Lebriz Uslu Beşli's research while affiliated with İstanbul University-Cerrahpaşa and other places

Purpose: To investigate the relationship between sonographic findings and the axillary status, especially the side of thickening in the presence of cortical asymmetry. Methods: Patients with biopsy-proven axillary lymph node (ALN) metastasis were included in this study. The lymph nodes were divided into three groups depending on the type of cortical thickening as diffuse, closer (eccentric cortical thickening on the side near the tumor and/or breast) and distant (thickening on the further side) asymmetry. Longitudinal to transverse axis (L/T) ratio, the largest cortical thickness, cortex to hilum ratio (C/H), hilar status (normal/displaced/absent), orientation (parallel/vertical), capsular integrity (sharp/indistinct), vascularisation pattern (hilar/peripheral/penetrant/anarchic/avascular) on superb microvascular imaging (SMI) and presence of conglomeration were recorded for each lymph node. Axillary nodal status on 18F-FDG PET-CT/MRI scans was recorded, if available. Features of the breast lesions like size, laterality, nuclear grade, hormone receptor status and the level of Ki-67 expression have been added. Results: A total of 219 metastatic ALNs [diffuse (n=122), closer asymmetry (n=71), distant asymmetry (n=26)] were evaluated. By the univariate analysis, ALN metastasis was significantly associated with the presence of closer asymmetrical cortical thickening (p<0,0001), C/H ratio (p=0.001), cortical thickness (p=0.001), hilar status (p<0.005) and vascular pattern (p<0.005). L/T ratio was only a statistically significant parameter for lymph nodes with diffuse cortical enlargement in predicting metastasis, and conglomeration was also observed only in this group (p<0.05). By multivariate analysis, nodal metastasis was significantly associated with asymmetrical cortical thickening (p=0.001), C/H ratio (p=0.005) and vascular pattern (p<0.0001). Conclusion: Asymmetrical cortical enlargement on the side closer to the breast, C/H ratio and abnormal microvascular pattern are the independent predictors of axillary nodal involvement. Closer asymmetry is an eligible, easy-to-detect grayscale US finding to decide sampling that highly predicts ALN metastasis.

Objectives: To describe 18 F-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18 F-FDG PET/MRI) along with semiology and electroencephalography (EEG) in patients with gray matter heterotopia (GMH); to evaluate the concordance between 18 F-FDG PET/MRI and clinical epileptogenic zone (EZ). Materials & methods: GMH (subcortical heterotopia [SCH] and periventricular nodular heterotopia [PNH]) patients with epilepsy who underwent 18 F-FDG PET/MRI were retrospectively enrolled. Two radiologists evaluated brain MRI, while two nuclear medicine specialists assessed the 18 F-FDG PET. The SUVmax values of visually hypometabolic cortical areas were compared to the contralateral cortex using a SUVmax threshold value of 10%; the SUVmax values of GMH lesions were compared with that of the right precentral gyrus. The cortex or GMH with hypometabolism on 18 F-FDG PET/MRI was considered representative of the EZ. The clinical EZ was identified using EEG and semiology. Results: Thirty patients (19 PNH; 11 SCH) with a mean age of 28.46 ± 9.52 years were enrolled. The heterotopic nodules were ametabolic in 3 patients (10%), hypometabolic in 16 (33.33%), isometabolic in 13 (26.66%), and hypermetabolic in 4 (10%). 18 F-FDG PET/MRI demonstrated hypometabolism in the cortex and GMH in 22/30 (73.33%) and 16/30 (53.33%). We could identify a clinical EZ in 18 patients, and 15 out of 18 (83.33%) had concordant 18 F-FDG PET/MRI findings. Conclusion: Heterotopic nodules in GMH patients show different metabolic patterns on 18 F-FDG PET/MRI, with nearly three-quarters of the patients having cortical hypometabolism. 18 F-FDG PET/ MRI findings are mostly concordant with the clinical EZ.

Purpose: To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels. Materials and Methods: A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb micro�vascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (Emean) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean Emean. PET scan parameters were obtained as SUVmax and SULpeak. Lesions were divided into two groups according to the Ki-67 expression, low as ≤ 14 and high as >14. Results: Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and Emean had poor correlation (p > 0.05). SUVmax and SULpeak indicated a significant linear correlation with Ki-67 but a moderate correla�tion with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, Emean, SUVmax and SULpeak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUVmax had the highest AUC value of 0.740, according to the ROC curve analysis. Conclusions: Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in inva�sive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.

