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    18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography Findings of Pancreatic Hemangiopericytoma
    (Medknow Publications & Media Pvt Ltd, 2017) Ustun, Funda; Aksoy, Salim; Serim, Burcu Dirlik; Altun, Gulay Durmus
    A 42-year-old woman with a large pancreatic tumor had undergone F-18-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) imaging. Moderate metabolic activity was detected on the head of the pancreas. The tumor was resected and it was histopathologically diagnosed as malign pancreatic hemangiopericytoma (HPC). HPC is a rare soft tissue sarcoma. The tumor is considered aggressive with high rates of local recurrence and metastasis regardless the localization. Herein, we present the imaging characteristics of HPC with F-18-FDG PET/CT.
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    18F-NaF PET/CT and Extraordinary Involvement: Non-calcific Brain Involvement in a Prostate Cancer Case
    (Galenos Yayincilik, 2020) Korkmaz, Ulku; Ustun, Funda
    With the increase in the diagnosis of the cancer, the frequency of using imaging methods for diagnosis and for staging is also increased. Because of the complex structure of cancer and tumor behavior, the assessment methods have been updated and metabolic imaging has gained weight. The most popular of these techniques is hybrid positron emission tomography/computed tomography (PET/CT) systems. Prostate cancer is the second most common cancer in the world, is the fifth common type in cancer-related male deaths. Estimation of prognosis and treatment planning of the patients are based on the TNM classification. Bone metastasis is a prognostic factor of morbidity and mortality in prostate cancer. Sodium fluoride (NaF) PET/CT is a promising imaging modality in evaluation of skeletal system. This article will review the involvement of F-18-NaF in extra-osseous tissues in the prostate cancer and reveal the fundamental differences between F-18-NaF imaging and F-18-FDG imaging in these areas.
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    68Ga-PSMA-I&T-PET/CT interobserver and intraobserver agreement for prostate cancer: a lesion based and subregional comparison study among observers with different levels of experience
    (Lippincott Williams & Wilkins, 2021) Soyluoglu, Selin; Korkmaz, Ulku; Ozdemir, Busra; Ustun, Funda; Durmus-Altun, Gulay
    Objective Ga-68-PSMA-PET/CT is a relatively new technique, that is rapidly becoming widespread. We aimed to contribute interobserver-intraobserver agreement of Ga-68-PSMA-PET/CT, among low/high-experienced interpreters. Methods Ga-68-PSMA-PET/CT of 56 patients with prostate cancer were evaluated blindly by four observers. Visual interpretation of malignant disease and SUVmax for lymph node (LN) regions, local tumor, bones and visceral organs were recorded. Cohen's Kappa and Fleiss' Kappa analyses were used to measure agreement between low/high/all-experienced observers. Variations were compared for regions, and the effect of prostate-specific antigen or Gleason score on the results was investigated. Results Interobserver agreement was almost perfect for all LN regions (LN1 low-experienced kappa: 0.84/0.84, high-experienced 0.89/0.96; LN2 low-experienced kappa: 0.88/0.79, high-experienced 0.95/0.95; LN3 low-experienced kappa: 0.84/0.89, high-experienced 0.87/0.94, first/second readings, respectively) and bone lesions (low-experienced kappa: 0.88/0.88, high-experienced 0.92/0.92, first/second readings, respectively). For local tumor, interobserver agreement was substantially-almost perfect among a high-experienced group (kappa: 0.74/0.89, first/second readings, respectively), and was moderate-substantial among a low-experienced group (kappa: 0.62/0.56, first/second readings, respectively). Intraobserver agreement was almost perfect for three observers for all regions and substantial for the observer with the lowest experience in LN3, local and visceral lesions (kappa: 0.74/0.79/0.62, respectively). Conclusion Interpretation of prostate-specific membrane antigen (PSMA) for prostate cancer is acceptably consistent among observers, but some details are noteworthy. The evaluation should be done more algorithmically for local tumors, since all observers showed relatively lower agreement. The agreement increased as prostate-specific antigen and Gleason score increased. The observer with PSMA experience <30 readings showed lower reliability, distinct from the others. This indicates that although a reader may be familiar with other PET agents, a more consistent interpretation of Ga-68-PSMA-PET/CT requires training with a small number of identified cases.
