The study was designed around a deceptively simple question: what happens to patients who arrive at the hospital with an intracranial tumor? In-hospital death is a clinically important short-term outcome because it captures acute neurological deterioration, the timing of treatment decisions, and the real-world capacity of hospital care pathways. In high-income countries, registries and hospital databases routinely track such outcomes, allowing clinicians to benchmark performance and identify modifiable weaknesses. In much of sub-Saharan Africa, however, outcome reporting from neuro-oncology settings has been limited, leaving clinicians and policymakers to operate largely without local evidence. The Luanda team set out to help close that gap using the records their own institution had accumulated over six years.

Methodologically, the researchers treated each admission as the unit of analysis rather than each patient. Because the anonymized institutional registry does not allow reliable patient-level linkage, the number of unique individuals and any repeat admissions could not be determined, a limitation the authors acknowledge explicitly. The primary outcome was death during the hospital stay. Univariable analyses examined age, sex, whether the patient underwent surgery, length of stay, the diagnostic group recorded in the registry, and the year of admission. Reporting followed the STROBE and RECORD guidelines, the international standards for strengthening the reporting of observational studies conducted with routinely collected health data, which lends the analysis a transparency often missing from small single-center studies.

The statistical challenge the team faced was one familiar to anyone working with rare events: only 21 deaths occurred across the entire cohort, fewer than ten events per candidate variable. That number is too small to support a conventional multivariable model with many predictors, which would risk producing unstable, unreliable estimates. Instead, the researchers pre-specified a restricted sensitivity analysis using Firth penalized logistic regression, a technique designed specifically for small-sample and sparse-data settings because it reduces the small-sample bias that plagues ordinary maximum-likelihood estimation. The penalized model was limited to just three predictors: age per ten-year increase, surgery, and a high-risk registry diagnosis category defined as glioblastoma or metastatic disease versus other registry diagnoses.

The results pointed in a consistent direction. Age of 50 years or older was associated with in-hospital death in univariable analysis, with an odds ratio of 4.51 and a 95 percent confidence interval of 1.61 to 12.67, and admissions ending in death were also older when age was analyzed as a continuous variable. Mortality differed across the registry diagnostic groups overall. In the penalized complete-case model, which included 89 admissions and 21 deaths, the high-risk registry diagnosis remained associated with death after adjustment, carrying an odds ratio of 5.70 with a 95 percent confidence interval of 1.58 to 20.52. Age, by contrast, became statistically imprecise in the adjusted model, with an odds ratio of 1.32 per ten years that crossed the null, and surgery showed no significant association, with an odds ratio of 0.79.

The authors are careful, and rightly so, about how far these numbers can be pushed. With only 21 events, the estimates are exploratory and susceptible to residual confounding, and the study does not establish a ranking of determinants of death. The apparent null association for surgery is a particularly instructive example of why crude associations in observational data can mislead. Patients selected for surgery likely had better performance status and more resectable tumors in the first place, so the absence of a statistical link between surgery and mortality should not be interpreted causally. In other words, the healthiest patients were probably the ones offered operations, which would mask any independent effect of the procedure itself.

Sex, surgery, and length of stay were not associated with death in the univariable analyses, a finding that may surprise readers accustomed to high-income datasets where treatment delays and operative variables often dominate outcome discussions. But the Angolan context matters here. Hospital do Prenda functions as a tertiary referral center, and the patients who reach its neurosurgery service represent a selected fraction of everyone in the country with an intracranial tumor. Many patients with suspected brain tumors in Angola may never reach neurosurgical evaluation at all, dying at home or in facilities without neurosurgical capacity. The 22.6 percent mortality figure therefore describes what happens among those who make it through the door, not the full burden of intracranial tumors in the population.

The study’s six-year window, spanning 2020 through 2025, also encompasses the COVID-19 pandemic era, a period when health systems across Africa faced extraordinary strain on hospital beds, staffing, and referral pathways. The researchers examined admission year as a variable but did not identify it as a driver of mortality in their reported findings. What the study does establish is a baseline, a documented starting point against which future improvements in Angolan neuro-oncology care can be measured. The authors note that the registry-based diagnostic groups showed overall differences in mortality, with the high-risk category of glioblastoma and metastatic disease standing out, which aligns with what global neuro-oncology would predict: the most aggressive tumors kill fastest, especially when treatment options are constrained.

