1
|
Gennari A, Brain E, De Censi A, Nanni O, Wuerstlein R, Frassoldati A, Cortes J, Rossi V, Palleschi M, Alberini JL, Matteucci F, Piccardo A, Sacchetti G, Ilhan H, D'Avanzo F, Ruffilli B, Nardin S, Monti M, Puntoni M, Fontana V, Boni L, Harbeck N. Early prediction of endocrine responsiveness in ER+/HER2-negative metastatic breast cancer (MBC): Pilot study with 18F-Fluoroestradiol (18F-FES) CT/PET. Ann Oncol 2024:S0923-7534(24)00057-7. [PMID: 38423389 DOI: 10.1016/j.annonc.2024.02.007] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 01/15/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND 18F-FES PET/CT is considered an accurate diagnostic tool to determine whole-body endocrine responsiveness. In the ET-FES trial, we evaluated 18F-FES PET/CT as a predictive tool in ER+/HER2- metastatic breast cancer (MBC). METHODS Eligible patients underwent a 18F-FES PET/CT at baseline. Patients with SUV≥2 received single agent ET until PD; patients with SUV<2 were randomized to single agent ET (Arm A) or chemotherapy (CT) (Arm B). Primary objective was to compare the activity of first line ET versus CT in patients with 18F-FES SUV <2. RESULTS Overall, 147 patients were enrolled; 117 presented with 18F-FES SUV≥2 and received ET; 30 pts with SUV<2 were randomized to ET or CT. After a median follow up of 62.4 months, 104 patients (73.2%) had disease progression and 53 died (37.3%). Median PFS was 12.4 months (95%CI 3.1-59.6) in patients with SUV <2 randomised to Arm A versus 23.0 months (95%CI 7.7-30.0) in Arm B, (HR = 0.71, 95%CI 0.3 - 1.7); median PFS was 18.0 months (95%CI 11.2-23.1) in patients with SUV≥2 treated with ET. Median OS was 28.2 months (95%CI 14.2-NE) in patients with SUV <2 randomized to ET (Arm A) versus 52.8 months (95%CI 16.2-NE) in Arm B (CT). Median OS was not reached in patients with SUV≥2. 60-month OS rate was 41.6% (95%CI 10.4-71.1%) in Arm A, 42.0% (95%CI 14.0-68.2%) in Arm B and 59.6% (95%CI 48.6-69.0%) in patients with SUV≥2. In patients with SUV≥2, 60-months OS rate was 72.6% if treated with aromatase inhibitors versus 40.6% in case of fulvestrant or tamoxifen (p<0.005). CONCLUSIONS The ET-FES trial demonstrated that ER+/HER2- MBC patients are a heterogeneous population, with different levels of endocrine responsiveness based on 18F-FES CT/PET SUV.
Collapse
Affiliation(s)
- A Gennari
- Department of Traslational Medicine, University of Piemonte Orientale, Novara, Italy;; Division of Medical Oncology, Maggiore University Hospital, Novara, Italy.
| | - E Brain
- Department of Medical Oncology, Institut Curie - Hôpital René Huguenin, Saint-Cloud, France
| | - A De Censi
- Medical Oncology, E.O. "Ospedali Galliera, Genova, Italy
| | - O Nanni
- Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - R Wuerstlein
- Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
| | - A Frassoldati
- Clinical Oncology, S. Anna University Hospital, Ferrara, Italy
| | - J Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Barcelona, Spain; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - V Rossi
- Division of Medical Oncology, Maggiore University Hospital, Novara, Italy
| | - M Palleschi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - J L Alberini
- Nuclear Medicine Department Centre Georges-Francois Leclerc, Dijon Cedex, France
| | - F Matteucci
- Nuclear Medicine Unit, IRCCS Istituto Romagnolo per lo studio dei tumori (IRST)- Dino Amadori, Meldola, Italy
| | - A Piccardo
- Department of Nuclear Medicine, E.O. "Ospedali Galliera, Genova, Italy
| | - G Sacchetti
- Division of Nuclear Medicine Unit, Maggiore University Hospital, Novara, Italy
| | - H Ilhan
- Department of Nuclear Medicine, LMU University Hospital, Munich, Germany
| | - F D'Avanzo
- Division of Medical Oncology, Maggiore University Hospital, Novara, Italy
| | - B Ruffilli
- Department of Traslational Medicine, University of Piemonte Orientale, Novara, Italy
| | - S Nardin
- Medical Oncology Unit 1, IRCCS - Ospedale Policlinico San Martino, Genoa, Italy
| | - M Monti
- Biostatistics and Clinical Trials Unit, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - M Puntoni
- Clinical and Epidemiological Research Unit, University Hospital of Parma, Parma, Italy
| | - V Fontana
- Department of Clinical Epidemiology, IRCSS Ospedale Policlinico San Martino, Genoa 20900, Italy
| | - L Boni
- Department of Clinical Epidemiology, IRCSS Ospedale Policlinico San Martino, Genoa 20900, Italy
| | - N Harbeck
- Department of Obstetrics and Gynecology and CCC Munich, LMU University Hospital, Munich, Germany
| |
Collapse
|
2
|
Clement SC, Visser WE, Lebbink CA, Albano D, Claahsen-van der Grinten HL, Czarniecka A, Dias RP, Dierselhuis MP, Dzivite-Krisane I, Elisei R, Garcia-Burillo A, Izatt L, Kanaka-Gantenbein C, Krude H, Lamartina L, Lorenz K, Luster M, Navardauskaitė R, Negre Busó M, Newbold K, Peeters RP, Pellegriti G, Piccardo A, Priego AL, Redlich A, de Sanctis L, Sobrinho-Simões M, van Trotsenburg ASP, Verburg FA, Vriens M, Links TP, Ahmed SF, van Santen HM. Development of a pediatric differentiated thyroid carcinoma registry within the EuRRECa project: rationale and protocol. Endocr Connect 2023; 12:e220306. [PMID: 37931414 PMCID: PMC9986407 DOI: 10.1530/ec-22-0306] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 01/10/2023] [Indexed: 10/06/2023]
Abstract
Background Although differentiated thyroid carcinoma (DTC) is the most frequent endocrine pediatric cancer, it is rare in childhood and adolescence. While tumor persistence and recurrence are not uncommon, mortality remains extremely low. Complications of treatment are however reported in up to 48% of the survivors. Due to the rarity of the disease, current treatment guidelines are predominantly based on the results of small observational retrospective studies and extrapolations from results in adult patients. In order to develop more personalized treatment and follow-up strategies (aiming to reduce complication rates), there is an unmet need for uniform international prospective data collection and clinical trials. Methods and analysis The European pediatric thyroid carcinoma registry aims to collect clinical data for all patients ≤18 years of age with a confirmed diagnosis of DTC who have been diagnosed, assessed, or treated at a participating site. This registry will be a component of the wider European Registries for Rare Endocrine Conditions project which has close links to Endo-ERN, the European Reference Network for Rare Endocrine Conditions. A multidisciplinary expert working group was formed to develop a minimal dataset comprising information regarding demographic data, diagnosis, treatment, and outcome. We constructed an umbrella-type registry, with a detailed basic dataset. In the future, this may provide the opportunity for research teams to integrate clinical research questions. Ethics and dissemination Written informed consent will be obtained from all participants and/or their parents/guardians. Summaries and descriptive analyses of the registry will be disseminated via conference presentations and peer-reviewed publications.
Collapse
Affiliation(s)
- S C Clement
- Department of Pediatrics, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
| | - W E Visser
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - C A Lebbink
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - D Albano
- Department of Nuclear Medicine, University of Brescia and Spedali Civili of Brescia, Brescia, Italy
| | - H L Claahsen-van der Grinten
- Department of Pediatrics, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - A Czarniecka
- The Oncologic and Reconstructive Surgery Clinic, M. Sklodowska-Curie National Research Institute of Oncology Gliwice Branch, Gliwice, Poland
| | - R P Dias
- Department of Endocrinology and Diabetes, Birmingham Children’s Hospital, Birmingham Women’s, and Children’s NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - M P Dierselhuis
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - I Dzivite-Krisane
- Department of Pediatric Endocrinology, Children's Clinical University Hospital, Riga, Latvia
| | - R Elisei
- Endocrine Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - A Garcia-Burillo
- Nuclear Medicine Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - L Izatt
- Department of Clinical Genetics, Guy's and St Thomas’ NHS Foundation Trust, London, UK
| | - C Kanaka-Gantenbein
- Division of Endocrinology, Diabetes, and Metabolism, First Department of Pediatrics National and Kapodistrian University of Athens Medical School, Aghia Sophia Children's Hospital, Athens, Greece
| | - H Krude
- Institute of Experimental Pediatric Endocrinology, Charité - Universitätsmedizin, Berlin, Germany
| | - L Lamartina
- Department of Endocrine Oncology, Gustave Roussy, Villejuif, France
| | - K Lorenz
- Department of Visceral, Vascular and Endocrine Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - M Luster
- Department of Nuclear Medicine, University Hospital Marburg, Marburg, Germany
| | - R Navardauskaitė
- Department of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - M Negre Busó
- Nuclear Medicine Service - Institut de diagnòstic per la Imatge, Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
| | - K Newbold
- Thyroid Therapy Unit, The Royal Marsden NHS Foundation Trust Hospital, London, UK
| | - R P Peeters
- Academic Center For Thyroid Disease, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - G Pellegriti
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
| | - A Piccardo
- Department of Nuclear Medicine, EO Ospedali Galliera, Genoa, Italy
| | - A L Priego
- Department of Medicine, Division of Endocrinology, Leiden, University medical Center, Leiden, The Netherlands
| | - A Redlich
- Pediatric Oncology Department, Otto von Guericke University Children's Hospital, Magdeburg, Germany
| | - L de Sanctis
- Regina Margherita Children Hospital - Department of Public Health and Pediatric Sciences, University of Torino, Torino, Italy
| | - M Sobrinho-Simões
- University Hospital of São João, Medical Faculty and Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
| | - A S P van Trotsenburg
- Department of Pediatric Endocrinology, Emma Children’s Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - F A Verburg
- Department of Radiology & Nuclear Medicine, Erasmus MC Rotterdam, Rotterdam, The Netherlands
| | - M Vriens
- Department of Endocrine Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - T P Links
- Department of Endocrinology, University Medical Center Groningen, Groningen, The Netherlands
| | - S F Ahmed
- Endocrinology, Endocrinology Division, Garibaldi-Nesima Medical Center, Catania, Italy
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow, Glasgow, UK
- Office for Rare Conditions, University of Glasgow, Glasgow, UK
| | - H M van Santen
- Department of Pediatric Endocrinology, Wilhelmina Children’s Hospital/ University Medical Center Utrecht, Utrecht, The Netherlands
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| |
Collapse
|
3
|
Tricard J, Chermat A, Abdelkafi E, Piccardo A. Giant intracardiac medullary thyroid cancer metastasis. J Card Surg 2022; 37:5455-5456. [PMID: 36423260 DOI: 10.1111/jocs.17162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 09/19/2022] [Accepted: 10/10/2022] [Indexed: 11/25/2022]
Abstract
We report an unusual case of giant intracardiac medullary thyroid cancer metastasis. A 76-year-old woman with a 9-year history of medullary thyroid cancer presented an unexpected 7.5 cm mass in the right ventricle. Complete resection and tricuspid valve replacement led to 40 months survival.
