The clinical impact of histopathologic response assessment by residual tumor cell quantification in esophageal squamous cell carcinomas

BACKGROUND: The objectives of this study were to investigate histomorphologic features as a response classification after neoadjuvant radiochemotherapy (RTx/CTx) and to correlate the results with clinical outcome parameters (e.g., postoperative morbidity and mortality, recurrence, and survival) in patients with locally advanced esophageal squamous cell carcinoma (ESCC). METHODS: Three hundred eleven patients with histologically proven, locally advanced, intrathoracic ESCC (clinical T3 or T4, N0-N+, M0) located at or above the level of the tracheal bifurcation underwent preoperative, combined, simultaneous RTx/CTx followed by esophagectomy. Response to RTx/CTx was classified by the quantification of residual tumor cells. A histopathologic response was defined as <10% residual tumor cells found within the specimen compared with a histopathologic nonresponse, which was characterized by >10% residual tumor cells. RESULTS: A histopathologic response was correlated significantly with complete tumor resection status (R0 resection) (P .0001), histopathologic tumor (ypT) category (P <.0001), lymph node involvement (P <.0001), lymphatic vessel invasion (P <.001), and survival (P <.0001). A multivariate Cox regression analysis revealed that histopathologic response classification according to the percentage of residual tumor cells was an independent prognostic factor (P <.0001). Nonresponders had greater postoperative pulmonary morbidity (P = .01), a greater 30-day mortality rate (P = .02), and a dismal survival rate compared to histopathologic responders (P <.0001). CONCLUSIONS: Histopathologic response evaluation based on the quantification of residual tumor cells provided meaningful information for the assessment of outcomes among patients with ESCC who have underwent neoadjuvant RTx/CTx. The current results indicated that histopathologic responders may represent a subgroup of patients who benefit from neoadjuvant therapy followed by surgery.     

18F]Fluorodeoxyglucose positron emission tomography predicts outcome for Ewing sarcoma family of tumors.

PURPOSE: Response to neoadjuvant chemotherapy is a significant prognostic factor for the Ewing sarcoma family of tumors (ESFTs). [18F]fluorodeoxyglucose (FDG) positron emission tomography (PET) is a noninvasive imaging modality that accurately predicts histopathologic response in several malignancies. To determine the prognostic value of FDG PET response for progression-free survival (PFS) in ESFTs, we reviewed the University of Washington Medical Center experience. PATIENTS AND METHODS: Thirty-six patients with ESFTs were evaluated by FDG PET. All patients received neoadjuvant and adjuvant chemotherapy. FDG PET standard uptake values before (SUV1) and after (SUV2) chemotherapy were analyzed and correlated with chemotherapy response, as assessed by histopathology in surgically excised tumors. Thirty-four patients had both SUV1 and SUV2. RESULTS: The mean SUV1, SUV2, and ratio of SUV2 to SUV1 (SUV2:1) were 7.9 (range, 2.3 to 32.8), 2.1 (range, 0 to 4.3), and 0.36 (range, 0.00 to 1.00), respectively. Good FDG PET response was defined as SUV2 less than 2.5 or SUV2:1 < or = 0.5. FDG PET response by SUV2 or SUV2:1 was concordant with histologic response in 68% and 69% of patients, respectively. SUV2 was associated with outcome (4-year PFS 72% for SUV2 < 2.5 v 27% for SUV2 > or = 2.5, P = .01 for all patients; 80% for SUV2 < 2.5 v 33% for SUV2 > or = 2.5, P = .036 for localized at diagnosis patients). SUV2:1 < or = 0.5 was not predictive of PFS. CONCLUSION: FDG PET imaging of ESFTs correlates with histologic response to neoadjuvant chemotherapy. SUV2 less than 2.5 is predictive of PFS independent of initial disease stage.     

