Publications by authors named "Ying Kan"

41 Publications

Simultaneous Detection of 2 Types of Malignancies in a Pediatric Patient on FDG PET/CT Led to Diagnosis of Li-Fraumeni Syndrome.

Clin Nucl Med 2022 May 11. Epub 2022 May 11.

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

Abstract: A 17-month-old girl underwent FDG PET/CT to evaluate a right adrenal lesion, which showed abnormal 18F-FDG avidity. In addition, an unexpected lesion with mild 18F-FDG uptake was noted in the right anterior thoracic wall. Pathology demonstrated adrenocortical carcinoma in the right adrenal and rhabdosarcoma in both the left forearm and right anterior thoracic wall. Gene analysis confirmed the diagnosis of Li-Fraumeni syndrome. The present case emphasized FDG PET/CT value of showing simultaneously multiple lesions in Li-Fraumeni syndrome, especially in the early stage without the gene analysis result.
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http://dx.doi.org/10.1097/RLU.0000000000004266DOI Listing
May 2022

New common bile duct morphological subtypes: Risk predictors of common bile duct stone recurrence.

World J Gastrointest Surg 2022 Mar;14(3):236-246

Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary treatment for removing common bile duct (CBD) stones. The risk factors for CBD stone recurrence after ERCP have been discussed for many years. However, the influence of CBD morphology has never been noticed.

Aim: To evaluate CBD morphology and other predictors affecting CBD stone recurrence in average patients.

Methods: A retrospective analysis of 502 CBD stone patients who underwent successful therapeutic ERCP for stone extraction at our centre from February 2020 to January 2021 was conducted. CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.

Results: CBD morphology ( < 0.01), CBD diameter ≥ 1.5 cm [odds ratio (OR) = 2.20, 95%CI: 1.08-4.46, = 0.03], and endoscopic biliary sphincterotomy with balloon dilation (ESBD) (OR = 0.35, 95%CI: 0.17-0.75, < 0.01) are three independent risk factors for CBD stone recurrence. Furthermore, the recurrence rate of patients with the S type was 6.61-fold that of patients with the straight type (OR = 6.61, 95%CI: 2.61-16.77, < 0.01). The recurrence rate of patients with the polyline type was 2.45-fold that of patients with the straight type (OR = 2.45, 95%CI: 1.14-5.26, = 0.02). The recurrence rate of S type patients was 2.70-fold that of patients with the polyline type (OR = 2.70, 95%CI: 1.08-6.73, = 0.03). Compared with no-ESBD, ESBD could decrease the risk of recurrence.

Conclusion: CBD diameter ≥ 1.5 cm and CBD morphology, especially S type and polyline type, were associated with increased recurrence of CBD stones. In addition, ESBD was related to decreased recurrence. Patients with these risk factors should undergo periodic surveillance and standard prophylactic therapy.
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http://dx.doi.org/10.4240/wjgs.v14.i3.236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8984516PMC
March 2022

Prediction of MYCN Amplification, 1p and 11q Aberrations in Pediatric Neuroblastoma Pre-therapy 18F-FDG PET/CT Radiomics.

Front Med (Lausanne) 2022 18;9:840777. Epub 2022 Mar 18.

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Purpose: This study aimed to assess the predictive ability of 18F-FDG PET/CT radiomic features for MYCN, 1p and 11q abnormalities in NB.

Method: One hundred and twenty-two pediatric patients (median age 3. 2 years, range, 0.2-9.8 years) with NB were retrospectively enrolled. Significant features by multivariable logistic regression were retained to establish a clinical model (C_model), which included clinical characteristics. 18F-FDG PET/CT radiomic features were extracted by Computational Environment for Radiological Research. The least absolute shrinkage and selection operator (LASSO) regression was used to select radiomic features and build models (R-model). The predictive performance of models constructed by clinical characteristic (C_model), radiomic signature (R_model), and their combinations (CR_model) were compared using receiver operating curves (ROCs). Nomograms based on the radiomic score (rad-score) and clinical parameters were developed.

Results: The patients were classified into a training set ( = 86) and a test set ( = 36). Accordingly, 6, 8, and 7 radiomic features were selected to establish R_models for predicting MYCN, 1p and 11q status. The R_models showed a strong power for identifying these aberrations, with area under ROC curves (AUCs) of 0.96, 0.89, and 0.89 in the training set and 0.92, 0.85, and 0.84 in the test set. When combining clinical characteristics and radiomic signature, the AUCs increased to 0.98, 0.91, and 0.93 in the training set and 0.96, 0.88, and 0.89 in the test set. The CR_models had the greatest performance for MYCN, 1p and 11q predictions ( < 0.05).

Conclusions: The pre-therapy 18F-FDG PET/CT radiomics is able to predict MYCN amplification and 1p and 11 aberrations in pediatric NB, thus aiding tumor stage, risk stratification and disease management in the clinical practice.
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http://dx.doi.org/10.3389/fmed.2022.840777DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8971895PMC
March 2022

Prognostic value of 18F-FDG PET/CT in malignant pleural mesothelioma: a meta-analysis.

Acta Radiol 2022 Mar 22:2841851221085378. Epub 2022 Mar 22.

Department of Nuclear Medicine, 26455Beijing Friendship Hospital of Capital Medical University, Beijing, PR China.

Background: Several FDG PET/CT parameters have been utilized to evaluate the prognosis in malignant pleural mesothelioma (MPM). However, there are still controversial results due to the low incidence of MPM.

Purpose: To assess the prognostic value of 18F-FDG PET/CT in MPM.

Material And Methods: A systematic literature search was performed in PubMed, Embase, Medline, and The Cochrane Library to identify eligible studies from inception to 12 February 2020. The pooled hazard ratios (HRs) and 95% confidence intervals (CIs) of several variables, such as maximum standardized uptake value (SUV), the reduction of SUV after treatment (ΔSUV), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and the reduction of TLG after treatment (ΔTLG), were calculated. Meta-regression with subsequent subgroup analyses were conducted to determine the heterogeneity of cutoff values, treatment regimen, study design, uptake time, and scanners across various studies.

