Preoperative Staging With 11C-Choline PET/CT Is Adequately Accurate in Patients With Very High-Risk Prostate Cancer

Purpose

To evaluate the accuracy of ¹¹C-choline positron emission tomography (PET)/computed tomography (CT) for nodal staging of prostate cancer (PCa) in different populations of high-risk patients.

Diagnostic Accuracy of Magnetic Resonance Imaging versus Clinical Staging in Cervical Cancer

Background: Cervical cancer is the third most common gynecological cancer and a widespread malignancy inwomen, accounting for a large proportion of the cancer burden in developing countries. We compared accuracyof MRI staging with clinical staging and also concordance between the two methods for newly diagnosed patientswith cervical cancer, using clinical staging as the reference. Materials and Methods: This prospective study wasconducted on 27 newly diagnosed patients with cervical cancer from Imam Khomeini hospital from June 2012to Feb 2014. New cases of cervical cancer with positive PAP test were staged separately with a clinical exambased on the FIGO system by a gynecologist, oncologist and also with MRI by an expert radiologist. Then wecompared the predicted stage for each patient with the two methods. Results: Based on clinical staging 9 patients(33%) were observed at stage 1. MRI staging was in coordination with clinical staging in eight of them and forone patient MRI accorded stage 2B (88% concordance). Conclusions: MRI is a reliable noninvasive methodwith high accuracy for cervical cancer staging. Also presently it is easily obtainable, so we recommend using thistechnique along with clinical examination for staging cervical cancer patients. We also recommend to radiologistsand residents of radiology to get experience with this method of staging.     

FDG‐PET/CT Compared with Conventional Imaging in the Detection of Distant Metastases of Primary Breast Cancer

Purpose.

Evidence from studies with small numbers of patients indicates that ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) accurately detects distant metastases in the staging of primary breast cancer. We compared the sensitivity and specificity of PET/CT and conventional imaging (CT, ultrasonography, radiography, and skeletal scintigraphy) for the detection of distant metastases in patients with primary breast cancer.

Patients and Methods.

We performed a retrospective review that identified 225 patients with primary breast cancer seen from January 2000 to September 2009 for whom PET/CT data were available for review. Imaging findings were compared with findings on biopsy, subsequent imaging, or clinical follow-up. Sensitivity and specificity in the detection of distant metastases were calculated for PET/CT and conventional imaging. Fisher''s exact tests were used to test the differences in sensitivity and specificity between PET/CT and conventional imaging.

Results.

The mean patient age at diagnosis was 53.4 years (range, 23–84 years). The sensitivity and specificity in the detection of distant metastases were 97.4% and 91.2%, respectively, for PET/CT and 85.9% and 67.3%, respectively, for conventional imaging. The sensitivity and specificity of PET/CT were significantly higher than those of conventional imaging (p = .009 and p < .001, respectively). Eleven cases of distant metastases detected by PET/CT were clinically occult and not evident on conventional imaging.

Conclusion.

PET/CT has higher sensitivity and specificity than conventional imaging in the detection of distant metastases of breast cancer. A prospective study is needed to determine whether PET/CT could replace conventional imaging to detect distant metastases in patients with primary breast cancer.     

MRI for Rectal Cancer: Staging,mrCRM, EMVI,Lymph Node Staging and Post-Treatment Response

Rectal cancer is a relatively common malignancy in the United States. Magnetic resonance imaging (MRI) of rectal cancer has evolved tremendously in recent years, and has become a key component of baseline staging and treatment planning. In addition to assessing the primary tumor and locoregional lymph nodes, rectal MRI can be used to help with risk stratification by identifying high-risk features such as extramural vascular invasion and can assess treatment response for patients receiving neoadjuvant therapy. As the practice of rectal MRI continues to expand further into academic centers and private practices, standard MRI protocols, and reporting are critical. In addition, it is imperative that the radiologists reading these cases work closely with surgeons, medical oncologists, radiation oncologists, and pathologists to ensure we are providing the best possible care to patients. This review aims to provide a broad overview of the role of MRI for rectal cancer.     

