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Title: Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia

Abstract

Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by small benign tumors of mesenchymal origin also known as phosphaturic mesenchymal tumors mixed connective tissue variant. Excellent prognosis is expected with eradication of the culprit tumor. These small tumors are notoriously difficult to localize with conventional imaging studies; this often leads to an extensive work up and prolonged morbidity. We report a patient with clinical diagnosis of TIO whose culprit tumor was localized with Ga-68 DOTATOC PET/CT and MRI. Biopsy and cryoablation were performed under Ga-68 DOTATOC PET/CT guidance. Autoradiography of the biopsy specimen was performed and showed in situ correlation between Ga-68 DOTATOC uptake and histopathology with millimeter resolution.

Authors:
 [1];  [2];  [3];  [4];  [5];  [6];  [2];  [5];  [7]
  1. Memorial Sloan Kettering Cancer Center, Interventional Radiology Service (United States)
  2. Memorial Sloan Kettering Cancer Center, Molecular Imaging and Therapy Service, Department of Radiology (United States)
  3. Memorial Sloan Kettering Cancer Center, Orthopedic Surgical Oncology Service, Department of Surgery (United States)
  4. Memorial Sloan Kettering Cancer Center, Department of Pathology (United States)
  5. Memorial Sloan Kettering Cancer Center, Department of Physics (United States)
  6. Memorial Sloan Kettering Cancer Center, Department of Radiology (United States)
  7. Memorial Sloan Kettering Cancer Center, Department of Medicine (United States)
Publication Date:
OSTI Identifier:
22645463
Resource Type:
Journal Article
Resource Relation:
Journal Name: Cardiovascular and Interventional Radiology; Journal Volume: 39; Journal Issue: 9; Other Information: Copyright (c) 2016 Springer Science+Business Media New York and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE); http://www.springer-ny.com; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; AUTORADIOGRAPHY; BIOMEDICAL RADIOGRAPHY; BIOPSY; CONNECTIVE TISSUE; CORRELATIONS; DIAGNOSIS; DISEASE INCIDENCE; GALLIUM 68; NEOPLASMS; NMR IMAGING; PATIENTS; POSITRON COMPUTED TOMOGRAPHY; UPTAKE

