Diagnostic accuracy of <Superscript>18</Superscript>F–FDG PET/CT and MR imaging in patients with adenoid cystic carcinoma

Background

The aim of this study was to evaluate the value of 18F–FDG PET/CT (PET/CT) and MRI for local and/or whole-body restaging of adenoid cystic carcinoma of the head and neck (ACC).

Methods

Thirty-six patients with ACC underwent conventional MRI of the head and neck and a whole-body PET/CT and were analysed with regards to detection of a local tumor recurrence, lymph node or distant metastases. A consensus interpretation of all available imaging data was used as reference standard. Sensitivity, specificity, diagnostic accuracy, positive and negative predictive values were calculated for MRI and PET/CT.

Results

The sensitivity of PET/CT and MRI was 96% (89%), specificity 89% (89%), PPV 96% (96%), NPV 89% (73%) and accuracy 94% (89%) for detection of local tumors. Additionally, PET/CT revealed lymph node metastases in one patient and distant metastases in 9/36 patients. In three patients secondary primaries were found.

Conclusions

Whole-body PET/CT in addition to MRI of the head and neck improves detection of local tumour and metastastic spread in ACC.

     

Physiological <Superscript>18</Superscript>F-FDG uptake by the spinal cord: is it a point of consideration for cancer patients?

It is essential to be familiar with normal patterns of ¹⁸F FDG distribution in the whole body for accurate PET interpretation. We assessed FDG uptake by the spinal cord to evaluate its characteristics in cancer patients. For 101 cancer patients who underwent ¹⁸F FDG PET/CT the spinal cord along its segments was visually assessed for FDG uptake, regarding MaxSUV-measurement ≥1 as cut-off point. This assessment was correlated with the patient’s database variables. MRI and FDG PET-CT follow-up were included in the evaluation of positive subjects with FDG cord uptake. Forty-nine (48.5%) were positive for FDG cord uptake. The most encountered sites were the eleventh and twelfth dorsal vertebrae (36/49; 73.5%), all cervical (24/49; 49%), and the first lumbar segments (19/49; 38.7%). 38/49 (77.6%) and 11/49 (22.4%) were detected in the winter and summer, respectively (P = 0.007). MRI was available for 25 of the positive FDG cord uptake patients and showed no cord abnormalities, and in follow-up FDG PET-CT studies within 3–6 months 41/49 (83.7%) faded completely, while stationary or reduced uptake was observed for the remainder (8/49; 16.3%). FDG uptake in multiple consecutive segments of the spinal cord is not uncommon in cancer patients. This must be recognized as physiological, to avoid misdiagnosis as malignant involvement. Such physiological uptake is mostly encountered in the cervical, last two dorsal, and first lumbar levels, and quite frequently in winter.     

<Superscript>18</Superscript>F-FDOPA PET and MRI characteristics correlate with degree of malignancy and predict survival in treatment-naïve gliomas: a cross-sectional study

Introduction

To report the potential value of pre-operative ¹⁸F-FDOPA PET and anatomic MRI in diagnosis and prognosis of glioma patients.

Methods

Forty-five patients with a pathological diagnosis of glioma with pre-operative ¹⁸F-FDOPA PET and anatomic MRI were retrospectively examined. The volume of contrast enhancement and T2 hyperintensity on MRI images along with the ratio of maximum ¹⁸F-FDOPA SUV in tumor to normal tissue (T/N SUV_max) were measured and used to predict tumor grade, molecular status, and overall survival (OS).

Results

A significant correlation was observed between WHO grade and: the volume of contrast enhancement (r?=?0.67), volume of T2 hyperintensity (r?=?0.42), and ¹⁸F-FDOPA uptake (r?=?0.60) (P?<?0.01 for each correlation). The volume of contrast enhancement and ¹⁸F-FDOPA T/N SUV_max were significantly higher in glioblastoma (WHO IV) compared with lower grade gliomas (WHO I–III), as well as for high-grade gliomas (WHO III–IV) compared with low-grade gliomas (WHO I–II). Receiver-operator characteristic (ROC) analyses confirmed the volume of contrast enhancement and ¹⁸F-FDOPA T/N SUV_max could each differentiate patient groups. No significant differences in ¹⁸F-FDOPA uptake were observed by IDH or MGMT status. Multivariable Cox regression suggested age (HR 1.16, P?=?0.0001) and continuous measures of ¹⁸F-FDOPA PET T/N SUV_max (HR 4.43, P?=?0.016) were significant prognostic factors for OS in WHO I–IV gliomas.

