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Background In the setting of primary hyperparathyroidism (PHPT), [18F]fluorocholine PET/CT (FCH-PET) has excellent diagnostic performance, with experienced practitioners achieving 97.7% accuracy in localising hyperfunctioning parathyroid tissue (HPTT). Due to the relative triviality of the task for human readers, we explored the performance of deep learning (DL) methods for HPTT detection and localisation on FCH-PET images in the setting of PHPT. Patients and methods We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model’s decision process. Results The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p < 0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model’s decision process, had correctly identified the foreground PET signal. Conclusions Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research.

In the setting of primary hyperparathyroidism (PHPT), [We used a dataset of 93 subjects with PHPT imaged using FCH-PET, of which 74 subjects had visible HPTT while 19 controls had no visible HPTT on FCH-PET. A conventional Resnet10 as well as a novel mPETResnet10 DL model were trained and tested to detect (present, not present) and localise (upper left, lower left, upper right or lower right) HPTT. Our mPETResnet10 architecture also contained a region-of-interest masking algorithm that we evaluated qualitatively in order to try to explain the model's decision process.The models detected the presence of HPTT with an accuracy of 83% and determined the quadrant of HPTT with an accuracy of 74%. The DL methods performed statistically worse (p0.001) in both tasks compared to human readers, who localise HPTT with the accuracy of 97.7%. The produced region-of-interest mask, while not showing a consistent added value in the qualitative evaluation of model's decision process, had correctly identified the foreground PET signal.Our experiment is the first reported use of DL analysis of FCH-PET in PHPT. We have shown that it is possible to utilize DL methods with FCH-PET to detect and localize HPTT. Given our small dataset of 93 subjects, results are nevertheless promising for further research.

Introduction Hypercalcaemia is most commonly a sign of primary hyperparathyroidism but can also be a sign of an active granulomatous disease. Standard treatment for primary hyperparathyroidism caused by a solitary parathyroid gland adenoma identified by localisation studies is minimally invasive focused parathyroidectomy. If unsuccessful, bilateral neck exploration is recommended. Case presentation We report the case of hypercalcaemia and ostheoporosis in a 63–year -old woman with a history of sarcoidosis and suspected primary hyperparathyroidism. Localisation studies for parathyroid adenoma were inconclusive due to active cervical and mediastinal granulomatous lymph nodes. Sarcoidosis was treated with corticosteroids but hypercalcaemia persisted. Focused parathyroidectomy was attempted with intraoperative parathyroid hormone measurement but an increase in parathyroid hormone levels was observed. However, with high clinical probability of a successfully removed adenoma and frozen section evaluation, we decided not to proceed with bilateral neck exploration. Serum parathyroid hormone and calcium levels dropped accordingly the following day. Clinical discussion We explored all possible underlying mechanisms for persistent elevated parathyroid hormone level described in literature. Conclusion We conclude that Wisconsin Criteria with intraoperative parathyroid hormone measured 20 minutes after adenoma removal should be applied in such cases., Highlights • Primary hyperparathyroidism (PHP) and sarcoidosis can both cause hypercalcaemia. Other possible mechanisms also contribute and can present a diagnostic and therapeutic challenge. • When Miami criterion fails, it is not always necessary to proceed with bilateral neck exploration. Wisconsin criteria can be used.

Medullary thyroid cancer (MTC) is a challenging neuroendocrine malignancy where the role of nuclear medicine imaging is currently limited. This paper investigates the potential diagnostic value of [We prospectively enrolled 25 patients (10 male, 15 female) with suspicion for primary MTC based on fine-needle aspiration biopsy (FNAB). All patients had a baseline three phase [Nineteen of 25 patients (76%) were surgically treated and histopathology reports were obtained. Patient-based sensitivity and positive predictive value for detection of any MTC lesion using [[

Background A significant disparity regarding survival outcome for melanoma among European regions is well recognized and access to high quality care for European melanoma patients needs to be improved. There is an unmet need for the implementation of minimal standard of care within defined clinical pathways and Quality Assurance (QA) indicators. Objective The EU-MELACARE study aims to identify shared variables for cutaneous melanoma cases recorded in melanoma registries across Europe. Material and methods Opinion leaders involved in melanoma data registration and care quality analysis in 34 European countries were invited to respond to an expert survey covering questions regarding the melanoma registration practice in their countries and the characteristics, coverage and variables collected by the relevant melanoma registries. Results Data regarding 13 melanoma registries from 11 European countries contributed to the study. The majority (61,5%) were population based registries and more than half (62%) had national coverage. The included registries collected a median of 38 variables (Interquartile Range, IRQ 21–76). We identified 24 shared variables available in >70% of registries. Conclusions This study provides valuable specific information on information recorded for melanoma cases are registered within Europe. A core of shared variables has been identified, which will constitute the basis for a standardized set of QA indicators for assessing and monitoring melanoma care across European countries.