Collapse
Affiliation(s)
- Jérémy Tricard
- Department of Cardiac and Thoracic Surgery, University Hospital of Limoges, Limoges, France
| | - Anaëlle Chermat
- Department of Cardiac and Thoracic Surgery, University Hospital of Limoges, Limoges, France
| | - Ezedin Abdelkafi
- Department of Cardiac and Thoracic Surgery, University Hospital of Limoges, Limoges, France
| | - Alessandro Piccardo
- Department of Cardiac and Thoracic Surgery, University Hospital of Limoges, Limoges, France
| |
Collapse
|
4
|
Foppiani L, Dezzana M, Del Monte P, Piccardo A. Coexistencia inusual de metástasis tiroidea de inicio tardío de carcinoma renal e hiperparatiroidismo primario: hallazgos en estudio con 18F-colina PET/TC y 18F-FDG PET/TC. Rev Esp Med Nucl Imagen Mol 2022. [DOI: 10.1016/j.remn.2021.09.006] [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]
|
5
|
Gennari A, Brain E, Nanni O, Harbeck N, Cortés J, De Censi A, Piccardo A, Alberini J, Matteucci F, Sacchetti G, Ilhan H, Monti M, Wuerlestein R, Saggia C, Rossi V, D'Avanzo F, Maggiora P, Iacozzi M, Frassoldati A, Boni L. 221P Early prediction of efficacy of endocrine therapy (ET) in metastatic breast cancer (MBC): Pilot study with [18F]fluoro-estradiol-17β (18F-FES) PET/CT. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.260] [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: 11/01/2022] Open
|
6
|
Scappaticcio L, Maiorino MI, Iorio S, Camponovo C, Piccardo A, Bellastella G, Docimo G, Esposito K, Trimboli P. Thyroid surgery during the COVID-19 pandemic: results from a systematic review. J Endocrinol Invest 2022; 45:181-188. [PMID: 34282552 PMCID: PMC8288414 DOI: 10.1007/s40618-021-01641-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE During the COVID-19 pandemic, elective thyroid surgery is experiencing delays. The problem is that the COVID-19 pandemic is ongoing. The research purposes were to systematically collect the literature data on the characteristics of those thyroid operations performed and to assess the safety/risks associated with thyroid surgery during the COVID-19 pandemic. METHODS We used all the procedures consistent with the PRISMA guidelines. A comprehensive literature in MEDLINE (PubMed) and Scopus was made using ''Thyroid'' and "coronavirus" as search terms. RESULTS Of a total of 293 articles identified, 9 studies met the inclusion criteria. The total number of patients undergoing thyroid surgery was 2217. The indication for surgery was malignancy in 1347 cases (60.8%). Screening protocols varied depending on hospital protocol and maximum levels of personal protection equipment were adopted. The hospital length of stay was 2-3 days. Total thyroidectomy was chosen for 1557 patients (1557/1868, 83.4%), of which 596 procedures (596/1558, 38.3%) were combined with lymph node dissections. Cross-infections were registered in 14 cases (14/721, 1.9%), of which three (3/721, 0.4%) with severe pulmonary complications of COVID-19. 377 patients (377/1868, 20.2%) had complications after surgery, of which 285 (285/377, 75.6%) hypoparathyroidism and 71 (71/377, 18.8%) recurrent laryngeal nerve injury. CONCLUSION The risk of SARS-CoV-2 transmission after thyroid surgery is relatively low. Our study could promote the restart of planned thyroid surgery due to COVID-19. Future studies are warranted to obtain more solid data about the risk of complications after thyroid surgery during the COVID-19 era.
Collapse
Affiliation(s)
- L. Scappaticcio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - M. I. Maiorino
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - S. Iorio
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
| | - C. Camponovo
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - A. Piccardo
- Department of Nuclear Medicine, E.O. Ospedali Galliera, Genoa, Italy
| | - G. Bellastella
- Division of Endocrinology and Metabolic Diseases, University of Campania “L. Vanvitelli”, 80138 Naples, Italy
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - G. Docimo
- Division of Thyroid Surgery, University of Campania “L. Vanvitelli”, Naples, Italy
| | - K. Esposito
- Department of Medical and Advanced Surgical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - P. Trimboli
- Clinic for Endocrinology and Diabetology, Lugano Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| |
Collapse
|
7
|
Trimboli P, Knappe L, Treglia G, Ruberto T, Piccardo A, Ceriani L, Paone G, Giovanella L. FNA indication according to ACR-TIRADS, EU-TIRADS and K-TIRADS in thyroid incidentalomas at 18F-FDG PET/CT. J Endocrinol Invest 2020; 43:1607-1612. [PMID: 32270410 DOI: 10.1007/s40618-020-01244-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/29/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Focal thyroid incidentaloma (TI) occurs in a 2% of 18F-FDG PET/CT and about one-third of TIs is cancer. Due to the lack of evidence on the optimal management of TI, current guidelines suggest performing fine-needle aspiration cytology (FNA). The study aim was to evaluate the reliability of ACR-TIRADS, EU-TIRADS, and K-TIRADS in indicating FNA in TIs. DESIGN We retrospectively reviewed 18F-FDG PET/CT TIs recorded during the period 2016-2019. Enrolled were TIs with histologic outcome and autonomous nodules. Cases with uncertain matching between 18F-FDG PET/CT, US/scintiscan and histology were excluded. RESULTS Eighty TIs at 18F-FDG PET/CT (median size 17 mm, median SUVmax 7.85) were included; a 26.2% was cancer. The percentage of nodules classified as high risk according to ACR-TIRADS, EU-TIRADS, and K-TIRADS was 20%, 30%, and 29.8%, respectively. The cancer prevalence in high-risk class was 56.2%, 66.7%, and 65.2% in ACR-TIRADS, EU-TIRADS, and K-TIRADS, respectively. ACR-TIRADS had the lowest number of cases with FNA indication (48%) and the K-TIRADS, the highest one (75%). Evaluating the reliability of the three systems in indicating FNA, we found a 100% sensitivity and NPV for EU-TIRADS and K-TIRADS; while all the three systems showed poor specificity and PPV. CONCLUSION All TIRADSs were reliable to stratify the risk of cancer in focal TI. Comparing their reliability in indicating FNA, we found a good performance of EU-TIRADS and K-TIRADS. Considering the high cancer percentage expected in this setting of patients, those TIRADS with higher propensity to indicate FNA should be preferred.
Collapse
Affiliation(s)
- P Trimboli
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | - L Knappe
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - G Treglia
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Department of Nuclear Medicine and Molecular Imaging, Lausanne University Hospital, Lausanne, Switzerland
- Health Technology Assessment Unit, Academic Education, Research and Innovation Area, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - T Ruberto
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy
| | - L Ceriani
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - G Paone
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.
| | - L Giovanella
- Clinic for Nuclear Medicine and Competence Center for Thyroid Diseases, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Clinic for Nuclear Medicine, University Hospital and University of Zurich, Zurich, Switzerland
| |
Collapse
|
8
|
Tholance Y, Tricard J, Chianea T, Marquet P, Ponsonnard S, Sturtz F, Piccardo A, Gauthier T. Metabolic alterations of uterine grafts after extended cold ischemic storage: experimental study in ewes. Mol Hum Reprod 2020; 25:647-659. [PMID: 31323687 DOI: 10.1093/molehr/gaz041] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 06/06/2019] [Accepted: 07/10/2019] [Indexed: 01/14/2023] Open
Abstract
Uterine transplantation from a deceased donor could become an available option for widely treating uterine infertility. However, this procedure requires more precise knowledge about the graft's tolerance to extended cold ischemia. Here, we sought to assess the uterine metabolic alterations after extended cold ischemic storage in a model of auto-transplantation in ewe. A total of 14 uterine auto-transplantations were performed, divided into 2 groups: 7 after 3 h of cold ischemia time (CIT) and 7 after 24 h. Venous uterine blood was collected before uterus retrieval and during reperfusion (30, 60 and 90 min); thereafter, blood gases, lactate, glucose and amino acids (AAs) were analyzed. Apoptosis analyses were performed before uterus retrieval and following reperfusion in uterus biopsies. A total of 12 uterine auto-transplantations were successfully performed and 7 ewes were alive ≥8 days after transplantation. After reperfusion, a decrease in pH, a rise of lactate and lactate/glucose ratio and a delayed decrease of pO2 were found in the 3 h CIT group. No significant variation of these parameters was observed in the 24 h CIT group. Significant decreases of AAs were observed during reperfusion and these decreases were more pronounced and concerned a larger number of compounds in the 24 h CIT group than in the 3 h CIT group. There was no significant uterine apoptotic signal in either group. Overall, these results suggest that extended CIT storage delayed restoration of aerobic glycolysis and induced an increase in AA requirements of the uterus after reperfusion. However, this biochemical alteration did not reduce success rate for uterine transplantation.