Beyond its specific findings, the research carries a broader significance for the field of global neurosurgery. Outcome data from African neuro-oncology settings remain limited, and every carefully documented cohort adds to a picture that international guidelines and resource-allocation decisions currently lack. The Luanda team’s decision to follow STROBE and RECORD reporting principles, to pre-specify a penalized regression strategy appropriate to their small number of events, and to publish with explicit caveats about residual confounding offers a model for how single-center studies in resource-limited settings can meet rigorous methodological standards. The work received no specific external funding, and the authors thank the clinical and administrative teams of Hospital do Prenda for maintaining the institutional records that made the analysis possible.

For clinicians in Luanda and comparable settings, the practical message is that older patients and those with registry diagnoses of glioblastoma or metastatic disease represent the groups at highest risk of dying during admission, and that care pathways, from imaging and biopsy capacity to palliative and neurocritical care, should be oriented accordingly. For researchers, the message is that larger, multi-center, and prospectively designed cohorts are needed to move from hypothesis-generating associations to actionable evidence. The authors themselves frame their findings as exploratory, a scientific foothold rather than a final word. Yet in a field where Angolan data have been nearly absent, even a foothold represents progress, and the 22.6 percent in-hospital mortality figure now stands as a documented reality that future studies, interventions, and health policies in Angola can be measured against.

Subject of Research: In-hospital mortality among intracranial tumor admissions at a tertiary hospital in Luanda, Angola

Article Title: In-hospital mortality among intracranial tumor admissions at a tertiary hospital in Luanda, Angola: a retrospective cohort study

Article References: Mayor, B. S., Xavier, M., Miguel, M. C., Pinto, C., & Neto, S. (2026). In-hospital mortality among intracranial tumor admissions at a tertiary hospital in Luanda, Angola: a retrospective cohort study. BMC Cancer. https://doi.org/10.1186/s12885-026-17039-2

Image Credits: AI Generated

DOI: 10.1186/s12885-026-17039-2

Keywords: intracranial tumors, in-hospital mortality, neuro-oncology, brain cancer, glioblastoma, metastatic disease, neurosurgery, Angola, Africa, retrospective cohort, prognosis, global health

The numbers reported by the research team are striking. Among 49 patients with renal medullary carcinoma who underwent 18F-FDG PET/CT scans at MD Anderson between 2016 and 2025, the radiotracer detected lesions in 98 percent of cases, or 48 of the 49 patients. Even more consequential, in 65 percent of patients the tracer revealed additional cancer lesions that were not visualized on standard anatomical imaging such as computed tomography or magnetic resonance imaging. Those extra findings were not merely academic curiosities: in 21 percent of patients with active disease, the PET/CT results directly changed the clinical management plan, steering physicians away from treatments that would have been futile or harmful and toward strategies better matched to the true extent of disease.

Renal medullary carcinoma is a disease that demands precision from the very first scan. It predominantly affects adolescents and young adults, occurs more often in males, and is strongly associated with sickle cell trait and related hemoglobinopathies, conditions in which the oxygen-carrying environment of the renal medulla appears to create conditions favorable to tumor development. At the time of diagnosis, patients frequently already present with metastatic disease, and the median overall survival is approximately 14.5 months. Against that grim backdrop, every staging decision carries enormous weight. Surgery that might offer curative potential in localized disease becomes a source of suffering and delay when the cancer has in fact spread undetected, because high-morbidity operations postpone the systemic therapies that metastatic patients urgently need.

