Abstract Purpose The application value of 18 F‐FDG PET‐CT combined with MRI in the radiotherapy of esophageal carcinoma was discussed by comparing the differences in position, volume, and the length of GTVs delineated on the end‐expiration (EE) phase of 4DCT, 18 F‐FDG PET‐CT, and T 2 W‐MRI. Methods A total of 26 patients with thoracic esophageal cancer sequentially performed 3DCT, 4DCT, 18 F‐FDG PET‐CT, and MRI simulation for thoracic localization. All images were fused with the 3DCT images by deformable registration. GTV CT and GTV 50% were delineated on 3DCT and the EE phase of 4DCT images, respectively. The GTV based on PET‐CT images was determined by thresholds of SUV ≥ 2.5 and designated as GTV PET2.5 . The images of T 2 ‐weighted sequence and diffusion‐weighted sequence were referred as GTV MRI and GTV DWI , respectively. The length of the abnormality seen on the 4DCT, PET‐CT, and DWI was compared. Results GTV PET2.5 was significantly larger than GTV 50% and GTV MRI ( P = .000 and 0.008, respectively), and the volume of GTV MRI was similar to that of GTV 50% ( P = .439). Significant differences were observed between the CI of GTV MRI to GTV 50% and GTV PET2.5 to GTV 50% ( P = .004). The CI of GTV MRI to GTV CT and GTV PET2.5 to GTV CT were statistically significant ( P = .039). The CI of GTV MRI to GTV PET2.5 was significantly lower than that of GTV MRI to GTV 50% , GTV MRI to GTV CT , GTV PET2.5 to GTV 50% , and GTV PET2.5 to GTV CT ( P = .000‐0.021). Tumor length measurements by endoscopy were similar to the tumor length as measured by PET and DWI scan ( P > .05), and there was no significant difference between the longitudinal length of GTV PET2.5 and GTV DWI ( P = .072). Conclusion The volumes of GTV MRI and GTV 50% were similar. However, GTV MRI has different volumes and poor spatial matching compared with GTV PET2.5 .The MRI imaging could not include entire respiration. It may be a good choice to guide target delineation and construction of esophageal carcinoma by combining 4DCT with MRI imaging. Utilization of DWI in treatment planning for esophageal cancer may provide further information to assist with target delineation. Further studies are needed to determine if this technology will translate into meaningful differences in clinical outcome.
Rationale: Occult breast cancer (OBC) is extremely rare in males with neither symptoms in the breast nor abnormalities upon imaging examination. Patient concerns: This current case report presents a young male patient who was diagnosed with male OBC first manifesting as axillary lymph node metastasis. The physical and imaging examination showed no primary lesions in either breasts or in other organs. Diagnoses: The pathological results revealed infiltrating ductal carcinoma in the axillary lymph nodes. Immunohistochemical (IHC) staining was negative for estrogen receptor (ER), progesterone receptor (PR), cytokeratin (CK)20 and thyroid transcription factor-1 (TTF-1), positive for CK7, gross cystic disease fluid protein-15 (GCDFP-15), epithelial membrane antigen (EMA) and carcinoembryonic antigen (CEA), and suspicious positive for human epidermal receptor-2 (Her-2). On basis of IHC markers, particularly such as CK7, CK20 and GCDFP-15, and eliminating other malignancies, male OBC was identified in spite of negativity for hormone receptors. Interventions: The patient underwent left axillary lymph node dissection (ALND) but not mastectomy. After the surgery, the patient subsequently underwent chemotherapy and radiotherapy. Outcomes: The patient is currently being followed up without any signs of recurrence. Lessons: Carefully imaging examination and pathological analysis were particularly essential in the diagnosis of male OBC. The guidelines for managing male OBC default to those of female OBC and male breast cancer.
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