OBJECTIVE: Yttrium-90 (Y) microsphere therapy has been increasingly used to treat hepatocellular carcinoma (HCC) and liver metastasis of colorectal cancer (mCRC). This study aims to compare two different criterias used for therapy response evaluation following Y therapy within the same group of patients. PATIENTS AND METHODS: A total of 21 patients with HCC and 19 patients with mCRC were included in this study, with 36 and 42 liver lesions, respectively. The lesions were evaluated before and after therapy by CT or MRI and fluorine-18 fluorodeoxyglucose (F-FDG) PET/CT. Several metabolic parameters were analyzed including maximum and mean standardized uptake values, peak standardized uptake value, metabolic tumor volume (MTV), and total lesion glycolysis. Tumor volume was determined using CT or MRI images for all lesions, and the applied activity was estimated to deliver 120±20 Gy for the treated lobe. Six weeks after Y microsphere therapy, F-FDG PET/CT scan was performed to evaluate tumor response using PERCIST and RECIST criteria. Overall survival was calculated using Kaplan-Meier method. RESULTS: A total of 78 liver lesions were treated without any major complication. The mean tumor volumes of HCC lesions calculated by CT or MRI before and after therapy were 84.38 and 86.62 cm, respectively. The average MTV of these lesions on PET images was calculated as 68.142 mm before therapy and 56.945 mm after treatment. In patients with mCRC, the mean tumor volume was 52.32 cm before therapy and 54.52 cm after therapy. The average MTV was calculated as 41.720 mm before and 44.967 mm after therapy for the same patient group. Response Evaluation Criteria In Solid Tumors (RECIST) and PET Response Criteria In Solid Tumors incompatibility was seen in seven of 36 lesions in HCC-diagnosed patients and seven of 42 lesions in patients with mCRC. The mean overall survival was calculated as 13.09 months in patients with HCC and 10.6 months in patients with mCRC. CONCLUSION: Y therapy response can be evaluated by both RECIST and European Organization for Research and Treatment of Cancer criteria. However, RECIST and European Organization for Research and Treatment of Cancer incompatibility can be seen. The anatomic methods for evaluating HCC response is relatively more accurate, whereas the metabolic parameters guided by PET/CT scan showed greater importance in response to evaluation of liver mCRC.

Aim: the goal of the current study was to show the efficacy of dose calculation on the treatment outcome and to analyse the impact of different rationales on the dose estimation through evaluating the treatment response in Greaves and Toxic Adenoma. Material and Methods: the involved patients (n= 25) were suffering from Graves (n=15) and Toxic Adenoma (n=10). The eligibility was determined by experienced nuclear medicine physician according to blood tests, 99mTc- pertechnetate scintigraphy and ultrasound scans (US). A properly calibrated thyroid uptake probe equipped with sodium iodide crystal NaI(Tl) was used to measure the uptake values at 2, 24, 48, 72, and 96 hours following administration of 0.5-1 MBq iodine tracer. Neck and femur quantification was made up to 1 minute and repeated 3 times to reduce the deviation error. Three models were employed to calculate the absorbed dose involving OLINDA, EANM, and ellipsoidal thyroid model. The treatment response was evaluated across one-year after therapy and subdivided into authyroid, minimum hypothyroidism, excessive hypothyroidism, hyperthyroidism Results: the mean effective half-life was 125.8 h (range: 73.7-180.1 h) and mean residence time was 110.1 h (range: 38.4-210.2 h). The calculated activity that would deliver 200 Gy for Graves patients (n=15) according to OLINDA was 359±246 MBq where the mean deviation of EANM and the ellipsoidal model was - 4% and 15%, respectively. The activity required to impart 300 Gy for toxic adenoma was determined as 672±348 MBq based on OLINDA, where the mean deviation of EANM and ellipsoidal thyroid model was 41% and 65% respectively. TA patients were evaluated as authyroid during follow up visits in which the absorbed dose was 360±99 Gy. For Graves patients, 10 out of 15 patients received 240±55 Gy and showed authyroid status, while the patients who received ≥ 385 Gy was deemed excessive hypothyroidism. Conclusion: mean dose of 350 Gy seems adequate for treating toxic adenoma that verify authyroid status while the desired dose due to graves should not be less than 200 Gy to ascertain authyroid. EANM method which is based on 3 measures seems more practical and cost effective to be applied for Graves patients, while unite density sphere model is indispensable and more feasible to be applied in toxic adenoma. On the basis of the current study, considering elliptical shape of thyroid gland / or nodule during treatment planning is apparently irrelevant as seen in the presented outcome after treatment.

