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Soffers F, Helsen N, Van den Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res 2022; 12:34. [PMID: 35695940 PMCID: PMC9192834 DOI: 10.1186/s13550-022-00905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated. Results In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = − 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small. Conclusions DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.
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Affiliation(s)
- Frederik Soffers
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Otto S Hoekstra
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Michel Martens
- Department of Radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Kristof Deben
- Department of Otolaryngology, Jessa Hospital, Hasselt, Belgium
| | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Remco De Bree
- Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - G J C Zwezerijnen
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Van Laer
- Department Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Allaeys T, Jongman L, Paelinck BP, Carp L, Rodrigus IE. Endocarditis and an unexpected entry port. Acta Cardiol 2021; 77:551-552. [PMID: 34006197 DOI: 10.1080/00015385.2021.1902107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Toon Allaeys
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Lindsay Jongman
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
| | | | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Inez E. Rodrigus
- Department of Cardiac Surgery, Antwerp University Hospital, Edegem, Belgium
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Van den Wyngaert T, De Schepper S, Carp L. Quality Assessment in FDG-PET/CT Imaging of Head-and-Neck Cancer: One Home Run Is Better Than Two Doubles. Front Oncol 2020; 10:1458. [PMID: 32923399 PMCID: PMC7457015 DOI: 10.3389/fonc.2020.01458] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 07/09/2020] [Indexed: 01/31/2023] Open
Abstract
2-deoxy-2-[18F]fluoro-D-glucose (FDG) positron emission tomography (PET)/computed tomography (CT) is indicated in head-and-neck cancer for the initial workup when clinically indicated (e. g., large tumors, clinically positive neck, cervical adenopathy from an unknown primary, etc.), for the assessment of treatment response 12 weeks after completion of (chemo)radiotherapy, and during follow-up when there is suspicion of relapse. The successful implementation of FDG-PET/CT in routine clinical practice requires an in-depth understanding of the recent advances in physics and engineering that have significantly improved the imaging capabilities of PET/CT scanners (e.g., digital silicon photomultipliers, point-spread function modeling, and time-of-flight, and Bayesian penalized likelihood reconstruction). Moreover, a coordinated harmonization effort from professional societies (e.g., EANM) and international bodies (e.g., IAEA) has resulted in the creation of quality assurance frameworks (e.g., QUANUM, EARL, GMP) and guidelines that collectively cover the entire spectrum from tracer production, hardware calibration, patient preparation, and scan acquisition, to image interpretation (e.g., PERCIST, Hopkins criteria). The ultimate goal is to standardize the PET/CT technique and to guarantee accurate and reproducible imaging results for every patient. This review summarizes the recent technical breakthroughs in PET/CT scan design and describes the existing quality assessment frameworks with a focus on applications in head-and-neck cancer. Strict adherence to these harmonization efforts will enable leveraging the full potential of PET/CT and translate the proven benefits of this technique into tangible improvements in outcome for patients with head-and-neck cancer in routine clinical care.
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Affiliation(s)
- Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Stijn De Schepper
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Helsen N, Van den Wyngaert T, Carp L, De Bree R, VanderVeken OM, De Geeter F, Maes A, Cambier JP, Spaepen K, Martens M, Hakim S, Beels L, Hoekstra OS, Van den Weyngaert D, Stroobants S, Van Laer C, Specenier P, Maes A, Debruyne P, Hutsebaut I, Van Dinter J, Homans F, Goethals L, Lenssen O, Deben K. Quantification of 18F-fluorodeoxyglucose uptake to detect residual nodal disease in locally advanced head and neck squamous cell carcinoma after chemoradiotherapy: results from the ECLYPS study. Eur J Nucl Med Mol Imaging 2020; 47:1075-1082. [PMID: 32040611 DOI: 10.1007/s00259-020-04710-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/28/2020] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Hopkins criteria were introduced for nodal response evaluation after therapy in head and neck cancer, but its superiority over quantification is not yet confirmed. METHODS SUVbody weight thresholds and lesion-to-background ratios were explored in a prospective multicenter