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    The Clinical Significance of Incidental Parotid Uptake in a PET/CT Study: A Diagnostic Algorithm
    (Bentham Science Publ Ltd, 2019) Ustun, Funda; Tastekin, Ebru; Tas, Abdullah; Altun, Gulay Durmus
    Background: Patients diagnosed with cancer do not have sufficient clinical data for the management of incidental parotid lesions. We aimed to reveal the importance of randomized parotid lesions encountered during oncologic F-18 fluorodeoxyglucose positron emission tomography (FDG PET/CT) imaging in our clinical practice and the diagnostic algorithm of such lesions. Methods: We performed a database search of PET/CT records generated from 2009 to 2015 for parotid in reports of patients who underwent PET/CT examination for a known malignancy elsewhere, or cancer screening. Results: Incidental parotid FDG uptake on PET/CT had a prevalence of 1.1%. The incidence of parotid metastasis in our series was 36.4%, and 75% of them had malign melanoma metastasis. Of the 11 cases, 5 were of Warthin tumours, and Warthin tumours showed stronger GLUT1 expression than metastatic parotid lesions. Conclusion: In patients with malignancy elsewhere, focal involvement of FDG by the parotid gland, especially if malignant melanoma or SCC is absent, should not be considered a metastatic disease without histopathologic confirmation. If parotid disease would change the patient's treatment plan and disease stage, the parotid lesion should be evaluated by additional methods, such as fine needle aspiration biopsy.
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    Clinicopathological and prognostic characteristics of acral metastases in patients with malignant disease: A retrospective study
    (Turkish Assoc Orthopaedics Traumatology, 2021) Ciftdemir, Mert; Ustabasioglu, Fethi Emre; Colbe, Suleyman Alp; Ustun, Funda; Usta, Ufuk; Cicin, Irfan
    Objective: This study aimed to investigate the clinical, pathological, and prognostic characteristics of acrel metastases in patients with malignant disease and to determine the impact of different types of acral metastasis treatment on patient survival. Methods: In this retrospective study, 64 acral metastatic lesions in 46 patients (17 women, 29 men; mean age, 61.5 years; age range, 35-82 years) who were evaluated by the Bone and Soft Tissue Tumors Council of our institute from 2015 to 2019 were included. The patients' primary tumor site, tumor type. localization of acrel metastases, main symptom, duration from the diagnosis of the primary tumor to the diagnosis of acral metastasis, duration from the diagnosis of acrel metastasis to death, and survival data were analyzed. The diagnosis of acral metastasis was confirmed by histopathological evaluation in 38 patients and clinical and radiological assessment of the lesions in 8 patients. The treatment type for each acral metastasis was individualized by the institutional Bone and Soft Tissue Tumors Council and categorized into 3 groups: excisional surgery (amputations and resections). palliative surgery (prophylactic fixation, intralesional curettage, and bone cement augmentation), and non-surgical treatment (chemotherapy. radiotherapy, and hormone therapy). Results: A total of 16 acral metastases (25%) were identified in the upper extremity and 48 (75%) in the lower extremity. The most common primary tumor site was the lungs (32.6%), and the most common tumor type was adenocarcinoma (43.2%). The most frequent symptom and the primary reason for admission was pain (58.7%). The mean duration between the diagnosis of primary tumor and the diagnosis of acral metastasis was 19.1 (range. 0-124) months. No significant correlation was determined between the primary tumor types and duration from the diagnosis of primary tumor to the diagnosis of acral metastasis (p=0.278). Acral metastases were treated by excisional surgery in 15 (32.6%) patients, palliative surgery combined with non-surgical treatment in 10 (21.7%) patients, and only non-surgical treatment modalities in 21 (45.7%) patients. No significant correlation existed between the treatment types and patient survival (p=0.058). At the final follow-up. 30 (65.2%) patients were dead owing to the disease. The mean overall survival of the entire study group was 24.9 (range. 3-55) months. The mean duration between the diagnosis of acral metastasis and death was 7.6 (range, 3-24) months in patients who were dead owing to the disease (p=0.012). Conclusion: When the diagnosis of acral metastasis is established, it should be borne in mind that the most common primary tumor site and type are most likely the lungs and adenocarcinoma, respectively. The treatment type for acral metastasis may have no significant impact on patient survival, but the extensiveness of the disease may be a critical factor for survival.