Simone Krebs, MD, MS, a nuclear medicine physician and scientist at MD Anderson and the study’s lead author, emphasized just how much rides on getting staging right in this disease. In renal medullary carcinoma, she noted, the value of accurate staging cannot be overstated, because upstaging a patient from localized to metastatic disease spares them from noncurative, high-morbidity surgeries that would only delay the initiation of essential systemic therapy. Identifying metastatic disease, she added, may also open opportunities for more effective therapies tailored to a patient’s actual disease burden. Her comments underscore a central tension in oncology: the difference between what imaging shows and what the cancer is actually doing can determine whether a patient receives the right treatment at the right time or loses precious months to the wrong one.

The biological basis for the study’s success lies in the way renal medullary carcinoma handles glucose. 18F-FDG is a glucose analog labeled with fluorine-18; it is taken up by cells through glucose transporters and then becomes metabolically trapped, allowing positron emission tomography to visualize tissues with high glycolytic activity. Many cancers are avid for FDG, but uptake varies considerably across kidney tumor subtypes, which has historically limited the tracer’s reputation in urologic oncology. Clear cell renal cell carcinoma, the most common kidney cancer, often shows variable FDG uptake, and some renal lesions are better characterized by other tracers or by dedicated CT protocols. Renal medullary carcinoma, however, demonstrates strong and consistent FDG uptake, distinguishing it from other kidney cancers and making it an unusually suitable target for FDG PET/CT imaging.

That metabolic avidity translated into practical diagnostic power even in patients who had already begun systemic treatment. The study found that 18F-FDG PET/CT remained highly effective after therapy had been initiated, an important point because treatment can alter tumor metabolism and degrade the performance of metabolic imaging in some cancers. In renal medullary carcinoma, the tracer continued to illuminate active disease, giving oncologists a reliable way to assess how patients were responding and whether residual lesions represented viable tumor. Quantitative PET/CT metrics were evaluated alongside visual interpretation, and the researchers systematically recorded every instance in which imaging findings altered treatment, providing a structured account of the scan’s real-world impact rather than anecdotal impressions.

The clinical consequences of the additional findings were often dramatic. In one illustrative case included in the published work, a patient demonstrated intense focal FDG uptake in nodal, hepatic, soft-tissue, and osseous metastases on maximum-intensity-projection imaging. Axial FDG PET and fused PET/CT images revealed focal intense uptake in the right iliac bone, a finding without a definite correlate on the dedicated CT image. That discrepancy, a metabolically active lesion invisible on anatomical imaging, led directly to changes in the patient’s clinical management. It is precisely this pattern, PET revealing disease that CT cannot confirm, that explains how the tracer upstaged so many patients and redirected so many treatment plans in the study cohort.

For patients, the implications of these findings are potentially life-altering. A young adult with renal medullary carcinoma who appears to have localized disease on a conventional CT scan might, in fact, harbor hepatic, nodal, or bone metastases that only PET/CT can reveal. Detecting those lesions before surgery could spare the patient a major operation that would never have been curative, while simultaneously accelerating access to systemic therapy, the treatment modality most likely to extend survival in metastatic disease. Conversely, for patients whose PET/CT confirms truly limited disease, the scan provides confidence that aggressive local treatment is justified. In both directions, the additional information changes decisions, and in a cancer with a median survival measured in months, better decisions translate directly into better use of the limited time available.

The study’s authors argue that the evidence now justifies a formal change in clinical practice. Their conclusion is that the findings may support the inclusion of 18F-FDG PET/CT in upcoming guidelines regarding renal medullary carcinoma, which would enable broader clinical use beyond specialized centers like MD Anderson. Guideline inclusion matters because renal medullary carcinoma is rare enough that many treating institutions will encounter only a handful of cases, and clinicians may default to conventional staging pathways unless professional society recommendations explicitly endorse metabolic imaging. Krebs and her colleagues contend that PET/CT provides clinically meaningful information beyond conventional imaging, helping doctors better assess the extent of disease and choose the most appropriate treatment strategy, and that on a larger scale the research supports wider adoption in routine patient care.

