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Social and communication skills play an important role in the relationship between healthcare professionals and their patients. In this field, it is plausible that clinical empathy and loneliness play an important role of influence. However, the knowledge about this roll is still scarce. The main purpose of this review was to collect findings reported on this matter in students and healthcare professionals. The review included: articles published in English or Spanish during the last fifty years that were indexed in MedLine or SCOPUS, with students or health professionals as participants, and where empathy and loneliness had been used as main measures. Eleven articles, published between 1986 and 2020, that met the abovementioned criteria were included in the analysis. From them, eight corresponded to observational studies and three to interventional studies. Eight studies included students and the other three included healthcare professionals in their study samples. A negative correlation between empathy and loneliness was found in four studies. Furthermore, loneliness in the family environment was described as a negative predictor of empathy towards patients. Training programs in empathic skills and group accompaniment proved not only effective in the improvement of empathy in students, but also in the reduction of loneliness. These findings confirm a close relationship between clinical empathy and loneliness. They also show that the improvement in empathic skills not only has a positive effect on the professional ethical behavior towards patients, but it also helps improving the professional's well-being by reducing loneliness.

A 77-year-old woman with follicular thyroid cancer underwent total thyroidectomy and subsequent Iodine-131 remnant ablation. She had a history of a wide tenosynovial giant cell tumor (TGCT) of the right wrist and hand that had been resected thirteen years ago. Post-therapeutic scintigraphy and single photon emission computed tomography showed mild uptake on the distal right forearm, wrist and hand. Magnetic resonance imaging and posterior histopathology confirmed a relapse of TGCT. No radioiodine adverse effects were reported after a one-year follow-up. As far as we know, this report is the first in the literature to a TGCT visualized on post-therapy radioiodine scan., Competing Interests: Conflict of Interest: No conflict of interest was declared by the authors., (©Copyright 2022 by Turkish Society of Nuclear Medicine, Molecular Imaging and Radionuclide Therapy published by Galenos Yayınevi.)

The objective of the present paper was to review the clinical application of [ 18 F]FDG PET/CT in follicular lymphoma (FL). Once it was clear that, despite it is characterized as indolent, this type of lymphoma usually shows a high [ 18 F]FDG avidity, PET/CT became more important and it's now considered the standard technique in staging, re-staging and response evaluation. Many studies have shown its impact on the management of patients (as it can change the stage in a significant proportion of cases and lead to treatment modifications), its superiority over CT (mainly because it's able to distinguish fibrosis in residual masses from viable tumor) and its prognostic value. The latter was initially associated only to the degree of metabolic response, which has proved to be a strong and independent predictive factor in terms of disease-free survival (DFS) and overall survival (OS). Thus, a negative PET/CT scan could be considered a guarantee in high-tumor-burden follicular lymphoma patients. However, semiquantitative parameters such as metabolic tumor volume or total lesion glycolysis, may also provide useful information and help us to identify patients with poor prognosis, guiding a risk-adjusted management and follow-up., (Copyright © 2022 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

Prostate cancer (PC) is the most common tumor in men in the West and the fifth leading cause of cancer-related death. The use of PSMA radioligands has represented an important advance both in its diagnosis, through PET molecular imaging, and in its treatment in advanced stages of the disease. This article reviews the contribution of PET studies with PSMA radioligands in initial staging, in tumor detection in biochemical recurrence (elevation of PSA) after treatment with curative intent, and in the more advanced stages of the disease (castration resistant PC or CRPC). The contribution of PSMA radioligand therapy (PSMA-RLT) in CRPC patients who progress to standard therapy is also analyzed., (Copyright © 2021 Sociedad Española de Medicina Nuclear e Imagen Molecular. Published by Elsevier España, S.L.U. All rights reserved.)