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    Comparison of clinicopathological features in patients with noninvasive follicular thyroid neoplasm with papillary-like nuclear features and follicular variant papillary thyroid cancer
    (Medycyna Praktyczna Sp K Sp Zoo, 2020) Celik, Mehmet; Bulbul, Buket Y.; Can, Nuray; Ayturk, Semra; Tastekin, Ebru; Sezer, Atakan; Ustun, Funda
    INTRODUCTION Noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) is a newly defined entity accepted as a tumor precursor. OBJECTIVE We aimed to examine the features of patients diagnosed with follicular variant papillary thyroid carcinoma (FVPTC), which are classified as NIFTP in the recent classification. This study compares clinical, radiological, histopathological, and molecular features of NIFTP and FVPTC. PATIENTS AND METHODS A total of 247 patients with FVPTC were retrospectively examined and pathology specimens were reviewed. RESULTS Patients were divided into 2 groups (NIFTP group: 107 patients; FVPTC group: 140 patients). There was a difference in terms of the percentage of pathologic nodules with irregular borders detected on preoperative neck ultrasonography (NIFTP group: 6.5%, FVPTC group: 15.7%; P = 0.02). Central lymph node dissection specimens of 50 patients in the NIFTP group were normal, while 4 of 70 patients (5.7%) in the FVPTC group had lymph node metastasis (P = 0.14). In addition, multivariable analysis (binary logistic regression) showed that FVPTC was positively associated only with irregular borders and extrathyroidal extensions (P = 0.02 and P <0.001, respectively). CONCLUSIONS We suggest that patients diagnosed with NIFTP according to the new classification are considered low risk, and margin characteristics of the nodule detected on preoperative ultrasonography may be helpful in the differential diagnosis.
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    Development of a Radiolabeled Folate-Mediated Drug Delivery System for Effective Delivery of Docetaxel
    (Amer Chemical Soc, 2023) Cetin, Oguz; Gungor, Burcu; Ichdef, Cigdem; Parlak, Yasemin; Bilgin, Elvan Sayit; Ustun, Funda; Altun, Gulay Durmus
    Many preclinical studies are carried out with the aimof developingnew formulations for the effective delivery of taxane class drugs,one of the most important anticancer drugs used clinically today.In this study, a radiolabeled folate-mediated solid lipid magneticnanoparticle (SLMNP) system was developed by loading superparamagneticiron oxide nanoparticles (MNP) and docetaxel (DTX) into the solidlipid nanoparticles as a drug delivery system that will function bothin cancer treatment and diagnosis. For this purpose, first, SLMNPwas synthesized by the hot homogenization method, and the surfaceof the particles was modified with a folate derivative to carry theparticles to tissues with folate receptors. The synthesized magneticsolid lipid nanoparticles were loaded with DTX, and then radiolabelingwas carried out with technetium-99 m (Tc-99m-DTX-SLMNP).Structural characteristics of these nanoparticles were determinedby characterization methods. According to the TEM images of MNPs,SLN, and SLMNPs, MNPs were observed between 25and 35 nm, SLNs between400 and 500 nm, and SLMNPs between 350 and 450 nm. The drug entrapmentefficiency of SLMNPs loaded with DTX was found to be 19%, and thepercentage efficiency of radiolabeling was found to be 98.0 & PLUSMN;2.0%. The biological behavior of this radiolabeled system was investigated in vitro and in vivo. Folate receptor-positiveSKOV-3 and folate receptor-negative A549 cancer cell lines were studied.The IC50 values of DTX-SLMNP in SKOV-3 and A549 cells were50.21 and 172.27 & mu;M at 48 h, respectively. Gamma camera imagingstudies of Tc-99m-DTX-SLMNP and magnetically applied Tc-99m-DTX-SLMNP compounds were performed on tumor-bearing CD-1nude mice. The uptake in the folate receptor-positive tumor regionwas higher than that in the folate receptor negative tumor region.We proposed that the drug delivery system we prepared in this studybe evaluated for preclinical studies of new drug carrier formulationsof the taxane class of anticancer drugs.