As molecular imaging continues to expand its role in oncology, the MD Anderson study offers a compelling case study in how an old, proven tool can find new purpose in an underserved disease. 18F-FDG has been a staple of nuclear medicine for decades, yet its value in kidney cancer has been considered limited and subtype-dependent. By rigorously documenting its performance specifically in renal medullary carcinoma, a population of predominantly young patients with few good options, the researchers have turned a routine radiotracer into a potential standard of care for one of oncology’s most aggressive diagnoses. With 98 percent detection, additional lesions found in nearly two-thirds of patients, and management changes in one in five, the case for FDG PET/CT in this disease is difficult to ignore, and the coming updates to clinical guidelines may soon make this powerful scan a routine part of the fight against renal medullary carcinoma.

Subject of Research: Use of 18F-FDG PET/CT imaging for staging and treatment planning in renal medullary carcinoma

Article Title: Proven radiotracer highly effective in detecting rare, aggressive kidney cancer

Article References: Proven radiotracer highly effective in detecting rare, aggressive kidney cancer. (n.d.). Original publication

Image Credits: AI Generated

DOI: Not provided

Keywords: renal medullary carcinoma, 18F-FDG PET/CT, kidney cancer, molecular imaging, metastatic disease, staging, nuclear medicine, radiotracer, MD Anderson Cancer Center, treatment planning, non-clear cell renal cell carcinoma, Journal of Nuclear Medicine

The research team, led by Knut Liepe of the Department of Nuclear Medicine at GH Hospital Klinikum Frankfurt (Oder) in Germany, together with colleagues from Ruhr University Bochum’s Johannes Wesling Hospital Minden and independent collaborators, examined 91 patients who underwent primary staging with [99mTc]Tc-PSMA SPECT/CT. Each patient received a median administered activity of 670 megabecquerels of the radiotracer [99mTc]Tc-MIP-1404, with a range of 470 to 792 megabecquerels. The imaging technique fuses single-photon emission computed tomography, which maps the distribution of the radiolabelled prostate-specific membrane antigen ligand, with computed tomography, which provides anatomical context. Together, the two modalities allow physicians to visualise both the primary tumour within the prostate and any metastatic deposits in pelvic lymph nodes or distant organs.

PSMA—prostate-specific membrane antigen—is a transmembrane protein expressed abundantly and relatively homogeneously on the surface of prostate cancer cells, a biological property that has made it one of the most successful molecular imaging targets in oncology. Radiolabelled ligands such as MIP-1404 bind to PSMA, concentrating radiation signal at tumour sites and enabling detection of lesions that conventional bone scans and CT frequently miss. While PSMA PET/CT has become the reference standard for staging in high-income centres, guided by landmark randomised trials such as proPSMA, PET infrastructure is expensive, dependent on short-lived isotopes, and unevenly distributed globally. SPECT cameras, by contrast, are far more widespread, which is precisely why the German team’s analysis of when technetium-based PSMA SPECT/CT delivers meaningful diagnostic yield matters so much.

The core of the study is a statistical interrogation of how two pre-imaging variables interact to determine what the scan will find. Using univariate and multivariate nominal logistic regression, the investigators tested whether the initial PSA level (iPSA) and the International Society of Urological Pathology grade group—assigned from 1, the least aggressive, to 5, the most aggressive—predicted the presence of metastatic disease. Both emerged as independent predictors. The effect of PSA was the stronger of the two, with a p-value of 0.0004, while ISUP grade remained significant at p equal to 0.0015. In practical terms, a man’s blood test and his biopsy pathology, taken together, already encode much of the information the scanner will later confirm.

The detection-rate thresholds that emerged from the analysis are strikingly concrete. Detection rates of metastatic disease on [99mTc]Tc-PSMA SPECT/CT exceeded 50 percent in two patient subgroups: those with ISUP grades 1 to 3 whose initial PSA exceeded 50 nanograms per millilitre, and those with ISUP grades 4 to 5 whose initial PSA exceeded 20 nanograms per millilitre. Even more dramatically, metastases were detected in every single patient whose initial PSA was above 50 nanograms per millilitre, regardless of how indolent or aggressive the tumour appeared under the microscope. For clinicians weighing whether to order the scan, these cutoffs offer an evidence-based filter: below them, the probability of finding spread disease drops enough that the examination may not justify its cost and radiation exposure.