正电子发射断层显像在心脏恶性肿瘤诊断中的临床应用价值

目的:探讨正电子发射断层显像(PET/CT)在心脏肿瘤诊断中的临床应用价值。方法:回顾性分析2011年1月-2018年12月,在我中心行PET/CT检查的23例心脏肿瘤患者的全身PET/CT的诊断结果,确诊依据为术后病理结果、临床随诊结果证实,评价PET/CT对心脏肿瘤诊断效能。结合影像学特征及SUVmax得到PET/CT的诊断结果,与确定诊断进行比较,采用两样本t检验分析数据,分析PET/CT对心脏恶性肿瘤的诊断能力。结果:23例心脏肿瘤患者中,恶性肿瘤19例,原发恶性肿瘤6例,转移瘤13例;良性病例4例。 PET/CT显像在心脏良恶性肿瘤诊断灵敏度、特异性、准确率分别为89.5%（17/19）、75.0%（3/4）、87.0%（20/23）;恶性肿瘤平均SUVmax为14.5±9.7,良性肿瘤SUVmax为3.0±2.4,两者比较差异有统计学意义（t=-1.95,P＜0.05）。恶性肿瘤PET/CT显像发现全身多部位、多器官转移的16人,改变了临床分期及治疗方案。结论:PET/CT显像对心脏恶性肿瘤的诊断,具有较高的灵敏度和特异性,可为鉴别诊断心脏占位性病变良恶性提供帮助,对肿瘤临床分期及治疗方案的确定具有非常大的指导意义。     

Evaluation of chemotherapy response in pediatric bone sarcomas by [F-18]-fluorodeoxy-D-glucose positron emission tomography

BACKGROUND: Response to neoadjuvant chemotherapy is a significant prognostic factor for osteosarcoma (OS) and the Ewing sarcoma family of tumors (ESFT). Conventional radiographic imaging does not discriminate between responding and nonresponding osseous tumors. [F-18]-fluorodeoxy-D-glucose (FDG) positron emission tomography (PET) is a noninvasive imaging modality that accurately predicts histopathologic response in patients with various malignancies. To describe the FDG PET imaging characteristics and to determine the correlation between FDG PET imaging and chemotherapy response in children with bone sarcomas, we reviewed our single institution experience. METHODS: Thirty-three pediatric patients with OS or ESFT with osseous primary sites were evaluated by FDG PET. All patients received standard neoadjuvant chemotherapy. FDG PET standard uptake values before (SUV1) and after (SUV2) chemotherapy were analyzed and correlated with chemotherapy response assessed by histopathology in surgically excised tumors. Twenty-six patients had SUV1, SUV2, and surgical excision. RESULTS: Although the mean SUV1 in children with OS or ESFT were similar (8.2. vs. 5.3, P = 0.13), mean SUV2 for OS patients was greater than the values for ESFT patients (3.3 vs. 1.5, P = 0.01). All ESFT patients and 28% of OS patients had a favorable histologic response to chemotherapy (>or= 90% necrosis). Combining ESFT and OS patients, both SUV2 and the ratio of SUV2 to SUV1 (SUV2:SUV1) were correlated with histologic response (P = 0.01 for both comparisons). CONCLUSION: FDG PET evaluation of pediatric bone sarcomas demonstrated significant alteration in response to neoadjuvant chemotherapy. SUV2 and SUV2:SUV1 correlated with histopathologic assessment of response and potentially could be used as a noninvasive surrogate to predict response in patients.     

Effects of respiration-averaged computed tomography on positron emission tomography/computed tomography quantification and its potential impact on gross tumor volume delineation

PURPOSE: Patient respiratory motion can cause image artifacts in positron emission tomography (PET) from PET/computed tomography (CT) and change the quantification of PET for thoracic patients. In this study, respiration-averaged CT (ACT) was used to remove the artifacts, and the changes in standardized uptake value (SUV) and gross tumor volume (GTV) were quantified. METHODS AND MATERIALS: We incorporated the ACT acquisition in a PET/CT session for 216 lung patients, generating two PET/CT data sets for each patient. The first data set (PET(HCT)/HCT) contained the clinical PET/CT in which PET was attenuation corrected with a helical CT (HCT). The second data set (PET(ACT)/ACT) contained the PET/CT in which PET was corrected with ACT. We quantified the differences between the two datasets in image alignment, maximum SUV (SUV(max)), and GTV contours. RESULTS: Of the patients, 68% demonstrated respiratory artifacts in the PET(HCT), and for all patients the artifact was removed or reduced in the corresponding PET(ACT). The impact of respiration artifact was the worst for lesions less than 50 cm(3) and located below the dome of the diaphragm. For lesions in this group, the mean SUV(max) difference, GTV volume change, shift in GTV centroid location, and concordance index were 21%, 154%, 2.4 mm, and 0.61, respectively. CONCLUSION: This study benchmarked the differences between the PET data with and without artifacts. It is important to pay attention to the potential existence of these artifacts during GTV contouring, as such artifacts may increase the uncertainties in the lesion volume and the centroid location.     