Results: In total, 19 eligible studies including 1819 patients were enrolled in the meta-analysis. The univariate analysis showed that the pooled HRs (95% CI) of SUV, ΔSUV, MTV, TLG, and ΔTLG were 1.29 (1.16-1.42), 1.12 (1.05-1.19), 1.15 (1.00-1.33), 1.47 (1.23-1.76), and 1.27 (1.12-1.45), respectively. The multivariate analysis showed that the pooled HRs (95% CI) of SUV, ΔSUV, MTV, and TLG for overall survival (OS) were 1.20 (1.08-1.33), 1.10 (1.02-1.19), 0.95 (0.81-1.11), and 1.13 (1.08-1.18), respectively.

Conclusion: SUV, ΔSUV, TLG, and ΔTLG are significant prognostic indicators for OS, while more clinical studies are needed to confirm the prognostic value of MTV in MPM.
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http://dx.doi.org/10.1177/02841851221085378DOI Listing
March 2022

Development and Validation of F-FDG PET/CT-Based Multivariable Clinical Prediction Models for the Identification of Malignancy-Associated Hemophagocytic Lymphohistiocytosis.

Korean J Radiol 2022 Apr 8;23(4):466-478. Epub 2022 Mar 8.

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Objective: F-fluorodeoxyglucose (FDG) PET/CT is often used for detecting malignancy in patients with newly diagnosed hemophagocytic lymphohistiocytosis (HLH), with acceptable sensitivity but relatively low specificity. The aim of this study was to improve the diagnostic ability of F-FDG PET/CT in identifying malignancy in patients with HLH by combining F-FDG PET/CT and clinical parameters.

Materials And Methods: Ninety-seven patients (age ≥ 14 years) with secondary HLH were retrospectively reviewed and divided into the derivation (n = 71) and validation (n = 26) cohorts according to admission time. In the derivation cohort, 22 patients had malignancy-associated HLH (M-HLH) and 49 patients had non-malignancy-associated HLH (NM-HLH). Data on pretreatment F-FDG PET/CT and laboratory results were collected. The variables were analyzed using the Mann-Whitney U test or Pearson's chi-square test, and a nomogram for predicting M-HLH was constructed using multivariable binary logistic regression. The predictors were also ranked using decision-tree analysis. The nomogram and decision tree were validated in the validation cohort (10 patients with M-HLH and 16 patients with NM-HLH).

Results: The ratio of the maximal standardized uptake value (SUVmax) of the lymph nodes to that of the mediastinum, the ratio of the SUVmax of bone lesions or bone marrow to that of the mediastinum, and age were selected for constructing the model. The nomogram showed good performance in predicting M-HLH in the validation cohort, with an area under the receiver operating characteristic curve of 0.875 (95% confidence interval, 0.686-0.971). At an appropriate cutoff value, the sensitivity and specificity for identifying M-HLH were 90% (9/10) and 68.8% (11/16), respectively. The decision tree integrating the same variables showed 70% (7/10) sensitivity and 93.8% (15/16) specificity for identifying M-HLH. In comparison, visual analysis of F-FDG PET/CT images demonstrated 100% (10/10) sensitivity and 12.5% (2/16) specificity.

Conclusion: F-FDG PET/CT may be a practical technique for identifying M-HLH. The model constructed using F-FDG PET/CT features and age was able to detect malignancy with better accuracy than visual analysis of F-FDG PET/CT images.
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http://dx.doi.org/10.3348/kjr.2021.0733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8961016PMC
April 2022

The Role of Pre-therapeutic F-FDG PET/CT in Pediatric Hemophagocytic Lymphohistiocytosis With Epstein-Barr Virus Infection.

Front Med (Lausanne) 2021 21;8:836438. Epub 2022 Jan 21.

Nuclear Medicine Department, Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing, China.

Objective: To evaluate the role of pre-therapeutic F-FDG PET/CT in pediatric hemophagocytic lymphohistiocytosis (HLH) with Epstein-Barr virus (EBV) infection.

Methods: This retrospective study included 29 HLH children (1-16 years) with EBV infection, who underwent pre-therapeutic F-FDG PET/CT from July 2018 to November 2020. Pathology results were considered as the reference standard. These patients were divided into two groups: EBV-induced malignancy-associated HLH (M-HLH, = 9) and EBV-induced non-malignancy-associated HLH (NM-HLH, = 20). The regions of interest (ROIs) of the liver, spleen (Sp), bone marrow (BM), lymph nodes (LN), hypermetabolic lesions, liver background (LiBG), and mediastinum (M) were drawn with software 3D-Slicer. The volumetric and metabolic parameters, including maximum standard uptake value (SUV), metabolic tumor volume, and total lesion glycolysis of these ROIs, clinical parameters, and laboratory parameters were compared between the two groups. The efficiency of the above parameters in predicting the treatment response and overall survival (OS) was analyzed.

Results: Receiver operating characteristic curve analysis indicated that SUV-lesions and SUV-LN/M (AUC = 0.822, 0.819, cut-off = 6.04, 5.74, respectively) performed better in differentiating M-HLH from NM-HLH. It had the best diagnostic performance when age was added with the SUV-LN/M (AUC = 0.933, sensitivity = 100%, specificity = 85.0%). The presence of extranodal hypermetabolic lesions in multiple organs indicated the M-HLH ( = 0.022). Older age, higher SUV-LN and SUV-lesions, and the presence of serous effusion were associated with poorer treatment response at the 2nd and 4th week (not reaching partial remission). Multivariate analysis showed that SUV-lesions > 7.66 and SUV-Sp/LiBG > 2.01 were independent prognostic factors for overall survival ( = 0.025, 0.036, respectively).