Conclusions

Current findings suggest a potential role for the use of pre-operative ¹⁸F-FDOPA PET in suspected glioma. Increased ¹⁸F-FDOPA uptake may not only predict higher glioma grade, but also worse OS.

     

<Superscript>99m</Superscript>Tc-Tetrofosmin brain SPECT in the assessment of meningiomas—correlation with histological grade and proliferation index

Meningiomas account for about 30% of all intracranial tumors. Evaluation of their proliferation rate is useful for assessing their biological behavior. We evaluated prospectively whether (99m)Tc-Tetrofosmin ((99m)Tc-TF) uptake in meningiomas correlates with cellular proliferative activity and with tumor grade. We prospectively studied 18 meningioma cases. Brain single-photon emission computed tomography (SPECT) by (99m)Tc-TF was performed within a week prior to surgical excision. In the excised tumor specimens we assessed Ki-67 antigen expression. 14 of 18 patients had benign meningiomas, while the remaining four had anaplastic meningiomas. A significant correlation was found between both (99m)Tc-TF uptake and tumor grade (r = 0.722, P = 0.001) and between (99m)Tc-TF uptake and Ki-67 expression (r = 0.930, P < 0.001). There was a significant correlation between the intensity of tracer uptake and tumor recurrence at 1 year postoperative (r = 0.574, P = 0.02). This pilot study implies that (99m)Tc-TF brain SPECT could prove useful in differentiating benign from anaplastic meningiomas and is a potential indicator of their proliferative activity.     

Retrospective analysis of 116 patients and diagnostic value of 18 F-FDG PET/CT in hepatic tumor北大核心CSCD

Objective: To evaluate the diagnostic value of 18F-fluorodeoxy glucose (FDG) positron emission tomography (PET)/CT in patients with hepatic tumor. Methods: One hundred and sixteen patients with clinical diagnosis of hepatic tumor (85 males, 31 females; average age was 56 years old) had undergone 18F FDG PET/CT scan before treatment from January 2010 to June 2017, and the imaging characteristics were retrospectively analyzed. The pathological results were used as a gold standard for evaluating the diagnostic value of 18F FDG PET/CT. The maximum diameter (dmax), the maximum standardized uptake value (SUVmax) and the tumor to non-tumor SUV ratio (TNR) were measured. Two-sample t test, one-way ANOVA, paired Chi-square test and receiver operating characteristic (ROC) curve were used for data analysis. Results: Of the 116 patients, 11 patients had benign tumor, and 105 patients had malignant tumor. The dmax, SUVmax and TNR of 105 patients with malignant tumor were significant higher than those of 11 patients with benign tumor (all P < 0.05). The sensitivity and specificity of visual analysis in the diagnosis of benign tumors were 84.8% and 54.5%, respectively. The sensitivity and specificity of the SUVmax method were 83.8% and 63.6%, respectively. The sensitivity and specificity of the TNR method were 57.1% and 90.9%, respectively. From the perspective of positive rate, visual analysis and SUVmax were better than TNR. The areas under receiver operating characteristic curve for diagnosis of intrahepatic cholangiocarcinoma and liver metastases by SUVmax and TNR methods were larger. Conclusion: 18F-FDG PET/CT is a useful examination in hepatic tumor, especially for intrahepatic cholangiocarcinoma and metastatic carcinoma. Copyright © 2018 by TUMOR. All rights reserved.     

Dosimetry study of <Superscript>18</Superscript>F-FMISO + PET/CT hypoxia imaging guidance on intensity-modulated radiation therapy for non-small cell lung cancer

Objectives

This study was to evaluate the feasibility of simultaneous integrated boost on tumor hypoxia area by studying the dosimetric change of hypoxia imaging guidance on intensity-modulated radiation therapy for non-small cell lung cancer (NSCLC).