study of standardized FDG-PET/CT 12 weeks after CRT in newly diagnosed locally advanced head and neck squamous cell carcinoma (LAHNSCC) patients (ECLYPS). Reference standard was histology, negative FDG-PET/CT at 12 months after treatment or ≥ 2 years of negative follow-up. Area under the receiver operator characteristics curves (AUROC) were estimated and obtained thresholds were validated in an independent cohort of HNSCC patients (n = 127). RESULTS In ECLYPS, 124 patients were available for quantification. With a median follow-up of 20.4 months, 23 (18.5%) nodal neck recurrences were observed. A SUV70 threshold of 2.2 (AUROC = 0.89; sensitivity = 79.7%; specificity = 80.8%) was identified as optimal metric to identify nodal recurrence within 1 year after therapy. For lesion-to-background ratios, an SUV50/SUVliver threshold of 0.96 (AUROC = 0.89; sensitivity = 79.7%; specificity = 82.8%) had the best performance. Compared with Hopkins criteria (AUROC = 0.81), SUV70 and SUV50/SUVliver provided a borderline significant (p = 0.040 and p = 0.094, respectively) improvement. Validation of thresholds yielded similar AUROC values (SUV70 = 0.93, SUV50/SUVliver = 0.95), and were comparable to the Hopkins score (AUROC = 0.91; not statistically significant). CONCLUSION FDG quantification detects nodal relapse in LAHNSCC patients. When using EARL standardized PET acquisitions and reconstruction, absolute SUV metrics (SUV70 threshold 2.2) prove robust, yet ratios (SUV50/SUVliver, threshold 0.96) may be more useful in routine clinical care. In this setting, the diagnostic value of quantification is comparable to the Hopkins criteria. TRIAL REGISTRATION US National Library for Medicine, NCT01179360. Registered 11 August 2010, https://clinicaltrials.gov/ct2/show/NCT01179360.
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Affiliation(s)
- Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium. .,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
| | - Remco De Bree
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olivier M VanderVeken
- Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium.,Department Otorhinolaryngology, and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | | | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Michel Martens
- Department of radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Sara Hakim
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Laurence Beels
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Otto S Hoekstra
- Amsterdam UMC, Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, wilrijk, 2650, Antwerp, Belgium
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Snoeckx A, Reyntiens P, Carp L, Spinhoven MJ, El Addouli H, Van Hoyweghen A, Nicolay S, Van Schil PE, Pauwels P, van Meerbeeck JP, Parizel PM. Diagnostic and clinical features of lung cancer associated with cystic airspaces. J Thorac Dis 2019; 11:987-1004. [PMID: 31019789 DOI: 10.21037/jtd.2019.02.91] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
"Lung cancer associated with cystic airspaces" is an uncommon manifestation, in which lung cancer presents on imaging studies with a cystic area with associated consolidation and/or ground glass. With the widespread use of computed tomography (CT), both in clinical practice and for lung cancer screening, these tumors are being more frequently recognized. An association of this entity with smoking has been established with the majority of cases reported being in former and current smokers. The true pathogenesis of the cystic airspace is not yet fully understood. Different causes of this cystic airspace have been described, including a check-valve mechanism obstructing the small airways, lepidic growth of adenocarcinoma on emphysematous lung parenchyma, cyst formation of tumor and tumor growth along the wall of a pre-existing bulla. Adenocarcinoma is the commonest histological type, followed by squamous cell carcinoma. Two classification systems have been described, based on morphological features of the lesion, taking into account both the cystic airspace as well as the morphology of the surrounding consolidation or ground glass. The cystic component may mislead radiologists to a benign etiology and the many different faces on imaging can make early diagnosis challenging. Special attention should be made to focal or diffuse wall thickening and consolidation or ground glass abutting or interspersed with cystic airspaces. Despite their atypical morphology, staging and management currently are still similar to that of other lung cancer types. Although the rarity of this entity will hamper larger studies, numerous aspects regarding this particular lung cancer type still need to be unraveled. This manuscript reviews the CT-imaging findings and gives an overview of available data in the English literature on pathogenesis, histopathology and clinical findings. Differential diagnosis and pitfalls are discussed as well as future directions regarding staging and management.