临床分期和磁共振成像(MRI)对前列腺癌分期的临床意义

目的：探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法：对32例局限性前列腺癌术前经直肠指诊进行临床分期及MRI分期预测前列腺癌根治术后的病理分期结果，评价诊断性实验结果。结果：直肠指诊临床分期和MRI分期预测前列腺癌的病理结果有显著相关性(P=0．002)。临床分期和MRI分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3％和80．9％；对浸润包膜及包膜外肿瘤的预测(NPV)分别为50．0％和88．9％。MRI对前列腺癌病理分期的预测更具有特异性和较高的准确性，能更好的预测前列腺癌的病理结果(P=0．023)。结论：MRI较直肠指诊能更好地预测局限于前列腺内的肿瘤，对前列腺包膜及包膜以外浸润的肿瘤能进行更准确的分期。     

磁共振成像(MRI)对前列腺癌分期的临床意义(英文)

目的探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法对32例病理证实的局限性前列腺癌行根治性手术前经直肠指诊进行临床分期及 MRI 分期预测术后前列腺病理分期结果,评价其预测前列腺癌病理分期的诊断性结果。结果本组32例前列腺癌中,临床分期局限于前列腺内的肿瘤(B 期)30例,10例前列腺癌根治术后病理诊断有前列腺包膜及包膜外浸润,1例左髂血管旁淋巴结转移癌,36.7%(11/30)病例临床分期偏低,2例临床分期为 C 期病例术后1例为 B 期,临床分期偏高。而 MRI 诊断的30例前列腺癌中,分期局限于前列腺内的肿瘤(B 期)21例中,4例前列腺根治术后病理诊断为 C 期,19.1%(4/21)的病例 MRI 分期偏低;9例 MRI 分期为 C 期病例1例术后为 B 期,分期偏高,另1例术后为 D1期,分期偏低。直肠指诊临床分期和 MRI 分期预测前列腺癌的病理结果有显著相关性(P=0.002)。临床分期和 MRI 分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3%和80.9%;对浸润包膜及包膜外肿瘤的预测(NPV)分别为50.0%和88.9%、MRI 对前列腺癌病理分期的预测更具有特异性和较高的准确性,能更好的预测前列腺癌的病理结果(P=0.023)。结论 MRI 分期较直肠指诊临床分期能更好地预测局限于前列腺内的肿瘤,对前列腺包膜及包膜以外浸润的肿瘤能进行更准确的分期。     

磁共振成像(MRI)对前列腺癌分期的临床意义

目的 探讨临床分期和磁共振成像(MRI)分期预测前列腺癌病理分期的临床意义。方法 对32例病理证实的局限性前列腺癌行根治性手术前经直肠指诊进行临床分期及MRI分期预测术后前列腺病理分期结果,评价其预测前列腺癌病理分期的诊断性结果。结果 本组32例前列腺癌中,临床分期局限于前列腺内的肿瘤(B期)30例,10例前列腺癌根治术后病理诊断有前列腺包膜及包膜外浸润,1例左髂血管旁淋巴结转移癌,36.7％(11/30)病例临床分期偏低,2例临床分期为C期病例术后1例为B期,临床分期偏高。而MRI诊断的30例前列腺癌中,分期局限于前列腺内的肿瘤(B期)21例中,4例前列腺根治术后病理诊断为C期,19.1％(4/21)的病例MRI分期偏低;9例MRI分期为C期病例1例术后为B期,分期偏高,另1例术后为D1期,分期偏低。直肠指诊临床分期和MRI分期预测前列腺癌的病理结果有显著相关性(P=0.002)。临床分期和MRI分期对局限于前列腺内肿瘤的预测(PPV)分别为63.3％和80.9％;对浸润包膜及包膜外肿瘤的预测(NPV)分别为50.0％和88.9％。MRI对前列腺癌病理分期的预测更具有特异性和较高的准确性,能更好的预测前列腺癌的病理结果(P=0.023)。结论 MRI分期较直肠指诊临床分期能更好地预测局限于前列腺内的肿瘤,对前列腺包膜及包膜以外浸润的肿瘤能进行更准确分     

Diagnostic Performance of PET/MRI in Breast Cancer: A Systematic Review and Bayesian Bivariate Meta-analysis

IntroductionBy performing a systematic review and meta-analysis, the diagnostic value of ¹⁸F-FDG PET/MRI in breast lesions, lymph nodes, and distant metastases was assessed, and the merits and demerits of PET/MRI in the application of breast cancer were comprehensively reviewed.MethodsBreast cancer-related studies using ¹⁸F-FDG PET/MRI as a diagnostic tool published before September 12, 2022 were included. The pooled sensitivity, specificity, log diagnostic odds ratio (LDOR), and area under the curve (AUC) were calculated using Bayesian bivariate meta-analysis in a lesion-based and patient-based manner.ResultsWe ultimately included 24 studies (including 1723 patients). Whether on a lesion-based or patient-based analysis, PET/MRI showed superior overall pooled sensitivity (0.95 [95% CI: 0.92-0.98] & 0.93 [95% CI: 0.88-0.98]), specificity (0.94 [95% CI: 0.90-0.97] & 0.94 [95% CI: 0.92-0.97]), LDOR (5.79 [95% CI: 4.95-6.86] & 5.64 [95% CI: 4.58-7.03]) and AUC (0.98 [95% CI: 0.94-0.99] & 0.98[95% CI: 0.92-0.99]) for diagnostic applications in breast cancer. In the specific subgroup analysis, PET/MRI had high pooled sensitivity and specificity for the diagnosis of breast lesions and distant metastatic lesions and was especially excellent for bone lesions. PET/MRI performed poorly for diagnosing axillary lymph nodes but was better than for lymph nodes at other sites (pooled sensitivity, specificity, LDOR, AUC: 0.86 vs. 0.58, 0.90 vs. 0.82, 4.09 vs. 1.98, 0.89 vs. 0.84).Conclusion¹⁸F-FDG PET/MRI performed excellently in diagnosing breast lesions and distant metastases. It can be applied to the initial diagnosis of suspicious breast lesions, accurate staging of breast cancer patients, and accurate restaging of patients with suspected recurrence.     

