Background Sentinel lymph node mapping (SLNM) using ^99mTc-nanocolloid single photon emission tomography/computed tomography (SPECT/CT) is a minimally invasive technique for detecting lymphatic metastasis in early-stage endometrial cancer. This study aimed to evaluate the detection rate (DR) of sentinel lymph nodes (SLNs) using SPECT/CT and compare the findings with intraoperative gamma probe evaluation and histopathological results. Methods A retrospective cohort study was conducted at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between December 2022 and January 2024. Twenty-six patients with FIGO (International Federation of Gynecology and Obstetrics) stage I endometrial cancer were included. ^99mTc-nanocolloid was injected into four cervical quadrants, followed by SPECT/CT imaging and intraoperative gamma probe evaluation. Histopathological analysis was performed to confirm the presence of metastasis. Results SLNs were detected in 20 patients (76.9%) using SPECT/CT, with 100% concordance with gamma probe findings. Histopathological analysis identified metastasis in four patients (15.4%). Tumor size was significantly associated with SLN detection (p < 0.001), with larger tumors (> 4 cm) more frequently associated with positive SLNs. However, no significant correlation was found between SPECT/CT maximum counts and histopathological metastasis (p: 0.156). Among the six patients with negative SPECT/CT findings, all patients underwent lymphadenectomy, and no metastasis was detected in these cases. Conclusion SPECT/CT using ^99mTc-nanocolloid is an effective tool for SLNM in early-stage endometrial cancer, demonstrating a high DR and perfect concordance with intraoperative gamma probe findings. Its superior anatomical accuracy enhances surgical planning. Tumor size significantly influences SLN detection, with larger tumors being more frequently associated with positive SLNs. However, SPECT/CT count intensity does not correlate with histopathological metastasis. Article published online: 12 March 2025 © 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/) Thieme Medical and Scientific Publishers Pvt. Ltd. A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

Comparative Insights into 18F-FDG and 68Ga-FAPI PET Imaging in Glioma: Diagnostic Value, Tumor Grading, and Clinical Implications - Molecular Imaging and Radionuclide Therapy

Marine-Lenhart syndrome (MLS) is a rare variant of hyperthyroidism characterized by the coexistence of Graves’ disease and autonomously functioning thyroid nodules. This comprehensive literature review aims to synthesize current knowledge regarding the pathophysiology, diagnostic approach, and management of MLS, with a particular focus on the role of nuclear medicine. A structured review of relevant literature—including clinical studies, case reports, and international guidelines—was conducted to explore thyroid anatomy, mechanisms of nodule formation, imaging findings, and therapeutic strategies. Thyroid scintigraphy using radiotracers such as ^99m Tc-pertechnetate remains central to the diagnosis of MLS, enabling functional distinction between diffusely hyperactive tissue and coexisting nodules. Despite advances in ultrasonography and fine-needle aspiration biopsy, nuclear imaging continues to offer unique functional insights. Treatment typically involves antithyroid drugs and radioiodine (¹³¹I) therapy; however, higher radioiodine doses may be necessary due to the relative resistance of autonomously functioning nodules. Newer imaging modalities, such as ¹⁸F-fluorodeoxyglucose PET/computed tomography (CT), are not useful for primary nodule characterization but may detect incidental fluorodeoxyglucose-avid nodules that warrant further evaluation. MLS poses a diagnostic challenge due to its overlapping features with other thyroid disorders and the potential for malignancy within cold nodules. This review highlights the indispensable role of nuclear medicine in diagnosing and tailoring treatment for MLS, ultimately promoting better outcomes through precise functional assessment.

The coexistence of multiple malignancies presents diagnostic and therapeutic challenges. Breast and thyroid cancers are among the most frequently diagnosed malignancies in women, and studies suggest a potential bidirectional association. While fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography (CT) is a valuable imaging modality for evaluating breast cancer, its sensitivity in detecting low-metabolic subtypes remains limited. Additionally, incidental FDG-avid thyroid lesions require further evaluation due to their potential malignancy risk. We present a 61-year-old female with a suspected left breast malignancy, suggestive of luminal A subtype, showing low FDG uptake (maximum standardized uptake value [SUVmax] 2.0) on PET/CT, despite mammographic and ultrasound findings suggestive of malignancy (Breast Imaging-Reporting and Data System 4A and V). Additionally, an incidental left thyroid lesion (4.0 × 3.8 cm, SUVmax 3.4) with calcifications was detected, raising suspicion for malignancy. The discordant imaging findings in this case highlight the limitations of FDG-PET/CT and emphasize the necessity of multimodal imaging and histopathological confirmation. This case underscores the importance of integrating multiple imaging modalities for accurate diagnosis. While PET/CT is useful for systemic staging, its limitations in detecting certain breast cancer subtypes necessitate complementary imaging techniques and histopathological confirmation. The incidental thyroid lesion also required further assessment, reinforcing the need for a comprehensive diagnostic approach.