Citation Formats

Maybody, Majid, E-mail: maybodym@mskcc.org, Grewal, Ravinder K., Healey, John H., Antonescu, Cristina R., Fanchon, Louise, Hwang, Sinchun, Carrasquillo, Jorge A., Kirov, Assen, and Farooki, Azeez. Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia. United States: N. p., 2016. Web. doi:10.1007/S00270-016-1350-1.
Maybody, Majid, E-mail: maybodym@mskcc.org, Grewal, Ravinder K., Healey, John H., Antonescu, Cristina R., Fanchon, Louise, Hwang, Sinchun, Carrasquillo, Jorge A., Kirov, Assen, & Farooki, Azeez. Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia. United States. doi:10.1007/S00270-016-1350-1.
Maybody, Majid, E-mail: maybodym@mskcc.org, Grewal, Ravinder K., Healey, John H., Antonescu, Cristina R., Fanchon, Louise, Hwang, Sinchun, Carrasquillo, Jorge A., Kirov, Assen, and Farooki, Azeez. 2016. "Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia". United States. doi:10.1007/S00270-016-1350-1.
@article{osti_22645463,
title = {Ga-68 DOTATOC PET/CT-Guided Biopsy and Cryoablation with Autoradiography of Biopsy Specimen for Treatment of Tumor-Induced Osteomalacia},
author = {Maybody, Majid, E-mail: maybodym@mskcc.org and Grewal, Ravinder K. and Healey, John H. and Antonescu, Cristina R. and Fanchon, Louise and Hwang, Sinchun and Carrasquillo, Jorge A. and Kirov, Assen and Farooki, Azeez},
abstractNote = {Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by small benign tumors of mesenchymal origin also known as phosphaturic mesenchymal tumors mixed connective tissue variant. Excellent prognosis is expected with eradication of the culprit tumor. These small tumors are notoriously difficult to localize with conventional imaging studies; this often leads to an extensive work up and prolonged morbidity. We report a patient with clinical diagnosis of TIO whose culprit tumor was localized with Ga-68 DOTATOC PET/CT and MRI. Biopsy and cryoablation were performed under Ga-68 DOTATOC PET/CT guidance. Autoradiography of the biopsy specimen was performed and showed in situ correlation between Ga-68 DOTATOC uptake and histopathology with millimeter resolution.},
doi = {10.1007/S00270-016-1350-1},
journal = {Cardiovascular and Interventional Radiology},
number = 9,
volume = 39,
place = {United States},
year = 2016,
month = 9
}
  • A giant cell tumor (GCT) is an intermediate grade, locally aggressive neoplasia. Despite advances in surgical and clinical treatments, cases located on the spine and pelvic bones remain a significant challenge. Failure of clinical treatment with denosumab and patient refusal of surgical procedures (hemipelvectomy) led to the use of cryoablation. We report the use of percutaneous CT-guided cryoablation as an alternative treatment, shown to be a minimally invasive, safe, and effective option for a GCT with extensive involvement of the pelvic bones and allowed structural and functional preservation of the involved bones.
  • We evaluated the value of CT-guided transthoracic core biopsy for the diagnosis of mycobacterial pulmonary nodules. The 30 subjects in this study had pulmonary nodules that had been either diagnosed histopathologically as tuberculosis or were suspected as tuberculosis based on a specimen obtained by CT-guided transthoracic core biopsy. The histopathological findings, the existence of acid-fast bacilli in the biopsy specimens, and the clinical course of the patients after the biopsy were reviewed retrospectively. Two of the three histological findings for tuberculosis that included epithelioid cells, multinucleated giant cells and caseous necrosis were observed in 21 of the nodules which weremore » therefore diagnosed as histological tuberculosis. Six of these 21 nodules were positive for acid-fast bacilli, confirming the diagnosis of tuberculosis. Thirteen of the 21 nodules did not contain acid-fast bacilli but decreased in size in response to antituberculous treatment and were therefore diagnosed as clinical tuberculosis. Seven nodules with only caseous necrosis were diagnosed as suspected tuberculosis, with a final diagnosis of tuberculosis being made in 4 of the nodules and a diagnosis of old tuberculosis in 2 nodules. Two nodules with only multinucleated giant cells were diagnosed as suspected tuberculosis with 1 of these nodules being diagnosed finally as tuberculosis and the other nodule as a nonspecific granuloma. When any two of the three following histopathological findings - epithelioid cells, multinucleated giant cells or caseous necrosis - are observed in a specimen obtained by CT-guided transthoracic core biopsy, the diagnosis of tuberculosis can be established without the detection of acid-fast bacilli or Mycobacterium tuberculosis.« less