MRI与CT在结直肠癌术前诊断与分期中的临床价值

目的 探讨MRI与CT在结直肠癌术前诊断与分期中的临床价值.方法 126例结直肠癌患者根据检查方法不同分为MRI组与CT组,各63例.术后将2组患者病理结果与术前诊断结果进行对比.结果 对T分期的诊断,MRI组诊断准确率为88.89％,CT组诊断准确率为73.02％,MRI组显著高于CT组,差异有统计学意义(P＜0.05);对N分期的诊断,MRI组诊断准确率为71.43％,CT组诊断准确率为55.56％,MRI组高于CT组,差异有统计学意义(P＜0.05).结论 在结直肠癌术前诊断与分期中,与CT相比,MRI具有更高的准确率.将2种方法结合进行术前诊断与分期,对于准确判断疾病程度,合理制定治疗方案具有十分积极的意义.     

The Future of Systemic Therapies for Localised Prostate Cancer

In the last decade, many systemic therapies have become available to improve survival in the setting of castration-resistant prostate cancer. Once effective treatments for advanced and incurable disease have been established, these agents are generally explored in the adjuvant and neoadjuvant settings to evaluate their role in increasing the chance of cure for localised disease. Clinical trials evaluating new therapies in high-risk prostate cancer can broadly be divided into two categories. Phase III (and some phase II) trials generally evaluate treatments that have already been shown to provide clinical benefit in the advanced disease setting; whereas smaller phase I (and some phase II) trials often serve as proof-of-principle assessments in the development of novel agents. The goal of this review is to provide an overview of present and ongoing clinical trials of both of these categories, evaluating the promise of systemic therapies in the setting of high-risk localised prostate cancer. We undertook a search of Ovid Medline, Embase and clinicaltrials.gov for prospective clinical studies assessing systemic therapy for early stage prostate cancer, either before or after definitive local treatment (surgery or radiation) from 2000 onwards. This resulted in 53 studies, of which 29 were deemed worthy of this overview and are presented herein, broadly divided by mechanism of action. Clearly, the arena evaluating the future of systemic therapies for localised prostate cancer will be a very active one.     

MRI成像对鼻咽癌的分期、诊断及治疗优势的探讨

 目的
探讨鼻咽癌1992年福州分期和2008年分期差异、CT和MRI对鼻咽癌病变的检出率和原发肿瘤靶区(GTV）勾画和体积
计算的影响。方法收集89例初治鼻咽癌患者的CT和MRI图像,分别按1992年福州分期和2008年分期标准进行,比较
两种检查手段对各解剖部位的检出差异,挑选出CT与MRI检出有差异的39例,在TPS下进行GTV勾画及体积计算。结
果MRI在1992年福州分期中的参与使早期(T1+T2）构成比降低,晚期(T3+T4）构成比升高。鼻咽癌2008年分期使T3
、T4期患者增多。两种分期标准对T2、T3分期差异有统计学意义(P=0.033,0.008);在N1、N2的判断中,差异有统
计学意义(P<0.05)。MRI较CT对头长肌、咽旁间隙、海绵窦、副鼻窦及颅神经的检出率明显提高;在对咽后淋巴结
及颈部肿大淋巴结的形态、包膜、坏死、融合的显示方面明显优于CT。对39例CT和MRI成像有差异的病例进行靶区
勾画,结果显示GTVMRI>GTVCT。结论 根据MRI图像进行1992年福州分期发现了更多的晚期病例,需要进行综合治疗
(放疗+化疗）的患者增多,为治疗方案的选择提供了重要参考。以MRI为基础的2008年分期是指导鼻咽癌治疗的主
要标准。按照MRI图像进行肿瘤靶区勾画能有效避免CT图像对肿瘤组织的漏诊以及对正常组织的误诊,既能加强局
部控制,又能保护正常组织,对于鼻咽癌患者的治疗有利无弊。     

Ultrahypofractionated Radiotherapy for Localised Prostate Cancer: How Far Can We Go?

