Tıp Fakültesi / Faculty of Medicine

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    F-18-FDG PET/CT Imaging in an Unusual Case of Cutaneous Melanoma Arising From Congenital Melanocytic Nevus in a Two-year-old Girl
    (2021) Erhamamci, Seval; Reyhan, Mehmet; Bal, Nebil; Torun, Nese; Yapar, Ali Fuat; 0000-0001-5016-4650; 0000-0001-8550-3368; 34082516; AAJ-5242-2021
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    Pretreatment Photopenia on F-18-Fluorodeoxyglucose Positron Emission Tomography-Computed Tomography Scans Predicts Poor Prognosis in Nasopharyngeal Cancer Patients Undergoing Concurrent Chemoradiotherapy
    (2020) Topkan, Erkan; Selek, Ugur; Mertsoylu, Huseyin; Ozdemir, Yurday; Kucuk, Ahmet; Torun, Nese; Besen, Ali Ayberk; 0000-0002-2218-2074; 0000-0002-1932-9784; 0000-0001-8120-7123; 0000-0002-7862-0192; 0000-0002-5597-676X; 32075362; AAG-5629-2021; M-9530-2014; AAG-2213-2021; AAD-6910-2021; AAE-2718-2021
    Objectives. To investigate the influence of pretreatment primary tumor or nodal photopenia (PP) on F-18-fluorodeoxyglu- case positron emission tomography-computed tomography (FDG PET-CT), an indicator of tumor ischemia, on survival results of nasopharyngeal cancers (NPCs) treated with concurrent chemoradiotherapy (C-CRT). Methods. The pre-C-CRT FDG PET-CT scans of 104 patients with NPC (cT1-4 N0-3 M0) were retrospectively examined to determine the presence of PP (PP+). Our primary endpoint was the influence of PP+ on overall survival (OS), while the progression-free survival (PFS) and locoregional PFS (LRPFS) constituted the secondary endpoints. Results. The PP+ was detected in 29 (27.9%): nine (8.7%), seven (6.7%), and 13 (12.5%) in the primary tumor alone, primary tumor plus neck nodes, and neck nodes alone, respectively. Because the PP+ cases were small by count per location, all comparative analyses were performed according to overall PP+/PP- status instead of per detected site. At a median follow-up of 67.8 months (range, 9 to 130 months), the median survival times were not reached (NR) for the entire population. while 5-year OS, LRPFS, and PFS rates were 73.3%, 68.2%, and 63.4%, respectively. Comparatively the PP patients exhibited significantly poorer median OS (49.8 months vs. NR, P<0.001), LRPFS (40.7 months vs. NR, P=0.001), and PFS (31.8 months vs. NR, P=0.002) durations than their PP- counterparts. Furthermore, the PP+ retained its independent prognostic significance in multivariate analysis (P <0.001). Conclusion. Present results uncovered the pre-C-CRT PP as an independent predictor of poor prognosis for NPC patients, which underscore the requirement for the fortification of the local and systemic treatments in hypoxic NPCs.
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    The role of PET-CT in the evaluation of the response of the vertebra metastases in stereotactic radiosurgery
    (2019) Ozdemir, Yurday; Torun, Nese; Topkan, Erkan; 0000-0001-8120-7123; AAG-5629-2021; AAG-2213-2021
    Purpose: The aim of this study was to evaluate the role of positron emission tomography in assessing the response of stereotactic radiosurgery (SRS) for vertebral metastases(VM). Materials and Methods: Patients who received 16 Gy or 18 Gy SRS with no history of vertebral compression fracture, proven histologies except small-cell lung carcinoma and hematologic malignancies which are known as radio sensitive tumors, available pre- and post SRS PET images were included. All vertebral segments were categorized according to spinal instability neoplastic score in terms of stability and PET Response Criteria in Solid Tumors (PERCIST) criteria was utilized for treatment response. Results: Seventy-five patients with 119 VS (101 single, 9 double VS) received SRS. Breast cancer (66.7%) was the commonest pathology. Most patients (70.6%) had SINS 06.The local control was achieved in 87.4% VS with a 1-year local relapse -free survival rate of 92.5%. The median PET-CT time for the first SRS response assessment was 3-months (range:1-3.5 months) and there were only 4 (3.3%)local relapses in contrast to the positive responses in the remainders (30.3% complete, 43.7% partial responses and 22.7% stabil disease). While there were 11 local relapses in the last PET-CT response, no patient experienced any relapse complete response was achieved in the first PET-CT.Complete response in the first PET-CT was correlated with positive response in the last PET CT also. Conclusion: First PET-CT response after SRS seems to be valuable in anticipation of both the final vertebral response status and planning of alternative interventions for non-responders.