The detection of pulmonary nodules has increased in recent decades due to the introduction of lung cancer screening programs and the massively use of routine chest computed tomography in patients with malignant neoplasms. Percutaneous biopsy of these nodules does not always characterize them, so sometimes a surgical biopsy is necessary, which often requires a presurgical localization. The radioguided occult lesion localization (ROLL) described for breast lesions was first applied in the resection of pulmonary nodules in 2000, becoming an alternative to other presurgical localization techniques such as hook-wire. The technique provides high detection rate with minimal morbidity, enhancing multidisciplinary work with specialists in Radiology and Chest Surgery. The present paper describes the different pre-surgical localization techniques currently available, the methodological procedure of the ROLL technique and the collected results in 20 years of experience., (Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: Recently, evidence has accumulated that demonstrates the potential for future applications of radiomics in many clinical settings, including thoracic oncology. Methodological reasons for the immaturity of image mining (radiomics and artificial intelligence-based) studies have been identified. However, data on the influence of the composition of the research team on the quality of investigations in radiomics are lacking., Aim: This review aims to evaluate the interdisciplinarity within studies on radiomics in thoracic oncology in order to assess its influence on the quality of research (QUADAS-2 score) in the image mining field., Methods: We considered for inclusion radiomics investigations with objectives relating to clinical practice in thoracic oncology. Subsequently, we interviewed the corresponding authors. The field of expertise and/or educational degree was then used to assess interdisciplinarity. Subsequently, all studies were evaluated applying the QUADAS-2 score and assigned to a research phase from 0 to IV., Results: Overall, 27 studies were included. The study quality according to the QUADAS-2 score was low (score ≤5) in 8, moderate (=6) in 12, and high (≥7) in 7 papers. An interdisciplinary team (at least 3 different expertise categories) was involved in half of the papers without any type of validation and in all papers with independent validation. Clinicians were not involved in phase 0 studies while they contributed to all papers classified as phase I and to 4/5 papers classified as phase II with independent validation., Conclusions: The composition of the research team influences the quality of investigations in radiomics. Also, growth in interdisciplinarity appears to reflect research development from the early phase to a more mature, clinically oriented stage of investigation., (Copyright © 2020 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: ECCO Essential Requirements for Quality Cancer Care (ERQCC) are written by experts representing all disciplines involved in cancer care in Europe. They give oncology teams, patients, policymakers and managers an overview of essential care throughout the patient journey., Prostate Cancer: Prostate cancer is the second most common male cancer and has a wide variation in outcomes in Europe. It has complex diagnosis and treatment challenges, and is a major healthcare burden. Care must only be a carried out in prostate/urology cancer units or centres that have a core multidisciplinary team (MDT) and an extended team of health professionals. Such units are far from universal in European countries. To meet European aspirations for comprehensive cancer control, healthcare organisations must consider the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis, to treatment, to survivorship., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest for this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Purpose: Recently new mobile systems for dispensing positron emitters have been produced, designed to guarantee dispensing cycles in an aseptic environment. The aim of the present work was to assess the advantage of one of these systems in radiation protection of operators in clinical settings., Methods: Recently, in our centre the new self-dispensing system named KARL 100 by Tema Sinergie was adopted for 18 F-FDG radiopharmaceuticals. The system is associated with an automatic Rad-inject infuser. The system that was previously used was a fixed isolator NMC DSI (Tema Sinergie), equipped with a μDDS-An activity fractioning system, together with a pneumatic post for the syringe delivery. The dosimetric evaluations on both systems were carried out through environmental measurements with an ionisation chamber and with the use of personal dosimeters., Results: The operations of preparation and administration of 18 F-FDG dose to the patient, with the use of Karl 100  + RadInject, involve exposures much lower than those obtained by the fixed isolator. The average body exposure of the technician was reduced by 31%, and for the physician by 77%. On the extremities, the equivalent dose to the hands of the technician was reduced by 78%, and for the physician by 96%. Also the additional dosimeters worn by the technician confirmed the estimated environmental assessments., Conclusions: The exposures of the working personnel were significantly reduced with the introduction of the new KARL 100 system.

Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18 F-FDG ( 18 F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique., (Copyright © 2019 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Stage III non-small cell lung cancer (NSCLC) is a very heterogeneous disease that encompasses patients with resected, potentially resectable and unresectable tumours. To improve the prognostic capacity of the TNM classification, it has been agreed to divide stage III into sub-stages IIIA, IIIB and IIIC that have very different 5-year survival rates (36, 26 and 13%, respectively). Currently, it is considered that both staging and optimal treatment of stage III NSCLC requires the joint work of a multidisciplinary team of expert physicians within the tumour committee. To improve the care of patients with stage III NSCLC, different scientific societies involved in the diagnosis and treatment of this disease have agreed to issue a series of recommendations that can contribute to homogenise the management of this disease, and ultimately to improve patient care.

Background: Inter-professional and interpersonal relationships in collaborative work environments can prove to be critical elements in healthcare practice. When implementers fail to understand the importance of a collaborative perspective, this can lead to communication problems which ultimately harm the users. Objectives: To improve the inter-professional collaborative work skills of Mexican students in their first year of medical and nursing degrees through the use of a training program geared toward development of interpersonal skills and interdisciplinary work. Methods: The sample was composed of 162 students (62 males and 99 females) from the School of Healthcare Sciences of the Autonomous University of Coahuila, Mexico. The main measures used were the Jefferson Scale of Empathy (JSE); the Jefferson Scale of Attitudes toward Inter-Professional Collaborative Work between Medical and Nursing Professionals (JSAPNC); and the Jefferson Scale of Lifelong Learning (JeffSPLL). The entire sample was divided into two groups (experimental and control groups). Both groups attended an extra-curricular program using a coaching methodology. In the first case the topic focused on attitudes toward inter-professional collaborative work. In the second case, the program focused on addiction. Both programs ran for 4 months. Psychometric instruments were applied at the beginning and at the end of both programs. After analyzing the reliability of the instruments, an ANOVA test was performed. Results: The control group of medical students showed a deterioration in the development of collaborative work skills ( p < 0.01), whereas in the experimental group this deterioration was not present. In the experimental group of nursing students, a significant increase in the development of collaborative work skills ( p < 0.05) was observed. The differences were clearly due to the professional area of study ( p < 0.001). Conclusion: There are differences in collaborative work skill development among different professional areas. These differences can be reduced through the implementation of a program aimed at developing collaborative work and interpersonal skills in the early stages of training.