Aim: Zirconium-89 has gained great interest for PET, when imaging at late time points is required. Desferrioxamine B (DFO), is mostly used for this radionuclide as bifunctional chelator (BFC) and w ...

OBJECTIVE To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma. DESIGN A cross-sectional, web-based survey. SETTING Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL). PARTICIPANTS A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%). MAIN OUTCOME MEASURES Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE). RESULTS After adjustment for age and sex, frequency of skin examination was higher in both Australia (odds ratio [OR]SSE=1.80 [99% CI, 1.49-2.18]; ORCSE=2.68 [99% CI, 2.23-3.23]) and the United States (ORSSE=2.28 [99% CI, 1.76-2.94]; ORCSE=3.39 [99% CI, 2.60-4.18]) than in the 3 European regions combined. Within Europe, participants from Southern Europe reported higher rates of SSE than those in Northern Europe (ORSSE=1.61 [99% CI, 1.31-1.97]), and frequency of CSE was higher in both Central (ORCSE=1.47 [99% CI, 1.22-1.78]) and Southern Europe (ORCSE=3.46 [99% CI, 2.78, 4.31]) than in Northern Europe. Skin examination behavior also varied according to melanoma history: participants with no history of melanoma reported the lowest levels of skin examination, while participants with a previous melanoma diagnosis reported the highest levels. After adjustment for region, and taking into account the role of age, sex, skin type, and mole count, engagement in SSE and CSE was associated with a range of psychosocial factors, including perceived risk of developing melanoma; perceived benefits of, and barriers to, skin examination; perceived confidence in one's ability to engage in screening; and social norms. In addition, among those with no history of melanoma, higher cancer-related worry was associated with greater frequency of SSE. CONCLUSIONS Given the strong association between psychosocial factors and skin examination behaviors, particularly among people with no history of melanoma, we recommend that greater attempts be made to integrate psycho-education into the fabric of public health initiatives and clinical care, with clinicians, researchers, and advocacy groups playing a key role in guiding individuals to appropriate tools and resources.

The most important prognostic factor for the patients with breast cancer are metastases to axillary lymph nodes (ALNs). Preoperative ultrasound (US) combined with fine needle aspiration biopsy (US-FNAB) has been proved to be the most reliable method to detect nonpalpable axillary metastases in patients with breast cancer. Our study was aimed to examine the value of US contrast agent (CA) SonoVue in the US examination of the axilla for the detection of axillary lymph node (ALN) metastases in breast cancer patients. Therefore, two studies were performed. The first study included 27/70 patients with breast cancer who had an indeterminate result of the standard US examination of the axilla (L/T3 mm or predominantly non-hilar vessel signal) and underwent US examination with CA. In the second study, 26 breast cancer patients underwent standard axillary US examination performed independently by two skilled operators. The patients with indeterminate or malignant ALN underwent US- guided fine needle aspiration biopsy (US-FNAB). For macrometastases, the sensitivity, specificity, NPV and PPV of US-FNAB were 91%, 93%, 100% and 100%, respectively. The reproducibility of the standard US examination (the second study) was 85% (22/26 patients), and for the metastases larger than 5 mm, it was 100%. Moreover, our second study proved that the same results as with CA can be achieved by two skilled operators performing a standard US examination. The sensitivity of both operators was 92%. In the case of metastases larger than 5 mm, the reproducibility was 100%. Micrometastases remain a problem also in the hands of very experienced operators even if using CA.