Conclusions: F-FDG PET/CT could be a valuable technique for identifying the underlying malignancy and predicting prognosis in pediatric HLH with EBV infection. M-HLH could be considered when SUV-lesions > 6.04, SUV-LN/M > 5.74, and the presence of extranodal hypermetabolic lesions in multiple organs on F-FDG PET/CT. SUV-lesions and SUV-Sp/LiBG might be independent prognostic factors for OS.
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http://dx.doi.org/10.3389/fmed.2021.836438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8813965PMC
January 2022

The Diagnostic Value of F-FDG PET/CT Bone Marrow Uptake Pattern in Detecting Bone Marrow Involvement in Pediatric Neuroblastoma Patients.

Contrast Media Mol Imaging 2022 6;2022:7556315. Epub 2022 Jan 6.

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Objectives: To explore the diagnostic value of F-FDG PET/CT bone marrow uptake pattern (BMUP) in detecting bone marrow involvement (BMI) in pediatric neuroblastoma (NB) patients.

Methods: Ninety-eight NB patients were enrolled in BMI analysis. Four patterns of bone marrow uptake were categorized based on pretreatment F-FDG PET/CT images. Some crucial inspection indexes and F-FDG PET/CT metabolic parameters were analyzed. The BMUP was divided into BMUP1, BMUP2, BMUP3, and BMUP4. Paired-like homeobox 2b (PHOX2B) of bone marrow and blood, bone marrow biopsy (BMB) result, and F-FDG PET/CT were compared to detect BMI. All patients were followed up for at least six months.

Results: BMUP had excellent consistency among different physicians. Kappa coefficients of two residents and two attending physicians and between the resident and attending physician, were 0.857, 0.891, and 0.845, respectively. The optimal cut-off value of SUVmax-Bone/Liver was 2.08 to diagnose BMI for BMUP3 patients, and the area under curve (AUC) was 0.873. AUC of PHOX2B of bone marrow (PHOX2B of BM), PHOX2B of blood, BMB, and F-FDG PET/CT were 0.916, 0.811, 0.806, and 0.904, respectively. There was no significant difference between PHOX2B of BM and PET/CT. Positive predictive value, negative predictive value, sensitivity, and specificity in diagnosis of BMI were 92.9%, 92.9%, 97.0%, and 83.9% for PET/CT and 96.7%, 80.6%, 89.6%, and 93.5% for PHOX2B of BM, respectively.

Conclusions: BMUP of pretreatment F-FDG PET/CT is a simple and practical method, which has a relatively high diagnostic efficiency in detecting BMI and might decrease unnecessary invasive inspections in some pediatric NB patients.
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http://dx.doi.org/10.1155/2022/7556315DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8758298PMC
April 2022

Development of a potential diagnostic monoclonal antibody against capsid spike protein VP27 of the novel goose astrovirus.

Poult Sci 2022 Mar 23;101(3):101680. Epub 2021 Dec 23.

College of Animal Science and Technology, Anhui Agricultural University, Hefei 230036, China; Anhui Province Key Laboratory of Veterinary Pathobiology and Disease Control, Hefei 230036, China. Electronic address:

Goose astrovirus (GAstVs) is an emerging pathogen of goslings that causes fatal gout, kidney hemorrhages, renomegaly, and high mortality. The GAstVs VP27 protein is an important capsid protein and a candidate for the development of diagnostic reagents. The aim of this study was to clone and express the VP27 gene for preparation of a specific monoclonal antibody (mAb). The VP27 protein was expressed and purified in the supernatant of Escherichia coli BL21. Then, the mAb was obtained with the hybridoma technique and named 2AF11. It was differentiated as IgG1 with the help of immunoglobulin subclass tests. This mAb can specifically recognize the VP27 protein in GAstVs-infected cells, as evidenced by western blot analysis and immunofluorescent assay. Furthermore, this mAb could also detect the VP27 protein in GAstVs-infected tissues, as demonstrated by immunohistochemistry. These findings indicate that this mAb has high diagnostic potential. Therefore, the newly produced anti-VP27 mAb, 2AF11, could be a useful tool as a specific diagnostic marker for GAstVs.
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http://dx.doi.org/10.1016/j.psj.2021.101680DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8883067PMC
March 2022

Development and Validation of a Nomogram Based on F-FDG PET/CT Radiomics to Predict the Overall Survival in Adult Hemophagocytic Lymphohistiocytosis.

Front Med (Lausanne) 2021 22;8:792677. Epub 2021 Dec 22.

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

Hemophagocytic lymphohistiocytosis (HLH) is a rare and severe disease with a poor prognosis. We aimed to determine if F-fluorodeoxyglucose (F-FDG) PET/CT-derived radiomic features alone or combination with clinical parameters could predict survival in adult HLH. This study included 70 adults with HLH (training cohort, = 50; validation cohort, = 20) who underwent pretherapeutic F-FDG PET/CT scans between August 2016 and June 2020. Radiomic features were extracted from the liver and spleen on CT and PET images. For evaluation of 6-month survival, the features exhibiting < 0.1 in the univariate analysis between non-survivors and survivors were selected. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to develop a radiomics score (Rad-score). A nomogram was built by the multivariate regression analysis to visualize the predictive model for 3-month, 6-month, and 1-year survival, while the performance and usefulness of the model were evaluated by calibration curves, the receiver operating characteristic (ROC) curves, and decision curves. The Rad-score was able to predict 6-month survival in adult HLH, with area under the ROC curves (AUCs) of 0.927 (95% CI: 0.878-0.974) and 0.869 (95% CI: 0.697-1.000) in the training and validation cohorts, respectively. The radiomics nomogram combining the Rad-score with the clinical parameters resulted in better performance for predicting 6-month survival than the clinical model or the Rad-score alone. Moreover, the nomogram displayed superior discrimination, calibration, and clinical usefulness in both the cohorts. The newly developed Rad-score is a powerful predictor for overall survival (OS) in adults with HLH. The nomogram has great potential for predicting 3-month, 6-month, and 1-year survival, which may timely guide personalized treatments for adult HLH.
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http://dx.doi.org/10.3389/fmed.2021.792677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8740551PMC
December 2021

Common bile duct morphology is associated with recurrence of common bile duct stones in Billroth II anatomy patients.