Cervical cancer is the second most common gynecological cancer worldwide. In locally advanced cervical cancer, 18 F-FDG PET/CT has become important in the initial staging, particularly in the detection of nodal and distant metastasis, aspects with treatment implications and prognostic value. The aims of this study were to review the role of 18 F-FDG PET/CT in uterine cervical cancer, according to the guidelines of the main scientific institutions (FIGO, NCCN, SEGO, SEOM, ESGO, and ESMO) and its diagnostic accuracy compared to conventional radiological techniques, as well as to review the acquisition protocol and its utility in radiotherapy planning, response assessment and detection of recurrence., (Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Bone metastatic disease is the main cause of morbidity / mortality in patients with prostate cancer, presenting frequently as bone pain, pathological fractures or spinal cord compression, which requires early and timely therapy. Although, for the moment, the therapeutic window for its use has not been definitively established, radium-223 ( 223 Ra), an alpha particle emitter, has proved to be an effective therapeutic tool, pre or post-chemotherapy, in patients with castration-resistant prostate cancer with symptomatic bone metastases and absence of visceral metastases, significantly modifying the prognosis of the disease. It is therefore imperative to define the ideal scenarios and the correct protocol for the use of this therapy and thus offer the greatest possible clinical benefit to the patient., (Copyright © 2018 Sociedad Española de Medicina Nuclear e Imagen Molecular. Publicado por Elsevier España, S.L.U. All rights reserved.)

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision-making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC.

Imaging in oncology is an essential tool for patient management but its potential is being profoundly underutilized. Each of the techniques used in the diagnostic process also conveys functional information that can be relevant in treatment decision making. New imaging algorithms and techniques enhance our knowledge about the phenotype of the tumor and its potential response to different therapies. Functional imaging can be defined as the one that provides information beyond the purely morphological data, and include all the techniques that make it possible to measure specific physiological functions of the tumor, whereas molecular imaging would include techniques that allow us to measure metabolic changes. Functional and molecular techniques included in this document are based on multi-detector computed tomography (CT), 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET), magnetic resonance imaging (MRI), and hybrid equipments, integrating PET with CT (PET/CT) or MRI (PET-MRI). Lung cancer is one of the most frequent and deadly tumors although survival is increasing thanks to advances in diagnostic methods and new treatments. This increased survival poises challenges in terms of proper follow-up and definitions of response and progression, as exemplified by immune therapy-related pseudoprogression. In this consensus document, the use of functional and molecular imaging techniques will be addressed to exploit their current potential and explore future applications in the diagnosis, evaluation of response and detection of recurrence of advanced NSCLC., (Copyright © 2018 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

The above article which was published in Volume 44/ Issue 12 has incorrect page numbers. Instead of 1-3, it should have been 2137-2139.

Positron emission tomography/computed tomography (PET/CT) with 68 Ga-PSMA is a non-invasive diagnostic technique to image prostate cancer with increased prostate-specific membrane antigen (PSMA) expression. PSMA is a transmembrane protein present in all prostatic tissues. Increased PSMA expression is seen in several malignancies, although prostate cancer is the tumour where it presents higher concentrations. Almost all prostate adenocarcinomas show PSMA expression in most of lesions, primary and metastatic. Immunohistochemistry has demonstrated that the expression of PSMA increases in patients with de-differentiated, metastatic or hormone-refractory tumours. Moreover, the expression level of PSMA has a prognostic value for disease outcome. PET measures the three-dimensional distribution of 68 Ga-PSMA, producing semi-quantitative images that allow for non-invasive assessment of PSMA expression., (Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.)

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe., Oesophageal and Gastric: ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality OG cancer service. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with OG cancer., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: ECCO essential requirements for quality cancer care (ERQCC) are explanations and descriptions of challenges, organisation and actions that are necessary to give high-quality care to patients who have a specific type of cancer. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe., Melanoma: ESSENTIAL REQUIREMENTS FOR QUALITY CARE: CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for melanoma. The ERQCC expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams and specialised treatments is guaranteed to all patients with melanoma., (Copyright © 2018 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Empathy in the context of patient care is defined as a predominantly cognitive attribute that involves an understanding of the patient's experiences, concerns, and perspectives, combined with a capacity to communicate this understanding and an intention to help. In medical education, it is recognized that empathy can be improved by interventional approaches. In this sense, a semiotic-based curriculum could be an important didactic tool for improving medical empathy. The main purpose of this study was to determine if in medical schools where a semiotic-based curriculum is offered, the empathetic orientation of medical students improves as a consequence of the acquisition and development of students' communication skills that are required in clinician-patient encounters. Design: This quasi-experimental study was conducted in three medical schools of the Dominican Republic that offer three different medical curricula: (i) a theoretical and practical semiotic-based curriculum; (ii) a theoretical semiotic-based curriculum; and (iii) a curriculum without semiotic courses. The Jefferson scale of empathy was administered in two different moments to students enrolled in pre-clinical cycles of those institutions. Data was subjected to comparative statistical analysis and logistic regression analysis. Results: The study included 165 students (55 male and 110 female). Comparison analysis showed statistically significant differences in the development of empathy among groups ( p < 0.001). Logistic regression confirmed that gender, age, and a semiotic-based curriculum contributed toward the enhancement of empathy. Conclusion: These findings demonstrate the importance of medical semiotics as a didactic teaching method for improving beginners' empathetic orientation in patients' care.