  • Purpose. To evaluate the efficacy and safety of CT-guided needle biopsy of brain lesions without a stereotactic device, and to determine the best possible indications for this technique. Methods. From February 2001 to February 2004, 20 patients (12 men, 8 women; age 61-82 years) underwent CT-guided brain lesion biopsy. The procedure started with a brain CT scan for lesion localization and for selection of the inlet for needle insertion. The patient was then transported to the operating room where cranioanatrisis was performed. Subsequently, the biopsy was performed under CT guidance using a 14G brain biopsy needle with a blind smoothmore » end and lateral holes. At the end of the biopsy, the field was checked for possible complications with a CT scan. Results. Histopathologic results were: brain tumor in 16 patients (80%), inflammatory process in 3 (15%), and no conclusive diagnosis in 1 (5%). A repeat of the process was required in 2 patients. A minor complication of local hematoma was found in 1 patient (5%). There were no deaths or other serious complications.Conclusion. CT-guided biopsy is a reliable method for histopathologic diagnosis of brain lesions in selected cases. It is a simple, fast, effective, low-cost procedure with minimal complications, indicated especially for superficial and large tumors.« less
  • Purpose: Targeted magnetic resonance imaging (MRI)/ultrasound fusion prostate biopsy (MRI-Bx) has recently been compared with the standard of care extended sextant ultrasound-guided prostate biopsy (SOC-Bx), with the former associated with an increased rate of detection of clinically significant prostate cancer. The present study sought to determine the influence of MRI-Bx on radiation therapy and androgen deprivation therapy (ADT) recommendations. Methods and Materials: All patients who had received radiation treatment and had undergone SOC-Bx and MRI-Bx at our institution were included. Using the clinical T stage, pretreatment prostate-specific antigen, and Gleason score, patients were categorized into National Comprehensive Cancer Network riskmore » groups and radiation treatment or ADT recommendations assigned. Intensification of the recommended treatment after multiparametric MRI, SOC-Bx, and MRI-Bx was evaluated. Results: From January 2008 to January 2016, 73 patients received radiation therapy at our institution after undergoing a simultaneous SOC-Bx and MRI-Bx (n=47 with previous SOC-Bx). Repeat SOC-Bx and MRI-Bx resulted in frequent upgrading compared with previous SOC-Bx (Gleason score 7, 6.7% vs 44.6%; P<.001; Gleason score 8-10, 2.1% vs 38%; P<.001). MRI-Bx increased the proportion of patients classified as very high risk from 24.7% to 41.1% (P=.027). Compared with SOC-Bx alone, including the MRI-Bx findings resulted in a greater percentage of pathologically positive cores (mean 37% vs 44%). Incorporation of multiparametric MRI and MRI-Bx results increased the recommended use and duration of ADT (duration increased in 28 of 73 patients and ADT was added for 8 of 73 patients). Conclusions: In patients referred for radiation treatment, MRI-Bx resulted in an increase in the percentage of positive cores, Gleason score, and risk grouping. The benefit of treatment intensification in accordance with the MRI-Bx findings is unknown.« less
  • Purpose: Our objective was to determine the efficacy and safety of image-guided, percutaneous cryoablation for American Joint Committee on Cancer pT1ANxMx and pT1BNxMx biopsy-proven renal cell carcinoma (RCC). Materials and Methods: Computed tomography (CT)-guided, percutaneous cryoablation was used to treat 117 renal lesions in 113 consecutive patients with pT1NxMx RCC. All 117 ablations were included in the safety analysis, and complications were categorized according to Common Terminology Criteria for Adverse Events version 3.0 (CTCAE v3.0). Eighty-one lesions were biopsy-proven RCC and were included in the efficacy analysis. Technical success was defined as the 'ice-ball' covering the entire lesion plus amore » minimum 5-mm margin. Efficacy was defined as complete lack of enhancement and continuous decrease in size on subsequent follow-up imaging studies. Results: Technical success was 100%, with 15% of ablations requiring air or saline injection to prevent nontarget ablation. We recorded a 7% rate of clinically significant complications (CTCAE category {>=}2) and 0% mortality. Renal function was not adversely affected. Seventy percent of patients were discharged to home on the same day. Efficacy was 98.7% for a median follow-up of 67 weeks (range 7-172). For the subgroup of patients that reached a median follow-up of 2 (n = 59) and 3 years (n = 13), efficacy was 98.3 and 92.3%, respectively. Cancer specific survival was 100%. Conclusions: CT-guided, percutaneous cryoablation has an excellent safety and efficacy profile for stage T1A and T1B RCC; however, longer follow-up is needed to compare it with other nephron-sparing surgical treatments. It is a great option for nonsurgical patients, those in whom renal function cannot be further sacrificed, and those at risk for metachronous lesions.« less