EGFR gene copy number in adenocarcinoma of the lung by FISH analysis: investigation of significantly related factors on CT, FDG-PET, and histopathology

It has been suggested that a high EGFR gene copy number may be an indicator of good response to EGFR tyrosine kinase inhibitor therapy and a marker of poor prognosis in NSCLC. However, imaging features related to EGFR gene copy number status in adenocarcinoma are still unknown. We therefore retrospectively analyzed CT, FDG-PET, and histopathologic slides of surgical resected lung adenocarcinoma in 132 patients. Tumor characteristics on preoperative chest-CT, such as, GGO proportions, tumor diameters, and cavitation; FDG-PET SUV(max); and histopathologically determined differentiation degrees and tumor subtypes were evaluated. EGFR gene copy number status was categorized as FISH-positive or -negative. FISH-positivity was found in 53 patients (40.2%) and was significantly more frequent in tumors with a SUV(max)>7.0 (P=0.007). Furthermore, FISH-negativity was found to be more frequent in tumors with a GGO>50% (P=0.023) and diameter <15.5mm (P=0.006) on CT, or a well-differentiated histopathology (P=0.002). Moreover, the frequency of FISH-positivity increased as SUV(max) increased (P=0.0008) and as the proportion of GGO decreased (P=0.01). SUV(max)>7.0 was an independent predictor of FISH-positive results (odds ratio, 3.941; 95% CI, 1.691-9.182; P=0.01). In conclusion, a high SUV(max) on FDG-PET was significantly related to FISH-positive results. A high proportion of GGO, small tumor diameter on CT, and a well-differentiated histopathology were more frequent in FISH-negative adenocarcinomas.     

18FDG PET/CT标准摄取值与非小细胞肺癌临床分期关系的研究

目的:探讨非小细胞肺癌(non-small cell lung cancer,NSCLC)患者治疗前的18氟脱氧葡萄糖(18F-deoxyglucose,18 FDG) PET／CT标准摄取值(standard uptake value, SUV)与临床分期、原发肿瘤大小及病理学类型的关系。方法:对75例治疗前的NSCLC患者接受18FDG PET／CT检查获得最高SUV (SUVmax)。分析SUVmax与临床分期、原发肿瘤分期、肿瘤大小和病理学类型的关系,并研究SUV在四者组内差异是否有统计学意义。结果:SUVmax与临床分期和原发肿瘤大小均呈正相关(r=0．279,P=0．014;r= 0．645,P=0．001),与肿瘤病理学类型无关(r=-0．077,P=0．507);SUV在两组不同大小肿瘤组(≤3．0 cm和>3．0 cm)间差异有统计学意义,t=-0．647,P=0．015,在各个临床分期组(ⅠA～ⅡB、ⅢA和m B～Ⅳ)间差异有统计学意义,F=3．807,P=0．027,在4个原发肿瘤分期组(T1、T2、T3和T4)间差异有统计学意义,F=8．025,P=0．022,而在不同病理学类型组(鳞癌、腺癌和腺鳞癌)间差异无统计学意义,F=1．911,P=0．155。结论:18FDG PET／CT SUV随肿瘤大小和病期的增加呈升高趋势,可以作为评价NSCLC临床分期的辅助手段,但不能为无法取得病理学诊断的患者提供帮助。     

The standardized uptake value for F-18 fluorodeoxyglucose is a sensitive predictive biomarker for cervical cancer treatment response and survival