Introduction: Empathy has been described as an essential competence of healthcare professionals who are working in palliative care and homecare services. In these services, usually accompanied by a high risk of physical and emotional burnout, empathy can play an important role in the improvement of occupational wellbeing. The aim of this study was to confirm the role of empathy in the prevention of loneliness and burn out, and in the promotion of life satisfaction., Methods: In 2016, an observational study was carried out in Chile with professional nurses who were working in palliative care and homecare services. Empathy with the patients, loneliness, life satisfaction, and burnout were measured using psychometric scales. Correlation analyses were applied to confirm relationships among the elements measured., Results: In a sample of 64 participants, positive correlations were confirmed between empathy and life satisfaction (P = 0.40; p = 0.003), and between empathy and professional experience (P = 0.29; p = 0.04). On the other hand, inverse correlations were confirmed between empathy and burnout (P = -0.38; p = 0. 01), and between empathy and loneliness (P = -0.41; p = 0.004)., Conclusions: These findings confirm the important role that empathy plays in the prevention of loneliness and burnout, and in the promotion of life satisfaction. Evidence found suggests that empathetic abilities can be improved by the professional experience., (Copyright © 2017 The Authors. Published by Elsevier España, S.L.U. All rights reserved.)

Human connections are key to the promotion of health and prevention of illness; moreover, illness can cause deterioration of human connections. Healthcare professional-patient relationships are key to ensuring the preservation of adequate human connections. It is important for healthcare professionals to develop their ability to foster satisfactory human connections because: (i) they represent social support for patients; and (ii) they prevent work-related stress. In this study we assessed the relationship between absence (loneliness) and presence (empathy) of human connections with the occupational well-being of healthcare professionals. The Scale of Collateral Effects, which measures somatization, exhaustion, and work alienation; the Jefferson Scale of Empathy; and the Social and Emotional Loneliness Scale for Adults, were mailed to 628 healthcare professionals working in Spanish public healthcare institutions. The following explanatory variables were used to evaluate work well-being: (a) empathy, as a professional competence; (b) loneliness, age, and family burden, as psychological indicators; and (c) professional experience, work dedication, and salary, as work indicators. Comparison, correlation, and regression analyses were performed to measure the relationships among these variables and occupational well-being. Of 628 surveys mailed, 433 (69% response rate) were returned fully completed. Adequate reliability was confirmed for all instruments. The entire sample was divided into four groups, based on the combined variable, "occupation by sex." Comparative analyses demonstrated differences among "occupation by sex" groups in collateral effects ( p = 0.03) and empathy ( p = 0.04), but not loneliness ( p = 0.84). Inverse associations between empathy and collateral effects were confirmed for somatization ( r = -0.16; p < 0.001), exhaustion ( r = -0.14; p = 0.003), and work alienation ( r = -0.16; p < 0.001). Furthermore, loneliness was positively associated with collateral effects ( r = 0.22; p < 0.001). Neither family burden, nor work dedication to clinics or management activities were associated with the three collateral effects measured. These findings support an important role for empathy in the prevention of work stress in healthcare professionals. They also confirm that loneliness, as a multidimensional and domain specific experience, is detrimental to occupational well-being.

Purpose & Methods: Neuroendocrine neoplasms are a heterogenous group of tumours, for which nuclear medicine plays an important role in the diagnostic work-up as well as in the targeted therapeutic options. This guideline is aimed to assist nuclear medicine physicians in recommending, performing, reporting and interpreting the results of somatostatin receptor (SSTR) PET/CT imaging using 68 Ga-DOTA-conjugated peptides, as well as 18 F-DOPA imaging for various neuroendocrine neoplasms., Results & Conclusion: The previous procedural guideline by EANM regarding the use PET/CT tumour imaging with 68 Ga-conjugated peptides has been revised and updated with the relevant and recent literature in the field with contribution of distinguished experts.

Objective: To assess the importance of false-negative and false-positive findings in computed tomography (CT) and 18 F-FDG positron emission tomography (PET) in mediastinal lymph node staging in patients undergoing surgery for non-small cell lung cancer (NSCLC)., Material and Methods: This retrospective study included 113 consecutive patients and 120 resected NSCLCs; 22 patients received neoadjuvant treatment. We compared the findings on preoperative 18 F-FDG PET-CT studies with the postoperative pathology findings. Lymph node size and primary tumor size were measured with CT, and lymph nodes and primary tumors were evaluated qualitatively and semiquantitatively (using standardized uptake values (SUVmax)) with PET., Results: Metastatic lymph nodes were found in 26 (21.7%) of the 120 tumors and in 41 (7.7%) of the 528 lymph node stations analyzed. 18 F-FDG PET-CT yielded 53.8% sensitivity, 76.6% specificity, 38.9% positive predictive value, 85.7% negative predictive value, and 71.7% diagnostic accuracy. The false-negative rate was 14.2%. Multivariable analysis found that the factors associated with false-negative findings were a moderate degree of differentiation in the primary tumor (p = 0.005) and an SUVmax of the primary tumor >4 (p = 0.027). The false-positive rate was 61.1%, and the multivariable analysis found that lymph node size >1cm was associated with false-positive findings (p < 0.001)., Conclusions: In mediastinal lymph node staging in patients with NSCLC, 18 F-FDG PET-CT improves the specificity and negative predictive value and helps clinicians to select the patients that will benefit from surgery. Given the high rate of false positives, histological confirmation of positive cases is recommendable., (Copyright © 2017 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Colorectal cancer: essential requirements for quality care CONCLUSION: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality CRC service. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary units or centres must be guaranteed for all those with CRC., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: ECCO essential requirements for quality cancer care (ERQCC) are checklists and explanations of organisation and actions that are necessary to give high-quality care to patients who have a specific tumour type. They are written by European experts representing all disciplines involved in cancer care. ERQCC papers give oncology teams, patients, policymakers and managers an overview of the elements needed in any healthcare system to provide high quality of care throughout the patient journey. References are made to clinical guidelines and other resources where appropriate, and the focus is on care in Europe. Sarcoma: essential requirements for quality care • Sarcomas - which can be classified into soft tissue and bone sarcomas - are rare, but all rare cancers make up more than 20% of cancers in Europe, and there are substantial inequalities in access to high-quality care. Sarcomas, of which there are many subtypes, comprise a particularly complex and demanding challenge for healthcare systems and providers. This paper presents essential requirements for quality cancer care of soft tissue sarcomas in adults and bone sarcomas. • High-quality care must only be carried out in specialised sarcoma centres (including paediatric cancer centres) which have both a core multidisciplinary team and an extended team of allied professionals, and which are subject to quality and audit procedures. Access to such units is far from universal in all European countries. • It is essential that, to meet European aspirations for high-quality comprehensive cancer control, healthcare organisations implement the requirements in this paper, paying particular attention to multidisciplinarity and patient-centred pathways from diagnosis and follow-up, to treatment, to improve survival and quality of life for patients., Conclusion: Taken together, the information presented in this paper provides a comprehensive description of the essential requirements for establishing a high-quality service for soft tissue sarcomas in adults and bone sarcomas. The ECCO expert group is aware that it is not possible to propose a 'one size fits all' system for all countries, but urges that access to multidisciplinary teams is guaranteed to all patients with sarcoma., (Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.)

