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Generalized Lymphadenopathy due to Chronic Lymphocytic Leukemia (CLL) : 18F-FDG PET Imaging Basuki Hidayat; Febby Hutomo; Ryan Yudistiro; Ivana D. Mulyanto; Hendra Budiawan; Johan S. Masjhur
Journal of Medicine and Health Vol 1 No 3 (2016)
Publisher : Universitas Kristen Maranatha

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.28932/jmh.v1i3.520

Lymphadenopaty is a common clinical finding with a broad differential diagnosis, withCarcinoma of Unknown Primary (CUP) as one of itâ€™s most common causes. Flourine-18 fluoro-2 deoxy glucose (18F- FDG) positron emission tomography (PET) is a Nuclear Medicinescintigraphy procedure commonly used to localize suspected a primary lesion by depicting ametabolic status. However, in the expertise of 18F FDG PET study, clinical finding andepidemiologic data must be considered to get a better conclusion. We describe 18F-FDG PETstudy in the presence of generalized lymphadenopathy due to chronic lymphocytic leukemia(CLL), a rare disease which is initially suspected of having CUP.Keywords: 18F-FDG PET, lymphadenopathy, lymphoma, leukemia

Diagnostic challenges in assessing treatment responds of primary bone lymphoma: A case report Angelina, Arlene; Kusumahstuti, Kharisma; Darmawan, Budi; Hidayat, Basuki
Deka in Medicine Vol. 2 No. 1 (2025): April 2025
Publisher : PT. DEKA RESEARCH INSTITUTE

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.69863/dim.2025.e570

BACKGROUND: Primary Bone Lymphoma (PBL) is quite difficult to assess treatment responses because of limited access to 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT). Therefore, this study intends to highlight one case regarding alternative imaging modalities, such as technetium-99m methylene diphosphonate (99mTc-MDP) and technetium-99m methoxyisobutyl isonitrile (99mTc-MIBI), for activity assessment in tumors as well as their involvement in the marrow. CASE: A 17-year-old male with persistent pain and swelling in the left knee over one month underwent a bone biopsy that confirmed the diagnosis of Diffuse Large B-Cell Lymphoma (DLBCL) in the tibia. The patient was subjected to chemotherapy using cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), followed by radiotherapy. PET/CT was unavailable; therefore, metabolic tumor evaluation was performed through 99mTc-MDP and 99mTc-MIBI scintigraphy for tumor activity and bone marrow involvement assessment. Bone scintigraphy with 99mTc-MDP showed increased tracer uptake in the proximal left tibia and distal left femur, indicating ongoing tumor activity. These findings were reinforced by the further assessment with 99mTc-MIBI, which confirmed high metabolic activity in these areas. Subsequently, a bone marrow biopsy evidenced infiltrative lymphoblasts constituting 24.8 percent infiltrating the involved marrow space, thus confirming the bone marrow being infiltrated. Hence, this patient received additional rituximab treatment to enhance treatment outcome. CONCLUSION: This case portrays the difficulties one faces while evaluating the treatment response in Primary Bone Lymphoma (PBL), as well as the role of 99mTc-MDP and 99mTc-MIBI scintigraphy as alternative metabolic imaging modalities in the absence of PET/CT.

Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin Jessica Ubercaprita; Endah Indriani Wahyono; Mas Adi Sunardi; Herry Herman; Bethy Suryawathy Hernowo; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1361

Background: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative. Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement. Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings.

Unmasking the Primary: The Role of 99mTc-Sestamibi SPECT/CT in a Case of Carcinoma of Unknown Primary with Suspected Lung Origin Jessica Ubercaprita; Endah Indriani Wahyono; Mas Adi Sunardi; Herry Herman; Bethy Suryawathy Hernowo; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 8 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i8.1361