BACKGROUND: The objective of this study was to evaluate cervical tumor uptake of F-18 fluorodeoxyglucose (FDG) measured as the maximal standardized uptake value (SUV(max)) by positron emission tomography (PET) and its association with treatment response and prognosis in patients with cervical cancer. METHODS: The study population consisted of 287 patients with stage IA2 through IVB cervical cancer who underwent pretreatment FDG-PET studies. SUV(max), tumor volume, and sites of lymph node metastasis were recorded. Therapy included surgery, chemoradiation, or palliation. RESULTS: The mean SUV(max) was 11.4 (range, 1-50.4). The mean tumor volume by stage was 42.1 cm(3) for stage I tumors (using International Federation of Gynecology and Obstetrics [FIGO] staging criteria), 63.7 cm(3) for stage II tumors, 129.2 cm(3) for stage III tumors, and 166.2 cm(3) for stage IV tumors. There was no correlation between tumor volume and SUV(max) (correlation coefficient [R(2)] = 0.01). No significant difference in SUV(max) was observed between squamous histology (n = 247 patients) and nonsquamous histology (n = 40 patients; P = .089). Higher SUV(max) was associated with an increased risk of lymph node metastasis at diagnosis (P = .0009). A Cox proportional-hazards model for death from cervical cancer was used to evaluate tumor histology, lymph node metastasis, tumor volume, and SUV(max). The results indicated that SUV(max) was the only significant independent factor (P = .0027). Three prognostic groups were established using SUV(max). The overall survival rates at 5 years were 95% for an SUV(max) 5.2 and 13.3 (P < .0001). Increasing SUV(max) was associated with persistent abnormal FDG uptake in the cervix on 3-month FDG-PET studies in 238 patients who received curative chemoradiation (P = .04). CONCLUSIONS: The SUV(max) of the cervical tumor at diagnosis was a sensitive biomarker of treatment response and prognosis for patients with cervical cancer.     

18 F-FLT PET/CT对食管鳞癌放化疗效果预测研究

背景与目的： ¹⁸ F-FLT是一种细胞增殖的示踪剂。探索 ¹⁸ F-FLT PET/CT对食管鳞癌根治性放（化）疗效果的预测价值。方法：对根治性放（化）疗的初治食管鳞癌患者,放疗前及放疗第4周行 ¹⁸ F-FLT PET/CT扫描,记录原发灶的SUV _max-T 、转移淋巴结的SUV _max-N 等参数。随访患者总生存期（overall survival,OS）及无进展生存期（progression-free survival,PFS）,分析PET/CT参数与患者预后的关系。结果：共入组39例患者,25例完成2次PET/CT扫描。 ¹⁸ F-FLT的SUV _max-T 由基线6.63下降到1.22,淋巴结SUV _max-N 由3.69下降到1.84,但下比例与生存率无关。 ¹⁸ F-FLT PET/CT的基线SUV _max-N ＜5.00的患者,其OS明显高于SUV _max-N ≥5.00的患者（P=0.002）。结论：对根治性放（化）疗食管鳞癌,治疗前的基线 ¹⁸ F-FLT PET/CT的淋巴结SUV _max-N 是一个较好的预测预后参数。放疗4周时,病灶在 ¹⁸ F-FLT PET/CT扫描中的SUV值明显下降,但不能预测预后。     

Histological type of esophageal cancer might affect response to neo-adjuvant radiochemotherapy and subsequent prognosis