Collapse
Affiliation(s)
- Yannick Tholance
- Department of Biochemistry and Molecular Genetics, Dupuytren University Hospital, F-87000 Limoges, France.,Synaptopathies and Autoantibodies, Institut NeuroMyoGene Institut national de la santé et de la recherche médicale (INSERM) U1217/Centre national de la recherche scientifique (CNRS) Unités Mixtes de Recherche (UMR) 5310, University of Lyon, University Jean-Monnet, F-42270 Saint-Priest-en-Jarez, France
| | - Jeremy Tricard
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, F-87000 Limoges, France.,Individual Profiling and Prevention of Risks with Immunosuppressive Therapies and Transplantation, UMR 1248 INSERM, School of Medicine, University of Limoges, F-87000 Limoges, France
| | - Thierry Chianea
- Department of Biochemistry and Molecular Genetics, Dupuytren University Hospital, F-87000 Limoges, France
| | - Pierre Marquet
- Individual Profiling and Prevention of Risks with Immunosuppressive Therapies and Transplantation, UMR 1248 INSERM, School of Medicine, University of Limoges, F-87000 Limoges, France.,Department of Pharmacology and Toxicology, Dupuytren University Hospital, F-87000 Limoges, France
| | | | - Franck Sturtz
- Department of Biochemistry and Molecular Genetics, Dupuytren University Hospital, F-87000 Limoges, France.,EA 6309-Myelin Maintenance and Peripheral Neuropathies, School of Medicine, University of Limoges, F-87000 Limoges, France
| | - Alessandro Piccardo
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, F-87000 Limoges, France
| | - Tristan Gauthier
- Individual Profiling and Prevention of Risks with Immunosuppressive Therapies and Transplantation, UMR 1248 INSERM, School of Medicine, University of Limoges, F-87000 Limoges, France.,Department of Gynecology and Obstetrics, Dupuytren University Hospital, F-87000 Limoges, France
| |
Collapse
|
9
|
Tiquet B, Blossier JD, Orsel I, Pihan F, Piccardo A, Marsaud JP, Vandroux D. Short-Term Outcomes After Off-Pump or On-Pump Coronary Artery Bypass Grafting in the Octogenarian Patients. J Cardiothorac Vasc Anesth 2019; 33:2100-2102. [PMID: 31060936 DOI: 10.1053/j.jvca.2019.03.053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 03/24/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Bérénice Tiquet
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Jean David Blossier
- Department of Cardiothoracic Surgery, Academic Teaching Hospital of Limoges, Limoges, France
| | - Isabelle Orsel
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Frank Pihan
- Department of Anesthesiology, Academic Teaching Hospital of Limoges, Limoges, France
| | - Alessandro Piccardo
- Department of Cardiothoracic Surgery, Academic Teaching Hospital of Limoges, Limoges, France
| | | | - David Vandroux
- Cardio-Surgical Intensive Care Unit, Academic Teaching Hospital of Limoges, Limoges, France
| |
Collapse
|
10
|
Le Bivic L, Magne J, Blossier JD, Piccardo A, Wojtyna H, Lacroix P, Mohty D, Cornu E, Le Guyader A, Aboyans V. Mid- and long-term prognosis of off- vs. on-pump coronary artery bypass graft in patients with multisite artery disease. J Cardiovasc Surg (Torino) 2018; 60:388-395. [PMID: 30465418 DOI: 10.23736/s0021-9509.18.10697-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Among patients with coronary artery disease (CAD), around 25% have multisite artery disease (MSAD). Patients with CAD and MSAD are at higher risk of peri-operative and long-term cardiovascular events. Whether off-pump coronary bypass grafting (CABG) can improve their prognosis is unknown. We aimed to assess the benefits of off- vs. on-pump cardiac surgery in patients undergoing CABG, according to coexistence of extra-cardiac artery disease. METHODS Between April 1998 and September 2008, 1221 patients undergoing CABG without any other intervention were enrolled. Overall death and major cardiovascular events were recorded at 1-month and during long-term follow-up. A propensity score (PS), derived from all relevant variables (P<0.25) associated with on-pump as compared to off-pump CABG, and representing the likelihood for each individual patient to receive off-pump CABG, was calculated. RESULTS MSAD was observed in 279 patients (23%). Off-pump CABG was performed in 208 (17%) patients. The median follow-up was 7.6 years. The 10-year mortality was significantly lower in off- vs. on-pump CABG group (74±4% vs. 68±2%, P=0.024). In patients with MSAD, there was a trend for better survival for off- vs. on-pump CABG (63±8% vs. 50±4%, P=0.078). After adjustment for PS, we found no further difference between on- and off-pump CABG both in the whole cohort (HR=1.30, P=0.10), as well as in MSAD patients (HR=1.51, P=0.14). CONCLUSIONS Patients with MSAD receiving CABG are at worst prognostic than those with isolated CAD. In these patients, we found no significant difference in the long-term mortality and cardiovascular events between on- and off-pump CABG.
Collapse
Affiliation(s)
- Louis Le Bivic
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Julien Magne
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Jean-David Blossier
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Alessandro Piccardo
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Hélène Wojtyna
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Philippe Lacroix
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Dania Mohty
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Elisabeth Cornu
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Alexandre Le Guyader
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France.,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| | - Victor Aboyans
- CHU Limoges, Service of Cardiology, Dupuytren Hospital, Limoges, France - .,INSERM 1094, Faculty of Medicine, Limoges, France.,CHU Limoges, Service of Thoracic and Cardiovascular Surgery, Dupuytren Hospital, Limoges, France
| |
Collapse
|
11
|
Daix T, Guérin E, Tavernier E, Marsaud J, Hacan A, Gauthier F, Piccardo A, Vignon P, Feuillard J, François B. Immature Granulocytes: A Risk Factor of Infection after Cardiac Surgery. Cytometry 2018; 94:887-894. [DOI: 10.1002/cyto.b.21739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 08/06/2018] [Accepted: 09/06/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Thomas Daix
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
| | - Estelle Guérin
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Elsa Tavernier
- Inserm CIC1415, Tours Teaching HospitalFrançois Rabelais University Tours France
| | | | - Adélaïde Hacan
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
| | | | - Alessandro Piccardo
- Cardiothoracic and Vascular Surgery UnitDupuytren Teaching Hospital Limoges France
| | - Philippe Vignon
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
| | - Jean Feuillard
- Hematology LaboratoryDupuytren Teaching Hospital Limoges France
- Medicine University UMR CNRS 7276 Limoges France
| | - Bruno François
- Inserm CIC1435Dupuytren Teaching Hospital Limoges France
- Réanimation PolyvalenteDupuytren Teaching Hospital Limoges France
- UMR 1092Medicine University Limoges France
| |
Collapse
|
12
|
Bertin F, Deluche E, Tricard J, Piccardo A, Denes E. First case of sternum replacement with a bioceramic prosthesis after radio-induced sarcoma. ACTA ACUST UNITED AC 2018; 25:e351-e353. [PMID: 30111981 DOI: 10.3747/co.25.4020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 11/15/2022]
Abstract
Objectives To date, no "gold standard" technique has been developed for sternum replacement in cases of radioinduced sarcoma, which is a rare and aggressive disease. Current techniques rely on metallic prostheses, meshes, or bone grafts-procedures that that are associated with several complications. We therefore tried a new solution that might simplify and optimize this surgery. Methods We used a porous alumina ceramic prosthesis (Ceramil: i.ceram, Limoges, France) that has several interesting characteristics, such as osseointegration, biocompatibility, radiolucency, and high mechanical strength. Results We report the first case of sternal replacement surgery involving the implantation of a ceramic prosthesis after radio-induced sternal sarcoma. In 2005, a 54-year-old woman was diagnosed with local breast cancer for which she underwent all appropriate treatment. Ten years later, she developed radio-induced sarcoma of the sternum. A complete sternal replacement was performed on 24 April 2015, with no postoperative complications. Imaging by 18F-flurodeoxyglucose positron-emission tomography-computed tomography performed 26 months after the surgery showed no local recurrence. The patient seems to have fully recovered and has resumed normal activity. Conclusions This new technique is promising. For the first time, we highlight the feasibility, safety, and efficacy of sternal replacement using a porous alumina ceramic prosthesis.
Collapse
Affiliation(s)
- F Bertin
- Department of Cardiothoracic Surgery, University Hospital
| | - E Deluche
- Department of Medical Oncology, University Hospital, and
| | - J Tricard
- Department of Cardiothoracic Surgery, University Hospital
| | - A Piccardo
- Department of Cardiothoracic Surgery, University Hospital
| | | |
Collapse
|
13
|
Magne J, Serena C, Salerno B, Mohty D, Marsaud JP, Blossier JD, Piccardo A, Cornu E, Le Guyader A, Aboyans V. Which echocardiographic parameters improve the risk prediction for peri-operative outcomes in patients undergoing coronary bypass surgery: a prospective study. Eur Heart J Acute Cardiovasc Care 2018; 9:504-512. [PMID: 29629598 DOI: 10.1177/2048872618768004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the performance of transthoracic echocardiographic parameters to predict operative mortality and morbidity in patients undergoing coronary artery bypass grafting, and to assess its incremental prognostic value as compared to the Society of Thoracic Surgeons (STS) score. MATERIALS AND METHODS We prospectively collected the clinical and biological data required to calculate the STS score in patients hospitalised for coronary artery bypass grafting. Preoperative transthoracic echocardiography was performed for each patient. The primary endpoint was 30-day mortality or major morbidity (i.e. stroke, renal failure, prolonged ventilation, deep sternal wound infection, reoperation) as defined by the STS. The secondary endpoint was prolonged hospitalisation for over 14 days. RESULTS A total of 172 patients was included (mean age 66.1±10.2 years, 12.2% were women). The primary endpoint occurred in 33 patients (19.2%), and 28 patients (16.3%) had a prolonged hospital stay. Independent predictive factors for the primary endpoint were an increased left atrial volume (>31 mL/m²; odds ratio (OR) 3.55, 95% confidence interval (CI) 1.38-9.12; P=0.004) and a decreased tricuspid annular plane systolic excursion (<20 mm; OR 3.45, 95% CI 1.47-8.21; P=0.008). The predictive value of the multivariate model increased when the two echocardiographic parameters were added to the STS score (area under the curve 0.598 vs. 0.695, P=0.001; integrated discrimination improvement 7.44%). CONCLUSION In patients undergoing coronary artery bypass grafting, preoperative assessment of left atrial size and tricuspid annular plane systolic excursion should be performed systematically, as it provides additional prognostic information to the STS score.
Collapse
Affiliation(s)
- Julien Magne
- Service Cardiologie, CHU Limoges, France.,Faculté de médecine de Limoges, INSERM 1094, France
| | - Claire Serena
- Service d'Anesthésie-Réanimation, CHU Limoges, France
| | | | - Dania Mohty
- Service Cardiologie, CHU Limoges, France.,Faculté de médecine de Limoges, INSERM 1094, France
| | | | | | | | - Elisabeth Cornu
- Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU Limoges, France
| | | | - Victor Aboyans
- Service Cardiologie, CHU Limoges, France.,Faculté de médecine de Limoges, INSERM 1094, France
| |
Collapse
|
14
|
Trimboli P, Imperiali M, Piccardo A, CampennÌ A, Giordani I, Ruggeri RM, Baldari S, Orlandi F, Giovanella L. Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma. Clin Endocrinol (Oxf) 2018; 88:295-302. [PMID: 28960391 DOI: 10.1111/cen.13487] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 08/21/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 μg/L and 1.82 μg/L for Elecsys® and 0.36 μg/L and 1.62 μg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.