Background: Carcinoma of unknown primary (CUP) is a challenging clinical diagnosis, representing histologically confirmed metastatic cancer where the primary tumor site remains unidentified after a standard diagnostic workup. While 18F-FDG PET/CT is recommended by current guidelines, its accessibility is limited in many regions. This report explores the diagnostic utility of Technetium-99m (99mTc)-Sestamibi Single Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) as a valuable alternative. Case presentation: A 67-year-old female presented with musculoskeletal pain. A biopsy of a right ulnar lesion confirmed metastatic carcinoma. Immunohistochemistry (IHC) suggested a possible primary from the lung, breast, or upper gastrointestinal tract. Due to the unavailability of 18F-FDG PET/CT, a 99mTc-Sestamibi whole-body scan with SPECT/CT was performed. The scan identified a metabolically active, malignant-appearing nodule in segment 6 of the left lung and confirmed widespread skeletal metastases. Although a lung biopsy was not feasible due to limited access, the patient was treated with a lung cancer protocol. This resulted in significant clinical improvement. Conclusion: 99mTc-Sestamibi SPECT/CT served as a critical diagnostic tool in this case of CUP. It successfully identified a suspected pulmonary primary, enabling targeted therapy and leading to a positive clinical outcome. This case highlights the modality's efficacy as a tumor-seeking agent and underscores its essential role in the diagnostic armamentarium for CUP, particularly in resource-limited healthcare settings.

Diagnostic Performance of Imaging Modalities in Persistent or Recurrent Hyperparathyroidism: A Network Meta-Analysis of 18F-Fluorocholine PET/CT, 4D-CT, and Scintigraphy Hendry Johan Renaldy Tandra; Endah Indriani; Hendra Budiawan; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1424

Background: The surgical management of persistent or recurrent primary hyperparathyroidism (PHPT) is critically dependent on accurate preoperative localization of ectopic or residual hyperfunctioning glands within a scarred anatomical field. While 18F-Fluorocholine Positron Emission Tomography/Computed Tomography (18F-FCH PET/CT), four-dimensional computed tomography (4D-CT), and 99mTc-Sestamibi scintigraphy are employed, a definitive evidence-based hierarchy to guide their use is absent. This study aimed to establish this hierarchy by comparing their diagnostic performance through a network meta-analysis. Methods: A systematic search of PubMed, Embase, and Scopus was conducted for comparative studies published between January 2015 and August 2025 evaluating these modalities in persistent/recurrent PHPT. A Bayesian bivariate network meta-analysis was performed to calculate pooled sensitivities and specificities on both a per-patient and per-lesion basis. Modalities were ranked using Surface Under the Cumulative Ranking (SUCRA) scores. Methodological quality, inconsistency, and heterogeneity were formally assessed. Results: Seven studies involving 687 patients were included. On a per-patient analysis, 18F-FCH PET/CT demonstrated the highest sensitivity at 94.1% (95% Credible Interval [CrI]: 89.8%–97.5%), significantly outperforming 4D-CT (82.5%; 95% CrI: 75.1%–88.9%) and scintigraphy with SPECT/CT (60.3%; 95% CrI: 51.2%–69.1%). Specificities were uniformly high. Per-lesion analysis confirmed this hierarchy. SUCRA rankings identified 18F-FCH PET/CT as the superior modality for both per-patient (98.7%) and per-lesion (99.1%) detection. No significant network inconsistency was detected. Conclusion: 18F-FCH PET/CT exhibits superior diagnostic accuracy for localizing culprit parathyroid glands in persistent or recurrent PHPT. Its performance, grounded in robust metabolic targeting that overcomes the challenges of a reoperative field, supports its positioning as the primary imaging modality in this setting. These findings advocate for a revision of current diagnostic algorithms to enhance surgical planning and improve patient outcomes.

Diagnostic Performance of Imaging Modalities in Persistent or Recurrent Hyperparathyroidism: A Network Meta-Analysis of 18F-Fluorocholine PET/CT, 4D-CT, and Scintigraphy Hendry Johan Renaldy Tandra; Endah Indriani; Hendra Budiawan; Basuki Hidayat
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 9 No. 11 (2025): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v9i11.1424