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    Evaluation of morphine effect on tumour angiogenesis in mouse breast tumour model, EATC
    (Humana Press Inc, 2011) Ustun, Funda; Durmus-Altun, Gulay; Altaner, Semsi; Tuncbilek, Nermin; Uzal, Cem; Berkarda, Sakir
    Breast cancer is the leading cause of death among women, and morphine is used to relieve the pain of patients with cancer. The data on the effects of morphine on tumour growth and angiogenesis are contradictory. We determined in mouse breast cancer model whether analgesic doses of morphine would affect tumour angiogenesis, and then the correlation between microvessel density (MVD), Doppler sonography (DS) and Tc-99m-Tetrofosmin (TF) uptake. Ehrlich ascites tumour cell xenografts, Pgp-negative tumour were divided into two groups: (a) Morphine sulphate [0.714 mg/kg/day (equivalent to 50 mg per day for a 70 kg human)], (b) no-morphine. For the determination of angiogenesis in mice tumour tissue, TF scintigraphy, microvessel density and DS were done. MVD was significantly different between groups (49.4 +/- 1.8 vs. 41.8 +/- 1.9, morphine and no-morphine groups, respectively, P < 0.001). A strong correlation was found between late uptakes of mass at scintigraphy and degree of angiogenesis in histopathologic examination (r = 0.52, P < 0.01). There was statistically significant inverse correlation between degree of angiogenesis in histopathologic examination and washout ratio of TF (r = 0.40, P < 0.05). The higher values for angiogenesis are related to higher TF reuptake. There was no statistically significant correlation between DS and TF. A strong correlation was found between MVD and grade of DS (r = 0.51, P < 0.01). Our preclinical mice study indicates that morphine at clinically relevant doses stimulates angiogenesis, and angiogenesis triggered of morphine is demonstrated with MVD and DS, but not TF. However, uptake and washout of TF are compared with immunohistochemically assessed morphine-stimulated angiogenesis in tumour tissue.
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    Evaluation of the factors affecting survival and local recurrence in thigh soft tissue sarcomas
    (Turkish Joint Diseases Foundation, 2024) Yildirim, Savas; Ciftdemir, Mert; Ustabasioglu, Fethi Emre; Ustun, Funda; Usta, Ufuk
    Objectives: The aim of this study was to evaluate the factors affecting local recurrence and survival in patients with soft-tissue sarcomas located in the thigh.Patients and methods: This retrospective cross-sectional study evaluated 41 soft tissue sarcoma patients (21 males, 20 females; mean age: 57.9 +/- 13.7 years; range, 18 to 90 years) with thigh involvement between January 2010 and December 2020. All surgical intervention was performed by one surgeon with an experience of 15 years in orthopedic oncologic surgery. Epidemiological, radiological, histopathological, and metabolic features, as well as surgical and oncological treatments and prognoses, were assessed. The data was statistically analyzed to determine factors affecting local recurrence and survival in these cases, staged using Enneking and the American Joint Committee on Cancer classifications.Results: Liposarcomas were the most common type of tumor (39%), followed by undifferentiated pleomorphic sarcomas (32%). Tumors >10 cm were associated with decreased survival rates. High-grade tumors, tumor necrosis, Ki-67 index >20%, and positive surgical margins were also associated with lower survival rates. Metastatic patients had significantly lower survival rates. Local recurrence was significantly more frequent in patients with positive surgical margins. Survival rates were significantly lower in metastatic patients.Conclusion: There are many factors that affect local recurrence and survival of soft tissue sarcomas. The size of the mass, the presence of necrosis, a high Ki-67 index, positive surgical margins, and the presence of metastasis are the main factors that should be taken into consideration.