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Affiliation(s)
- Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Pieter Reyntiens
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Maarten J Spinhoven
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Haroun El Addouli
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Astrid Van Hoyweghen
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Simon Nicolay
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Patrick Pauwels
- Department of Pathology Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Jan P van Meerbeeck
- Department of Pulmonology and Thoracic Oncology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
| | - Paul M Parizel
- Department of Radiology, Antwerp University Hospital and University of Antwerp, Edegem, Belgium
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6
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Berzenji L, Van Schil PE, Carp L. The eighth TNM classification for malignant pleural mesothelioma. Transl Lung Cancer Res 2018; 7:543-549. [PMID: 30450292 PMCID: PMC6204412 DOI: 10.21037/tlcr.2018.07.05] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/12/2018] [Indexed: 11/06/2022]
Abstract
In 2016, the International Association for the Study of Lung Cancer (IASLC) published a number of revisions of the seventh edition of the tumor, node and metastasis (TNM) classification for malignant pleural mesothelioma (MPM). The purpose was to establish a set of recommendations for the eighth edition of the TNM staging system. A large number of patients were included in the IASLC database and subsequently analysed to determine new definitions for the components of the TNM classification. A number of important changes were introduced for the T component. Survival analysis of the different T categories showed no significant difference in categories T1a and T1b. This has resulted in a collapse of categories T1a and T1b into one category T1. In addition, tumor thickness was also significantly associated with overall survival. The descriptors for the N components have been redefined as well for the eighth TNM classification. A major revision is the removal of category N3 in the N component. Both intrapleural and extrapleural (N1 and N2 in the seventh edition) are now combined into a single category N1. Lymph nodes that were previously categorized as N3 are now considered N2. For the M component, no redefinition has been published. However, a recommendation has been made to only consider M1 involvement as stage IV disease. This is in contrast to the seventh edition in which T4 and N3 disease were considered stage IV as well. In conclusion, a number of important revisions for the eighth TNM classification of MPM have been published as a result of this IASLC project. This type of large-scale and international joint efforts are key in establishing effective staging systems. Research into using tumor thickness as a prognostic instrument will be an important part of any future editions of the TNM classification.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E. Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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Berzenji L, Van Schil PE, Snoeckx A, Hertoghs M, Carp L. Mesothelioma With a Large Prevascular Lymph Node: N1 Involvement or Something Different? Ann Thorac Surg 2018; 105:e189-e191. [PMID: 29355487 DOI: 10.1016/j.athoracsur.2017.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 12/12/2017] [Indexed: 11/25/2022]
Abstract
A 64-year-old man presented with a large amount of right-sided pleural fluid on imaging, together with calcified pleural plaques and an enlarged nodular structure in the prevascular mediastinum, presumably an enlarged lymph node. Pleural biopsies were obtained during video-assisted thoracoscopic surgery to exclude malignancy. Histopathology showed an epithelial malignant pleural mesothelioma. Induction chemotherapy with cisplatin and pemetrexed was administered followed by an extended pleurectomy and decortication with systematic nodal dissection. Histopathology confirmed the diagnosis of a ypT3N0M0 (stage IB) mesothelioma, and an unexpected thymoma type B2 (stage II) was discovered in the prevascular nodule. Simultaneous occurrence of a mesothelioma and thymoma is extremely rare.
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Affiliation(s)
- Lawek Berzenji
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Paul E Van Schil
- Department of Thoracic and Vascular Surgery, Antwerp University Hospital, Edegem, Belgium.