Collapse
Affiliation(s)
- P Trimboli
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M Imperiali
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - A Piccardo
- Department of Nuclear Medicine, Ente Ospedaliero "Ospedali Galliera", Genova, Italy
| | - A CampennÌ
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - I Giordani
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - R M Ruggeri
- Department of Clinical and Experimental Medicine, Endocrinology Unit, University of Messina, Messina, Italy
| | - S Baldari
- Department of Biomedical and Dental Science and Morpho-Functional Images, Nuclear Medicine Unit, University of Messina, Messina, Italy
| | - F Orlandi
- Department of Internal Medicine and Endocrinology, University of Torino, Torino, Italy
| | - L Giovanella
- Department of Nuclear Medicine and Thyroid Centre, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
- Department of Clinical Chemistry and Laboratory Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| |
Collapse
|
15
|
Abstract
CONTEXT: To date, there is no gold standard technique for sternum replacement. Current techniques rely on metallic prosthesis, meshes and bars, or bone grafts. However, they have several pitfalls. AIMS: The aim of this article is to report the results of sternal replacement with a porous alumina ceramic sternum. SETTINGS AND DESIGN: Surgeries were performed in two teaching hospitals in France. METHODS: We designed a porous alumina ceramic prosthesis which possesses interesting characteristics for this surgery such as great biocompatibility, a certain level of bacterial resistance, radiolucency, and compatibility with radiotherapy. The implant is stitched to the ribs with suture thread and does not require osteosynthesis material. RESULTS: Six patients with a mean age of 60.6 years received this prosthesis. Indication was tumor in five cases and mediastinitis in one case. The mean follow-up is 20 months (3–37 months). No major complication occurred and healing was fine for all patients. Patients did not complain of breathing discomfort or pain related to the prosthesis. CONCLUSIONS: This new technique is promising even if there are only six patients in this study.
Collapse
Affiliation(s)
- François Bertin
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
| | - Alessandro Piccardo
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
| | - Eric Denes
- Department of R and D, I.Ceram, Limoges, France
| | - Gonzagues Delepine
- Department of Cardiothoracic Surgery, Reims Teaching Hospital, Reims, France
| | - Jeremy Tricard
- Department of Cardiothoracic Surgery, Limoges Teaching Hospital, Limoges, France
| |
Collapse
|
16
|
Piccardo A, Puntoni M, Morbelli S, Bongioanni F, Paparo F, Altrinetti V, Gonella R, Gennari A, Iacozzi M, Sambuceti G, DeCensi A, Massollo M. 18F-FDG PET/CT is a prognostic biomarker in patients affected by bone metastases from breast cancer in comparison with 18F-NaF PET/CT. Nuklearmedizin 2017; 54:163-72. [DOI: 10.3413/nukmed-0727-15-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/26/2015] [Indexed: 01/18/2023]
Abstract
SummaryAim: To compare 18F-FDG PET/CT and 18F-NaF PET/CT with respect to disease prognostication and outcome in patients affected by bone metastases from breast cancer (BC). Patients, methods: We retrospectively investigated 32 women with BC and documented bone metastases. Semi-quantitative parameters were applied to 18F-FDG PET/CT and 18F-Na PET/CT in order to evaluate disease extent and tumour metabolism. We used time-to-event analyses (Kaplan Meier and COX proportional hazard methods) to estimate progression-free (PFS) and overall survival (OS) in order to assess the independent prognostic value of 18F-FDG PET/CT and 18F-Na PET/CT. Results: The sensitivity of 18F-NaF PET/CT (100%) was higher (p < 0.05) than that of 18F-FDG PET/CT (72% and 72%). None of the 18F-FDG PET/CT-negative patients showed disease progression at the end of follow-up. After adjustment for age, Ki-67 levels, presence of visceral metastases, hormone therapy, duration of bone disease and response to first-line therapy, only 18F-FDG SUV mean [HR 15.7, 95% confidence interval (CI) 1.15-214.5] and 18F-FDG whole-body bone metabolic burden (WB-B-MB) (HR 16.9; 95%CI 1.87-152.2) were independently and significantly associated with OS. None of the 18F-NaF PET/CT parameters were associated with OS. None of the conventional clinical prognostic parameters remained significantly associated with OS after the inclusion of PET/ CT parameters in the model. Conclusion: 18F-FDG PET/CT is independently associated with OS in BC patients with bone metastases and its prognostic impact seems to be higher than conventional clinical and biological prognostic factors. Although 18F-NaF PET/CT has a higher diagnostic sensitivity than 18F-FDG PET/ CT, it is not independently associated with OS.
Collapse
|
17
|
Guinot B, Magne J, Le Guyader A, Bégot E, Bourgeois A, Piccardo A, Marsaud JP, Mohty D, Aboyans V. Usefulness of Electrocardiographic Strain to Predict Survival After Surgical Aortic Valve Replacement for Aortic Stenosis. Am J Cardiol 2017; 120:1359-1365. [PMID: 28823481 DOI: 10.1016/j.amjcard.2017.06.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/15/2017] [Accepted: 06/30/2017] [Indexed: 11/28/2022]
Abstract
Electrocardiographic (ECG) strain has been reported as a specific marker of midwall left ventricular (LV) myocardial fibrosis, predictive of adverse clinical outcomes in aortic stenosis (AS), but its prognostic impact after aortic valve replacement (AVR) is unknown. We aimed to assess the impact of ECG strain on long-term mortality after surgical AVR for AS. From January 2005 to January 2014, patients with interpretable preoperative ECG who underwent isolated AVR for AS were included. ECG strain was defined as ≥1-mm concave downslopping ST-segment depression with asymmetrical T-wave inversion in lateral leads. Mortality was assessed over a follow-up period of 4.8 ± 2.7 years. Among the 390 patients included, 110 had ECG strain (28%). They had significantly lower body mass index, higher mean transaortic pressure gradient and Cornell-product ECG LV hypertrophy than in those without ECG strain. There was also a trend for lower LV ejection fraction in patients with ECG strain as compared with those without. Patients with ECG strain had significantly lower 8-year survival than those without. ECG strain remained associated with reduced survival both in patients with and without LV hypertrophy (p <0.0001 for both). After adjustment, ECG strain remained a strong and independent determinant of long-term survival (hazard ratio 4.4, p <0.0001). Similar results were found in patients with LV hypertrophy or without LV hypertrophy. In the multivariate model, the addition of ECG strain provided incremental prognostic value (p <0.0001). In conclusion, in patients with AS, ECG strain is associated with 4-fold increased risk of long-term mortality after isolated AVR, regardless of preoperative LV hypertrophy.
Collapse
Affiliation(s)
- Barthélémy Guinot
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France
| | - Julien Magne
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France; Faculté de médecine de Limoges, INSERM 1094, Limoges, France
| | | | - Emmanuelle Bégot
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France
| | - Antoine Bourgeois
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France
| | - Alessandro Piccardo
- Hôpital Dupuytren, Service de Chirurgie cardiaque, CHU Limoges, Limoges, France
| | | | - Dania Mohty
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France; Faculté de médecine de Limoges, INSERM 1094, Limoges, France
| | - Victor Aboyans
- Hôpital Dupuytren, Service Cardiologie, CHU Limoges, Limoges, France; Faculté de médecine de Limoges, INSERM 1094, Limoges, France.
| |
Collapse
|
18
|
Bertin F, Tricard J, Eveno C, Denes E, Piccardo A. P-159POROUS ALUMINA CERAMIC STERNUM AS AN OPTION FOR STERNAL REPLACEMENT: A REPORT OF 7 CASES. Interact Cardiovasc Thorac Surg 2017. [DOI: 10.1093/icvts/ivx280.159] [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: 11/15/2022] Open
|
19
|
Gennari A, Brain E, Nanni O, Muñoz Couselo E, Harbeck N, Geiss R, Rocca A, Cortés J, Degenhardt T, Piccardo A, Albérini JL, Matteucci F, Decensi A, Corradengo D, Andreis D, Marra D, Gebhart G, Brambati C, Amadori D, Bruzzi P. Molecular imaging with 18F-fluoroestradiol (18F-FES) to assess intra-patient heterogeneity in metastatic breast cancer (MBC): A European TRANSCAN program. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.030] [Citation(s) in RCA: 2] [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: 11/14/2022] Open
|
20
|
Aboyans V, Magne J, Guinot B, Bourgeois A, Piccardo A, Guyader AL, Mohty D. IMPACT OF RENIN-ANGIOTENSIN SYSTEM BLOCKERS ON LONG TERM SURVIVAL FOLLOWING ISOLATED AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35312-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
21
|
Magne J, Guinot B, Mohty D, Bourgeois A, Piccardo A, Guyader AL, Aboyans V. ELECTROCARDIOGRAPHIC STRAIN IS ASSOCIATED WITH REDUCED SURVIVAL AFTER SURGICAL AORTIC VALVE REPLACEMENT FOR AORTIC STENOSIS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35321-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
22
|
Brain E, Corradengo D, Oriana N, Piccardo A, Matteucci F, Cortes J, Harbeck N, Würstlein R, Piris A, Alberini JL, Merlo DF, Degenhardt T, Turbiez I, Madar O, Monti M, Cesaro A, Rivitti E, Rollandi GA, Iacozzi M, Campazzi E, Campora S, Camporese D, Gennari A. Abstract OT3-03-03: Challenges faced across borders to open European academic multicentre projects: The ET-FES program part of the ERA-Net TRANSCAN JTC 2011. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot3-03-03] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The activation of international non-profit clinical trials funded by the European Commission (EC) is challenging given the cross-borders regulations and the need to follow specific timelines according to EC rules. We report here the logistic procedures and challenges faced by 4 academic centres from 4 different countries from the European Union (EU) for the activation of such program in metastatic breast cancer (MBC).
Materials and Methods
The primary objective of the ET-FES program is to validate the use of a new radiotracer 18F Fluoroestradiol (FES), targeting estrogen receptors, as a tool to better predict endocrine responsiveness in MBC, with PET/CT. The trial is sponsored by EO Galliera (Genoa, Italy) and brings together Italy, Spain, France and Germany. In 10/2012, ET-FES was approved for funding from EC under the Seventh Framework Programme after the first ERA-NET TRANSCAN Joint Transnational Call (JTC) for Proposals (2011) on validation of new biomarkers for personalized cancer medicine.