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    Local control and vertebral compression fractures following stereotactic body radiotherapy for spine metastases
    (2019) Ozdemir, Yurday; Torun, Nese; Guler, Ozan Cem; Yildirim, Berna Akkus; Besen, Ali A.; Yetisken, Aylin Gunesli; Onal, H. Cem; Topkan, Erkan; 0000-0002-2742-9021; 0000-0001-6908-3412; 0000-0002-2742-9021; 30815342; D-5195-2014; AAC-5654-2020
    Purpose: We aimed to retrospectively assess the incidence of vertebral compression fractures (VCF), examine clinicopathologic factors potentially associated with VCF, and evaluate treatment response in patients who received stereotactic body radiotherapy (SBRT) for spine metastases (spMets). Methods and Materials: We identified 78 patients with 125 spMets at baseline and subsequent assessments. Patients received SBRT doses of 16 or 18 Gy. Patients with pre-existing VCF and co-existing local progression were excluded. Spine instability neoplastic score (SINS) was used for spMets categorization. Response to SBRT and VCF were assessed according to the Positron Emission tomography Response Criteria In Solid Tumors (PERCIST) and Genant scores, respectively. Kaplan-Meier analyses were used to assess local control of disease and vertebral compression fracture-free survival (FFS). Results: We treated 103 cases with single spMets and 11 cases involving double spMets with SBRT. Progressive disease was reported in 3.2% and 8.2% of the cases in the first and last PET/CT reports, respectively. The distribution of treatment response in the remaining patients was: complete response in 30.6% of patients, partial response in 47.1% of patients, and stable disease in 22.3% of patients in the first PET/CT; complete response in 62.3% of patients, partial response in 16.7% of patients, and stable disease in 21% of patients at the last monitoring. Local failures were observed in 15 (12%) of cases. Median SINS was 5 (range: 1 - 13); majority of patients in our cohort (70.4%) were categorized as stable according to SINS, five (4%) patients had Grade 3 VCF at a median time of 16 months after SBRT (range: 2 - 22 months), and 60% of VCF occurred after an interval of at least 12 months after SBRT. No bisphosphonate usage was significantly associated with VCF (r = -0.204; p = 0.022). Median FFS was 21 months. Univariate analyses indicated that female gender (p < 0.001), bisphosphonate use (p = 0.005), >6 months of bisphosphonates use (p = 0.002), and the lowest vertebral body collapse score (p = 0.023) were associated with higher FFS. Female gender (p = 0.007), >6 months of bisphosphonates usage (p = 0.018), and the lowest vertebral body collapse score (p = 0.044) retained independent significance. Conclusions: This study demonstrated that spine SBRT with doses of 16-18 Gy promises good local control of disease with acceptable VCF rates. Lowest vertebral body collapse score, female gender, and >6 months of bisphosphonate use were significantly associated with longer FFS.
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    A Case of Primary Colon Carcinoma Demonstrated by FDG PET/CT Imaging After Detection of a Solitary Brain Metastasis
    (2015) Erhamamci, Seval; Reyhan, Mehmet; Nursal, Gul Nıhal; Torun, Nese; Yapar, Ali Fuat
    The detection of brain metastases as the initial manifestation of colorectal carcinoma without liver or lung involvement is extremely rare. Herein we present a case of a 52-year-old male patient with an unusual presentation of colon cancer, with primary lesions demonstrated by fluorine- 18-labeled fluorodeoxyglucose (FDG) Positron-emission tomography/computed tomography (PET/CT) after detection of a solitary brain metastasis. Brain CT images revealed a brain tumor. Histopathologic evaluation indicated metastatic poorly differentiated adenocarcinoma, while his physical examination was normal. The PET/CT revealed abnormal intense FDG uptake in the right parietal region and in descending colon, with no other abnormal FDG uptake elsewhere in the body. The histopathologic diagnosis of the descending colon lesion revealed moderately differentiated adenocarcinoma. This case indicates that FDG PET/CT imaging may have a positive impact on the evaluation of patients with brain metastasis from an unknown primary.
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    An Unusual Gastrointestinal Stromal Tumor Presentain: Breast, Liver and Lymph Node Metastasis
    (2017) Hasbay, Bermal; Aytac, Huseyin Ozgur; Kayaselcuk, Fazilet; Torun, Nese; 000-0002-1180-3840; 0000-0002-5597-676X; 29082381; AAE-2550-2021; AAE-2718-2021
    Gastrointestinal Stromal Tumors (GIST) are the common mesenchymal tumors of gastrointestinal tract. They can display benign and malignant clinical behavior. The most common metastasis sites of malignant stromal tumor are liver, peritoneum, lung and bones. Metastasis to breast is extremely rare. Here, we present a case of GIST with liver, bone, lymph node and breast metastasis by reviewing the literature.
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    Hounsfield unit value has null effect on thyroid nodules at F-18-FDG PET/CT scans
    (2018) Haydedeoglu, Filiz Eksi; Bagir, Gulay Simsek; Torun, Nese; Kocer, Emra H.; Reyhan, Mehmet; Ertorer, Melek Eda; 30304111
    Objective: Detection rate of thyroid nodules is increasing with the use of new imaging modalities, especially in screening for malignancies. Positron emission tomography/computed tomography (PET/CT)-positive thyroid nodules should be differentiated for malignancy to avoid unnecessary operations and further follow-up. Most trials evaluate the role of SUVmax, but there is no definitive information about the utility of Hounsfield unit (HU) values for prediction of malignancy. This study aimed to evaluate the HU values beside SUVmax for detecting malignancy risk of PET/CT-positive thyroid nodules. Subjects and methods: Results of 98 cancer patients who had fine needle aspiration biopsy (FNAB) for thyroid nodules detected on PET/CT between January 2011 and December 2015 were assessed. The FNABs and surgical pathological results were recorded. Results: FNABs revealed benign results in 32 patients (32.7%), malignant in 18 (18.4%), non-diagnostic in 20 (20.4%), and indeterminate in 28 (28.5%). Twenty-four patients underwent thyroidectomy. The mean HU values were not significantly different in benign and malignant nodules (p = 0.73). However, the mean SUVmax was significantly higher (p < 0.001) in malignant ones. Area under curve (AUC) was 0.824 for SUVmax; the cut-off value was over 5.55 (p < 0.001), with 80% sensitivity, 84.5% specificity. Conclusions: Our current study demonstrated that HU value does not add any additional valuable information for discriminating between malignant and benign thyroid nodules. We also defined a SUVmax cut-off value of 5.55 for malignant potential of thyroid nodules detected on PET/CT.