Background: This study investigates response and prognosis afterneo-adjuvant chemoradiation (CTx/RTx) in patients with advancedesophageal carcinoma, according to histological type. Patients and methods: Patients with uT3 carcinoma of the esophagustreated with curative-intention esophagectomy from 1997 until2006 were included in this retrospective analysis. Patientsreceiving preoperative CTx/RTx (5-fluorouracil, cisplatin, 36Gy) were compared with those with primary surgery for pT3 tumors.Therapy response after CTx/RTx was evaluated using ‘CologneRegression Grade’ (minor response: 10% vital residualtumor cells (VRTCs), major response: <10% VRTC or pathologiccomplete response). Prognosis was evaluated for adenocarcinoma(AC) and squamous cell carcinoma (SCC). Results: Of 297 patients, 52% were SCC and 48% AC. In all, 192patients underwent CTx/RTx, 100 (65%) SCC and 92 (64%) AC (nonsignificant).In SCC group 51% and in AC group 29% achieved major response(P < 0.01). Patients with major response had a 2-year survivalrate (2y-SR) of 78% versus those with minor response or withoutCTx/RTx, with a 2y-SR of 45% (P = 0.001). Examining patientswith major response exclusively, the prognosis of AC (2y-SR85%) is better than that of SCC (2y-SR 54%) (P < 0.01). Conclusion: This retrospective study concludes that in esophagealtumors, response to and prognosis after neo-adjuvant CTx/RTxvary according to histology. Key words: adenocarcinoma squamous cell carcinoma, esophageal cancer, lymph node metastases, neo-adjuvant chemoradiation, prognosis Received for publication May 4, 2008. Revision received August 5, 2008. Accepted for publication August 6, 2008.     

2-[11C]thymidine positron emission tomography reproducibility in humans.

PURPOSE: To evaluate the reproducibility of 2-[11C]thymidine positron emission tomography (PET) scanning in patients with advanced intra-abdominal malignancies. PATIENTS AND METHODS: The reproducibility of 2-[11C]thymidine PET was studied by comparing interpatient and intrapatient variability (coefficient of variability, COV) of both blood and tissue data. Arterial plasma metabolite levels were measured using on-line sampling and high-pressure liquid chromatography. 2-[11C]Thymidine retention in tissue was measured as the standardized uptake value at the end of the scan (SUV(end)), the area under the time-activity curve (AUC(0-1 hour)), and the fractional retention of thymidine (FRT). A group of seven patients were scanned 1 week apart with no intervening anticancer therapy. RESULTS: There was interpatient variability in the levels of 2-[11C]thymidine and its main metabolite, 11CO2, in plasma. Variability in 2-[11C]thymidine PET data was greater between (COV: SUV(end) = 38%, AUC(0-1 hour) = 32%, FRT = 47%) than within (COV: SUV(end) = 8%, AUC(0-1 hour) = 2%, FRT = 9%) patients. There was a borderline significant difference between the paired tumor data for SUV(end) (P = 0.041), but not for AUC(0-1 hour) (P = 0.81) or FRT (P = 0.90). There was a good correlation between paired data for SUV(end) (r = 0.98), AUC(0-1 hour) (r = 0.99), and FRT (r = 0.95). CONCLUSIONS: This is the first report showing that 2-[11C]thymidine PET scanning is reproducible in humans. Repeat scanning of tumor proliferation using 2-[11C]thymidine PET is feasible to perform in human intra-abdominal malignancies and should aid the future rapid assessment of antiproliferative tumor agents.     

移形上皮与鳞状上皮来源的恶性肿瘤摄取18F-FDG差异性的实验研究

[目的]探讨来自不同上皮来源的肿瘤组织葡萄糖代谢的差异,为临床PET/CT应用中如何判断上皮组织来源的恶性肿瘤葡萄糖摄取出现的假阳性和假阴性等问题提供理论依据.[方法] BALB/C裸鼠12只,随机分为2组,并且皮下分别接种膀胱癌EJ细胞和宫颈癌Hela细胞,1×106/0.2ml使其成瘤.行小动物PET扫描,取得葡萄糖标准化摄取值(SUV),测量SUVmax和SUVmean对肿瘤组织葡萄糖代谢进行评价.[结果]膀胱癌SUVmax:4.22±0.39,SUVmean:2.60±0.43;宫颈癌SUVmax:6.18±0.23,SUVmean:2.40±0.57.膀胱癌与宫颈癌的SUVmax值差异有统计学意义(t=-9.474,P＜0.01),而SUVmean值无统计学差异.[结论]鳞状上皮来源的肿瘤葡萄糖摄取要高于移形上皮来源的.     

