Publications by authors named "Boon Nang Lee"

9 Publications

  • Page 1 of 1

Impact of Ga-DOTA-Peptide PET/CT on the Management of Gastrointestinal Neuroendocrine Tumour (GI-NET): Malaysian National Referral Centre Experience.

Nucl Med Mol Imaging 2018 Apr 8;52(2):119-124. Epub 2017 Dec 8.

2Department of Nuclear Medicine, National Cancer Institute, No 4, Jalan P7, Presint 7, 62250 Putrajaya, Malaysia.

Purpose: The National Cancer Institute is the only referral centre in Malaysia that provides Ga-DOTA-peptide imaging. The purpose of this study is to determine the impact of Ga-DOTA-peptide PET/CT on the management of gastrointestinal neuroendocrine tumours (GI-NET).

Materials And Methods: A cross-sectional study was performed to review the impact of Ga-DOTA-peptide (Ga-DOTATATE or Ga-DOTATOC) PET/CT on patients with biopsy-proven GI-NET between January 2011 and December 2015. Suspected NET was excluded. Demographic data, tumoral characteristics, change of disease stage, pre-PET intended management and post-PET management were evaluated.

Results: Over a 5-year period, 82 studies of Ga-DOTA-peptide PET/CT were performed on 44 GI-NET patients. The most common primary site was the rectum (50.0%) followed by the small bowel, stomach and colon. Using WHO 2010 grading, 40.9% of patients had low-grade (G1) tumour, 22.7% intermediate (G2) and 4.5% high (G3). Of ten patients scheduled for pre-operative staging, Ga-DOTA-peptide PET/CT only led to therapeutic change in three patients. Furthermore, false-negative results of Ga-DOTA-peptide PET/CT were reported in one patient after surgical confirmation. However, therapeutic changes were seen in 20/36 patients (55.6%) scheduled for post-surgical restaging or assessment of somatostatin analogue (SSA) eligibility. When Ga-DOTA-peptide PET/CT was used for monitoring disease progress during systemic treatment (sandostatin, chemotherapy, everolimus and PRRT) in metastatic disease, impact on management modification was seen in 19/36 patients (52.8%), of which 84.2% had inter-modality change (switch to everolimus, chemotherapy or PRRT) and 15.8% had intra-modality change (increased SSA dosage).

Conclusions: Ga-DOTA-peptide PET/CT has a significant impact on management decisions in GI-NET patients as it can provide additional information on occult metastasis/equivocal lesions and supply the clinician an opportunity to select patients for targeted therapy.
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http://dx.doi.org/10.1007/s13139-017-0496-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5897256PMC
April 2018

Role of Pre-therapeutic (18)F-FDG PET/CT in Guiding the Treatment Strategy and Predicting Prognosis in Patients with Esophageal Carcinoma.

Asia Ocean J Nucl Med Biol 2016 ;4(2):59-65

Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia.

Objectives: The present study aimed to evaluate the role of pre-therapeutic (18)fluorine-fluorodeoxyglucose positron emission tomography-computed tomography ((18)F-FDG PET-CT) and maximum standardized uptake value (SUVmax) in guiding the treatment strategy and predicting the prognosis of esophageal carcinoma, using the survival data of the patients.

Methods: The present retrospective, cohort study was performed on 40 consecutive patients with esophageal carcinoma (confirmed by endoscopic biopsy), who underwent pre-operative (18)F-FDG PET-CT staging between January 2009 and June 2014. All the patients underwent contrast-enhanced CT and non-contrasted (18)F-FDG PET-CT evaluations. The patients were followed-up over 12 months to assess the changes in therapeutic strategies. Survival analysis was done considering the primary tumor SUVmax, using the Kaplan-Meier product-limit method.