| | - Annemie Snoeckx
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Marjan Hertoghs
- Department of Anatomical Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
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8
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Snoeckx A, Reyntiens P, Pauwels P, Spinhoven M, Van Schil P, Carp L, Parizel P, Van Meerbeeck J. P3.13-008 Lung Cancer Associated with Cystic Airspaces: Clinical, Imaging, Histopathological and Molecular Correlation. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Snoeckx A, Dendooven A, Carp L, Desbuquoit D, Spinhoven MJ, Lauwers P, Van Schil PE, van Meerbeeck JP, Parizel PM. Wolf in Sheep’s Clothing: Primary Lung Cancer Mimicking Benign Entities. Lung Cancer 2017; 112:109-117. [DOI: 10.1016/j.lungcan.2017.07.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 07/24/2017] [Accepted: 07/31/2017] [Indexed: 12/12/2022]
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Van den Wyngaert T, Helsen N, Carp L, Hakim S, Martens MJ, Hutsebaut I, Debruyne PR, Maes ALM, van Dinther J, Van Laer CG, Hoekstra OS, De Bree R, Meersschout SAE, Lenssen O, Vermorken JB, Van den Weyngaert D, Stroobants S. Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography After Concurrent Chemoradiotherapy in Locally Advanced Head-and-Neck Squamous Cell Cancer: The ECLYPS Study. J Clin Oncol 2017; 35:3458-3464. [PMID: 28854069 DOI: 10.1200/jco.2017.73.5845] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Purpose To assess the standardized implementation and reporting of surveillance [18F]fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) scan of the neck in locoregionally advanced head-and-neck squamous cell carcinoma (LAHNSCC) after concurrent chemoradiotherapy (CCRT). Patients and Methods We performed a prospective multicenter study of FDG-PET/CT scanning 12 weeks after CCRT in newly diagnosed patients with LAHNSCC (stage IVa/b) that used standardized reconstruction and Hopkins reporting criteria. The reference standard was histology or > 12 months of clinical follow-up. The primary outcome measure was the negative predictive value (NPV) of FDG-PET/CT scans and other supporting diagnostic test characteristics, including time dependency with increasing follow-up time. Results Of 152 patients, 125 had adequate primary tumor control after CCRT and entered follow-up (median, 20.4 months). Twenty-three (18.4%) had residual neck disease. Overall, NPV was 92.1% (95% CI, 86.9% to 95.3%; null hypothesis: NPV = 85%; P = .012) with sensitivity of 65.2% (95% CI, 44.9% to 81.2%), specificity of 91.2% (95% CI, 84.1% to 95.3%), positive predictive value of 62.5% (95% CI, 45.5% to 76.9%), and accuracy of 86.4% (95% CI, 79.3% to 91.3%). Sensitivity was time dependent and high for residual disease manifesting up to 9 months after imaging but lower (59.7%) for disease detected up to 12 months after imaging. Standardized reporting criteria reduced the number of equivocal reports (95% CI for the difference, 2.6% to 15.0%; P = .003). Test characteristics were not improved with the addition of lymph node CT morphology criteria. Conclusion FDG-PET/CT surveillance using Hopkins criteria 12 weeks after CCRT is reliable in LAHNSCC except for late manifesting residual disease, which may require an additional surveillance scan at 1 year after CCRT to be detected.
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Affiliation(s)
- Tim Van den Wyngaert
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Nils Helsen
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Laurens Carp
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Sara Hakim
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Michel J Martens
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Isabel Hutsebaut
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Philip R Debruyne
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Annelies L M Maes
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Joost van Dinther
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Carl G Van Laer
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Otto S Hoekstra
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Remco De Bree
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Sabine A E Meersschout
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Olivier Lenssen
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Jan B Vermorken
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Danielle Van den Weyngaert
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
| | - Sigrid Stroobants
- Tim Van den Wyngaert, Nils Helsen, Laurens Carp, Carl G. Van Laer, Jan B. Vermorken, and Sigrid Stroobants, Antwerp University Hospital, Edegem; Tim Van den Wyngaert, Laurens Carp, and Sigrid Stroobants, University of Antwerp, Wilrijk; Michel J. Martens, Algemeen Ziekenhuis (AZ) Turnhout, Turnhout; Isabel Hutsebaut and Sabine A.E. Meersschout, AZ Sint-Jan, Brugge; Philip R. Debruyne, AZ Groeninge, Kortrijk; Annelies L.M. Maes, Jessa Ziekenhuis, Hasselt; Joost van Dinther, Sint-Augustinus Hospital; Olivier Lenssen and Danielle Van den Weyngaert, Ziekenhuis Netwerk Antwerpen Middelheim, Antwerp, Belgium; Sara Hakim, Otto S. Hoekstra, and Remco De Bree, Vrije Universiteit Medical Center, Amsterdam; Remco De Bree, University Medical Center Utrecht, Utrecht, the Netherlands; and Philip R. Debruyne, Anglia Ruskin University, Chelmsford, United Kingdom