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    Experimental Breast Cancer Models: Preclinical Imaging Perspective
    (Bentham Science Publ Ltd, 2021) Korkmaz, Ulku; Ustun, Funda
    Background: Breast cancer is the leading cause of cancer in women. 13% of breast cancer patients are at a distant stage and mortality is due to metastases rather than primary disease. The unique genetic structure and natural process of breast cancer make it a very suitable area for targeted therapies. Experimental tumor models are validated methods to examine the pathogenesis of cancer, the onset of the neoplastic process and progression. Objective: This study aims to review the current literature on experimental breast cancer models and to bring a new perspective to the use of these models in teranostic preclinical studies in terms of the imaging. Methods: Search for relevant literature from academic databases using keywords (Breast cancer, theranostic, preclinical imaging, tumor models, animal study, and tailored therapy) was conducted. The full text of the articles was reached and reviewed. Current scientific data has been reevaluated and compiled according to subtitles. Results and Conclusion: The development of animal models for breast cancer research has been done in the last century. Imaging methods used in breast cancer are used for tumor localization, quantification of tumor mass, imaging of genes and proteins, evaluation of tumor microenvironment, evaluation of tumor cell proliferation and metabolism and treatment response evaluation. Since human breast cancer is a heterogeneous group of diseases in terms of genetics and phenotype; it is not possible for a single model to adequately address all aspects of breast cancer biology. Considering that each model has advantages and disadvantages, the most suitable model should be chosen to verify the thesis of the study.
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    Glucose-Induced Alteration of Accumulation of Organotechnetium Complexes Accumulation in Pgp-Negative Tumor-Bearing Mice
    (Mary Ann Liebert Inc, 2009) Ustun, Funda; Durmus-Altun, Gulay; Cukur, Ziya; Altaner, Semsi; Berkarda, Sakir
    The biologic and microenvironmental factors determining (99m)Tc sestamibi (MIBI) and (99m)Tc tetrofosmin (TF) uptake in breast tumors are incompletely understood, especially in P-glycoprotein (Pgp)-negative tumors. We analyzed the influence of glucose administration on the uptake and retention of MIBI and TF in Pgp-negative tumor-bearing mice in vivo. Twenty (20) mice bearing Ehrlich ascites tumor cell (EATC) xenografts were divided into four groups: (1) MIBI, (2) MIBI+glucose, (3) TF, and (4) TF+glucose. Glucose was administered (5.0 g/kg body weight) intraperitoreally (i.p.) 1 hour before scintigraphy. There were significant differences between the E-UPR MIBI and MIBI+glucose groups (p = 0.009) and minor differences in L-UPR between these groups (p = 0.04). There was a significant inverse correlation between E-UPR of MIBI and glucose levels (r = 0.71, p = 0.02). Comparing the four groups, the highest E-UPR was obtained in the MIBI group (p = 0.006). Other parameters were not different in the MIBI and MIBI+glucose groups and in the TF and TF+glucose groups. Increased blood glucose level affected the MIBI uptake of tumor tissue, particularly for E-UPR. We suggest that these findings were due to basically decreased blood flow and secondarily decreased extracellular pH. However, glucose administration did not affect TF.
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    HISTOPATHOLOGICAL AND SCINTIGRAPHIC COMPARISONS OF THE PROTECTIVE EFFECTS OF l-CARNITINE AND AMIFOSTINE AGAINST RADIATION-INDUCED LATE RENAL TOXICITY IN RATS
    (Wiley-Blackwell Publishing, Inc, 2009) Caloglu, Murat; Yurut-Caloglu, Vuslat; Durmus-Altun, Gulay; Oz-Puyan, Fulya; Ustun, Funda; Cosar-Alas, Rusen; Saynak, Mert
    The aim of the present study was to compare the protective effects of l-carnitine and amifostine against radiation-induced late nephrotoxicity using technetium-99m diethylenetriaminepentaacetic acid scintigraphy and histopathological examination. Seventy-one Albino rats were randomly divided into six groups as follows: (i) AMI + RAD (n = 15), 200 mg/kg, i.p., amifostine 30 min prior to irradiation (a single dose of 9 Gy); (ii) LC + RAD (n = 15), 300 mg/kg, i.p., l-carnitine 30 min prior to irradiation; (iii) LC (n = 10), 300 mg/kg, i.p., l-carnitine 30 min prior to sham irradiation; (iv) AMI (n = 10), 200 mg/kg, i.p., amifostine 30 min prior to sham irradiation; RAD (n = 11), 1 mL/kg, i.p., normal saline 30 min prior to irradiation; and (vi) control (n = 10), 1 mL/kg, i.p., normal saline 30 min prior to sham irradiation. Scintigraphy was performed before treatment and again 6 months after treatment. Kidneys were examined by light microscopy and a histopathological scoring system was used to assess the degree of renal damage. The main histopathological findings were proximal tubular damage and interstitial fibrosis. Glomerular injury was similar in all groups. Tubular degeneration and atrophy were less common in the AMI + RAD group than in the RAD group (P = 0.011 and P = 0.015, respectively), as well as in the LC + RAD group compared with the RAD group (P = 0.028 and P = 0.036, respectively). Interstitial fibrosis in the AMI + RAD and LC + RAD groups was significantly less than that in the RAD group (P = 0.015 and P = 0.015, respectively). The highest total renal injury score (9) was seen in the RAD group. On scintigraphy, there were significant differences in post-treatment time to peak count (T(max)) and time from peak count to half count (T(1/2)) values (P = 0.01 and 0.02, respectively) between groups in the right kidney. In the control and RAD groups, the T(1/2) of the right kidney was 8 +/- 2 and 21 +/- 2 min, respectively. The T(max) values for the AMI + RAD and LC + RAD groups (2.8 +/- 0.2 and 3.2 +/- 0.2 min, respectively) were similar to those in the control group (2.5 +/- 0.3 min). Based on the results of the present study, l-carnitine and amifostine have comparable and significant protective effects against radiation-induced late nephrotoxicity.
