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D'Amico A.,Zaklad Diagnostyki PET | Przeorek C.,Zaklad Diagnostyki PET | Siewinska J.,Zaklad Diagnostyki PET | Gorczewski K.,Zaklad Diagnostyki PET | And 6 more authors.
Nuclear Medicine Review | Year: 2012

BACKGROUND: CT scan provides information about the anatomy and morphology, may confirm whether the change is single or has multifocal character and may suggest the probability of malignancy. Due to increased metabolism, at PET examination malignant tissues usually show a greater uptake of 18F-FDG than benign changes and healthy tissue. In several cases, PET-CT is described only by a specialist in nuclear medicine without consulting a radiologist. The aim of this study is to evaluate the accuracy of PET with assessment performed by a single nuclear medicine specialist and multidisciplinary assessment by both nuclear medicine and radiology specialists. MATERIALS AND METHODS: PET-CT was performed in 58 consecutive patients referred from John Paul II Hospital in Cracow because of radiologically diagnosed solitary pulmonary nodule (SPN) with diameter > 1 cm. An histopatological specimen was obtained in 37 patients. In 17 cases PET-CT images were evaluated by a single nuclear medicine specialist (group A), while for the remaining 20 cases, the image evaluation was performed shoulder-to-shoulder by a nuclear medicine specialist and a radiologist (group B). ANALYSIS OF DATA: Overall PET sensitivity, specificity, positive and negative predictive value and accuracy were calculated on the basis of anatomopathologic results. These data were also calculated separately for groups A and B. RESULTS: The histopatologic examination demonstrated the non neoplastic character of 7/37 lesions. The sensitivity, specificity, accuracy, positive and negative predictive values for group A were 85.7%, 100%, 100%, 33.3% and 88% while for group B were 92.8%, 83.3%, 92.8%, 83.3% and 90% respectively. CONCLUSION: PET-CT is an accurate diagnostic method to assess the nature of solitary pulmonary nodules. The consultation with radiologist does not substantially affect the PET-CT diagnostic accuracy, but can lead to a higher negative predictive value. Copyright © 2012 Via Medica.

The aim of the study was to evaluate the effectiveness of microvascular anastomoses in free flaps used in the reconstruction of large postresective defects of the head and neck area. Our special aim was to find and define potential factors which can affect this issue, and also to propose an algorithm with a choice of techniques useful while performing the microanastomosis. Material and methods. The clinical material consisted of 267 patients with locally advanced squamous cell carcinoma of the head and neck area, who underwent surgical treatment at the Department of Oncological and Reconstructive Surgery of the MSCMCC in Gliwice, Poland over the period of 2002-2007. Every resection and reconstruction, was carefidly planned before the surgical procedure. For immediate reconstruction the RFFF was used in 124 cases, FFF in 74 cases, ALTF in 41 cases, ICFF in 13 cases, and chimeric or dual flaps were used in the remaining 15 cases. The main criterion of the effectiveness of microvascular anastomoses is the presence or absence of flap necrosis. In the statistical analysis partial and total flap necroses were treated as the same occurrence, therefore logit regression analysis was used. Results. In all 267cases the resection was macroscopically radical. Postoperative histopatological examination confirmed microscopical radicality in over 80% of cases. Postoperative complications were observed in 20% of cases. The rate of total flap necrosis was 4% (10 cases), thus total flap survival was achieved in 96% of cases. The rate of partial flap necrosis was 5% (13 cases). Other complications were observed in 31 cases (11%). The lowest risk of flap necrosis was associated with the use of RFFF, while the highest with the ICFF. The age of the patients had significant impact on the risk of necrosis. An analysis of the influence of donor vessels revealed that the donor vein diameter is a critical factor in terms of potential necrosis. Further analysis revealed that the use of the internal jugular vein lowers the risk of flap necrosis by approx. 38%. The type of microanastomosis (end to end or end to side) has no impact on the risk of necrosis. Analysis of morphological aspects of free flaps has shown that the use of bone flaps or flaps with a skin island exceeding 50 cm2 increases the necrosis risk. Primary tumor location, as well as the presence or absence of comorbidities, have no influence on increased necrosis rate. The overall results of the analysis were divided into three groups depending on the risk of the necrosis. The first two groups (0-5% and 5.1-8.9%) were recognized as low and moderate risk. The third one, also referred to as the "group of increased risk" contained 7 of all the 20 analyzed factors - age, bone flaps, large skin island flaps, donor vein and artery diameter lower than 2 mm, comorbidities at older age, middle face reconstruction. Conclusions. 1.The use of reconstructive microsurgery in patients with locally advanced cancer of head and neck area results in a 96% primary free flap survival rate. 2. Total or partial flap necrosis are the most serious complications with a risk ratio of about 9%. 3. The factors affecting the increased necrosis rate are: age, the use of bone or large skin island flaps, donor veins diameter below 2 mm. The use of the internal jugular vein reduces the risk of necrosis by 38%. 4. Detailed and regular flap monitoring allows for the early detection of potential abnormalities. 5. An algorithm of techniqes of performing microanastomoses depending of clinical factors is proposed.

Zeman M.,Klinika Chirurgii Onkologicznej I Rekonstrukcyjnej | Kryj M.,Klinika Chirurgii Onkologicznej I Rekonstrukcyjnej | Czarnecki M.,Klinika Chirurgii Onkologicznej I Rekonstrukcyjnej | Widel M.,Klinika Chirurgii Onkologicznej I Rekonstrukcyjnej | And 5 more authors.
Nowotwory | Year: 2012

Background. 15-25% of patients with colorectal cancer have metastatic disease in the liver at the time of primary diagnosis, and another 35-45% suffer from metachronic metastases in the liver. Only about 20% of them can be resected for a cure. Material and methods. Between 2000 and 2007, 96 patients were qualified to liver resection due to metastatic colorectal cancer. 25 (36%) of them were evaluated intraoperatively as nonresectable. They were treated by thermoablation. In 71 patients, radical resection was performed: in 33 (46.5%) patients this took the form of a hemihepatectomy, in 23 (32.5%) a segmentectomy, and in five (21%) a nonanatomical metastasectomy. In analysis, we used Kaplan-Meier DFS and OS estimation and Cox regression to assess prognostic factors. Results. Two (1.7%) patients died in the perioperative period. Three patients had prolonged biliary drainage. Five years with no evidence of disease was noted in 19.9% of all qualified patients vs 25.3% in the group with radical surgical resection. Five year OS was 22% and 27.7%, respectively. Prognostic factors that significantly influenced DFS and OS were: radical and anatomical resection, free surgical margins, primary tumour stage as well as adjuvant chemotherapy given after primary tumour resection. Conclusions. Resection of hepatic metastases in colorectal cancer patients is valuable, safe and effective treatment. © Polskie Towarzystwo Onkologiczne.

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