Background: The surgical management of persistent or recurrent primary hyperparathyroidism (PHPT) is critically dependent on accurate preoperative localization of ectopic or residual hyperfunctioning glands within a scarred anatomical field. While 18F-Fluorocholine Positron Emission Tomography/Computed Tomography (18F-FCH PET/CT), four-dimensional computed tomography (4D-CT), and 99mTc-Sestamibi scintigraphy are employed, a definitive evidence-based hierarchy to guide their use is absent. This study aimed to establish this hierarchy by comparing their diagnostic performance through a network meta-analysis. Methods: A systematic search of PubMed, Embase, and Scopus was conducted for comparative studies published between January 2015 and August 2025 evaluating these modalities in persistent/recurrent PHPT. A Bayesian bivariate network meta-analysis was performed to calculate pooled sensitivities and specificities on both a per-patient and per-lesion basis. Modalities were ranked using Surface Under the Cumulative Ranking (SUCRA) scores. Methodological quality, inconsistency, and heterogeneity were formally assessed. Results: Seven studies involving 687 patients were included. On a per-patient analysis, 18F-FCH PET/CT demonstrated the highest sensitivity at 94.1% (95% Credible Interval [CrI]: 89.8%–97.5%), significantly outperforming 4D-CT (82.5%; 95% CrI: 75.1%–88.9%) and scintigraphy with SPECT/CT (60.3%; 95% CrI: 51.2%–69.1%). Specificities were uniformly high. Per-lesion analysis confirmed this hierarchy. SUCRA rankings identified 18F-FCH PET/CT as the superior modality for both per-patient (98.7%) and per-lesion (99.1%) detection. No significant network inconsistency was detected. Conclusion: 18F-FCH PET/CT exhibits superior diagnostic accuracy for localizing culprit parathyroid glands in persistent or recurrent PHPT. Its performance, grounded in robust metabolic targeting that overcomes the challenges of a reoperative field, supports its positioning as the primary imaging modality in this setting. These findings advocate for a revision of current diagnostic algorithms to enhance surgical planning and improve patient outcomes.

Prevalence and Analysis of Risk Factors for RAI-Refractory Thyroid Cancer Patients: A 5-Year Retrospective Analysis from a Single Institution in Indonesia Putri, Syifa Azizah; Monty Priosodewo Soemitro; Basuki Hidayat; Kharisma Perdani Kusumahstuti
Bioscientia Medicina : Journal of Biomedicine and Translational Research Vol. 8 No. 11 (2024): Bioscientia Medicina: Journal of Biomedicine & Translational Research
Publisher : HM Publisher

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.37275/bsm.v8i11.1116

Background: Radioactive iodine (RAI) therapy is a cornerstone in the management of differentiated thyroid cancer (DTC). However, a subset of patients develops RAI-refractory disease, characterized by the inability to concentrate radioiodine, leading to limited treatment options and a poorer prognosis. This study aimed to investigate the prevalence and identify potential risk factors associated with RAI-refractory DTC in an Indonesian population. Methods: A retrospective analysis was conducted on patients diagnosed with DTC and treated with RAI at a single tertiary care center in Indonesia between 2019 and 2023. Data on demographics, clinical characteristics, tumor features, and treatment outcomes were collected. RAI-refractoriness was defined as the absence of iodine uptake on diagnostic whole-body scans after cumulative RAI activity of 600 mCi or more. Bivariate and multivariate analyses were performed to identify risk factors for RAI-refractoriness. Results: A total of 194 patients with DTC were included in the study. The prevalence of RAI-refractoriness was 90%. The median age at diagnosis was 55 years (range 18-82), and 72% were female. Papillary thyroid carcinoma was the most common histological subtype (92%). In bivariate analysis, older age at diagnosis (p=0.02), male gender (p=0.04), and the presence of distant metastases at diagnosis (p<0.001) were significantly associated with RAI-refractoriness. In multivariate analysis, only the presence of distant metastases remained an independent predictor of RAI-refractoriness (odds ratio 3.8, 95% confidence interval 1.5-9.2, p=0.003). Conclusion: RAI-refractoriness is a significant clinical challenge in the management of DTC, with a high prevalence observed in this Indonesian cohort. The presence of distant metastases at diagnosis emerged as a strong predictor of RAI-refractoriness. Further research is needed to elucidate the underlying mechanisms of RAI-refractoriness and develop novel therapeutic strategies for this patient population.

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