The maximum uptake of (18)F-deoxyglucose on positron emission tomography scan correlates with survival, hypoxia inducible factor-1alpha and GLUT-1 in non-small cell lung cancer

The purpose of this study was to investigate the relation between the standardised uptake value (SUV) on (18)F-fluoro-2-deoxy-glucose-positron emission tomography scan and hypoxia related markers (HIF-1alpha and CAIX), a proliferation-related marker (Ki-67) and glucose transporters (GLUT-1 and GLUT-3) in non-small cell lung cancer (NSCLC). One hundred and two patients, scheduled for complete resection, received a PET scan in Leuven or Maastricht/Aachen. The maximal SUV (SUV(max)) was correlated with survival and immunohistochemical staining patterns. The actuarial survival was worse for patients showing a high SUV(max), the best discriminative value being 8.0 (Leuven, p=0.032) and 11.0 (Maastricht, p=0.007). Tumours with a high SUV(max) expressed in a higher proportion HIF-1alpha (63.1% versus 37.9%, p=0.024) and GLUT-1 (82.9% versus 62.5%, p=0.025), than tumours with a low SUV(max). No significant difference was found in the expression of CAIX, Ki-67 and GLUT-3. This study supports preclinical data that hypoxia is associated with a higher uptake of FDG.     

Comparison of hyperfractionation and conventional fractionation radiotherapy with concurrent docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy in patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN)

Purpose Radiotherapy (RTx) has been considered as the treatment for locally advanced squamous cell carcinoma of the head and neck (SCCHN). However, with only conventional fractionation (Cfx), response rates are relatively low. In this study, we report the results of hyperfractionation (Hfx) RTx with concurrent docetaxel, cisplatin and 5-fluorouracil (TPF) chemotherapy (CTx) in patients with locally advanced SCCHN and compare Hfx and Cfx RTx with concurrent TPF CTx. Methods Fifty patients with previously untreated stage III–IV SCCHN were entered into this study. Eligible patients received RTx delivered using arm 1: Hfx at 1.2 Gy/fraction, twice daily, 5 days/week to 76.8 Gy/64 fractions, and arm 2: Cfx at 2 Gy/fraction/day, 5 days/week to 70 Gy/35 fractions. Patients received 2 cycles CTx every 4 weeks. The doses were docetaxel 50 mg/m² (day 1), cisplatin 60 mg/m² (day 4), and 5-FU 600 mg/m²/day (days 1–5). Results The overall clinical response rate and the pathological CR were 100% (25/25) and 84% (21/25) in arm 1, and 100% (25/25) and 80% (20/25) in arm 2. Local–regional control was better significant in arm 1 than arm 2 (P = 0.048). There were also trend toward improved disease-free survival (P = 0.059) and overall survival (P = 0.078) in arm 1. Mucositis was significantly more frequent in arm 1 (P = 0.048). Conclusion There were trend toward improved local–regional control, disease-free survival and overall survival in Hfx RTx with concurrent TPF CTx, compared to Cfx RTx with concurrent TPF CTx.     

Standardised FDG uptake: a prognostic factor for inoperable non-small cell lung cancer

The aim of this study was to investigate the relationship between standardised uptake value (SUV) obtained from [(18)F]fluorodeoxyglucose positron emission tomography (FDG PET) and treatment response/survival of inoperable non-small cell lung cancer (NSCLC) patients treated with high dose radiotherapy. Fifty-one patients were included recording stage, performance, weight loss, tumour volume, histology, lymph node involvement, SUV, and delivered radiation dose. The maximum SUV (SUV(max)) within the primary tumour was a sensitive and specific factor for predicting treatment response. Apart from SUV(max), stage and performance were also independent predictive factors for treatment response. In a multivariate disease-specific survival (DSS) analysis, SUV(max) (P = 0.01), performance status (P = 0.008) and stage (P = 0.04) were prognostic factors. For overall survival (OS), SUV(max) (P = 0.001) and performance (P = 0.06) were important prognostic factors. SUV(max) was an important prognostic factor for survival of inoperable NSCLC patients and a predictive factor for treatment response. Although the number of patients was small, the treatment was not homogeneous and the use of FDG SUV may have had constraints, we still conclude that the FDG SUV is potentially a good indicator for selecting patients for different treatment strategies.     