Results
The official start of the program was set up on 06/2013 by the Italian Ministry of Health. Time to institutional review board and to competent authority (CA) approvals were 1.5 and 11, 2 and 5, 3 and 16, and 13 and 14+ months in Italy, France, Spain and Germany respectively. Overall, no blocking comment was raised by the ethical committees; only minor clinical and methodological issues were raised in Germany and Spain. Issues from CA were raised in all countries except France (12, 21 and 23 queries in Italy, Spain and Germany respectively), on quality aspects of 18F-FES investigational medicinal product dossier. At the sponsor level, time to final agreement signature with Advanced Accelerator Applications, the 18F-FES manufacturing company, required 13 months. First patient could be enrolled in Italy 14 and 22 months after ethical committee approval and after the official start of the ET-FES project respectively.
Conclusions
As of May 2016, of 310 patients expected, only 28 have been enrolled from Italy. From a regulatory viewpoint and acknowledging that 18F-FES does not have yet any marketing approval in the EU, the ET-FES program approval process was timely completed at the ethical committee level in Italy, France and Spain. Time to CA approval varied across countries and was timely achieved only in France, due to requirements varying from CA to CA, stressing the serious lack of harmonized procedures although intended by the 2001/20/EC directive. Regarding sponsor's responsibilities (i.e. Italy), the administrative procedures needed to activate this type of EU projects remain critical, appealing for more tolerant time span in order to satisfy all the legal aspects on contracts by public bodies, according to national rules and laws. One needs to be very conscious of these timelines when applying to EU/EC calls, especially when the time allowed for the conduction of research is limited (3 years here), unless jeopardizing the entire multicentre and multinational effort.
Citation Format: Brain E, Corradengo D, Oriana N, Piccardo A, Matteucci F, Cortes J, Harbeck N, Würstlein R, Piris A, Alberini J-L, Merlo DF, Degenhardt T, Turbiez I, Madar O, Monti M, Cesaro A, Rivitti E, Rollandi GA, Iacozzi M, Campazzi E, Campora S, Camporese D, Gennari A. Challenges faced across borders to open European academic multicentre projects: The ET-FES program part of the ERA-Net TRANSCAN JTC 2011 [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr OT3-03-03.
Collapse
Affiliation(s)
- E Brain
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - D Corradengo
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - N Oriana
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - A Piccardo
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - F Matteucci
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - J Cortes
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - N Harbeck
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - R Würstlein
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - A Piris
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - J-L Alberini
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - DF Merlo
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - T Degenhardt
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - I Turbiez
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - O Madar
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - M Monti
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - A Cesaro
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - E Rivitti
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - GA Rollandi
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - M Iacozzi
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - E Campazzi
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - S Campora
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - D Camporese
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| | - A Gennari
- Institut Curie / Hôpital René Huguenin, Saint-Cloud, France; E.O. Ospedali Galliera, Genova, Italy; IRCCS Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori - I.R.S.T., Meldola, Italy; Vall d´Hebrón Institute of Oncology, Barcelona, Spain; University of Munich, Frauenkliniken Maistrasse-Innenstadt und Großhadern, Münich, Germany; IRCCS Azienda Osp. Univ. San Martino- IST, Genova, Italy; IBSA Institut Biochimique SA, Lugano, Switzerland; Covance, Milano, Italy; Advanced Accelerator Applications AAA, St Genis Pouilly, France
| |
Collapse
|
23
|
Magne J, Salerno B, Mohty D, Serena C, Rolle F, Piccardo A, Echahidi N, Le Guyader A, Aboyans V. Echocardiography is useful to predict postoperative atrial fibrillation in patients undergoing isolated coronary bypass surgery: A prospective study. European Heart Journal: Acute Cardiovascular Care 2017; 8:104-113. [DOI: 10.1177/2048872616688419] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: Postoperative atrial fibrillation is a major complication following coronary artery bypass graft. We hypothesized that, beyond clinical and electrocardiogram (ECG) data, transthoracic echocardiography could improve the prediction of postoperative atrial fibrillation. Methods: We prospectively studied 169 patients in sinus rhythm who underwent isolated coronary artery bypass graft in our institution. Clinical, biological, ECG and transthoracic echocardiography data were collected within 24 h before surgery. The patients were continuously monitored during the first five days, and then had daily 12-lead ECG afterwards until discharge. Postoperative atrial fibrillation was defined by any episode >10 min. Results: Postoperative atrial fibrillation was found in 65 patients (38%). Compared with those without, patients with postoperative atrial fibrillation were significantly older ( p=0.008), had more frequently a history of hypertension ( p=0.009), history of atrial fibrillation ( p<0.001) and New York Heart Association class ⩾III ( p=0.004). They also had longer PR interval ( p=0.005), higher preoperative NT-pro brain natriuretic peptide level ( p=0.006), left ventricle end-diastolic volume ( p=0.002), indexed left ventricle mass ( p<0.0001), indexed maximal left atrial volume ( p<0.0001), maximal right atrial area ( p<0.001) and lower left ventricle ejection fraction ( p=0.04). In multivariate analysis, history of atrial fibrillation (odds ratio =6.1, 95% confidence interval: 1.4–26.0, p=0.02) and indexed maximal left atrial volume (odds ratio =1.13, 95% confidence interval: 1.1–1.2, p=0.001) were the only two independent predictive factors of postoperative atrial fibrillation. The addition of echocardiographic parameters improved the predictive value (χ2) of the model, from 34 to 57. Conclusion: A history of atrial fibrillation and indexed left atrial maximal volume are the best predictors of the occurrence of postoperative atrial fibrillation following coronary artery bypass graft. The identification of high risk population of postoperative atrial fibrillation using these two factors could lead to the development of targeted strategies to limit this frequent complication in these patients.
Collapse
Affiliation(s)
- Julien Magne
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, France
- INSERM 1094, Faculté de médecine de Limoges, France
| | | | - Dania Mohty
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, France
- INSERM 1094, Faculté de médecine de Limoges, France
| | - Claire Serena
- CHU Limoges, Hôpital Dupuytren, Service de Chirurgie thoracique et cardiovasculaire, France
| | - Florence Rolle
- CHU Limoges, Hôpital Dupuytren, Service de Chirurgie thoracique et cardiovasculaire, France
| | - Alessandro Piccardo
- CHU Limoges, Hôpital Dupuytren, Service de Chirurgie thoracique et cardiovasculaire, France
| | | | - Alexandre Le Guyader
- CHU Limoges, Hôpital Dupuytren, Service de Chirurgie thoracique et cardiovasculaire, France
| | - Victor Aboyans
- CHU Limoges, Hôpital Dupuytren, Service Cardiologie, France
- INSERM 1094, Faculté de médecine de Limoges, France
| |
Collapse
|
24
|
Piccardo A, Regesta T, Le Guyader A, Di Lorenzo N, Bertin F, Pesteil F, Cornu E. Outcomes after surgery for acute type A aortic dissection in “non-Marfan syndrome” patients with long life expectancy: A 24-year follow-up. Arch Cardiovasc Dis 2017; 110:14-25. [DOI: 10.1016/j.acvd.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Revised: 02/27/2016] [Accepted: 05/12/2016] [Indexed: 10/20/2022]
|
25
|
Lebivic L, Magne J, Desormais I, Piccardo A, Lacroix P, Mohty D, Aboyans V. Prognostic value of ankle-brachial index according to methods of its calculation in patients undergoing coronary bypass surgery. Archives of Cardiovascular Diseases Supplements 2017. [DOI: 10.1016/s1878-6480(17)30280-x] [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: 10/19/2022]
|
26
|
Monti M, Corradengo D, Nanni O, Piccardo A, Matteucci F, Brain E, Cortes J, Harbeck N, Wuerstlein R, Piris A, Merlo D, Degenhardt T, Cesario A, Rivitti E, Rollandi G, Iacozzi M, Campazzi E, Campora S, Camporese D, Gennari A. ERA-Net TRANSCAN JTC 2011: Critical aspects of the startup procedures of an International Academic Clinical trial (ET-FES), funded by the European Community (EC) and coordinated by an Italian Institution. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw345.22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
27
|
Piccardo A, Puntoni M, Treglia G, Foppiani L, Bertagna F, Paparo F, Massollo M, Dib B, Paone G, Arlandini A, Catrambone U, Casazza S, Pastorino A, Cabria M, Giovanella L. Thyroid nodules with indeterminate cytology: prospective comparison between 18F-FDG-PET/CT, multiparametric neck ultrasonography, 99mTc-MIBI scintigraphy and histology. Eur J Endocrinol 2016; 174:693-703. [PMID: 26966173 DOI: 10.1530/eje-15-1199] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/19/2016] [Indexed: 01/03/2023]
Abstract
PURPOSE To evaluate the role of (18)F-flurodeoxiglucose positron emission tomography/computed tomography ((18)F-FDG-PET/CT) in predicting malignancy of thyroid nodules with indeterminate cytology. PATIENTS AND METHODS We analysed 87 patients who have been scheduled to undergo surgery for thyroid nodule with indeterminate cytology. All patients underwent (18)F-FDG-PET/CT, multiparametric neck ultrasonography (MPUS), and (99m)Tc-methoxyisobutylisonitrile scintigraphy ((99m)Tc-MIBI-scan). Histopathology was the standard of reference. We compared the sensitivity (SE), specificity (SP), accuracy (AC), positive (PPV) and negative predictive (NPV) values of (18)F-FDG-PET/CT with those of (99m)Tc-MIBI-scan and MPUS in detecting cancer. Univariate and multivariate analyses evaluated the association between each diagnostic tool and histopathology. RESULTS On histopathology, 69 out of 87 nodules were found to be benign and 18 to be malignant. The SE, SP, AC, PPV and NPV of (18)F-FDG-PET/CT were 94, 58, 66, 37 and 98% respectively. The SE, AC and NPV of (18)F-FDG-PET/CT were significantly higher than those of MPUS and (99m)Tc-MIBI-scan. The association of both positive (18)F-FDG-PET/CT and MPUS (FDG+/MPUS+) showed significantly lower SE (61% vs 94%) and NPV (88% vs 98%) than (18)F-FDG-PET/CT alone, but significantly higher SP (77% vs 58%). On univariate analysis, (18)F-FDG-PET/CT and the combination of FDG+/MPUS+ and of FDG+/MIBI- were all significantly associated with histopathology. On multivariate analysis, only FDG+/MIBI- was significantly associated with histopathology. CONCLUSION The AC of (18)F-FDG-PET /CT in detecting thyroid malignancy is higher than that of (99m)Tc-MIBI-scan and MPUS. A negative (18)F-FDG-PET/CT correctly predicts benign findings on histopathology. The association of FDG+/MPS+ is significantly more specific than (18)F-FDG-PET/CT alone in identifying differentiated thyroid cancer. A positive (18)F-FDG-PET/CT is significantly associated with malignancy when qualitative (99m)Tc-MIBI-scan is rated as negative.