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Helsen N, Roothans D, Van Den Heuvel B, Van den Wyngaert T, Van den Weyngaert D, Carp L, Stroobants S. 18F-FDG-PET/CT for the detection of disease in patients with head and neck cancer treated with radiotherapy. PLoS One 2017; 12:e0182350. [PMID: 28771540 PMCID: PMC5542639 DOI: 10.1371/journal.pone.0182350] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/17/2017] [Indexed: 11/20/2022] Open
Abstract
Objective The aim of this study is to evaluate the diagnostic performance of FDG-PET/CT for the detection of residual disease after (chemo)radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) and to evaluate the prognostic value of the FDG-PET/CT findings. Methods Patients with HNSCC who underwent FDG-PET/CT after (chemo)radiotherapy were studied retrospectively. Results 104 FDG-PET/CT-scans were performed at a median of 13.2 weeks post-treatment (5.4–19.0 weeks). The diagnostic performance was time dependent with decreasing sensitivity and slightly increasing specificity over time. Sensitivity, specificity, PPV and NPV at 9 months after imaging were 91%, 87%, 77% and 95%, respectively. In a logistic regression model, the odds of a correct FDG-PET/CT increased with 33% every additional week after end of therapy (p = 0.01) and accuracy plateaued after 11 weeks (97%; p<0.001). A complete response on FDG-PET/CT was associated with an overall survival benefit (50.7 versus 10.3 months; p<0.001). Residual disease on FDG-PET/CT increased the risk of death 8-fold (p<0.001). Conclusion FDG-PET/CT is able to detect residual disease after (chemo)radiotherapy, with an optimal time point for scanning between 11–12 weeks after therapy. However, a reevaluation is probably necessary 10–12 months after the FDG-PET/CT to detect late recurrences. In addition, FDG-PET/CT can guide decisions about neck dissection and identifies patients with poor prognosis.
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Affiliation(s)
- Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
- * E-mail:
| | - Dessie Roothans
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Bert Van Den Heuvel
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | | | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10 Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, Wilrijk, Belgium
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Snoeckx A, Desbuquoit D, Dendooven A, Spinhoven M, Hiddinga B, Carp L, Van Schil P, Parizel P, Van Meerbeeck J. P1.03-028 Wolf in Sheep's Clothing - Primary Lung Cancer Mimicking Benign Diseases. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Van Den Wyngaert T, Helsen N, Carp L, De Bree R, Martens MJ, Van Laer C, Hutsebaut I, Debruyne PR, Maes A, van Dinther J, Meersschout S, Goethals L, Verstraete H, Deben K, Hakim S, Specenier PM, Lenssen O, Hoekstra OS, Van den Weyngaert D, Stroobants S. ECLYPS: Multicenter trial of FDG-PET/CT to detect residual nodal disease in locally advanced head-and-neck squamous cell carcinoma (LAHNSCC) after chemoradiotherapy (CRT). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.6021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Nils Helsen
- Antwerp University Hospital, Edegem, Belgium
| | | | - Remco De Bree
- VU University Medical Center, Amsterdam, Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Sara Hakim
- VU Medical Center, Amsterdam, Netherlands
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Szturz P, Specenier P, Van Laer C, Van Den Weyngaert D, Corthouts B, Carp L, Van Marck E, Vanderveken O, Vermorken JB. Long-term remission of locally recurrent oropharyngeal cancer after docetaxel-based chemotherapy plus cetuximab. Eur Arch Otorhinolaryngol 2015; 273:1629-36. [PMID: 26044403 DOI: 10.1007/s00405-015-3673-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Accepted: 05/25/2015] [Indexed: 01/27/2023]
Abstract
BACKGROUND In recurrent head and neck squamous cell carcinoma ineligible for resection or irradiation, treatment aims primarily at symptom control and quality of life enhancement with an expected outcome of 6-12 months. METHODS In 2005, a male patient, born in 1944, with a second local recurrence of human papillomavirus negative tonsil cancer was enrolled in the EXTREME trial, and randomized to platinum/5-fluorouracil/cetuximab arm resulting in partial remission with progression-free survival of 12 months. The second-line systemic therapy comprised 5 cycles of 3-weekly docetaxel/cisplatin/5-fluorouracil regimen plus weekly cetuximab. RESULTS As confirmed on imaging and repeated biopsies, complete response was achieved with disease-free survival of 8 years and follow-up period of 12 years. Severe acute toxicities during the taxane-based chemotherapy plus cetuximab included grade 4 anorexia and grade 3 febrile neutropenia. CONCLUSIONS Poor tumor differentiation, no weight loss, oropharyngeal location, white race, and particularly the induced complete response were most likely the key favorable prognostic factors in the reported patient. The possibility of a synergistic interaction between taxanes and cetuximab should be further explored.