Methods

Five NSCLC patients with large hypoxic volume participated in this study. FDG PET/CT images were fused with CT localization images to delineate gross tumor volume. FMISO PET/CT images were fused with CT localization images to delineate hypoxic biological target volume (BTV) (tissue maximum ratio ≥?1.3) by threshold. BTV was irradiated with 72, 78 and 84 Gy, respectively, 30 times. The dosimetry differences were compared in target volume and organ at risk between simultaneous integrated boost plans and conventional radiotherapy plans.

Results

Dosages on BTV of NSCLC hypoxic area were increased to 72, 78 and 84 Gy, respectively, by simultaneous integrated boost intensity-modulated radiation therapy. There was no obvious difference in dosage distributions on original target volume compared with those in conventional radiotherapy. Dosages on main organ at risk in chest met the dosimetric constraint, and there was no significant difference compared with those in conventional radiotherapy.

Conclusion

It is feasible in dosiology that the dosages in NSCLC hypoxic area were added to 72, 78 and 84 Gy by simultaneous integrated boost with the guidance of ¹⁸F-FMISO PET/CT.

     

Effect of paroxetine hydrochloride (Paxil<Superscript>®</Superscript>) on fatigue and depression in breast cancer patients receiving chemotherapy

Summary Background. Fatigue can significantly interfere with a cancer patients ability to fulfill daily responsibilities and enjoy life. It commonly co-exists with depression in patients undergoing chemotherapy, suggesting that administration of an antidepressant that alleviates symptoms of depression could also reduce fatigue.Methods. We report on a double-blind clinical trial of 94 female breast cancer patients receiving at least four cycles of chemotherapy randomly assigned to receive either 20 mg of the selective serotonin re-uptake inhibitor (SSRI) paroxetine (Paxil®, SmithKline Beecham Pharmaceuticals) or an identical-appearing placebo. Patients began their study medication seven days following their first on-study treatment and continued until seven days following their fourth on-study treatment. Seven days after each treatment, participants completed questionnaires measuring fatigue (Multidimensional Assessment of Fatigue, Profile of Mood States-Fatigue/Inertia subscale and Fatigue Symptom Checklist) and depression (Profile of Mood States-Depression subscale [POMS-DD] and Center for Epidemiologic Studies-Depression [CES-D]).Results. Repeated-measures ANOVAs, after controlling for baseline measures, showed that paroxetine was more effective than placebo in reducing depression during chemotherapy as measured by the CES-D (p=0.006) and the POMS-DD (p=0.07) but not in reducing fatigue (all measures, ps > 0.27).Conclusions. Although depression was significantly reduced in the 44 patients receiving paroxetine compared to the 50 patients receiving placebo, indicating that a biologically active dose was used, no significant differences between groups on any of the measures of fatigued were observed. Results suggest that modulation of serotonin may not be a primary mechanism of fatigue related to cancer treatment.     

Evaluation of the sonographic visibility and sonographic appearance of the breast biopsy marker (UltraClip<Superscript>®</Superscript>) placed in phantoms and patients

Purpose

To evaluate the usefulness of the UltraClip^® dual trigger breast tissue marker (UltraClip) for sonographic localization, we investigate the sonographic visibility and sonographic appearance of the UltraClip placed in phantoms and patients.

Materials and methods

Ten UltraClips were placed in the target lesions in the phantoms. After the ultrasound examination of the UltraClip, the ultrasound images were compared to the real appearance of the UltraClip obtained by cutting the phantoms. In the patient, the UltraClip markers were placed after biopsy of a suspicious breast lesion or before or during neoadjuvant chemotherapy. The patients consented to return 1–3 weeks after the procedure for ultrasound imaging of the UltraClip.

Results

The UltraClip placed in the phantom appeared as a hyperechoic structure with a mean maximum diameter of 5.5 mm, which was found to correspond to the metallic clip in 90% (9/10) of the cases, and as a hyperechoic tubular structure with a maximum diameter of 9.0 mm corresponded to the expanded polyvinyl alcohol polymer in the remaining 10% (1/10) of cases. On the other hand, the UltraClip was detected as a hyperechoic structure measuring 3.5 mm in size only in 9 of the 15 (60%) patients. The sonographic visibility of the UltraClip was not affected depending on whether the target lesion or post-biopsy scar was sonographically detectable or not [60% (6/10) vs. 60% (3/5)].