World J Clin Cases 2021 Sep;9(26):7671-7681

Department of Digestive Endoscopy, General Hospital of Northern Theater Command, Shenyang 110840, Liaoning Province, China.

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is the primary choice for removing common bile duct (CBD) stones in Billroth II anatomy patients. The recurrence of CBD stones is still a challenging problem.

Aim: To evaluate CBD morphology and other predictors affecting CBD stone recurrence.

Methods: A retrospective case-control analysis was performed on 138 CBD stones patients with a history of Billroth II gastrectomy, who underwent therapeutic ERCP for stone extraction at our center from January 2011 to October 2020. CBD morphology and other predictors affecting CBD stone recurrence were examined by univariate analysis and multivariate logistic regression analysis.

Results: CBD morphology ( < 0.01) and CBD diameter ≥ 1.5 cm (odds ratio [OR] = 6.15, 95% confidence interval [CI]: 1.87-20.24, < 0.01) were the two independent risk factors. In multivariate analysis, the recurrence rate of patients with S type was 16.79 times that of patients with straight type (OR = 16.79, 95%CI: 4.26-66.09, < 0.01), the recurrence rate of patients with polyline type was 4.97 times that of patients with straight type (OR = 4.97, 95%CI: 1.42-17.38, = 0.01), and the recurrence rate of S type patients was 3.38 times that of patients with polyline type (OR = 3.38, 95%CI: 1.07-10.72, = 0.04).

Conclusion: CBD morphology, especially S type and polyline type, is associated with increased recurrence of CBD stones in Billroth II anatomy patients.
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http://dx.doi.org/10.12998/wjcc.v9.i26.7671DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8462226PMC
September 2021

Diagnostic Value of Seven Different Imaging Modalities for Patients with Neuroblastic Tumors: A Network Meta-Analysis.

Contrast Media Mol Imaging 2021 1;2021:5333366. Epub 2021 Sep 1.

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Objective: We performed a systematic review and network meta-analysis (NMA) to compare the diagnostic value of seven different imaging modalities for the detection of neuroblastic tumors in diverse clinical settings.

Methods: PubMed, Embase, Medline, and the Cochrane Library were searched to identify eligible studies from inception to Sep 29, 2020. Quality assessment of included studies was appraised with Quality Assessment of Diagnostic Accuracy Studies. Firstly, direct pairwise meta-analysis was conducted to calculate the pooled estimates of odds ratio (OR) and 95% confidence interval (CI) of the sensitivity, specificity, NPV, PPV, and DR. Next, NMA using Bayesian methods was performed. The superiority index was assessed to quantify the rank probability of a diagnostic test. The studies performed SPECT/CT or SPECT were analyzed separately from the ones only performed planar imaging.

Results: A total of 1135 patients from 32 studies, including 7 different imaging modalities, were eligible for this NMA. In the pairwise meta-analysis, F-FDOPA PET/CT had a relatively high value of all the outcomes (sensitivity: 10.195 [5.332-19.493]; specificity: 17.906 [5.950-53.884]; NPV: 16.819 [7.033-40.218]; PPV: 11.154 [4.216-29.512]; and DR 5.616 [3.609-8.739]). In the NMA, F-FDOPA PET/CT exhibited relatively high sensitivity in all subgroups (all data: 0.94 [0.87-0.98]; primary tumor: 0.89 [0.53-1]; bone/bone marrow metastases: 0.96 [0.83-1]; and primary tumor and metastases ( + ): 0.92 [0.80-0.97]), the highest specificity in the subgroup of  +  (0.85 [0.61-0.97]), and achieved the highest superiority index in the subgroups of all data (8.57 [1-15]) and  +  (7.25 [1-13]).

Conclusion: F-FDOPA PET/CT exhibited the best diagnostic performance in the comprehensive detection of primary tumor and metastases for neuroblastic tumors, followed by Ga-somatostatin analogs, I-meta-iodobenzylguanidine (MIBG), F-FDG, and I-MIBG tomographic imaging.
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http://dx.doi.org/10.1155/2021/5333366DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8429030PMC
February 2022

Muscle Involvement Caused by Chronic Active Epstein-Barr Virus Infection on 18F-FDG PET/CT in a Pediatric Patient.

Clin Nucl Med 2022 Mar;47(3):268-270

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Xi Cheng District, Beijing, China.

Abstract: A 7-year-old girl with chronic active EBV (CAEBV) infection-associated hemophagocytic lymphohistiocytosis presented with fever. 18F-FDG PET/CT revealed heterogeneous FDG uptake in multiple muscle groups without significant abnormal activity elsewhere. On repeat FDG PET/CT scan 1 year later after therapy, the abnormal activity in muscles disappeared. Skeletal muscle involvement by CAEBV infection should be included as differential diagnosis for increased muscle activity on FDG PET/CT study.
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http://dx.doi.org/10.1097/RLU.0000000000003899DOI Listing
March 2022

Nuclear Factor-κB Activating Protein Plays an Oncogenic Role in Neuroblastoma Tumorigenesis and Recurrence Through the Phosphatidylinositol 3-Kinase/Protein Kinase B Signaling Pathway.

Front Cell Dev Biol 2020 21;8:622793. Epub 2021 Jan 21.

Department of Nuclear Medicine, Beijing Friendship Hospital, Affiliated to Capital Medical University, Beijing, China.