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Affiliation(s)
- Petr Szturz
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium. .,Department of Internal Medicine, Hematology and Oncology, School of Medicine, University Hospital Brno and Masaryk University, Brno, Czech Republic.
| | - Pol Specenier
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Carl Van Laer
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Danielle Van Den Weyngaert
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Radiotherapy, University Radiotherapy Antwerp, Antwerp, Belgium
| | - Bob Corthouts
- Department of Radiology, Antwerp University Hospital, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium
| | - Eric Van Marck
- Department of Pathology, Antwerp University Hospital, Edegem, Belgium
| | - Olivier Vanderveken
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Jan B Vermorken
- Department of Medical Oncology, Antwerp University Hospital, Wilrijkstraat 10, 2650, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Janssens A, Vos W, Van Holsbeke C, Van Schil P, Oostveen E, De Backer J, Carp L, Snoeckx A, De Backer W, van Meerbeeck JP. Estimation of post-operative forced expiratory volume by functional respiratory imaging. Eur Respir J 2014; 45:544-6. [DOI: 10.1183/09031936.00168314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Van Schil PE, Hendriks JM, Carp L, Lauwers PR. Surgery for oligometastatic disease in non-small-cell lung cancer. Expert Rev Anticancer Ther 2014; 8:1931-8. [DOI: 10.1586/14737140.8.12.1931] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Waele MD, Hendriks J, Lauwers P, Hertoghs M, Carp L, Salgado R, Van Schil P. Restaging the mediastinum in non-small cell lung cancer after induction therapy: non-invasive versus invasive procedures. Acta Chir Belg 2011; 111:161-4. [PMID: 21780523 DOI: 10.1080/00015458.2011.11680728] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Nodal status after induction therapy in patients with stage III non-small cell lung cancer (NSCLC) is an independent prognostic factor for survival. Prognosis is poor in patients with persisting mediastinal lymph node involvement. METHODS From February 2000 to September 2007, restaging for NSCLC was performed in 25 patients (23 men, 2 women) by computed tomography (CT), positron emission tomography (PET) as well as repeat mediastinoscopy. Initial proof of N2 or N3 disease was obtained by mediastinoscopy. RESULTS The non-invasive restaging modalities CT and PET had a rather low accuracy of 64% and 72%, respectively. Repeat mediastinoscopy performed better with an accuracy of 84%. CONCLUSION Histological proof of mediastinal involvement after induction therapy in NSCLC is necessary to select those patients who will benefit from surgical resection. When a first mediastinoscopy has been performed to obtain pathological proof of N2 or N3 disease, repeat mediastinoscopy proves to be more accurate than CT or PET scanning for mediastinal restaging.
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Affiliation(s)
- M. De Waele
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - J. Hendriks
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - P. Lauwers
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - M. Hertoghs
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
| | - L. Carp
- Departments of Nuclear Medicine, Edegem, Belgium
| | - R. Salgado
- Departments of Radiology,Antwerp University Hospital, Edegem, Belgium
| | - P. Van Schil
- Departments of Thoracic and Vascular Surgery, Edegem, Belgium
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Lauwers P, Van den Broeck S, Carp L, Hendriks J, Van Schil P, Blockx P. The Use of Positron Emission Tomography With (18)F-Fluorodeoxyglucose for the Diagnosis of Vascular Graft Infection. Angiology 2007; 58:717-24. [DOI: 10.1177/0003319707299205] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Vascular graft infection is associated with a high morbidity and mortality rate. Diagnosis is difficult, as there is no single diagnostic criterion that has a 100% accuracy. A combination of physical examination, laboratory tests, and several imaging techniques is mandatory. Beside a wide range of indications in the oncological field, positron emission tomography with (18)F-fluorodeoxyglucose (FDG-PET) has a well-known role in the diagnosis of bone and soft-tissue infections. Some authors have recently reported on the potential use of FDG-PET in the diagnosis of vascular graft infections. The aim of this study is to review personal experience. Five consecutive patients with a suspected prosthetic infection (1 aortobifemoral bypass, 3 femoropopliteal bypasses, and 1 femorofemoral bypass) underwent FDG-PET. All prostheses showed a moderate or intense FDG tracer uptake. All 3 patients with an intense FDG uptake proved to have a prosthetic infection (based on microbiologic examination). These preliminary results suggest that FDG-PET might be an interesting tool to confirm vascular graft infection.