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    A new imaging modality in detection of caustic oesophageal injury: Technetium-99m pyrophosphate scintigraphy
    (Elsevier Ireland Ltd, 2009) Aksu, Burhan; Durmus-Altun, Gulay; Ustun, Funda; Torun, Nese; Kanter, Mehmet; Umit, Hasan; Sut, Nejdet
    Objectives: Early oesophagoscopy is usually recommended in children after caustic ingestion to assess the severity of the initial digestive lesions. An oesophagoscopic procedure in children always demands to be performed under sedation and bears a certain risk of iatrogenic injury. The purpose of the study is to determine the value and sensitivity of Tc-99m pyrophosphate (99mTc-PYP) scintigraphy for the detection of caustic oesophageal injury. Methods: The caustic oesophageal burns were created with 25% NaOH in an experimental rat model. Seventeen rats were divided into two groups. The BURN group (n = 9) included caustic oesophageal burning rats. Non-BURN group (n = 8) included sham-operated rats. All animals underwent 99mTc-PYP scintigraphy 72 In after the burning experiment. Anterior static and single-photon emission computed tomography images were obtained using a tow-energy all-purpose collimator, 2.55 zoom factor, 3 h after intravenous injection of 10 mCi 99mTc-PYP. After the imaging, all the oesophagi were explored for external determination of the injury sites and macroautoradiographic scintigraphy as well. Rectangular region of interest were placed in the visually determined lesion of oesophagus (0) as well as non-lesion area (N), and an ON ratio was created. The severity and extension of oesophageal burn were assessed 3 days after burning by histopathologic evaluation. The injuries were graded according to the ulcer depth, ulcer width, thrombus formation, and the development of perivascular fibrinoid necrosis. Results: The oesophageal burning areas were demonstrated by visual evaluation of the Tc-99m PYP scintigraphy on all animals. The mean ON ratio of 99mTc-PYP was 21.61 +/- 7.01 in the BURN group and in the non-BURN group, was 2.25 +/- 0.24 (p < 0.001). The best cut-off point of the ON ratio for caustic oesophageal injury was 5.45, with sensitivity and specificity of 100%. PYP scan findings were also confirmed by histological evidence of ulcer depth, ulcer width, thrombus formation, and perivascular fibrinoid necrosis in the same areas. Conclusions: The caustic oesophageal injuries have been demonstrated by 99mTc-PYP scintigraphy in burning experiment. 99mTc-PYP scintigraphy is sensitive for detection of caustic oesophageal injury. This new imaging tool is found to be sensitive and specific for the detection of caustic oesophageal injury in the rats. Published by Elsevier Ireland Ltd.