Conclusions

While sonographic localization by targeting the UltraClip may be useful in 60% of the patients, another localization technique will be needed in the remaining patients.

     

Efficacy and safety of nab-paclitaxel 125 mg/m<Superscript>2</Superscript> and nab-paclitaxel 150 mg/m<Superscript>2</Superscript> compared to paclitaxel in early high-risk breast cancer. Results from the neoadjuvant randomized GeparSepto study (GBG 69)

Purpose

The GeparSepto study demonstrated that the use of nab-paclitaxel instead of paclitaxel prior to anthracycline-based chemotherapy could lead to a significantly increased pCR rate, especially in the triple negative subpopulation. We report efficacy and safety for patients treated with two different doses of nab-paclitaxel in comparison to weekly solvent-formulated paclitaxel.

Methods

Patients were treated for 12 weeks with either intravenous nab-paclitaxel 150 mg/m² (nP150) weekly, after study amendment 125 mg/m² (nP125) weekly or solvent-based paclitaxel 80 mg/m² (P80) weekly followed by epirubicin 90 mg/m² and cyclophosphamide 600 mg/m² on day 1 for four 3-week cycles.

Results

229 patients received nP150, 377 nP125. Baseline characteristics were fairly balanced between these two sequential cohorts as well as compared to 601 patients receiving P80 except for hormone receptor status, HER2 status, and Ki67. Taxane treatment was discontinued in 26.8% (nP150), 16.6% (nP125), and 13.3% of (P80) patients, respectively. Median relative total dose intensity (mRTDI) based on 125 mg/m² for nP was 103% with nP150, 95% with nP125, 99% with P80 before and 98% with P80 after the amendment. PSN grade 3–4 was observed in 14.5% of patients with nP150, 8.1% of patients with nP125 (p = 0.018), and 2.7% of patients with P80. Overall pCR before the amendment was 33.6% after nP150 and 23.5% after P80 (OR 1.65 [95% CI 1.10–2.50]; p = 0.022); pCR after the amendment was 41.4% after nP125, and 32.4% after P80 (1.48 [95% CI 1.10–1.99]; p = 0.013).

Conclusions

Nab-paclitaxel 125 mg/m² was associated with a better safety profile and compliance without compromising the efficacy compared to nab-paclitaxel 150 mg/m².

     

Special issue “The advance of solid tumor research in China”: 68Ga-PSMA-11 PET/CT for evaluating primary and metastatic lesions in different histological subtypes of renal cell carcinoma

Conventional imaging examinations are not sensitive enough for the early detection of recurrent or metastatic lesions in renal cell carcinoma (RCC) patients. We aimed to explore the role of ⁶⁸Ga-prostate specific membrane antigen (PSMA)-11 positron emission tomography (PET)/computed tomography (CT) in the detection of primary and metastatic lesions in such patients. We retrospectively analyzed 50 RCC patients who underwent ⁶⁸Ga-PSMA-11 PET/CT from November 2017 to December 2020. We observed a higher median accuracy and tumor-to-background maximum standard uptake value (SUV_max) ratio (TBR) of ⁶⁸Ga-PSMA-11 PET/CT in clear cell RCC (ccRCC; 96.57% and 6.00, respectively) than in non-clear cell RCC (ncRCC; 82.05% and 2.99, respectively). The accuracies in detecting lesions in the renal region, bone, lymph nodes and lungs in ccRCC were 100.00%, 95.00%, 98.08% and 75.00%, respectively, and those in the renal region, bone and lymph nodes in ncRCC were 100.00%, 86.67% and 36.36%, respectively. The median TBRs of the lesions from the above locations were 0.38, 10.96, 6.69 and 13.71, respectively, in ccRCC and 0.13, 4.02 and 0.73, respectively, in ncRCC. The PSMA score evaluated with immunohistochemistry was correlated with the SUV_max (P = .046) in RCC. Higher PSMA scores were observed in ccRCC than in ncRCC (P = .031). ⁶⁸Ga-PSMA-11 PET/CT resulted in changes in clinical management in 12.9% (4/31) of cases because of the discovery of new metastases not detected with conventional imaging. These results indicate that ⁶⁸Ga-PSMA-11 PET/CT is a promising method for the detection of metastatic lesions in ccRCC, especially for those in the bone and lymph nodes.