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Affiliation(s)
- Patrick Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium,
| | - Sylvie Van den Broeck
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, University Hospital of Antwerp, Edegem, Belgium
| | - Jeroen Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Paul Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - Pierre Blockx
- Department of Nuclear Medicine, University Hospital of Antwerp, Edegem, Belgium
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Helleman JN, Hendriks JMH, Deblier I, Tran VT, Bouhouch A, Carp L, Lauwers P, Van Schil P. Mycotic aneurysm of the descending thoracic aorta. Review and case report. Acta Chir Belg 2007; 107:544-7. [PMID: 18074916 DOI: 10.1080/00015458.2007.11680119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A 74-year-old male presented with bilateral invalidating claudication. A bilateral percutaneous transluminal angioplasty (PTA) with stenting of both superficial femoral arteries was performed but complicated by an urosepsis with Escherichia coli and a septic phlebitis at the site of an intravenous line. The phlebitis was complicated by a local abcedation for which incision and drainage were performed. One month after discharge he was readmitted at our hospital with septic fever and positive hemocultures for Escherichia coli. Positron emission tomography-computed tomographic scan (PET/CT-scan) showed a mycotic aneurysm of the thoracic aorta. Because no cryopreserved donor aorta was available and the aneurysm size rapidly increased, an open in situ repair was performed with a Dacron silver prosthesis soaked in rifampicin. His recovery was further complicated by a perforated toxic megacolon for which a subtotal colectomy was performed. Further recovery was uncomplicated and 10 months after the aortic repair patient is still free from infection.
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Affiliation(s)
- J. N. Helleman
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - J. M. H. Hendriks
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - I. Deblier
- Department of Cardiac Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - V. T. Tran
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - A. Bouhouch
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - L. Carp
- Department of Nuclear Medicine, University Hospital of Antwerp, Edegem, Belgium
| | - P. Lauwers
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
| | - P. Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Edegem, Belgium
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Salgado RA, Corthouts R, Parizel PM, Germonpré P, Carp L, Van Schil P, Van Marck E. Malignant pleural mesothelioma with heterologous osteoblastic elements: computed tomography, magnetic resonance, and positron emission tomography imaging characteristics of a rare tumor. J Comput Assist Tomogr 2005; 29:653-6. [PMID: 16163037 DOI: 10.1097/01.rct.0000174028.06600.53] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The imaging findings of a rare mixed type of malignant mesothelioma of the pleura with heterologous bone stroma in a patient without a previous history of asbestos exposure are reported. Imaging findings of this type of bone-forming pleural mesothelioma are scarcely reported in the literature, with only a few case reports describing findings on conventional radiography, computed tomography, and magnetic resonance imaging. To the best of our knowledge, no positron emission tomography imaging characteristics of this type of mesothelioma have been previously reported.
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Affiliation(s)
- Rodrigo A Salgado
- Department of Radiology, University Hospital of Antwerp, Edegem, Belgium.
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De Waele M, Carp L, Lauwers P, Hendriks J, De Maeseneer M, Van Schil P, Blockx P. Paravertebral schwannoma with high uptake of fluorodeoxyglucose on positron emission tomography. Acta Chir Belg 2005; 105:537-8. [PMID: 16315843 DOI: 10.1080/00015458.2005.11679777] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
A paravertebral mass was discovered in a 27-year-old woman, while investigating a painful shoulder and arm. CT, MRI and fine needle aspiration cytology (FNAC) pointed in the direction of a benign mass, but positron emission tomography (PET) showed a high uptake of [(18)F]fluorodeoxyglucose (FDG), which was indicative of a malignant lesion. Pathological analysis of the thoracoscopically resected tumour gave us the final diagnosis of a benign schwannoma. This report demonstrates that a high uptake of FDG in a non-malignant mediastinal tumour is possible.
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Affiliation(s)
- M De Waele
- Departments of Thoracic and Vascular surgery, University Hospital of Antwerp, Edegem, Belgium.