Collapse
Affiliation(s)
- A Piccardo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - M Puntoni
- Clinical Trial UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Treglia
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - L Foppiani
- Internal MedicineGalliera Hospital, Genoa, Italy
| | - F Bertagna
- Department of Nuclear MedicineUniversity of Brescia and Spedali Civili di Brescia, Brescia, Italy
| | - F Paparo
- Department of RadiologyGalliera Hospital, Genoa, Italy
| | - M Massollo
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - B Dib
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - G Paone
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - A Arlandini
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - U Catrambone
- Department of SurgeryThyroid Centre, Galliera Hospital, Genoa, Italy
| | - S Casazza
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - A Pastorino
- Department of PathologyGalliera Hospital, Genoa, Italy
| | - M Cabria
- Nuclear Medicine UnitOffice of the Scientific Director, Galliera Hospital, Genoa, Italy
| | - L Giovanella
- Department of Nuclear Medicine and PET/CT CentreOncology Institute of Southern Switzerland, Bellinzona, Switzerland
| |
Collapse
|
28
|
Piccardo A, Blossier JD, Le Guyader A, Orsel I, Sekkal S, Cornu E, Laskar M. Fate of aortic bioprostheses: An 18-year experience. J Thorac Cardiovasc Surg 2016; 151:754-761.e1. [DOI: 10.1016/j.jtcvs.2015.10.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 06/30/2015] [Accepted: 10/06/2015] [Indexed: 01/08/2023]
|
29
|
Tricard J, Piccardo A, Le Guyader A, Darodes N, Bosle S, Laskar M. Coronary Artery Embolism Following Aortic Valve Replacement. J Card Surg 2015; 30:581-2. [PMID: 25953030 DOI: 10.1111/jocs.12567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jérémy Tricard
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital Center, Limoges, France
| | - Alessandro Piccardo
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital Center, Limoges, France
| | - Alexandre Le Guyader
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital Center, Limoges, France
| | - Nicole Darodes
- Department of Cardiology, Dupuytren University Hospital Center, Limoges, France
| | - Sébastien Bosle
- Department of Cardiology, Brive Hospital Center, Brive, France
| | - Marc Laskar
- Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital Center, Limoges, France
| |
Collapse
|
30
|
Concistrè G, Dell'Aquila AM, Piccardo A, Pansini S, Gargiulo R, Gallo A, Merlanti B, Passerone G, Regesta T. Biological and clinical outcomes in the elderly with left ventricular dysfunction: Are there differences between on-pump and off-pump coronary artery bypass grafting? Ann Ital Chir 2015; 86:106-113. [PMID: 25951894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To compair biological and clinical outcomes after off-pump coronary artery bypass grafting (OPCABG) and conventional on-pump coronary artery bypass grafting (CCABG) in the elderly with left ventricular (LV) dysfunction. MATERIAL OF STUDY We retrospectively reviewed 90 consecutive patients aged more than 75 years with preoperative left ventricular ejection fraction (LVEF) < 50% who underwent isolated coronary artery bypass grafting at our Institution between January 2000 and July 2009. According to operative technique, patients were categorized in to the OPCABG group (39 patients) or in to the CCABG group (51 patients). We compared postoperative CK, CK-MB, troponin T serum levels and major adverse cardiac and cerebrovascular events (MACCE). RESULTS The overall in-hospital mortality was 2% (2/90) and was similar in both groups (p=0.8336). Mean troponin T levels at 6,24,48 hours after operation were significantly lower in the OPCABG group (p=0.0001; p=0.0021; p=0.0070, respectively). Overall survival was 77.6% at 10 years and no significant difference in MACCE was observed (p=0.3016). DISCUSSION Our results show a lower incidence of myocardial injury in OPCABG group, but there aren't differences in term of MACCE in both groups. Recent studies have indicated the advantages of OPCABG in the elderly patients, reporting a reduction of postoperative morbidity and organ dysfunction. However these studies not analyzed the impact of LV dysfunction on early and late postoperative outcomes in high-risk patients. CONCLUSIONS In the elderly with LV dysfunction, the OPCABG technique showed lower incidence of postoperative myocardial injury. However, at the follow-up, this does not reflect any significant differences in incidence of MACCE.
Collapse
|
31
|
Concistrè G, Dell'Aquila AM, Gallo A, Pansini S, Piccardo A, Rapetto F, Passerone G, Regesta T. Coronary artery bypass grafting in the octogenarian. Is complete revascularization always necessary? Ann Ital Chir 2015; 86:14-21. [PMID: 25819230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM The aim of this study was to investigate whether the completeness of revascularization affects the outcomes in the octogenarian. MATERIAL OF STUDY We retrospectively reviewed 130 consecutive octogenarians who underwent isolated coronary artery bypass grafting (CABG) between January 2003 and September 2010. According to operative technique, patients were categorized in Complete Revascularization (CRV) Group (96 patients) and in Incomplete Revascularization (IRV) Group (34 patients). Follow-up was 98% complete (mean: 30 ± 25 months). RESULTS The overall in-hospital mortality was 13% and was similar in both groups (p=0.0553). Multivariate regression analysis identified preoperative left ventricular ejection fraction ≤ 40% (p= 0.0060; OR= 0.19) and NHYA class > II (p= 0.0042; OR= 0.17) as risk factor for in-hospital death. Cox regression analysis not identified incomplete revascularization as risk factor for early or late death (p= 0.1381 and p= 0.8865). No differences in 5-year survival and freedom from major adverse cardiac and cerebrovascular events (MACCE) was found between two groups (p=0.8865 and p=0.6283). DISCUSSION CRV is important in young patients undergoing CABG, but this principle remains less absolute in elderly patients. In our study, the survival benefit of CRV was less in octogenarians. Probably, the major benefit of CRV was seen in patients less than 80 years of age. This makes sense because these patients have a longer expected survival, and there were more patients available to statistically confirm any difference in outcome. CONCLUSIONS In octogenarians undergoing CABG, IRV does not affect survival and freedom from MACCE. Patients' preoperative conditions are important in determining short and long term outcomes.
Collapse
|
32
|
Desrois M, Piccardo A, Zogheib E, Dalmasso C, Lan C, Fourré D, Cozzone P, Caus T, Bernard M. Heart Donation After Cardiac Death: Preliminary Study on an Isolated, Perfused Swine Heart After 20 Minutes of Normothermic Ischemia. Transplant Proc 2014; 46:3314-8. [DOI: 10.1016/j.transproceed.2014.04.021] [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] [Received: 10/17/2013] [Accepted: 04/22/2014] [Indexed: 10/24/2022]
|
33
|
Gauthier T, Piver P, Pichon N, Bibes R, Guillaudeau A, Piccardo A, Pesteil F, Tricard J, Gardet E, Laskar M, Lalloué F, Marquet P, Aubard Y. Uterus retrieval process from brain dead donors. Fertil Steril 2014; 102:476-82. [DOI: 10.1016/j.fertnstert.2014.04.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 04/10/2014] [Accepted: 04/10/2014] [Indexed: 01/22/2023]
|
34
|
Burnelli R, Lopci E, Elia C, Piccardo A, Todesco A, Garaventa A, Sala A, Farruggia P, Zucchetta P, Guerra L, Indolfi P, Buffardi S, Moleti ML, Cistaro A, Fanti S, Chiti A, Mascarin M. Role of Interim FDG-PET for Mediastinal Response Assessment in Pediatric Hodgkin's Lymphoma (HL):Preliminary Results from the Italian AIEOP-LH2004 Protocol. Klin Padiatr 2014. [DOI: 10.1055/s-0034-1371115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
35
|
Caus T, Houbert-Janssens A, Gaubert JY, Piccardo A, Petit A, Poulain H. Early experience with the DJUMBODIS system: what did we observed, what can we expect? Part 2. Angiol Sosud Khir 2014; 20:61-73. [PMID: 24722022] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The authors describe their experience with the Djumbodis system, reporting the findings of a comparative study focussing on the outcomes of surgical management of patients presenting with real type I aortic dissection. The most common feature observed in patients receiving a 9 or 14 cm stent into the proximal descending aorta was stabilization of the dissected thoracic segments. Clinical outcomes were, however, comparable between the groups of stented patients and controls. This clinical result is to be shared with other endovascular devices used in acute dissections and which might require a hybrid operating room, since they might compromise blood flow in collateral arteries. Carefully analysing our data and current literature we propose to consider real type I aortic dissections complicated by dynamic malperfusion symptoms or for which the diameter of the proximal descending aorta is already noticeably dilated as justified indications according to the current knowledge about stenting of acute dissections.
Collapse
Affiliation(s)
- T Caus
- Department of Cardiac Surgery, Amiens-Picardy University Hospital, Amiens, France; INSERM U 1088, Jules Verne University, Amiens, France
| | | | | | | | | | | |
Collapse
|
36
|
Borsò E, Grosso M, Boni G, Manca G, Bianchi P, Puccini M, Arganini M, Cabria M, Piccardo A, Arlandini A, Orlandini C, Mariani G. Radioguided occult lesion localization of cervical recurrences from differentiated thyroid cancer: technical feasibility and clinical results. Q J Nucl Med Mol Imaging 2013; 57:401-411. [PMID: 24322795] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM We explored the feasibility of radioguided occult lesion localization (ROLL) for radioiodine-negative cervical recurrences from differentiated thyroid cancer (DTC). METHODS The procedure was performed in 32 patients (3 patients being operated twice); 15/32 patients had had multiple prior lymph node dissections ("hostile" anatomy). 99mTc-albumin macro-aggregates (99mTc-MAA) were injected intra-lesionally under ultrasound guidance; 2 to 18 hours later, a hand-held gamma-probe helped to localize the lesions intraoperatively and to ascertain removal of the radiolabeled lesions. Mini-invasive excision of the radiolabelled lesions was performed in 12 cases (m-ROLL), while a modified radical neck dissection was performed in 23 cases after radioguided lymphadenectomy (d-ROLL). Fifty-nine lesions were radiolabelled (mean size 11±4.5 mm). RESULTS Radioguidance allowed to identify/remove 56/59 lesions (95%). Some leakage of 99mTc-MAA in the surrounding tissues hampered detection of 3 lesions, which were removed anyway (100% overall localization). Histopathology confirmed metastatic involvement of the radiolabeled lesions and some additional metastases in other nodes. Neither nerve injury nor hypoparathyroidism occurred. After a median follow-up of 29 months, 19 patients were disease-free, 12 patients developed loco-regional recurrences, 1 patient had distant metastases and 1 patient had both loco-regional and distant metastases. Recurrences rates were 33% for m-ROLL and 40% for d-ROLL. CONCLUSIONS The ROLL technique is feasible in selected patients with loco-regional recurrence from DTC, proving to be particularly useful also in patients already submitted to cervical dissections and/or with small lesions located in surgically difficult sites. It can therefore have a clinical role in the management of cervical DTC recurrences.