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    Pre-therapy Iodine-131 Uptake Value as a Prediction Method for Metastatic Lymph Node Status in Patients with Differentiated Thyroid Carcinoma
    (Bentham Science Publ Ltd, 2017) Aktas, Gul Ege; Demir, Selin Soyluoglu; Ustun, Funda; Sarikaya, Ali; Altun, Gulay Durmus
    Background: We hypothesized that postoperative lymph node status would affect I-131 uptake (RIU) due to pathophysiological behavior of benign and malign thyroidal tissue. This retrospective study was designed to assess whether RIU would predict the presence of lymph node metastasis (LNM). Methods: Data for differentiated thyroid cancer patients who received postoperative I-131 therapy at our institution between 2013 and 2016 were reviewed. Age, histopathology, TSH, Tg, anti-Tg, 2 and 24 hour RIU (2-24RIU), ultrasonography, I-131 dose, scans were reviewed. Patients were divided into groups according to lymph node status. The Delta RIU was calculated (Delta RIU=24RIU-2RIU) to define different metabolic behavior of I-131. Patients were grouped according to Delta RIU to assess the sensitivity, specificity, negative/positive predictive values, accuracy of Delta RIU predicting LNM. Results: 198 patients (38 males/160 females, age: 47 +/- 14 years) who received mean: 118 +/- 27 mCi I-131 were enrolled in the study. There was no difference between ages, TSH level, 2RIU values and the I-131 therapy dose of patients with and without LNM. Tg, anti-Tg, 24RIU, Delta RIU values were higher in patients with LNM. Patients with Delta RIU >= 1% had higher Tg values (mean +/- std: 16.63 +/- 46.53 vs. 6.70 +/- 31.18, p: 0.04). When Delta RIU >= 1% was used for predicting LNM, sensitivity, specificity, positive, negative predictive values, diagnostic accuracy were, 66%, 72%, 64%, 74 %, and 70% respectively. Conclusion: RIU was evaluated to predict neck LN status in this study. The sensitivity and specificity were comparable with modalities which are commonly used for determination of LNM. In light of the results of this study, when a pre-therapy RIU increase in time is observed, carrying out further investigation protocols for LNM, would contribute to pre-therapy staging.
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    Recurrent Merkel cell carcinoma of the gluteal region: A case report
    (Wiley, 2019) Turkkan, Gorkem; Agdogan, Ozgur; Saynak, Mert; Uygun, Arzu C.; Ustun, Funda
    Merkel cell carcinoma (MCC) is a rare malignant tumor of the skin. The development of MCC on non-sun-exposed skin is extremely rare, with few cases reported in the literature. The present authors aimed to highlight the characteristic features and treatment options of this tumor. The present authors present a 50-year-old man who developed MCC on the left gluteal region (non-sun-exposed skin). After surgery with clear margins, adjuvant radiotherapy was given. Three months after radiotherapy, lymphatic recurrence was observed and he was treated with chemotherapy. On follow-up, systemic metastases were found and palliative treatment was planned.
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    The relationship between FDG PET/CT-defined metabolic parameters and the histopathological subtype of oesophageal carcinomas
    (Int Scientific Information Inc, 2020) Korkmaz, Ulku; Hacioglu, Muhammet Bekir; Kostek, Osman; Sut, Necdet; Kodaz, Hilmi; Erdogan, Bulent; Ustun, Funda
    Purpose: 18F-fluorodeoxyglucose (F-18-FDG) positron emission tomography (PET) combined with computed tomography (CT) scan is accepted as a standard tool in the staging of oesophageal cancer (OC). Histological subtype of tumour is known to be a major determinant of prognosis and metabolic behaviour. In this study, we aimed to evaluate the effect of histological subtypes of OC on standard uptake value (SUVmax), metabolic tumour volume (MTV), and total lesion glycolysis (TLC) obtained by PET/CT, and also to compare this effect with prognosis. Material and methods: Images and clinical course data of 57 patients who were diagnosed with EC and treated in our hospital between 2009 and 2016 were evaluated in a retrospective manner. PET/CT images were re-analysed in terms of metabolic parameters, and observations were compared with histological subtypes. Results: No significant difference was observed between histological subtypes with SUVmax, overall survival (OS), or progression-free survival (PPS). Thus, MTV was observed to be related with histological subtype; MTV values of adenocancer patients were significantly higher than those of squamous cell cancer patients. Conclusions: Metabolic tumour volume was related with histological subtype of OC, but clinical staging, TLG, and SUVmax values were not related with histological subtype, which may suggest the use of MTV as a routine parameter for OC and inclusion of MTV observations in prognostic scoring.