Nuclear factor-κB activating protein (NKAP) is a conserved nuclear protein that acts as an oncogene in various cancers and is associated with a poor prognosis. This study aimed to investigate the role of NKAP in neuroblastoma (NB) progression and recurrence. We compared NKAP gene expression between 89 recurrence and 134 non-recurrence patients with NB by utilizing the ArrayExpress database. The relationship between NKAP expression and clinicopathological features was evaluated by correlation analysis. We knocked down NKAP expression in NB1 and SK-N-SH cells by small interfering RNA transfection to verify its role in tumor proliferation, apoptosis, and the phosphatidylinositol 3-kinase/protein kinase B (PI3K/AKT) signaling pathway. NKAP gene expression in NB tissues was significantly overexpressed in the recurrence group compared with the non-recurrence group, and NKAP was enriched in the PI3K/AKT pathway. Correlation analysis revealed NKAP expression was correlated with chromosome 11q deletion in patients with NB. Knockdown of NKAP expression significantly inhibited the proliferation and promoted the apoptosis of NB1 and SK-N-SH cells. Moreover, we found that small interfering NKAP significantly reduced p-PI3K and p-AKT expression. NKAP knockdown played an oncogenic role in NB by inhibiting PI3K/AKT signaling pathway activations both and . Our research revealed that NKAP mediates NB cells by inhibited proliferation and promoted apoptosis through activating the PI3K/AKT signaling pathways, and the expression of NKAP may act as a novel biomarker for predicting recurrence and chromosome 11q deletion in patients with NB.
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http://dx.doi.org/10.3389/fcell.2020.622793DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859273PMC
January 2021

Primary Cutaneous Natural Killer/T-Cell Lymphoma: A Posttransplant Lymphoproliferative Disorder Demonstrated by 18F-FDG PET/CT.

Clin Nucl Med 2021 Jul;46(7):595-598

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

Abstract: A 24-year-old man with a history of hemophagocytic lymphohistiocytosis (HLH) presented with swelling of the left foot and skin ulcer. The patient received bone marrow transplantation for HLH 3 years ago for his HLH. Biopsy of left foot skin demonstrated primary cutaneous natural killer/T-cell lymphoma: a posttransplant lymphoproliferative disorder. FDG PET/CT images demonstrated multiple foci of abnormal accumulation in the body, especially in the skin. Follow-up PET/CT after chemotherapy demonstrated that most abnormal activities disappeared except for the lesion in the left foot.
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http://dx.doi.org/10.1097/RLU.0000000000003524DOI Listing
July 2021

Longitudinal Multi-omics Analyses Identify Responses of Megakaryocytes, Erythroid Cells, and Plasmablasts as Hallmarks of Severe COVID-19.

Immunity 2020 12 26;53(6):1296-1314.e9. Epub 2020 Nov 26.

Institute of Clinical Molecular Biology, Kiel University and University Medical Center Schleswig-Holstein, 24105 Kiel, Germany.

Temporal resolution of cellular features associated with a severe COVID-19 disease trajectory is needed for understanding skewed immune responses and defining predictors of outcome. Here, we performed a longitudinal multi-omics study using a two-center cohort of 14 patients. We analyzed the bulk transcriptome, bulk DNA methylome, and single-cell transcriptome (>358,000 cells, including BCR profiles) of peripheral blood samples harvested from up to 5 time points. Validation was performed in two independent cohorts of COVID-19 patients. Severe COVID-19 was characterized by an increase of proliferating, metabolically hyperactive plasmablasts. Coinciding with critical illness, we also identified an expansion of interferon-activated circulating megakaryocytes and increased erythropoiesis with features of hypoxic signaling. Megakaryocyte- and erythroid-cell-derived co-expression modules were predictive of fatal disease outcome. The study demonstrates broad cellular effects of SARS-CoV-2 infection beyond adaptive immune cells and provides an entry point toward developing biomarkers and targeted treatments of patients with COVID-19.
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http://dx.doi.org/10.1016/j.immuni.2020.11.017DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7689306PMC
December 2020

Clinical value of Ga-DOTA-SSTR PET/CT in the diagnosis and detection of neuroendocrine tumors of unknown primary origin: a systematic review and meta-analysis.

Acta Radiol 2021 Sep 26;62(9):1217-1228. Epub 2020 Sep 26.

Nuclear Medicine Department, Beijing Friendship Hospital of Capital Medical University, Beijing, PR China.

Background: The ability of Ga-DOTA-SSTR to detect the primary sites of neuroendocrine tumors (NETs) remains undetermined, and the clinical benefit of this imaging agent is not clear.

Purpose: To evaluate the diagnostic accuracy of Ga-DOTA-SSTR for carcinoma unknown primary (CUP) neuroendocrine tumors and to further analyze the detection rate of Ga-DOTA-SSTR for primary and metastatic sites.

Material And Methods: A comprehensive literature search of PubMed/MEDLINE and ScienceDirect was performed in October 2019 in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. We critically reviewed all studies based on the PICOS criteria. QUADAS-2 was used to evaluate the quality of the methodology of the included studies.

Results: A total of 10 studies (484 patients, mean age = 56.6 ± 4.3 years) were included in the study. The pooled sensitivity and specificity of Ga-DOTA-SSTR in identifying CUP-NETs were 82% and 55%, respectively. The area under the receiver operating characteristic curve was 69%. Regarding metastasis sites, Ga-DOTA-SSTR found the most metastases in the liver (57.9%), followed by the lymph nodes (22.8%), bones (12.8%), lung (2.8%), and others (1.7%). The pooled detection rate of Ga-DOTA-SSTR for CUP-NETs was 61%.

Conclusion: The present study demonstrated the high diagnostic sensitivity of Ga-DOTA-SSTR for CUP-NETs. Ga-DOTA-SSTR PET/CT was highly effective in locating the primary and metastatic sites of CUP-NETs.
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http://dx.doi.org/10.1177/0284185120958412DOI Listing
September 2021

Incidental Detection of Pancreatic Arteriovenous Malformation by 99mTc-RBC SPECT/CT.

Clin Nucl Med 2020 Dec;45(12):1026-1028

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

A patient with multiple episodes of gastrointestinal bleeding underwent Tc-labeled red blood cell scintigraphy to detect the source of bleeding, which showed a focally increased activity in the upper midabdomen. SPECT/CT demonstrated that the activity was located in the pancreatic head. Angiography confirmed the diagnosis of pancreatic arteriovenous malformation. After transarterial embolization therapy, the patient no longer had bleeding episode. Based on the present case, pancreatic arteriovenous malformation should be included as differential diagnosis during Tc-red blood cell scintigraphy.
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http://dx.doi.org/10.1097/RLU.0000000000003293DOI Listing
December 2020

Significance of plasma free fatty acid level for assessing and diagnosing acute myocardial infarction.