Estimation of the risk of malignancy in a Hürthle cell (HC) neoplasm is important for optimum extent of thyroid surgical treatment. The aim of this retrospective study was to find predictive factors of carcinoma in patients with HC neoplasm.A total of 279 patients (241 females, 38 males; median age 55 years, range 15-86 years) with HC neoplasm in whom carcinoma was only suspected and who were surgically treated at our Institute in the period 1990-2007, were included in this study. Risk factors for malignancy were identified by the chi-squared test and logistic regression.The histopatological diagnoses were carcinoma, benign goiter and adenoma in 71 (25%), 68 (25%) and 140 (50%) patients, respectively. Predictive factors for carcinoma, shown by chi-square test, were: age of patients, tumor diameter, thyroid volume and T(g) concentration. The independent predictors of malignancy as shown by multivariate logistic regression were age of patients and pre-operative T(g) concentration. Carcinoma was more common in the patients older than 65 years of age and with T(g) concentration over 1,000 ng/ml.The independent predictors of malignancy in HC neoplasm were age of patients and pre-operative T(g) concentration.

The aim of this retrospective study was to find predictive factors of carcinoma in patients with follicular neoplasm. The specific aim was to discover whether preoperative serum thyroglobulin (Tg) concentration in patients with thyroid neoplasm can differentiate between those with thyroid carcinoma and those with benign disease.A total of 327 patients (263 females, 64 males, median age: 51.5 years) with follicular neoplasm in whom carcinoma was only suspected and who were surgically treated at the authors' institute in 1988-2004 were included in the study. Patients who had distant and/or regional metastases were excluded. Risk factors for malignancy were identified by the chi-squared test and logistic regression.The histopathological diagnoses were carcinoma, benign goiter, and adenoma in 119 (36%), 104 (32%), and 104 (32%) patients, respectively. The independent predictors of malignancy as shown by multivariate logistic regression were tumor diameter and preoperative Tg concentration. Thyroid carcinoma was more common in the patients with follicular neoplasm and serum Tg concentration over 300 ng/ml than in those with lower Tg concentrations.Predictors of malignancy were tumor diameter and preoperative Tg concentration.

Within the group of patients with papillary thyroid microcarcinoma (PTMC), the prognostic factors have not been well defined and the optimal treatment has not been proved. The aim of this study was to find out the factors associated with the tumor recurrence in the patients with PTMC.A total of 228 patients with PTMC (189 females, 39 males; age 14-85 years, median 46 years) were treated at our Institute between 1975 and 2006. The data on patients' gender, age, extent of disease, pathomorphological characteristics, therapy, locoregional control, disease-free survival and disease-specific survival were collected. Statistical correlation between possible prognostic factors and the duration of disease-free interval was analyzed by univariate and Cox's multivariate survival analysis.The tumor diameter ranged from 0.1 to 10 mm (mean 6.1 mm). The median length of observation was 84 months (range 1-385). During the follow-up period, the recurrence was diagnosed in 7 patients (6 locoregional and 1 distant). Multivariate analysis showed that tumor size and lymph node metastases were independent prognostic factors for disease-free interval.Longer disease-free interval was found in the patients with a tumor diameteror =6 mm and without lymph-node metastases.

Background Minimally invasive parathyroidectomy (MIP) can be performed under cervical plexus block (CPB). Superficial CPB has been reported to be easier to perform with similar efficacy and less anesthesia-related complications than combined deep and superficial CPB. In this study, we compared the efficacy of superficial and combined (deep and superficial) CPB in patients undergoing MIP. Methods Forty-two patients with primary hyperparathyroidism due to a solitary adenoma were randomized to receive either a superficial (group superficial, n = 20) or a combined deep and superficial CPB (group combined, n = 22) using 0.35 mL/kg of 0.5% levobupivacaine. The primary end-point was the amount of supplemental fentanyl required to complete surgery. Results There were no differences in onset of block, pain scores during surgery, or time to first analgesic request between groups. Fentanyl consumption was similar in both groups, i.e., 50 (0-200) microg in group superficial and 50 (0-100) microg in group combined (P = 0.60). Six patients [1 in group superficial (5%) and 5 in group combined (22.7%)] were converted to general anesthesia for surgically required bilateral neck dissection (P = 0.18). General anesthesia for block failure was reported in three superficial (15%) and two combined group patients (9%) (P = 0.99). In group combined, only one patient (4.5%) showed diaphragmatic paresis after the block (P = 0.99). Conclusion Superficial CPB is an alternative to combined block for MIP.