Results: In a total of 40 patients, (18)F-FDG PET-CT scan led to changes in disease stage in 26 (65.0%) cases, with upstaging and downstaging reported in 10 (25.0%) and 16 (40.0%) patients, respectively. The management strategy changed from palliative to curative in 10 out of 24 patients and from curative to palliative in 7 out of 16 cases. Based on the (18)F-FDG PET-CT scan alone, the median survival of patients in the palliative group was 4.0 (95% CI 3.0-5.0) months, whereas the median survival in the curative group has not been reached, based on the 12-month follow-up. Selection of treatment strategy on the basis of (18)F-FDG PET/CT alone was significantly associated with the survival outcomes at nine months (P=0.03) and marginally significant at 12 months (P=0.03). On the basis of SUVmax, the relation between survival and SUVmax was not statistically significant.

Conclusion: (18)F-FDG PET/CT scan had a significant impact on stage stratification and subsequently, selection of a stage-specific treatment approach and the overall survival outcome in patients with esophageal carcinoma. However, pre-treatment SUVmax failed to stablish its usefulness in the assessment of patient prognosis and survival outcome.
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http://dx.doi.org/10.7508/aojnmb.2016.02.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938875PMC
July 2016

Erratum to: Diagnostic Performance of (68)Ga-DOTATATE PET/CT, (18)F-FDG PET/CT and (131)I-MIBG Scintigraphy in Mapping Metastatic Pheochromocytoma and Paraganglioma.

Nucl Med Mol Imaging 2016 Mar 23;50(1):98. Epub 2015 Jul 23.

Department of Radiology, Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang Malaysia.

[This corrects the article DOI: 10.1007/s13139-015-0339-z.].
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http://dx.doi.org/10.1007/s13139-015-0351-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4762867PMC
March 2016

Primary Squamous Cell Carcinoma of Trachea Arising 4 Years After Radioiodine Treatment of Papillary Carcinoma of Thyroid.

Clin Nucl Med 2016 May;41(5):e259-60

From the Department of Nuclear Medicine, National Cancer Institute, Putrajaya, Malaysia.

Primary squamous cell carcinoma (SCC) of the trachea is rare. Here, we presented a rare case of primary SCC of the trachea arising 4 years after radioiodine (RAI) treatment of papillary carcinoma of the thyroid. In this case, concomitant uptake of I-RAI and F-FDG was demonstrated in the thyroidal mass with tracheal invasion, which mimicked mixed well-differentiated and dedifferentiated thyroid carcinoma. The diagnosis of SCC of the trachea was made only after tracheal biopsy. This case illustrates that FDG-avid thyroid bed lesion, in the presence of thyroid carcinoma, may not necessarily be related to the thyroid pathology.
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http://dx.doi.org/10.1097/RLU.0000000000001140DOI Listing
May 2016

Unusual Bone Superscan, MIBG Superscan, and 68Ga DOTATATE PET/CT in Metastatic Pheochromocytoma.

Clin Nucl Med 2015 Nov;40(11):867-8

From the *Department of Nuclear Medicine, National Cancer Institute, Putrajaya; and †Department of Nuclear Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

A 17-year-old adolescent boy with biochemically raised 2-hour urinary metanephrine and normetanephrine as well as CT findings of retroperitoneal soft tissue mass and bony metastases was referred for further assessment. Apart from Ga DOTATATE PET/CT evaluation, pretargeted systemic radionuclide therapy assessment with I-MIBG scintigraphy showed unusual phenomenon of MIBG superscan. Postsurgically, restaging Tc-MDP bone scintigraphy showed typical bone superscan features. The MIBG superscan was better delineated on post-I-MIBG therapy images.
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http://dx.doi.org/10.1097/RLU.0000000000000920DOI Listing
November 2015

Erratum to: Diagnostic Performance of (68)Ga-DOTATATE PET/CT, (18)F-FDG PET/CT and (131)I-MIBG Scintigraphy in Mapping Metastatic Pheochromocytoma and Paraganglioma.

Nucl Med Mol Imaging 2015 Jun;49(2):152

Department of Radiology, Advanced Medical and Dental Institute, University Sains Malaysia, Bertam, 13200 Kepala Batas, Pulau Pinang Malaysia.

[This corrects the article DOI: 10.1007/s13139-015-0331-7.].
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http://dx.doi.org/10.1007/s13139-015-0339-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4463878PMC
June 2015

False Negative (99m)Tc-Hydroxymethane Diphosphonate Three-phase Bone Scintigraphy and (99m)Tc-besilesomab Scan in Detecting Tibia Osteomyelitis Concomitant with Necrotizing Fasciitis.