Collapse
Affiliation(s)
- E Borsò
- Regional Center of Nuclear Medicine University of Pisa, Pisa, Italy -
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Dell'Aquila AM, Concistrè G, Gallo A, Pansini S, Piccardo A, Passerone G, Regesta T. Fate of the preserved aortic root after treatment of acute type A aortic dissection: 23-year follow-up. J Thorac Cardiovasc Surg 2013; 146:1456-60. [DOI: 10.1016/j.jtcvs.2012.09.049] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/18/2012] [Accepted: 09/20/2012] [Indexed: 10/27/2022]
|
38
|
Piccardo A, Le Guyader A, Regesta T, Gariboldi V, Zannis K, Tapia M, Collart F, Kirsch M, Caus T, Cornu E, Laskar M. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg 2013; 96:851-6. [PMID: 23916804 DOI: 10.1016/j.athoracsur.2013.04.066] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 04/06/2013] [Accepted: 04/22/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The management of acute type A aortic dissection (aTAAD) in octogenarian patients is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations. METHODS Beginning in January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 79 consecutive patients enrolled up to December 2010. Their median age was 81.6 years (range, 80 to 89 years). Sixteen patients (20%) presented a complicated type because of a neurologic deficit, mesenteric ischemia, a requirement for cardiopulmonary resuscitation, or some combination of those features. Operations followed the standard procedure recommended for younger patients. Follow-up was 95% complete (mean, 4.6±2.8 years). RESULTS The overall in-hospital mortality was 44.3%. The in-hospital mortality among patients with uncomplicated aTAAD was 33.3%. Multivariate analysis identified complicated aTAAD as the only risk factors for in-hospital mortality (p<0.0001). Postoperative complications occurred in 50 patients (68.5%) and were associated with a higher mortality (p<0.0001). The overall survival was 53% at 1 year and 32% at 5 years. In uncomplicated aTAAD, the overall survival was 63% at 1 year and 38% at 5 years. CONCLUSIONS Octogenarians with uncomplicated aTAAD benefit from emergency surgical repair. In those patients, early and midterm outcomes are good and are similar to those in published series of younger patients. Complicated aTAAD should be medically managed.
Collapse
|
39
|
Concistrè G, Dell'Aquila A, Pansini S, Corsini B, Costigliolo T, Piccardo A, Gallo A, Passerone G, Regesta T. Aortic Valve Replacement with Smaller Prostheses in Elderly Patients: Does Patient Prosthetic Mismatch Affect Outcomes? J Card Surg 2013; 28:341-7. [DOI: 10.1111/jocs.12136] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Giovanni Concistrè
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Angelo Dell'Aquila
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Stefano Pansini
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Biagino Corsini
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Tiziano Costigliolo
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Alessandro Piccardo
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Alina Gallo
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Giancarlo Passerone
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| | - Tommaso Regesta
- Division of Cardiac Surgery of San Martino University Hospital; Genova Italy
| |
Collapse
|
40
|
Piccardo A, Lopci E, Conte M, Foppiani L, Garaventa A, Cabria M, Villavecchia G, Fanti S, Cistaro A. PET/CT imaging in neuroblastoma. Q J Nucl Med Mol Imaging 2013; 57:29-39. [PMID: 23474633] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
123Iodine-metaiodobenzylguanidine (123I-MIBG) scintigraphy is currently the tracer of choice for neuroblastoma (NB). It has high diagnostic accuracy and prognostic value for the assessment of patients after chemotherapy. A positive 123I-MIBG scan is also used for the basis of targeted radionuclide therapy with 131I-MIBG. I-123 MIBG scan however has some limitations which should be taken into account. Moreover the reasons for false negative MIBG results have not been entirely elucidated. Meticulous correlation with radiological examinations and recognition of the normal distribution pattern of 123I-MIBG in children is vital to obtain optimal results. With its technical superiorities, positron emission tomography/computed tomography (PET/CT) can be successfully introduced into the diagnostic workup of NB. Different PET tracers have been offered for imaging in patients with NB, and the efficacy of this modality has been compared with that of 123I-MIBG scan. Our review aims to analyze the present role of PET/CT imaging and radiopharmaceuticals in NB.
Collapse
Affiliation(s)
- A Piccardo
- Nuclear Medicine Unit, Galliera Hospital, Genoa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
41
|
Kaus T, Houbert-Janssen A, Gaubert JY, Piccardo A, Petit A, Poulain H. Early experience with the DJUMBODIS system: what did we observed, what can we expect? Part 1. Angiol Sosud Khir 2013; 19:61-74. [PMID: 24429561] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE In order to remodel or to stabilize the dissected descending aorta following conventional replacement of proximal aorta for real type I acute dissection, the deployment of a bare-metal stent that expand the true lumen and compress the false lumen has been proposed. To date results have been insufficiently assessed through comparative studies. We conducted this study to compare midterm results according to the optional deployment of an antegradely inserted balloon inflated stainless steel stent at the level of the proximal descending aorta during conventional aortic surgery in real type I aortic dissections. METHODS Control study including a consecutive series of patients operated on conventionally for real type I aortic dissection involving descending aorta between 2006 and 2011. For stented patients, an optimal inflation volume was determined a priori according to the measured diameter of landing zone and a bare stent 90 or 140mm long was deployed antegradely during circulatory arrest. Endpoints were mid-term aortic event free survival and the evolution of the indexed (body surface area) diameter of descending aorta. RESULTS We included 19 and 26 patients in the stented and control group respectively. Aortic event free survival at 4 years was 57% and 43% (p=0.37) in the stented and control group respectively. The proximal descending aorta remained remodeled or stabilized during follow-up for 11 stented and only 9 control patients (p=0.05). After a mean follow up of 2 years, the mean indexed diameter of the upper third aorta was 4 mm wider in the control group due to false lumen enlargement (p=0.01). CONCLUSION Anatomic evolution is favorable in the stented group. Increment of comparative followup data is mandatory before considering a revision of conventional approach of TAAD to influence mid- term aortic event free survival.
Collapse
Affiliation(s)
- Thierry Kaus
- Department of Cardiac Surgery, Amiens-Picardy University Hospital, Amiens, France; INSERM U 1088, Jules Verne University, Amiens, France
| | | | | | | | | | | |
Collapse
|
42
|
Piccardo A, Foppiani L, Puntoni M, Hanau G, Calafiore L, Garaventa A, Arlandini A, Villavecchia G, Bianchi P, Cabria M. Role of low-cost thyroid follow-up in children treated with radiotherapy for primary tumors at high risk of developing a second thyroid tumor. Q J Nucl Med Mol Imaging 2012; 56:459-467. [PMID: 23090072] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
AIM Differentiated thyroid cancer (DTC) is uncommon in childhood and data on its prevalence as a second malignant neoplasm (SNM) after radiotherapy (RT) for malignancies are limited. We evaluated: 1) the incidence DTC in pediatric-oncologic patients treated with RT; 2) the relationship between DTC, RT and the features of the first malignancy; 3) the usefulness of thyroid follow-up in irradiated oncological patients. METHODS We have followed up 252 patients treated with RT out of 966 oncologic pediatric patients. Thyroid follow-up included TSH level evaluation and neck ultrasonography. In the presence of thyroid nodule/s ≥1 cm and/or with ultrasonography suspicious for malignancy, fine needle aspiration biopsy (FNAB) was performed. When papillary/follicular lesions were detected by cytology, thyroidectomy was performed. If DTC was confirmed, patients underwent radioactive iodine (RAI) treatment. RESULTS At least one thyroid nodule was detected in 106 irradiated patients (42%): 45 patients underwent FNAB and 27 underwent thyroidectomy. Seventeen DTC (6.7%) were found on histology. A higher incidence of DTC was seen in patients with neuroblastoma (38%) or Wilms' tumor (18%). One third of DTC showed capsule invasion, and one fourth node involvement. Eleven patients, treated with a single RAI treatment, showed undetectable thyroglobulin levels after rh-TSH-stimulation. Five patients underwent at least two RAI treatments: four patients showed complete remission and one patient partial remission. CONCLUSION A high rate of DTC, often with invasive features, was observed in children treated with RT for primary tumors. This finding underlines the usefulness of thorough low-cost thyroid follow-up in this high-risk population.
Collapse
Affiliation(s)
- A Piccardo
- Nuclear Medicine, Galliera Hospital, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Amoroso L, Villavecchia G, Cabria M, Piccardo A, Conte M, Nantron M, Garaventa A, De Bernardi B. Toxicity of 131I-MIBG combined with high-dose chemotherapy in children with refractory neuroblastoma. J Clin Oncol 2011. [DOI: 10.1200/jco.2011.29.15_suppl.9549] [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: 11/20/2022] Open
|
44
|
Piccardo A, Foppiani L, Morbelli S, Bianchi P, Barbera F, Biscaldi E, Altrinetti V, Villavecchia G, Cabria M. Could [18]F-fluorodeoxyglucose PET/CT change the therapeutic management of stage IV thyroid cancer with positive (131)I whole body scan? Q J Nucl Med Mol Imaging 2011; 55:57-65. [PMID: 21285923] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
AIM Stage-IV differentiated thyroid cancer (DTC) patients may present elevated serum thyroglobulin (Tg) levels associated with positive [(131)I] whole-body-scan (WBS). Nevertheless some patients in whom WBS does not reveal new sites of disease show increased Tg levels. This finding prompts thorough restaging in order to exclude the presence of metastases unable to concentrate iodine. The aim of our study was to evaluate the impact of [(18)F]FDG-PET/CT in both the assessment of overall extent of the disease and the therapeutic management in a group of stage-IV DTC patients. METHODS On suspicious of non-iodine concentrating additional metastases, 20 stage-IV DTC patients with increasing Tg levels and stable positive post-therapy WBS were enrolled. Conventional imaging (CI) procedures, including neck ultrasonography, bone-scintigraphy and computed tomography (CT) were performed before [(18)F]FDG-PET/CT. RESULTS [(18)F]FDG-PET/CT was positive in 16 out of 20 patients (80%). In 9 patients (45%) [(18)F]FDG PET/CT detected a larger number of tumour recurrences/metastatic sites than WBS+CI. [(18)F]FDG PET/CT findings prompted modification of the management of 11 patients (55%), in whom surgery or external radiotherapy were eventually considered more appropriate than radioactive iodine therapy. These further therapies improved the quality of life in several patients but did not change their survival rate. CONCLUSION Our results showed that [18F]FDG-PET/CT can detect new radioiodine-negative metastases in advanced DTC patients with unchanged positive WBS and increasing Tg levels. [(18)F]FDG-PET/CT may constitute a useful tool in the choice of the best therapeutic strategy in such difficult cases.