Biomark Med 2020 06 10;14(9):739-747. Epub 2020 Jul 10.

Department of Cardiology, Shanghai Pudong Gongli Hospital, Shanghai 200135, China.

To clarify the diagnostic value of the circulating free fatty acid (FFA) level for acute myocardial infarction (AMI) in coronary heart disease patients. A total of 1776 patients were screened by coronary angiography from October 2014 to February 2016. The plasma FFA level was significantly higher in coronary heart disease patients with lesions in three or more vessels than those with lesions in one or two vessels. Moreover, an elevated FFA level was identified as an independent risk factor for AMI on multivariate regression analysis and shown to be a sensitive and specific indicator for AMI diagnosis by receiver operating characteristic curve analysis. An elevated FFA level is an independent risk factor and independent diagnostic marker for AMI.
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http://dx.doi.org/10.2217/bmm-2019-0291DOI Listing
June 2020

The impact of sedation on quality metrics of colonoscopy: a single-center experience of 48,838 procedures.

Int J Colorectal Dis 2020 Jun 16;35(6):1155-1161. Epub 2020 Apr 16.

Department of General Surgery, Gastric and Colorectal Surgery division, Daping Hospital, Army Medical University, 10# Changjiangzhilu, Daping, Yuzhong District, Chongqing, 400042, China.

Purpose: Investigation of the role of sedation during colonoscopy is meaningful as the advantages of colonoscopy performing with sedation are still controversial.

Methods: Medical records of patients who underwent colonoscopy in our institution were retrospectively analyzed. The sedation rate, adenoma detection rate (ADR), polyp detection rate (PDR), cecal intubation rate (CIR), iatrogenic colonic perforation rate (ICP) were calculated.

Results: A total of 48,838 colonoscopies (24,498 in males) dated from July 2007 to February 2017 were analyzed. The median age was 50 years (range 16-85 years). An overall sedation rate was 80.38%. The PDR was 26.77%, and was not statistically different between colonoscopy with or without sedation (26.67% vs 27.22, p = 0.474). ADR was 12.9% regardless of applying sedation or not (13.0% vs 12.44%, p = 0.337). The CIR was 87.42% in all examinations with an adjusted CIR of 90.34%, and was higher when performed with sedation than without sedation (88.92% vs 80.64%, p < 0.0001). Five cases (0.01%) of ICP were reported, all of which occurred in patients under sedation.

Conclusions: The use of sedation is associated with increased CIR, but ADR and PDR remain unchanged with or without sedation. However, perforation rate, albeit very low, is significantly higher in sedated patients.
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http://dx.doi.org/10.1007/s00384-020-03586-yDOI Listing
June 2020

Impurity identification and quantification for arginine vasopressin by liquid chromatography/high-resolution mass spectrometry.

Rapid Commun Mass Spectrom 2020 Jun;34(12):e8799

Department of Gastrointestinal Surgery, The Second Hospital of Jilin University, Changchun, China.

Rationale: For pharmaceutical quality control, impurities may have unexpected pharmacological or toxicological effects on quality, safety, and efficacy of drugs. Arginine vasopressin (AVP) is an important cyclic peptide drug that is mainly used for the treatment of diabetes insipidus and esophageal varices bleeding. With the advancement made in analytical techniques, liquid chromatography/high-resolution mass spectrometry (LC/HRMS) has emerged as a critical technique for the identification and quantification of structurally related peptide impurities in AVP.

Methods: An LC/HRMS/MS-based method using a quadrupole ion trap-Orbitrap mass spectrometer operated in the positive ion electrospray ionization mode was developed for the determination and quantification of structurally related peptide impurities in AVP.

Results: Under optimized experimental conditions, three deamidation products, ([Glu ]AVP, [Asp ]AVP, and AVP acid), two amino acid deletion impurities (des-Pro -AVP and des-Gly -AVP), one amino acid insertion impurity (endo-Gly -AVP), one end chain reaction product (N-acetyl-AVP), and one AVP isomer were detected. Subsequent quantification using an external standard method estimated the total mass fraction of all structurally related peptide impurities in the AVP study material to be 30.3 mg/g with an expanded uncertainty of 3.0 mg/g (k = 2).

Conclusions: This study complements the AVP impurity profile and improves the separation and discovery of other potential impurities in vasopressin analogues.
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http://dx.doi.org/10.1002/rcm.8799DOI Listing
June 2020

Impurities identification and quantification for calcitonin salmon by liquid chromatography-high resolution mass spectrometry.

J Pharm Biomed Anal 2020 Jul 20;186:113271. Epub 2020 Mar 20.

Division of Chemical Metrology & Analytical Science, National Institute of Metrology, Beijing 100029, PR China. Electronic address:

Calcitonin salmon is an important peptide pharmaceutical, which is mainly used for the treatment of osteoporosis and hypercalcemia. Structurally related peptide impurities in a peptide pharmaceutical probably have side effect or even toxicity, thus needs to be carefully characterized according to pharmacopoeia. With the improvement of analytical techniques, liquid chromatography-high resolution mass spectrometry (LC-HRMS) has become a pivotal technique for the identification and quantification of structurally related peptide impurities in peptide materials. In this study, an LC-HRMS-based method has been developed for the identification and quantification of structurally related peptide impurities in calcitonin salmon material. With this method, 7 peptide impurities (> 1 mg/g) in United States Pharmacopoeia (USP) reference standard and 9 peptide impurities (> 1 mg/g) in European Pharmacopoeia (EP) reference standard were identified and accurately quantified. Besides the peptide impurities reported by USP and EP, several new impurities such as [7-Dehydroalanine] calcitonin salmon, triple-sulfate-calcitonin salmon, [26-Proline] calcitonin salmon, [14-Glutamic acid] calcitonin salmon, [20-Glutamic acid] calcitonin salmon, [26-Aspartic acid] calcitonin salmon, calcitonin salmon acid were observed in the reference standard materials studied. The total mass fractions of all structurally related peptide impurities in calcitonin salmon study materials were estimated to be 57.4 mg/g for USP and 46.3 mg/g for EP with associated expended uncertainties at a 95 % confidence level of 5.2 mg/g (k = 2) and 3.1 mg/g (k = 2), respectively.
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http://dx.doi.org/10.1016/j.jpba.2020.113271DOI Listing
July 2020

Neural metabolic activity in idiopathic tinnitus patients after repetitive transcranial magnetic stimulation.