全身PET/CT和VEGF-C检查对非小细胞肺癌诊治的应用价值

目的：探讨全身PET/CT和血浆血管内皮生长因子-C（VEGF-C）在非小细胞肺癌（NSCLC）诊断和治疗选择中的临床应用价值。方法：收集2005年1月17日～2007年1月17日86例病理确诊的NSCLC患者的PET/CT资料并留取血清样本备用。比较PET/CT、胸部CT、支气管镜活检及经皮肺穿刺切割活检4种不同方法对NSCLC的诊断敏感性;分析SUV值（standardized uptake value）和延迟相SUV对NSCLC的诊断价值;比较PET/CT与常规检查的TNM分期在淋巴结和远处转移中的检出率和检出分布上的差异。用双抗体夹心ELISA法试剂盒测定血清VEGF-C浓度辅助胸部CT评价N分期。结果：入组研究NSCLC患者86例,男性67例,女性19例;腺癌41例、鳞癌37例、混合型腺癌5例及大细胞癌3例。PET/CT和胸部CT、支气管镜活检、经皮肺穿切割活检术对NSCLC患者肺部原发病变的诊断敏感性分别为90.89%（78/86）、76.47%（60/86）、80%（36/45）和90%（45/50）,PET/CT与胸部CT在诊断敏感性上差异显著（P=0.02）。86例NSCLC患者PET/CT初始相SUV均值为8.27±4.90,其中46例患者延迟相SUV均值为8.35±5.29,高于其初始相SUV均值7.62±4.50（P=0.003）。PET/CT对N1、N2、N3分别检出10、24、26例,合计检出率为69.77%（60/86）;胸部CT/VEGF-C分别检出9、29、6例,合计53.88%（46/86）,PET/CT组与CT/VEGF-C组在阳性检出率和淋巴结分布上差异均非常显著（P=0.006和P=0.004）。本组PET/CT诊断Ⅳ期肺癌38例,与常规检查组诊断29例,两组在阳性发现率上无显著差异（P=0.211）,在分布上两组差异也不显著（P=0.712）。结论：PET/CT对NSCLC原发肿瘤的诊断敏感性显著优于胸部CT,延迟相SUV值对SUV初始值诊断NSCLC有重要参考价值。PET/CT对NSCLC的TNM分期比常规检查分期可能对治疗帮助更大。     

Monitoring of Tumor Response to Neoadjuvant Radio-Chemotherapy of Esophageal Carcinoma by F-18-FDG-PET

Introduction Esophageal carcinoma is an aggressive malignancy. Thelong-term survival of patients with locoregionally advanceddisease treated with surgery alone ranges between 40%and 4% with median times of survival of 9–29 months[1?6].Because of such poor results additional chemotherapy andradiotherapy have been evaluated[7?10]. There is contin-uing discussion under which conditions such multimodaltherapy regimens can mean a bene?t in terms of longersurvival[4,8?11]. A multimodal therapy o…     

Fractionated stereotactic body radiation therapy in the treatment of primary, recurrent, and metastatic lung tumors: the role of positron emission tomography/computed tomography-based treatment planning

PURPOSE: The aim of this study was to assess the outcomes of patients treated with stereotactic body radiation therapy (SBRT) in patients with primary, recurrent, or metastatic lung lesions, with a focus on positron emission tomography (PET)/computed tomography (CT)-based management. PATIENTS AND METHODS: Fifty-one patients with primary stage I non-small-cell lung cancer (NSCLC; n = 26), recurrent lung cancer after definitive treatment (n = 12), or solitary lung metastases (n = 13) were treated with SBRT between 2005 and 2007. Patients were treated with the CyberKnife Robotic Radiosurgery System with Synchrony respiratory tracking. A dose of 60 Gy was delivered in 3 fractions. All patients had CT or PET/CT performed at approximately 3-month intervals after treatment. RESULTS: The median follow-up was 12 months. Local control at median follow-up was 85% in patients with stage I NSCLC, 92% in patients with recurrent lung cancer, and 62% in the patients with solitary lung metastasis. Analysis of the 28 patients with pre- and post-treatment PET/CT scans demonstrated that those with stable disease (n = 4) had a mean standardized uptake value (SUV) decrease of 28%, partial responders (n = 11) had a decrease of 48%, and patients with a complete response (n = 11) had a decrease of 94%. Patients with progressive disease (n = 2) had an SUV decrease of only 0.4%. Only 2 patients (7%) who had reduced fluorodeoxyglucose avidity later progressed locally. No correlations were found between pretreatment SUV and tumor response, disease progression, or survival. Overall 1-year survival rates were 81%, 67%, and 85% among the patients with primary NSCLC, recurrent lung cancer, and solitary lung metastases, respectively. CONCLUSION: Stereotactic body radiation therapy with CyberKnife is an effective treatment for patients with medically inoperable recurrent or metastatic lung cancer. Positron emission tomography/CT is valuable in staging, planning, and evaluating treatment response and might predict long-term outcome.     