Study Objective To evaluate the pharmacokinetic profile of 0.35 mL/kg of 0.5% levobupivacaine during superficial and combined (deep and superficial) cervical plexus block (CPB) in patients undergoing minimally invasive parathyroidectomy. Design Prospective randomized study. Setting Operating theater of a university hospital. Patients 12 ASA physical status II and III patients (11 women and 1 man), scheduled for minimally invasive parathyroidectomy. Interventions Seven and 5 patients were randomly assigned to receive either superficial or combined CPB, respectively. The superficial CPB was performed with an injection of 0.35 mL/kg of 0.5% levobupivacaine subcutaneously along the posterior border of the sternocleidomastoid muscle and deeper on its medial surface. The combined CPB was initiated by the deep block at the C3 level vertebra by injecting 0.2 mL/kg of 0.5% levobupivacaine, followed by the superficial block with an injection of the remaining 0.15 mL/kg. After completion of the block, venous blood was sampled at the intervals of 5, 10, 15, 20, 30, 45, and 60 minutes. Measurements and Main Results Venous plasma concentrations were measured using gas chromatography-mass spectroscopy. Mean ± SD of maximal concentrations of levobupivacaine was 0.58 ± 0.41 mg/L in group superficial and 0.52 ± 0.28 mg/L in group combined ( P = 0.71). The median (range) time required to reach the maximal concentrations was 30 minutes (20-30 min) in group superficial and 20 minutes (15-30 min) in group combined ( P = 0.45). The areas under the drug concentration/time curve (AUC 10-60 ) were also similar in both groups. No signs of central nervous system or cardiovascular toxicity or other untoward events were observed in any patient. Conclusion With the given dose regimen, levobupivacaine plasma concentrations were within safe ranges.

We report an unusual case of a malignant blue nevus in a five-year-old girl, which turned out to be malignant only after the development of lymph node metastases three years after the excision of the primary tumor on the patient's cheek. A functional bilateral neck dissection was performed and the patient is alive with no evidence of disease 8 years after the excision of the primary skin lesion.

About 10% of melanoma cases have clinical factors indicative of hereditary cancer. CDKN2A is a major melanoma susceptibility gene in familial malignant melanoma. In this study a novel L94Q missense mutation of the CDKN2A gene is described in a melanoma kindred with two affected second-degree family members. To detect the mutation, polymerase chain reaction (PCR) amplification methods and direct sequencing were used. The presence of the mutation was confirmed by restriction fragment length polymorphism analysis after digestion of the PCR amplicons with the restriction endonuclease BspMI. The penetrance of the novel mutation was shown to be incomplete. Functional importance of the mutation was assumed from the protein p16 structure.

Soft tissue sarcomas of the breast account for less than 1% of all malignant breast tumors. The majority of these lesions have an epithelial component and are thus classified as "cystosarcoma phyllodes." All other types of sarcomas are categorized according to the existing histological soft tissue classification. It is difficult to determine the relative frequency of the different types of breast sarcoma because there are wide variations among the reported series. We report a case of myxofibrosarcoma, a variant of malignant fibrous histiocytoma, in a 58-year-old woman.

Aims. There is no reliable diagnostic test for pre-operative differentiation between benign and malignant follicular and Hurthle cell neoplasms. Measurements of serum thyroglobulin (Tg) are currently only used post-operatively as a marker of recurrent disease or distant metastases in the follow-up of patient with diffentiated thyroid cancer. In this study pre-operative serum Tg measurements were performed with the aim of investigating whether Tg levels differ in benign and malignant follicular and Hurthle cell neoplasms. Methods. In 516 patients who underwent thyroid surgery at the Institute of Oncology in Ljubljana, Slovenia, from 1990 to 1996, serum Tg concentration was measured in addition to the standard pre-operative tests (fine-needle aspiration biopsy, ultrasonography, 99m Tc scanning and hormonal profile). After the operation, patients were divided into 11 groups based on their histological diagnosis (papillary cancer-classic, papillary cancer-follicular variant. papillary cancer-oncocytic variant, occult papillary cancer, follicular adenoma, follicular cancer, Hurthle cell adenoma, Hurthle cell cancer, anaplastic cancer, medullary cancer, nodular goiter) and the serum Tg values of the different groups were compared. Results. In groups of patients with follicular and Hurthle cell cancer, median Tg values were higher (2895 and 638.5 ng/ml) and, statistically, differed significantly from the serum Tg values in all other groups (P