World J Clin Cases 2019 Jul;7(13):1582-1590

Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.

Background: The central mechanism of idiopathic tinnitus is related to hyperactivity of cortical and subcortical auditory and non-auditory areas. Repetitive transcranial magnetic stimulation (rTMS) is a well-tolerated, non-invasive potential treatment option for tinnitus.

Aim: To investigate the changes of neural metabolic activity after rTMS in chronic idiopathic tinnitus (IT) patients.

Methods: Eleven patients underwent rTMS (1 Hz, 90% motor threshold, 1000 stimuli/day for consecutive 10 d) on the left temporoparietal region cortex. Tinnitus handicap inventory (THI) and visual analogue score (VAS) were assessed at baseline and posttreatment. All patients underwent F-fluorodeoxyglucose (FDG) positron emission tomography to evaluate the neural metabolic activity. Data were preprocessed using statistical parametric mapping and Gretna software to extract the regions of interest (ROIs). The correlation between brain areas involved and THI scores was analyzed.

Results: Baseline and posttreatment parameters showed no significant difference regarding THI score ( = 1.019, = 0.342 > 0.05) and VAS ( = 0.00, = 1.0 > 0.05). Regions with the highest FDG uptake were the right inferior temporal gyrus (ITG), right parahippocampa gyrus (PHG), right hippocampus, rectus gyrus, left middle frontal gyrus, and right inferior frontal gyrus in IT patients. After rTMS treatment, IT patients showed increased activities in the right PHG, right superior temporal gyrus, right superior frontal gyrus, anterior insula, left inferior parietal lobule, and left precentral gyrus, and decreased activities in the left postcentral gyrus and left ITG. The ROIs in the right parahippocampa gyrus and right superior frontal gyrus were positively correlated with THI scores ( = 0.737, = 0.037 < 0.05; = 0.735, = 0.038 < 0.05).

Conclusion: Our study showed that 1-Hz rTMS directed to the left temporo-parietal junction resulted no statistically significant symptom alleviation. After treatment, brain areas of the limbic and prefrontal system showed high neutral metabolic activity. The auditory and non-auditory systems together will be the target for rTMS treatment.
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http://dx.doi.org/10.12998/wjcc.v7.i13.1582DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658381PMC
July 2019

Effects of miR‑103a‑3p on the autophagy and apoptosis of cardiomyocytes by regulating Atg5.

Int J Mol Med 2019 05 12;43(5):1951-1960. Epub 2019 Mar 12.

Department of Cardiology, Shanghai Pudong New Area Gongli Hospital, Shanghai 200135, P.R. China.

Autophagy and apoptosis are associated with cardiovascular diseases. Emerging evidence shows that microRNAs (miRs) are critical in the development of pathological processes underlying cardiovascular diseases by regulating the induction of apoptosis and autophagy. The present study aimed to investigate the role of miR‑103a‑3p in cardiomyocyte injury through autophagy and apoptosis. H9c2 cells were cultured under hypoxia and reoxygenation (H/R) conditions and were used to mimic cells under ischemia. The transfection of cells with miR‑103a‑3p (mimics and inhibitors) was performed to examine its function in cardiomyocytes. The expression levels of miR‑103a‑3p were evaluated by reverse transcription‑quantitative polymerase chain reaction analysis. Cell viability was determined using an MTT assay, and the lactate dehydrogenase assay (LDH) was used to investigate cell injury. The expression levels of B‑cell lymphoma 2 (Bcl‑2), Bcl‑2‑associated X protein, Beclin‑1, autophagy‑related 5 (Atg5), cleaved caspase‑3 and cleaved caspase‑9 were detected using western blotting. Immunofluorescence assays were performed to detect the expression of LC3 as a marker of autophagy. The target gene of miR‑103a‑3p was identified using dual‑luciferase reporter assays. The results revealed that the expression levels of miR‑103a‑3p were significantly downregulated in cardiomyocytes under H/R conditions. Injury of the cardiomyocytes was evaluated under H/R conditions. Following transfection of the cells with miR‑103a‑3p inhibitors, cell injury was increased, as determined by LDH and MTT assays. The expression levels of apoptotic proteins were consistent with the results obtained in the LDH and cell viability assays. The induction of autophagy was increased in cells under H/R conditions and cells with miR‑103a‑3p inhibitor transfection, whereas the induction of autophagy was decreased in cells transfected with miR‑103a‑3p mimics. In addition, the data indicated that miR‑103a‑3p directly targeted Atg5, which regulated the induction of autophagy and apoptosis. Taken together, these findings indicate that, following the inhibition of miR‑103a‑3p, Atg5 promotes autophagy and apoptosis in cardiomyocytes by directly targeting Atg5. Therefore, miR‑103a‑3p can be considered a potential therapeutic target for myocardial ischemia.
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http://dx.doi.org/10.3892/ijmm.2019.4128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6443343PMC
May 2019

Concurrent Pancreatic Metastasis From Lung Adenocarcinoma and Primary Cholangiocarcinoma on FDG PET/CT Imaging.

