-induced skin injury. It is a common complication of tumor radiotherapy and radioactive nuclear accidents, which seriously affects the life quality of patients. Radiation-induced skin fibrosis is characterized by changes in skin appearance, loss of skin elasticity and contracture, hard skin and difficult to pinch creases, which may be accompanied by capillary dilatation, pain and itching. Some patients may even develop progressive fibrosis and recurrent skin infections. However, the mechanism of radiation-induced skin fibrosis is not completely clear at present, and there are no effective drugs and therapies to prevent or mitigate this disease. Therefore, it is particularly important to explore the mechanism of ionizing radiation-induced skin fibrosis and find more effective prevention and treatment methods. This article reviews the influencing factors, clinical manifestations, mechanism and treatment of radiation-induced skin fibrosis, and prospects its development, aiming to provide a reference for the research of radiation-induced skin fibrosis.
2022, 46(8): 513-517.
doi: 10.3760/cma.j.cn121381-202108013-00194
Abstract:
The authors reported a case of breast metastasis of gastric adenocarcinoma with 18F-FDG PET/CT imaging, and analyzed the disease characteristics from clinical symptoms, manifestation of 18F-FDG PET/CT imaging, pathological diagnosis and differential diagnosis. As the breast metastasis of gastric adenocarcinoma was rare with a non-specific clinical manifestation, it is easy to be missed and misdiagnosed. The disease diagnosis depended on histopathological examination. 18F-FDG PET/CT imaging of total body can detect primary tumor and metastases in an early stage and improve the accuracy of diagnosis.
The authors reported a case of breast metastasis of gastric adenocarcinoma with 18F-FDG PET/CT imaging, and analyzed the disease characteristics from clinical symptoms, manifestation of 18F-FDG PET/CT imaging, pathological diagnosis and differential diagnosis. As the breast metastasis of gastric adenocarcinoma was rare with a non-specific clinical manifestation, it is easy to be missed and misdiagnosed. The disease diagnosis depended on histopathological examination. 18F-FDG PET/CT imaging of total body can detect primary tumor and metastases in an early stage and improve the accuracy of diagnosis.
2022, 46(8): 518-520.
doi: 10.3760/cma.j.cn121381-202107029-00208
Abstract:
Bone epithelioid angiosarcoma (EA) is a highly malignant bone tumor of vascular endothelial origin. Bone EA is a rare disease in clinical practice. A case of femoral EA with 99Tcm-methylenediphosphonate (MDP) SPECT/CT was reported and reviewed in terms of clinical symptoms, laboratory examination, CT and 99Tcm-MDP SPECT/CT imaging, the imaging features of EA were summarized by literature review. 99Tcm-MDP SPECT/CT imaging is helpful for the detection of metastatic and the differential diagnosis of EA from other diseases, which has certain clinical significance.
Bone epithelioid angiosarcoma (EA) is a highly malignant bone tumor of vascular endothelial origin. Bone EA is a rare disease in clinical practice. A case of femoral EA with 99Tcm-methylenediphosphonate (MDP) SPECT/CT was reported and reviewed in terms of clinical symptoms, laboratory examination, CT and 99Tcm-MDP SPECT/CT imaging, the imaging features of EA were summarized by literature review. 99Tcm-MDP SPECT/CT imaging is helpful for the detection of metastatic and the differential diagnosis of EA from other diseases, which has certain clinical significance.
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