Beyond the headline thresholds, the study revealed that the two risk variables shape not just whether metastases appear but where they appear. Among patients with ISUP grades 1 to 3 across all PSA levels, and among those with ISUP grades 4 to 5 whose PSA was 20 nanograms per millilitre or below, pelvic lymph node metastases predominated—spread confined to the regional drainage basins around the prostate. In contrast, patients with ISUP grades 4 to 5 and initial PSA above 50 nanograms per millilitre were far more likely to harbour distant metastases, the true game-changers in treatment planning, since they shift management from curatively intended surgery or radiotherapy toward systemic therapy. The pattern echoes the biological logic of tumour progression: increasingly disorganised, high-grade tumours paired with heavy tumour burden, reflected in soaring PSA, are more capable of seeding far-flung sites.

The team also examined whether the scanner’s own quantitative output could substitute for pathology. The maximum standardised uptake value, SUVmax, which reflects the peak concentration of the radiotracer in the primary tumour, correlated strongly with ISUP grade, with a correlation coefficient of 0.61. Yet the authors caution that SUVmax was not a reliable surrogate marker for aggressiveness. The correlation, while robust statistically, is too loose to replace histopathological grading, whose tissue-based assessment captures architectural and nuclear features that tracer uptake only approximates. The finding is a reminder of a broader lesson in molecular imaging: quantitative biomarkers complement but do not supplant the pathologist’s verdict on biopsy material.

The implications reach well beyond the German centres where the data were collected. In the United States, Europe, and Australia, PSMA PET/CT is increasingly embedded in guidelines for high-risk disease, but in much of Asia, Africa, Latin America, and Eastern Europe, PET capacity remains a bottleneck. Technetium-99m, the isotope used in this study, is produced in widely distributed generator systems, requires no on-site cyclotron, and its SPECT cameras are already installed in thousands of nuclear medicine departments worldwide. When PSMA PET/CT is simply unavailable, the authors conclude, [99mTc]Tc-PSMA SPECT/CT may represent a valuable alternative for the primary staging of carefully selected prostate cancer patients—and the combined PSA-plus-ISUP criteria from this study supply exactly the selection logic that such an alternative needs to be used economically and effectively.

Of course, the study’s retrospective design and modest cohort of 91 patients mean the findings require prospective validation before they can be written into guidelines. Selection bias is possible, since the patients who received SPECT/CT may not represent the full spectrum of newly diagnosed disease, and detection thresholds derived from one tracer, one administered activity range, and one scanner generation may not transfer unchanged to other settings. The authors received no external funding for the work and declared relevant consultancy and lecture-fee relationships in the nuclear medicine industry. Still, the core message is likely to endure: the two numbers sitting at the top of every prostate cancer chart—the PSA value and the biopsy grade—together form a powerful pre-test probability engine. Used deliberately, they can direct PSMA imaging, whether by SPECT or PET, to the men most likely to benefit, sparing others an unnecessary scan while ensuring that metastatic disease, wherever it hides, is found before treatment plans are locked in.

Subject of Research: Patient selection criteria for primary staging of prostate cancer using [99mTc]Tc-PSMA SPECT/CT based on PSA level and ISUP grade

Article Title: Patient selection for primary staging with [99mTc]Tc-PSMA SPECT/CT: influence of combined PSA and ISUP grade on detection of metastatic disease

Article References: Liepe, K., Hoang, T. M., Dietrich, I., Piechota, H.-J., & Baehr, M. (2026). Patient selection for primary staging with [99mTc]Tc-PSMA SPECT/CT: influence of combined PSA and ISUP grade on detection of metastatic disease. European Journal of Nuclear Medicine and Molecular Imaging. https://doi.org/10.1007/s00259-026-08168-8

Image Credits: AI Generated

DOI: 10.1007/s00259-026-08168-8

Keywords: prostate cancer, PSMA SPECT/CT, PSA, ISUP grade, primary staging, metastatic disease, [99mTc]Tc-MIP-1404, SUVmax, pelvic lymph node metastases, nuclear medicine, patient selection, molecular imaging