Context: Empathy, teamwork, and lifelong learning are described as key elements of professionalism. The first recipients of their benefits are professionals themselves. Paradoxically, scarce studies have reported association between professionalism and occupational well-being. The main purpose of this study was to characterize the influence that empathy, teamwork, and lifelong learning, play in the occupational well-being of physicians and nurses working in Latin American healthcare institutions. Materials and Methods: The Jefferson Scale of Empathy, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, the Jefferson Scale of Physicians Lifelong Learning, and the Scale of Collateral Effects (somatization, exhaustion, and work alienation), were administered to 522 physicians and nurses working in institutions of Mexico, Colombia, Ecuador, and Argentina. Internal reliability was calculated. Gender and discipline were used as explanatory variables in comparison analysis. Two-way analysis of variance was performed to examine differences due to the main effects of the gender, and discipline, and to determine possible combined effects. Correlation analysis was performed to measure associations between collateral effects and age, and between collateral effects and professionalism. Results: A total of 353 (68%) surveys were returned fully completed. Adequate reliability was confirmed in all instruments. No differences were found among countries for collateral effects. Correlation analysis confirmed in physicians an inverse association between empathy and collateral effects ( P = -0.16; p < 0.05), and between collateral effects and lifelong learning ( P = -0.18; p < 0.01). In nurses, this association was confirmed only for empathy ( P = -0.19; p < 0.05). Important differences in the development of professionalism and in its effects on occupational well-being appeared associated to inter-professional collaboration and work roles. An inverse correlation between age and collateral effects was confirmed in physicians ( P = -0.22; p < 0.001) and in nurses ( P = -28; p < 0.001). Comparison by gender confirmed higher somatization in women physicians and nurses than in men groups ( p < 0.001). On the other hand, comparison by discipline confirmed higher exhaustion and alienation in physicians than in nurses ( p < 0.01). Conclusion: The findings support the importance that empathy, teamwork, and lifelong learning have in practitioners' health and welfare, and the role that cultural behaviors, associated to work professional models and social stereotypes, play in the interaction between professionalism and occupational well-being.

Objective: To characterise some of the environmental factors that are sensitive to cultural influence, and are involved in the development of medical empathy in Spanish and Latin American physicians-in-training., Design: Cross-sectional study using questionnaires., Setting: Primary care and specialized medicine centres of the Healthcare System of La Rioja, Logroño, Spain., Participants: Physicians-in-training MAIN MEASUREMENTS: : Empathy was measured using the Jefferson Scale of Physician Empathy, version for healthcare professionals (JSE-HP). Socio-demographic, academic, and professional background information was collected., Results: A total of 104 residents (67 from Spain and 32 from Latin America) answered and returned the questionnairess. The JSE-HP showed adequate psychometric properties. The empathy mean score of Spanish group was higher than that of the Latin American group (P=.01). Differences in the development of empathy were associated with: the development of professional models (P<.001), the positive encounter with other professionals (P=.001), and with a continuing medical education (P=.008)., Conclusions: Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested., (Copyright © 2015 Elsevier España, S.L.U. All rights reserved.)

Purpose: The radionuclide bone scan is the cornerstone of skeletal nuclear medicine imaging. Bone scintigraphy is a highly sensitive diagnostic nuclear medicine imaging technique that uses a radiotracer to evaluate the distribution of active bone formation in the skeleton related to malignant and benign disease, as well as physiological processes., Methods: The European Association of Nuclear Medicine (EANM) has written and approved these guidelines to promote the use of nuclear medicine procedures of high quality., Conclusion: The present guidelines offer assistance to nuclear medicine practitioners in optimizing the diagnostic procedure and interpreting bone scintigraphy. These guidelines describe the protocols that are currently accepted and used routinely, but do not include all existing procedures. They should therefore not be taken as exclusive of other nuclear medicine modalities that can be used to obtain comparable results. It is important to remember that the resources and facilities available for patient care may vary.