World J Nucl Med 2014 Sep;13(3):190-2

Department of Nuclear Medicine, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.

We described a case of 51-year-old female patient presented with a right calf necrotising fasciitis (NF) where osteomyelitis (OM) was suspected. (99m)Tc-hydroxymethane diphosphonate three-phase bone scintigraphy and (99m)Tc-besilosomab scan failed to demonstrate classical features of OM. The final diagnosis was only made by isolating Acinetobacter sp. in both intra-operative bone and tissue cultures from below-knee amputation. As conclusions, the detection of lower limb OM by (99m)Tc-besilosomab scan is not easy when there is concurrence overlying NF. The unusual three-phase bone scan finding of pericortical accumulation of tracer as an early sign of OM is highlighted in this case.
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http://dx.doi.org/10.4103/1450-1147.144820DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262878PMC
September 2014

Diagnostic Value of (68)Ga-DOTATATE PET/CT in Liver Metastases of Neuroendocrine Tumours of Unknown Origin.

Nucl Med Mol Imaging 2014 Sep 18;48(3):212-5. Epub 2013 Dec 18.

Nuclear Medicine Department, Hospital Putrajaya, Presint 7, 62250 Putrajaya, Wilayah Persekutuan Malaysia.

Purpose: In neuroendocrine liver metastases of unknown primary, a multimodality approach is usually adopted and consists of transabdominal ultrasound, endoscopic ultrasound (EUS), computed tomography (CT), magnetic resonance imaging (MRI), nuclear medicine techniques, endoscopy and exploratory surgery. The purpose of the study is to evaluate the diagnostic value of (68)Ga-DOTATATE positron emission tomography (PET)/CT as part of a multimodality approach in neuroendocrine liver metastases of unknown primary.

Materials And Methods: Six patients (M:F = 5:1, age range 28-56 years) with immunohistochemically proven neuroendocrine liver metastases but inconclusive initial CT work-up were retrospectively analysed. Clinical finding, histopathology, comparative imaging and follow-up were used to validate the results when ethically justified.

Results: (68)Ga-DOTATATE PET/CT identified the primary tumour in five out of six (83.3 %) patients: pancreas (n = 4) and stomach (n = 1). Out of three patients with indeterminate primary on initial CT, two patients were confirmed by (68)Ga-DOTATATE PET/CT. Absence of uptake in indeterminate primary of one patient was later confirmed negative by histopathology. In another three patients with undetected primary on initial CT, primary site was demonstrated in all patients with unsuspected metastases in two patients on (68)Ga-DOTATATE PET/ CT. No further work-up was done to confirm the primary in patients with distant metastases. Change of management was observed in three out of six (50 %) patients.

Conclusion: Our small study indicates that (68)Ga-DOTATATE PET/CT is a promising diagnostic option in the multimodality approach to neuroendocrine liver metastases of unknown primary origin.
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http://dx.doi.org/10.1007/s13139-013-0258-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145102PMC
September 2014

Dual thyroid ectopia with graves' disease: a case report and a review of the literature.

Nucl Med Mol Imaging 2012 Dec 9;46(4):300-3. Epub 2012 Aug 9.

Department of Endocrinology, Putrajaya Hospital, 62250 Putrajaya, Wilayah Persekutuan, Malaysia.

Ectopic thyroid or thyroid ectopia is a rare developmental anomaly with the prevalence of 1 per 100,000-300,000 population. Even rarer, such an anomaly manifests as dual thyroid ectopia. To our best knowledge, only one case has been reported on dual thyroid ectopia with Graves' disease in the English literature. We present here a case of dual thyroid ectopia complicated by Graves' disease, whereby the diagnosis was rendered through judicious use of various diagnostic modalities coupled with a close clinical follow-up. In this case, therapeutic consideration should be personalized with proper informed consent of the patient.
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http://dx.doi.org/10.1007/s13139-012-0160-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4043071PMC
December 2012
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