Positron emission tomography in patients with Hodgkin's disease: correlation to histopathologic subtypes

The aim of this study was to evaluate the initial staging and restaging of Hodgkin's disease (HD) according to histopathologic subtype (HST) using fluorine-18-deoxyglucose-positron emission tomography (PET). Special attention was paid to the accuracy of PET for detection of bone marrow infiltration (BMI). 44 patients with HD (m:f = 28:16, mean age 36 +/- 15 years) underwent PET; 16 were primary stagings and 28 restaging examinations. PET results were compared with methods of conventional staging including computed tomography (CT) and bone marrow biopsy. Viable tumor tissue was detected by PET in 25/44 cases, 16 nodular sclerosis (NS), 4 mixed cellularity (MC), 3 lymphocyte predominance (LP) and 2 cases with a nonclassified subtype (NC). FDG tumor uptake, measured as standard uptake value (SUV), ranged from 1.7 to 13. Maximum SUV in NS was 5.2 +/- 1.5 (2.5-7.3), 3.2 +/- 2.4 for MC, 2.6 +/- 0.7 for LP, and 9.1 +/- 3.8 for NC, respectively. In 7% of all patients (3/44) bone marrow infiltrations were detected by PET. PET is known for its superior detection of viable tissue in HD. In this study it was shown that HST does not influence the intensity of glucose metabolism, although 2 patients with NC showed the highest SUVs. In addition PET accurately detected focal BMI and may thus be applied before BMB to guide its optimal use.     

Improvement in preoperative staging of gastric adenocarcinoma with positron emission tomography

BACKGROUND: Positron emission tomography (PET) with 18- fluorodeoxyglucose (FDG) has been used to both detect and stage a variety of malignancies. The current study examined the value of PET for preoperative staging of gastric adenocarcinoma. METHODS: Sixty-eight patients (49 males and 19 females) with gastric adenocarcinoma, who were referred for preoperative FDG-PET scans, were enrolled in this study. The patients underwent spiral-computed tomography (CT) within 1 week of referral. The final diagnosis in all patients was made by histologic and surgical findings. For quantitative PET analysis, the regional tumor FDG uptake was measured by the standardized uptake value (SUV). RESULTS: For the primary tumor of a gastric adenocarcinoma, PET demonstrated an increased uptake in 64 of 68 patients (sensitivity, 94%), with a mean SUV of 7.0 (range, 0.9-27.7). A comparison of FDG uptake and clinicopathologic features showed significant association between FDG uptake and macroscopic type, tumor size, lymph node metastasis, histologic type, and TNM stage. The PET scan had a similar accuracy with that of CT for diagnosing local and distant lymph node metastases as well as peritoneal status. In assessing local lymph node status, however, PET had a higher specificity than CT (92% vs. 62%, P = 0.000). Moreover, PET had additional diagnostic value in 10 (15%) of 68 patients by upstaging 4 (6%) and downstaging 6 (9%) patients. PET combined with CT was more accurate for preoperative staging than either modality alone (66% vs. 51%, 66% vs. 47%, respectively; P = 0.002). CONCLUSIONS: FDG-PET improves the preoperative TNM staging of gastric adenocarcinoma. Based on its superior specificity, FDG-PET can facilitate the selection of patients for a curative resection by confirming a nodal status identified by CT.