Clin Nucl Med 2019 May;44(5):426-428

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

A 67-year-old man with a history of left upper lobe resection of poorly differentiated adenocarcinoma 1 year ago underwent FDG PET/CT for restaging. The images demonstrated a round cystic lesion with peripheral FDG uptake and centrally photopenic region. Additional focus of increased activity was detected in the left lobe of the liver. The patient underwent the Whipple and partial hepatectomy. The surgical pathology demonstrated concurrently the metastasis to the pancreas from the lung adenocarcinoma and a primary moderately differentiated cholangiocarcinoma.
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http://dx.doi.org/10.1097/RLU.0000000000002496DOI Listing
May 2019

FDG PET/CT Findings of a Synovial Sarcoma in a Renal Transplant.

Clin Nucl Med 2019 Mar;44(3):259-261

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

A 48-year old man who underwent renal transplantation 2 years ago due to chronic renal failure underwent FDG PET/CT to determine the etiology of multiple lesions in the renal transplant incidentally found on routine examination. The images demonstrated several foci of the abnormally increased activity in the transplanted kidney with SUVmax of 7.5. Surgical pathology demonstrated multiple synovial sarcoma in the transplanted kidney.
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http://dx.doi.org/10.1097/RLU.0000000000002429DOI Listing
March 2019

Unexpected Corpus Callosum Involvement of Diffuse Large B-Cell Lymphoma on FDG PET/CT.

Clin Nucl Med 2018 Dec;43(12):933-935

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

Diffuse large B-cell lymphoma (DLBCL) was the most frequent subtype of lymphoid malignancy. Corpus callosum involvement of DLBCL was rarely reported. We present a case of DLBCL involving not only lymph nodes and bowels but also corpus callosum, detected by FDG PET/CT in a patient without neurological symptoms. After 4 cycles of systemic and intrathecal chemotherapy, all previously visualized abnormal activity disappeared on the follow-up FDG PET/CT.
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http://dx.doi.org/10.1097/RLU.0000000000002307DOI Listing
December 2018

Contribution of 18F-FDG PET/CT in a case-mix of fever of unknown origin and inflammation of unknown origin: a meta-analysis.

Acta Radiol 2019 Jun 11;60(6):716-725. Epub 2018 Sep 11.

2 Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China.

Background: Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are challenging medical problems. Previous studies have shown that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) plays an important role in the diagnosis of FUO, but few studies have explored this diagnostic technique in relation to IUO.

Purpose: To systematically review and perform a meta-analysis of published data on the diagnostic performance of PET/CT in the diagnosis of FUO and IUO.

Material And Methods: A comprehensive literature search was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines published in March 2018. Meta-analysis of diagnostic performance was performed using STATA 12.0 software. Subgroup analysis was performed by stratification based on study design, number of patients, geographic area, and final diagnosis based on 18F-FDG PET/CT. Meta-regression analyses were performed to recognize heterogeneity.

Results: Our meta-analysis included 23 studies, comprising a total sample size of 1927 patients. The pooled diagnosis performance was calculated with a per-patient-based analysis: sensitivity = 0.84 (95% confidence interval [CI] = 0.79-0.89), specificity = 0.63 (95% CI = 0.49-0.75), positive likelihood ratio = 2.3 (95% CI = 1.5-3.4), negative likelihood ratio = 0.25 (95% CI = 0.16-0.38), diagnostic odds ratio = 9 (95% CI = 4.0-20), and AUC = 0.84 (95% CI = 0.81-0.87).

Conclusion: In patients with non-specific symptoms and signs, 18F-FDG PET/CT is very helpful for recognizing and excluding diseases, directing further diagnostic decisions, and avoiding unnecessary invasive examinations. We recommend that 18F-FDG PET/CT should be considered among the first-line diagnostic tools for patients with FUO and IUO.
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http://dx.doi.org/10.1177/0284185118799512DOI Listing
June 2019

Increased Skeletal Muscle FDG Uptake Due to Sexual Activity on PET/CT in a Middle Age Woman.

Clin Nucl Med 2018 Nov;43(11):837-839

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

A 48-year-old woman with gradually growing left lung nodule underwent FDG PET/CT scan, which demonstrated mild F-FDG uptake in the nodule of the left lobe, suggestive of malignancy. Unexpectedly, increased FDG uptake in bilateral gluteus medius, gluteus minimus, and piriformis was shown. She described having sexual activity in missionary position the night prior. The case emphasizes the importance of avoiding sexual activity before the FDG PET/CT study.
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http://dx.doi.org/10.1097/RLU.0000000000002228DOI Listing
November 2018

Intense FDG Uptake in the Muscles Due to Severe Vomiting.

Clin Nucl Med 2018 Oct;43(10):e363-e365

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

A 22-year-old woman with acute lymphoblastic leukemia underwent FDG PET/CT to evaluate possible extramedullary disease. The patient experienced severe nausea and vomiting due to ongoing chemotherapy. The image demonstrated increased FDG uptake in multiple muscle groups, including intercostal, bilateral external oblique, internal oblique, transverse abdominal muscles, and psoas major. One week after the patient stopped vomiting, a repeated PET/CT showed much less muscle uptake.
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http://dx.doi.org/10.1097/RLU.0000000000002184DOI Listing
October 2018

Right Ureteral Carcinoma Suggested by 99mTc-DTPA Renography in a Patient With Left Pyelocaliceal Carcinoma.

Clin Nucl Med 2018 Jul;43(7):537-539

From the Department of Nuclear Medicine, Beijing Friendship Hospital of Capital Medical University, Beijing, China.

Abdominal enhanced CT of a 72-year-old woman demonstrated 1 enhancing lesion in the left kidney, which suggested malignancy. No significant findings were reported in the right kidney and ureter. A Tc-DTPA renography was performed as part of the presurgical evaluation. However, the dynamics of urine elimination by the left kidney was normal, whereas elimination of the urine on the right one delayed, which was unexpected. The patient's CT images were further analyzed. An enhancing lesion in the right ureter was noted by further review, suggesting malignancy, which was subsequently pathologically proven as low-grade papillary urothelial carcinoma.
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http://dx.doi.org/10.1097/RLU.0000000000002088DOI Listing
July 2018
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