Context: Medical educators agree that empathy is essential for physicians' professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners., Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and 13 Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis (PCA) with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis (CFA). Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons., Results: A total of 715 (80%) surveys were returned fully completed. Cronbach's alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p < 0.001)., Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy (JSE). The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research.

The purpose of these guidelines is to assist physicians in recommending, performing, interpreting and reporting the results of FDG PET/CT for oncological imaging of adult patients. PET is a quantitative imaging technique and therefore requires a common quality control (QC)/quality assurance (QA) procedure to maintain the accuracy and precision of quantitation. Repeatability and reproducibility are two essential requirements for any quantitative measurement and/or imaging biomarker. Repeatability relates to the uncertainty in obtaining the same result in the same patient when he or she is examined more than once on the same system. However, imaging biomarkers should also have adequate reproducibility, i.e. the ability to yield the same result in the same patient when that patient is examined on different systems and at different imaging sites. Adequate repeatability and reproducibility are essential for the clinical management of patients and the use of FDG PET/CT within multicentre trials. A common standardised imaging procedure will help promote the appropriate use of FDG PET/CT imaging and increase the value of publications and, therefore, their contribution to evidence-based medicine. Moreover, consistency in numerical values between platforms and institutes that acquire the data will potentially enhance the role of semiquantitative and quantitative image interpretation. Precision and accuracy are additionally important as FDG PET/CT is used to evaluate tumour response as well as for diagnosis, prognosis and staging. Therefore both the previous and these new guidelines specifically aim to achieve standardised uptake value harmonisation in multicentre settings.

Rationale: Refractory angina constitutes a clinical problem., Objective: The aim of this study was to assess the safety and the feasibility of transendocardial injection of CD133(+) cells to foster angiogenesis in patients with refractory angina., Methods and Results: In this randomized, double-blinded, multicenter controlled trial, eligible patients were treated with granulocyte colony-stimulating factor, underwent an apheresis and electromechanical mapping, and were randomized to receive treatment with CD133(+) cells or no treatment. The primary end point was the safety of transendocardial injection of CD133(+) cells, as measured by the occurrence of major adverse cardiac and cerebrovascular event at 6 months. Secondary end points analyzed the efficacy. Twenty-eight patients were included (n=19 treatment; n=9 control). At 6 months, 1 patient in each group had ventricular fibrillation and 1 patient in each group died. One patient (treatment group) had a cardiac tamponade during mapping. There were no significant differences between groups with respect to efficacy parameters; however, the comparison within groups showed a significant improvement in the number of angina episodes per month (median absolute difference, -8.5 [95% confidence interval, -15.0 to -4.0]) and in angina functional class in the treatment arm but not in the control group. At 6 months, only 1 simple-photon emission computed tomography (SPECT) parameter: summed score improved significantly in the treatment group at rest and at stress (median absolute difference, -1.0 [95% confidence interval, -1.9 to -0.1]) but not in the control arm., Conclusions: Our findings support feasibility and safety of transendocardial injection of CD133(+) cells in patients with refractory angina. The promising clinical results and favorable data observed in SPECT summed score may set up the basis to test the efficacy of cell therapy in a larger randomized trial., (© 2014 American Heart Association, Inc.)

La sarcoidosis is a granulomatous disease of unknown etiology. It may mimic malignancy and may affect multiple organs, with a variable clinical course. Pancreatic involvement is very rare. We present the case of a 78-year-old woman with systemic sarcoidosis whose (18)F-FDG PET/CT scan showed a pancreatic lesion and multiple lymphatic (thoracic and non-thoracic) and visceral lesions. The abnormal (18)F-FDG uptake in the pancreas was limited to the tail. A second (18)F-FDG PET/CT study performed 4 months and 3 weeks after the first PET/CT, following corticosteroid therapy during three and a half months, evidenced partial regression of the disease, with persistent (18)F-FDG pathological uptake in the pancreatic lesion., (Copyright © 2010 Elsevier España, S.L. and SEMNIM. All rights reserved.)

Introduction: The prognosis of patients with cutaneous melanoma is greatly influenced by the presence of lymph node metastases. One of the most innovative and fascinating concepts to emerge in the field of oncology in recent years is the use of sentinel lymph node biopsy (SLNB)., Aim: The aim of this study was to determine what SPECT-CT images contribute to the search for sentinel nodes in patients with melanoma., Methods: From March 2007 to October 2008, 18 patients were examined for sentinel nodes using dynamic scintigraphy, planar images, and SPECT-CT in the Nuclear Medicine Department of San Carlos University Hospital. The group contained 10 women and 8 men, age range 14-83 years, mean age 57 years (57+/-20.1)., Results: The sentinel node was located by conventional imaging techniques (dynamic scintigraphy and planar images) in 16 of 18 patients (88.88%). SPECT-CT identified the sentinel node in 18 of 18 patients (100%) and detected clinically relevant findings in 6 of 18 patients (33.33%), Conclusions: SPECT-CT imaging contributed clinically relevant information on sentinel nodes of melanoma, which is particularly important in patients with melanoma of the trunk or head and neck.