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Tjalma WAA, Carp L, De Beeck BO. False-positive positron emission tomographic scan and computed tomography for recurrent vaginal cancer: pitfalls of modern imaging techniques. Gynecol Oncol 2004; 92:726-8. [PMID: 14766276 DOI: 10.1016/j.ygyno.2003.10.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2003] [Indexed: 11/19/2022]
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Van Schil P, van der Schoot J, Poniewierski J, Pauwels M, Carp L, Germonpré P, De Backer W. Remediastinoscopy after neoadjuvant therapy for non-small cell lung cancer. Lung Cancer 2002; 37:281-5. [PMID: 12234697 DOI: 10.1016/s0169-5002(02)00101-0] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite technical difficulties due to mediastinal fibrosis, remediastinoscopy can be a valuable tool in the restaging of non-small cell lung cancer after neoadjuvant therapy. The aim of our study was to evaluate the feasibility, sensitivity and accuracy of remediastinoscopy. From November 1994 to July 2001 we performed a remediastinoscopy in 27 patients after neoadjuvant therapy. Their age ranged from 35 to 80 years (mean 61.9+/-11.9). In all 27 patients it was possible to perform a remediastinoscopy without major technical difficulties and take biopsies of the lymph nodes that were initially invaded by tumour. Remediastinoscopy was positive in 11 patients (40.7%) and negative in 16 (59.3%). In the 11 patients with a positive remediastinoscopy a complete resection was not judged possible and therefore, an unnecessary thoracotomy was avoided. In four patients, remediastinoscopy turned out to be false negative. So, in our series, sensitivity was 73%, specificity 100% and accuracy 85%. The positive and negative predictive values were 100 and 75%, respectively. Previous mediastinoscopy is no contra-indication for a repeat one after neoadjuvant therapy. Although sensitivity and accuracy are lower than that of a first mediastinoscopy, remediastinoscopy is useful to select patients for surgical resection after induction therapy.
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Affiliation(s)
- P Van Schil
- Department of Thoracic and Vascular Surgery, University Hospital of Antwerp, Wilrijkstraat 10, B-2650 Edegem, (Antwerp), Belgium.
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Affiliation(s)
- Ivan Huyghe
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
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Huyghe I, Carp L, De Bondt P, Blockx P. Intra-arterial injection of Tc-99m mimicking reflex sympathetic dystrophy (RSD). Clin Nucl Med 2001; 26:803. [PMID: 11507313 DOI: 10.1097/00003072-200109000-00024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Carp L, De Bondt P, Van Schil P, Blockx P. Ventilation scintigraphy for the detection of bronchopleural fistulae. Eur J Nucl Med 1999; 26:1379-80. [PMID: 10681177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
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Shivalkar B, Engelmann I, Carp L, De Raedt H, Daelemans R. Shoshin syndrome: two case reports representing opposite ends of the same disease spectrum. Acta Cardiol 1998; 53:195-9. [PMID: 9842404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Thiamine deficiency can have cardiovascular and neurological manifestations. Cardiac beriberi is classically thought to represent a high-output state with oliguria and lactic acidosis. The condition can, however, also present itself with a low cardiac output and fulminant vascular collapse, or as an acute fatal form, causing sudden death, without clear-cut signs of cardiomegaly. In the western society beriberi is mainly encountered in alcoholics. We report on two cases, one with high-output failure and the other with low-output failure and cardiovascular collapse. In both patients the diagnosis of shoshin syndrome was made, and and both showed a spectacular improvement of congestive heart failure symptoms after treatment with thiamine. A therapeutic trial with thiamine is the only way to rapid diagnosis.
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Affiliation(s)
- B Shivalkar
- Department of Cardiology K.U. Leuven, Belgium
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Carp L. George Gershwin-illustrious American composer: his fatal glioblastoma. Am J Surg Pathol 1979; 3:473-8. [PMID: 231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Carp L. A discussion of ganglia. J Am Podiatry Assoc 1972; 62:60-4. [PMID: 5009684 DOI: 10.7547/87507315-62-2-60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Mihail C, Carp L, Fotiade-Popescu G. [Temporary prosthesis as a developed means in stomatologic therapy]. Stomatologia (Bucur) 1969; 16:141-6. [PMID: 5254262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Carp L. Basic Principles in Geriatric Surgery. Ann Surg 1946; 123:1101-10. [PMID: 17858802 PMCID: PMC1803560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
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