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    Relationship between lymphovascular invasion and clinicopathological features of papillary thyroid carcinoma
    (Assoc Basic Medical Sci Federation Bosnia & Herzegovina Sarajevo, 2017) Sezer, Atakan; Celik, Mehmet; Bulbul, Buket Yilmaz; Can, Nuray; Tastekin, Ebru; Ayturk, Semra; Ustun, Funda
    Lymphovascular invasion (LVI) is an important prognostic factor in various solid tumors, however, data on the association between LVI and thyroid carcinomas are limited. In this study, we evaluated the relationship between LVI and clinicopathological features of papillary thyroid carcinoma (PTC). Six hundred seventy- eight patients diagnosed with PTC between 2012 and 2015 were included into the study. Patients were classified based on the presence or absence of LVI. Gender, age, ultrasonography (US), tumor size and multifocality, BRAFV600E mutation, perineural and capsular invasion, extrathyroid extension (ETE), nodal metastasis, and recurrences were evaluated, and risk analysis was performed for each parameter. The number of patients with LVI [LVI (+)] was 63, while the number of patients without LVI [LVI (-)] was 615. The female/male ratio was 564/114. LVI was present in 18.4% of male patients and in 7.4 % of female patients. In the age group between 17- 25 years LVI was detected in 6/13 patients, and this result was statistically significant compared to other age groups (p = 0.004). Suspicious lymph nodes upon US, perineural or capsular invasion, ETE, tumor size, and nodal metastasis were significantly more frequent in LVI (+) group (p < 0.001). The frequency of BRAFV600E mutation was also significantly higher in LVI (+) group (p < 0.001). Overall, the presence of LVI was associated with gender, tumor size, age, lymph node metastasis, pathological lymph nodes, perineural and capsular invasion, ETE, and BRAFV600E mutation. These results suggest that in PTC patients undergoing thyroidectomy, the presence of LVI should be considered as an indicator of aggressive clinicopathological features and those patients should be followed up carefully for recurrences and metastasis.
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    The Role of 68Ga PSMA Imaging in Evaluating Adrenal Lesions in Prostate Cancer Patients
    (Thieme Medical Publ Inc, 2024) Ustun, Funda; Gunay, Busra Ozdemir; Ustabasioglu, Fethi Emre; Korkmaz, Selcuk
    Objectives Gallium-68 prostate-specific membrane antigen (Ga-68-PSMA) imaging is valuable for staging because an accurate diagnosis, metastatic or nonmetastatic for prostate cancer patients, is required for deciding to treatment approaches and prognostic assessment. The aim of this study was primarily to distinguish between benign and metastatic adrenal gland lesions detected during Ga-68-PSMA positron emission tomography (PET)/CT imaging, to evaluate the presence of factors predicting its development, and then to determine the life expectancy of patients with metastatic adrenal lesions. Materials and Methods We performed a database search for PET/CT records generated from June 2016 to February 2021 for adrenal gland in report for patients who underwent Ga-68-PSMA examination with prostate cancer patients. Results Twenty-three patients (10 benign and 13 metastatic) were included in this study. The total prostate-specific antigen, adrenal gland size, adrenal gland density, and maximum standardized uptake (SUVmax) values are significantly different between groups (p < 0.05). On receiver operating characteristic curve analysis, the SUVmax cutoff value > 6.8 provided both sensitivity and specificity of 100%. However, with 29 mm as the adrenal gland size cutoff and 21.2 as Hounsfield unit, the sensitivity and specificity were 56.2 and 92.3%, and 93.8 and 92.3%, respectively. The survival of the benign and metastatic groups was compared and a statistically significant difference was found (p = 0.006). The presence of pelvic lymph nodes was statistically negatively affected the surveillance between the groups. Conclusion The presence of atypical metastases such as adrenal gland is not insignificant in prostate cancer patients. Because of this degree of impact on patient management, accurate staging by imaging with Ga-68-PSMA should be an integral part of prostate cancer management.
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    Skeletal trauma and torture detection with 18F-FDG PET/CT
    (Soc Nuclear Medicine Inc, 2016) Altun, Gurcan; Serim, Burcu Dirlik; Ustun, Funda; Altun, Gulay Durmus
    [Abstract Not Available]