Collapse
Affiliation(s)
- A Piccardo
- Department of Nuclear Medicine, Galliera Hospital, Genoa, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Fonteneau A, Petit A, Piccardo A, Marticho P, Bernardy A, Lewandowski E, Desablens F, Caus T. Medical and economic interest of the use of cryosurgery in the instrumental treatment of atrial fibrillation. Pharmacology 2010; 87:28-35. [PMID: 21178387 DOI: 10.1159/000322524] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Accepted: 10/25/2010] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In order to definitively integrate cryosurgery for the surgical treatment of atrial fibrillation (AF) into the therapeutic armamentarium, the medical and economic impact of its use on a population of patients with a high risk of recurrence of postoperative AF must be evaluated. METHOD An observational study of patients who benefited from cryosurgery between July 2006 and December 2008 was performed. The cost of consumables and hospitalization was determined and compared to that of a control group of 27 patients with preoperative AF that had not benefited from cryosurgery. RESULTS Twenty-nine patients benefited from cryosurgery during a mitral (65.5%) or aortic intervention (37.9%) to treat a paroxystic (44.8%) or permanent AF (55.2%). More than half of them (58.6%) had a 12-month follow-up; 82.4% of these patients showed a permanent sinus rhythm and 32.6% had stopped their antiarrhythmic medication. There was no significant difference between the duration and cost of hospitalization for the 2 groups. CONCLUSION Cryosurgery provides a clear clinical and economic advantage with no recurrence of AF, and it reduces antiarrhythmic medication treatment.
Collapse
|
46
|
DeCensi A, Piccardo A, Altrinetti V, Bacigalupo L, Biscaldi E, Bianchi P, Barbera F, Cabria M, Camti C, Zanardi S, Campora S, Puntoni M, Rollandi GA, Villavecchia G. E. Abstract P2-05-01: A Comparative Study of 18F-Fluoride PET/CT and Whole-Body High Resolution CT (HRCT) for the Detection of Bone Metastases in Patients with Advanced Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p2-05-01] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Bone scintigraphy (BS) have been shown to be of value in detecting bone metastases several months before conventional radiography, whereas computed tomography (HRCT) and magnetic resonance imaging (MRI) can reveal more metastases in the spine than conventional BS. 18F-Fluoride PET has been shown to be more accurate than BS for the detection bone lesions in different malignancies and has been suggested as an alternative to BS. Recent studies have shown that integrated 18F-Fluoride-PET/CT is both sensitive and specific for detection of lytic and sclerotic lesions and is superior to 18F-Fluoride PET. The aim of our study is to evaluate the diagnostic accuracy of 18F-Fluoride-PET/CT in comparison to HRCT for the detection of bone metastases in breast cancer patients.
Material and methods: The study involved 39 patients with breast cancer with known bone metastases or at high risk for its presence. All patients presented indications for skeletal surveys. Imaging was performed on an integrated PET/CT system. All PET scans were acquired in 2D mode and were reconstructed using an iterative reconstruction algorithm; diagnostic HRCT data of PET/CT were acquired for detecting bone lesions and were used for attenuation correction. PET acquisition started 60 min after intravenous injection of 370-550 MBq 18F-labelled NaF and included 10-12 bed positions.
The interpretation of PET/CT and High resolution CT studies was made as a consensus reading of two nuclear medicine physicians and a radiologist who had access to clinical, as well as previous radiological imaging information. 12 months follow-up based on previous and/or following imaging studies was considered the gold standard. Results: Overall 671 bone lesions were detected in our analysis including both PET/CT and CT results. Of these lesions 530 malignant, 32 equivocal and 109 benign were classified by consensus reading. 18F-Fluoride PET/CT detected 491 bone metastases, 114 (23%) of which without any clear morphological changes on CT. HRCT detected 416 bone metastases, 39 (9.3%) of which without any 18F-fluoride uptake. The overall sensitivity and specificity was 90% and 91% for 18F-Fluoride-PET/CT and 79 and 93% for HRCT, respectively. In a patients based analysis both 18F-Fluoride-PET/CT and HRCT identified the same number of patients with bone metastases (27 of 39).
Conclusions: Our data show a high agreement (71% of lesions and 100% of the patients) between 18F-Fluoride-PET/CT and HRCT for bone metastases detection. However integrated analysis of 18F-Fluoride-PET/HRCT has the best diagnostic option to evaluate bone involvement in breast cancer, and 18F-Fluoride-PET/CT seems to have the highest sensitivity. Follow-up is ongoing to assess the prognostic/predictive value of 18F-Fluoride-PET/CT.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P2-05-01.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - M Cabria
- Ospedali Galliera, Genova, Italy
| | - C Camti
- Ospedali Galliera, Genova, Italy
| | | | | | | | | | | |
Collapse
|
47
|
Piccardo A, Rusinaru D, Petitprez B, Marticho P, Vaida I, Tribouilloy C, Caus T. Thrombocytopenia After Aortic Valve Replacement With Freedom Solo Bioprosthesis: A Propensity Study. Ann Thorac Surg 2010; 89:1425-30. [DOI: 10.1016/j.athoracsur.2010.01.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 01/21/2010] [Accepted: 01/25/2010] [Indexed: 12/18/2022]
|
48
|
Rusinaru D, Piccardo A, Petitprez B, Marticho P, Vaida I, Tribouilloy C, Caus T. THROMBOCYTOPENIA AFTER AORTIC VALVE REPLACEMENT WITH THE FREEDOM SOLO STENTLESS BIOPROSTHESIS: A PROPENSITY-MATCHED STUDY. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61394-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
49
|
Piccardo A, Arecco F, Morbelli S, Bianchi P, Barbera F, Finessi M, Corvisieri S, Pestarino E, Foppiani L, Villavecchia G, Cabria M, Orlandi F. Low thyroglobulin concentrations after thyroidectomy increase the prognostic value of undetectable thyroglobulin levels on levo-thyroxine suppressive treatment in low-risk differentiated thyroid cancer. J Endocrinol Invest 2010; 33:83-7. [PMID: 19636213 DOI: 10.1007/bf03346558] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
DESIGN Recombinant human TSH-stimulated thyroglobulin (Tg) levels (rhTSH-Tg) are sufficient for early follow-up of low-risk differentiated thyroid cancer (DTC) patients after thyroidectomy and radioiodine (131I) remnant ablation (RAI). Serum Tg levels at the time of remnant ablation (ablation-Tg) is thought to be related with rhTSH-Tg and may be predictive of recurrent disease. During long-term follow-up, Tg levels on levo-T4 (L-T4) suppressive treatment (suppressive-Tg) is sufficiently sensitive to avoid further evaluations in patients with undetectable rhTSH-Tg. The aim of our study was to verify whether, in a subgroup of low-risk DTC patients, the association of low ablation-Tg levels (<10 microg/l) with undetectable suppressive-Tg concentrations has a sufficient negative predictive value (NPV) for recurrence of disease, leading to avoid rhTSH testing. METHODS We enrolled 169 low-risk DTC patients treated by thyroidectomy + RAI and undetectable suppressive-Tg at 12-month followup. In all patients, we retrospectively evaluated ablation-Tg and rhTSH-Tg. For all patients, 2-yr follow-up was available. RESULTS Based on rhTSH-Tg>2 microg/l, relapsing disease was histologically proven in 2 patients. rhTSH-Tg levels between 0.6-2.0 microg/l, with no evidence of disease, was observed in 10 patients (6%). One hundred and fifty-seven patients showed undetectable rhTSH-Tg. The NPV of undetectable suppressive- Tg was 92.8%. The ablation-Tg level was <10 microg/l in 140 patients. In this group, the NPV of undetectable suppressive- Tg was 100%. CONCLUSION Our data indicate that undetectable suppressive-Tg value, combined with ablation- Tg levels <10 microg/l, may avoid a significant number of high-cost rhTSH-Tg test.
Collapse
Affiliation(s)
- A Piccardo
- Department of Nuclear Medicine, Galliera Hospital, Mura delle Cappuccine 14, Genoa, Italy.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Piccardo A, Regesta T, Pansini S, Dell'Aquila AM, Concistrè G, Martinelli L, Passerone G. Fate of the aortic valve after root reconstruction in type A aortic dissection: a 20-year follow up. J Heart Valve Dis 2009; 18:507-513. [PMID: 20099691] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The study aim was to evaluate the fate of the aortic valve after root reconstruction in acute type A aortic dissection. METHODS Between 1982 and 2006, a total of 373 consecutive patients underwent emergency surgery for acute type A aortic dissection at the authors' institution. Of these patients, 298 (mean age 63 +/- 11 years; range: 22-85 years) underwent replacement of the supracoronary aorta with root reconstruction. The mean follow up period was 6.9 +/- 5.2 years (range: 2 months to 23 years), and was 98% complete. Aortic valve function was assessed by the incidence of aortic valve reoperation and transthoracic echocardiography. RESULTS The 30-day mortality was 27% (82/298). Survival was 80%, 57% and 49% at five, 10 and 15 years, respectively. For survivors at the latest follow up, freedom from moderate or severe aortic regurgitation (AR) was 93%, 84% and 72% at five, 10 and 15 years, respectively. Four patients had severe AR but were not reoperated on. Among 200 patients discharged, 13 (6.5%) were reoperated on for severe AR, with an operative mortality of 15% (n = 2). Freedom from aortic valve replacement was 97%, 92% and 84% at five, 10 and 15 years, respectively. Cox regression analysis identified age < or = 59 years (p = 0.0201) and 'low-volume surgeon' (p = 0.0004) as risk factors for recurrent moderate or severe AR. CONCLUSION The study results showed that, when the aortic dissection involves the aortic root, supracoronary replacement of the ascending aorta with a root reconstruction allows preservation of the aortic valve in the majority of patients, with a satisfactory long-term outcome.
Collapse
Affiliation(s)
- Alessandro Piccardo
- Division of Cardiac Surgery of San Martino University Hospital, Genova, Italy.
| | | | | | | | | | | | | |
Collapse
|