INTRODUCTION: The aim of our study is to calculate the embriyo/fetüs dose in pregnant patients who have accidentally received radioiodine before realizing their pregnancy and to evaluate the termination of their pregnancy giving teratological advice to the family. METHODS: We have calculated the embriyo/fetus dose of 16 pregnant patients that have applied to our faculty after receiving radioiodine 131I for therapy or diagnosis during pregnancy in different nuclear medicine centers. RESULTS: Mean fetus dose of three pregnant patients, who have received 0,37 MBq (10 μCi) oral 131I was found as 0.063 mGy. For six pregnant patients who have received 1.85 MBq (0.05 mCi) 131I for thyroid uptake/scintigraphy, mean embriyo/fetus dose was 0.13 mGy and mean fetal thyroid dose was 1073 mGy (1.073 Gy). Mean embriyo/fetus dose of three patients who have received mean 185 MBq (5 mCi) 131I orally for whole body radioiodine scintigraphy was calculated as 13.2 mGy. One of the two hyperthyroid patients, who have received 370 MBq (10 mCi) 131I orally for treatment had embriyo/fetus dose of 26.64 mGy and fetal thyroid dose of 215340 mGy (215.34 Gy). The other patient with hyperthyroidism received 481 MBq (13 mCi) radioiodine and related embriyo/fetus dose was calculated as 34.63 mGy. One of the two thyroid cancer patients have received 3700 MBq (100 mCi) 131I and embriyo/fetus dose was found as 266.64 mGy. For the other thyroid cancer patient, who have received 5555 MBq (150 mCi) 131I at 15th week of pregnancy, fetus dose was 377.8 mGy and fetal thyroid dose was 3221.9 Gy. DISCUSSION AND CONCLUSION: Diagnostic 131I administration before 10th week of pregnancy does not cause a high radiation burden, therefore it is not an indication for termination of pregnancy. High dose 131I treatment in pregnant women causes more than 100 mGy embriyo/fetus dose and these patients should be counselled for termination of pregnancy.

Radioactive iodine is utilized commonly for ablation of remnant thyroid tissue after thyroidectomy and treatment of persistent disease and metastases in differentiated thyroid cancer patients. As it involves ionizing radiation, it is important to ensure that the patients receive optimum amount of radiation to destruct the target tissue while keeping the radiation-related side effects to minimum. In clinical practice, standard activity doses are preferred for thyroid cancer patients, assuming that biokinetics are similar in all patients. Lately, many clinicians offered to individualise the radioactive iodine therapy by calculating the optimal amount of radioactivity using patient dosimetry. Radiation dosimetry is used to calculate the minimum effective and maximum tolerated absorbed dose for a successful radioactive iodine therapy. This approach enables to administer increased amount of therapeutic activity while minimizing the related side effects. This chapter presents some of the basic principles of patient dosimetry and radioiodine biokinetics following radioactive iodine administration in differentiated thyroid cancer patients. Following radioactive iodine therapy, radiation protection measures are necessary to protect the public from ionizing radiation after discharge of the patient from hospital. Radiation exposure to patients, family members and caregivers and attempts to decrease the exposure during therapy are also going to be discussed.

Thyroid cancer is the eighth most common type of cancer and is most frequently diagnosed among people aged 45-54. Nearly three out of four cases are found in women, while about 2% of thyroid cancers occur in children and teenagers. This book is for medical doctors with experience in the field of thyroid cancer. It comprises different subjects, especially the advances in the diagnosis of thyroid cancer with PET imaging and elastography, as well as the new therapeutic approaches with tyrosine kinase inhibitors.