Introduction: Sentinel lymph node biopsy has become a widely accepted procedure for axillary lymph node staging in patients with breast cancer., Aim: The aim of this study was to determine the advantages of using SPECT-CT instead of planar scintigraphy in the presurgical localisation of sentinel lymph nodes., Methods: We prospectively included 25 consecutive patients with breast cancer who were admitted to our department for SLN localisation. Patients were divided into two groups, depending on whether neoadjuvant chemotherapy had been received (B, n = 6) or not (A, n = 19). Four doses (1.0 mCi each) of 99mTc-nanocolloid were injected intradermallly in all patients, and SPECT-CT and planar images were acquired. All patients underwent surgery and SLN localisation with a hand-held gamma probe. Any axillary "hot spots" were resected. The kappa index (ki) was calculated using surgical findings as the gold standard., Results: In group A, the SLN was correctly detected in 17/19 patients (89.5 %) with SPECT-CT and in 12/19 (63.2 %) with planar images. The correlation between SPECT-CT and surgical findings (ki 0.91) was better than between planar images and surgical findings (ki 0.57). In group B, the results of SPECT-CT and planar images were identical, with accurate localisation of the SLN in 5/6 patients (ki 0.76)., Conclusions: The results of this study suggest that SPECT-CT may be useful for locating the SLN in breast cancer patients, as it provides accurate localization of the SLN with useful anatomical information. This may allow the surgeon to search exclusively for SLN viewed on SPECT-CT, and avoid false negative and false positive results.

We present the case of a male patient with gastrointestinal stromal tumor (GIST) in whom we conducted two (18)F-fluorodeoxyglucose positron emission tomography ((18)F-FDG PET) studies, the first one prior to beginning the treatment with Glivec and the second after one month of treatment. The first (18)F-FDG PET scan detected multiple FDG avid foci in distal esophagus, liver and in an interaortocava lymph node. The second (18)F-FDG PET showed very good response to therapy, with an almost complete disease remission. After 23 months of follow-up, the early response to treatment detected by (18)F-FDG PET was confirmed. The utility of (18)F-FDG PET in the evaluation of response to treatment in GIST is discussed and compared with CT.

Introduction: 18F-FDG PET has demonstrated its usefulness in detecting recurrences of differentiated thyroid cancer (DTC) with high thyroglobulin (Tg) levels and negative 131I whole-body scan (WBS); however, the number of patients analyzed is low and different studies report disparate results., Objective: To estimate the diagnostic accuracy of 18F-FDG PET in this subgroup of patients., Materials and Methods: Fifty eight patients (64 18F-FDG PET studies) with histologically proven DTC treated with total thyroidectomy followed by at least one session of 131I therapy for the ablation of thyroid remnants were retrospectively analyzed. Results were verified by pathology, clinical follow-up, response to treatment, or by comparison with conventional diagnostic methods. Sensitivity (Se), specificity (Sp), likelihood ratios (LR), diagnostic accuracy (DA), positive and negative predictive values (PPV, NPV), and Tg levels were calculated for patients with positive and negative 18F-FDG PET results., Results: Twenty seven studies were true positives, 1 false positive, 25 true negatives, and 11 false negatives. Se was 71 %, Sp 96 %, PPV 96.4 %; NPV 69.4 %, DA 81.3 %, positive LR 17.75, and negative LR 0.3. The mean Tg level was 202.34 ng/ml in patients with positive 18F-FDG PET and 40.94 ng/ml in those with negative 18F-FDG PET; the difference between the two groups (161.4 ng/ml) was significant at p <0.05., Conclusions: 18F-FDG PET is a useful for detecting residual or recurrent DTC in patients with elevated Tg and negative 131I WBS.

Aim: Renal cell carcinoma is the most frequent solid kidney tumor. At present, PET is not the imaging test of choice, the helical CT being the best method to assess these patients. The aim of the study was to perform a meta-analysis of the literature to evaluate the performance and accuracy of 18F-FDG PET in the detection of primary disease, recurrence and metastasis of renal cell carcinoma., Materials and Methods: A systematic search was done of the available literature in primary and secondary databases published until October 2004 indexed in MEDLINE and CANCERLIT. Exclusion/inclusion criteria were applied. Their quality was evaluated using the Flynn criteria and joint estimators of sensitivity (S), specificity (Sp), likelihood ratios (LR), diagnostic odds ratio (DOR) and summary ROC (SROC) curve were obtained. The presence of the threshold effect was evaluated and the summary ROC (SROC) curve was calculated., Results: Seven out of 46 studies fulfilled the inclusion criteria and were analyzed. Three studies evaluated the use of 18F-FDG PET in the differential diagnosis of renal masses. Two studies analyzed restaging and two analyzed the role of 18F-FDG PET in the detection of metastatic disease. All the selected studies were classified according to Flynn's criteria. We found the highest S in restaging with S 0.87 (95 % CI, 0.75-0.95) and in metastases detection with S 0.72 (95 % CI, 0.56-0.85) as well as the high Sp in differential diagnosis of renal masses., Conclusions: The results of this meta-analysis suggest that 18F-FDG PET can be useful in restaging and detection of metastatic disease, based on its acceptable S and Sp. However, the performance of 18F-FDG PET in the detection of primary disease is limited, but this may improve with the new PET/CT systems.

Background: This study aimed to assess the results obtained with the positron emission tomography (PET) and conventional anatomic imaging methods (CT scan and MRI) in the diagnosis of suspicion of tumor recurrence in head and neck cancers., Methods: Thirty patients with suspicion of tumor recurrence due to head and neck cancers were reviewed retrospectively. Consequently, 34 PET studies were performed. The images were obtained in the PET Institute of Madrid. They were interpreted by visual and semiquantitative analysis. The results were confirmed with clinical follow-up, response to treatment or with histological studies in some cases., Results: Sensitivity and specificity of the PET were 95.6% and 81.8% respectively, while it was 65% and 80% for the CT scan/MRI., Conclusions: We can conclude that PET provides better results than conventional imaging techniques in the detection of head and neck cancer recurrence.

Objective: To present the case report of a patient with undifferentiated and diffuse signet-ring cell gastric carcinoma in which FDG-PET evidenced recurrent disease., Materials and Methods: The patient was diagnosed of a stage III gastric carcinoma in 1994 and was treated with a subtotal gastrectomy. In February 2003, recurrent disease was detected in mediastinal and left supraclavicular lymph nodes. The patient was treated with chemotherapy and radiotherapy, reaching a complete response. After 6 months free of disease, he presented an elevation of the tumor markers with negative results in conventional imaging methods (upper digestive endoscopy, bone scintigraphy, and CT). An FDG-PET scan was performed to rule out recurrent disease., Results: FDG-PET detected pathologic findings suggestive of malignant disease in right supraclavicular and mediastinal lymph nodes. These findings were confirmed by clinical follow-up and with another CT scan performed 4 months later., Conclusions: In this case report we stress the importance of early recurrence by FDG-PET in a non-intestinal gastric carcinoma. This is of interest given the greater difficulty to detect mucous secreting and/or producing carcinomas with the PET-FDG.

Aim: The aim of this paper was to perform a meta-analysis of the literature to evaluate the accuracy of FDG-PET in recurrence detection in patients with ovarian cancer., Methods: The search strategy consisted in identifying papers published between November 1972 and October 2003 indexed in MEDLINE and CANCERLITE. Inclusion criteria were publications that evaluated recurrence with FDG-PET in patients with ovarian carcinoma. Exclusion criteria were duplicated papers or those outdated by subsequent ones. The statistical analysis included 95 % confidence intervals (CI) of sensitivity (S), specificity (Sp) and natural logarithm of the odds ratio (Ln OR)., Results: Seventeen publications fulfilled the inclusion criteria and were analyzed. The S and Sp were 0.94 (95% CI, 0.93-0.96) and 0.65 (95% CI, 0.46-0.85), respectively. The Ln OR presented global homogeneity and significant values in > 75% of the studies., Conclusion: According to our meta-analysis, FDG-PET has high S and intermediate Sp, with few false negative results. These preliminary findings suggest that FDG-PET may be an effective means of identifying patients with recurrent ovarian cancer.

Aim: Recurrent ovarian cancer is a major problem and an accurate diagnosis can often change patients' management. This study aimed to assess the impact on management of FDG-PET in recurrent ovarian cancer., Material and Methods: Forty-three patients in whom FDG-PET scan was performed due to suspected recurrent ovarian cancer were included. FDG-PET results were confirmed by histopathology and clinical follow-up of at least 12 months. To assess impact on management the treatment plan based on conventional imaging methods was compared with the treatment plan based on inclusion of PET findings, classifying FDG-PET impact on management as high, medium, low or no impact. Management changes, when present, were classified as intermodality or intramodality., Results: FDG-PET had a high impact on therapeutic management in 28 patients (65.1 %), medium impact in 2 patients (4.6 %), low impact in 9 patients (20.9 %), and no impact in 4 patients (9.3 %). FDG-PET induced an intermodality change in management in 27 patients (62,8 %); intramodality changes were induced in 3 patients (7 %). Finally, it produced no treatment changes in 13 patients (30.2 %)., Conclusion: FDG-PET supplied additional information when compared to conventional diagnostic procedures and allowed adequate management changes in most patients.

We present the case of an 11 year-old Caucasian girl who presented chest pain of 12 weeks evolution, with no other symptoms and a negative physical examination. Lactate dehydrogenase levels were increased to 797 U/l, whereas beta-2-microglobulin (BM2) levels were normal. The thoracic CT showed a bulky mediastinal mass that occupied the pretracheal, paratracheal and right prevascular regions. The gallium scintigraphy showed high uptake in the mediastinic region; the bone scintigraphy was negative. Biopsy of the mediastinal mass revealed the presence of diffuse large B-cell non-Hodgkin's lymphoma. Treatment included 4 cycles of chemotherapy followed by 7 days of subcutaneous granulocyte colony-stimulating factor (G-CSF, Lenogastrim) at a dose of 5 mg/Kg/day. Following treatment, a CT scan was performed to evaluate response, finding a calcification of the mass without significant reduction of the overall size. Because CT was inconclusive in the assessment of response to therapy, a 18F-FDG PET scan was performed. The 18F-FDG PET scan did not show any pathological uptake in the mediastinum but revealed a splenic and bone marrow diffusely increased 18F-FDG uptake. The differential diagnosis included a secondary effect induced by G-CSF therapy as one of the main possibilities, but other possibilities such as a malignant infiltration by lymphoma could not be discarded. Therefore, a second 18F-FDG PET scan was performed 3 months later. This study showed no pathological findings, with a normal 18F-FDG uptake in the spleen and bone marrow. Thus, the benign and reactive nature of the splenic and bone marrow 18F-FDG increased uptake found in the previous study was confirmed. We consider that the stimulating effect that G-CSF therapy has on the spleen and bone marrow must be taken into account when performing a 18F-FDG PET scan, as it can be an important source of false-positive results.