Following adoption of moderately hypofractionated radiotherapy as a standard for localised prostate cancer, ultrahypofractioned radiotherapy delivered in five to seven fractions is rapidly being embraced by clinical practice and international guidelines. However, the question remains: how low can we go? Can radiotherapy for prostate cancer be delivered in fewer than five fractions? The current review summarises the evidence that radiotherapy for localised prostate cancer can be safely and effectively delivered in fewer than five fractions using high dose rate brachytherapy or stereotactic body radiotherapy. We also discuss important lessons learned from the single-fraction high dose rate brachytherapy experience.     

前列腺特异性膜抗原PET/CT特异性分子显像在非前列腺癌诊断中的应用

前列腺特异性膜抗原（PSMA）是由前列腺上皮细胞分泌的一种Ⅱ型谷氨酸缩肽酶,特异性高表达于前列腺癌及其转移灶的细胞中,在多数实体瘤部位毛细血管内皮细胞中有较高程度的表达。目前,已有超过二十种PSMA靶向的分子探针用于前列腺癌的诊断与治疗。本文综述了PSMA在除前列腺癌以外的多种实体瘤中的表达情况及PSMA-PET/CT特异性探针在非前列腺癌诊断中的临床应用实例,以期拓展以PSMA为靶点的新型PET探针在肿瘤分子诊断中的临床应用。     

Imaging primary prostate cancer with 11C-Choline PET/CT: relation to tumour stage,Gleason score and biomarkers of biologic aggressiveness

Background

As a significant overlap of 11C-Choline standardized uptake value (SUV) between prostate cancer and benign prostate hyperplasia (BPH) tissue, controversy exists regarding the clinical value of 11C-Choline PET/CT scan in primary prostate cancer. In this study, the SUVmax of the prostate lesions and the pelvic muscles were measured and their ratios (SUVmax-P/M ratio) were calculated. Then we evaluated whether the tracer 11C-Choline uptake, quantified as SUVmax-P/M ratio, correlated with tumour stage, Gleason score, and expression levels of several biomarkers of aggressiveness.

Methods

Twenty-six patients with primary prostate cancer underwent 11C-Choline PET/CT. Tumour specimens from these patients were graded histopathologically, and immunnohistochemistry for Ki-67, CD31, androgen receptor (AR), Her-2/neu, Bcl-2, and PTEN were performed.

Results

Both SUVmax and SUVmax-P/M ratio showed no significant difference between patients with tumour stage II and III, but significantly elevated in patients with tumour stage IV. SUVmax-P/M ratio was also significantly higher in lesions with Gleason score of 4+3 or higher versus less than or equal to 3+4. SUVmax-P/M ratio was found significantly correlated with expression levels of Ki-67 and CD31. In addition, a higher SUVmax-P/M ratio was demonstrated in Her-2/neu positive subgroup than negative subgroup. At the same time, Gleason score and expression levels of these biomarkers showed no significant association with SUVmax.

Conclusions

Using the parameter SUVmax-P/M ratio, 11C-Choline PET/CT may be a valuable non-invasive imaging technology in the diagnosis of primary prostate cancer.     

Diagnostic Performance of PI-RADS v2, Proposed Adjusted PI-RADS v2 and Biparametric Magnetic Resonance Imaging for Prostate Cancer Detection: A Preliminary Study

Purpose: To evaluate the diagnostic performance of PI-RADS v2, proposed adjustments to PI-RADS v2 (PA PI-RADS v2) and biparametric magnetic resonance imaging (MRI) for prostate cancer detection. Methods: A retrospective cohort of 224 patients with suspected prostate cancer was included from January 2016 to November 2018. All the patients underwent a multi-parametric MR scan before biopsy. Two radiologists independently evaluated the MR examinations using PI-RADS v2, PA PI-RADS v2, and a biparametric MRI protocol, respectively. Receiver operating characteristic (ROC) curves for the three different protocols were drawn. Results: In total, 90 out of 224 cases (40.18%) were pathologically diagnosed as prostate cancer. The area under the ROC curves (AUC) for diagnosing prostate cancers by biparametric MRI, PI-RADS v2, and PA PI-RADS v2 were 0.938, 0.935, and 0.934, respectively. For cancers in the peripheral zone (PZ), the diagnostic sensitivity was 97.1% for PI-RADS v2/PA PI-RADS v2 and 96.2% for biparametric MRI. Moreover, the specificity was 84.0% for biparametric MRI and 58.0% for PI-RADS v2/PA PI-RADS v2. For cancers in the transition zone (TZ), the diagnostic sensitivity was 93.4% for PA PI-RADS v2 and 88.2% for biparametric MRI/PI-RADS v2. Furthermore, the specificity was 95.4% for biparametric MRI/PI-RADS v2 and 78.0% for PA PI-RADS v2. Conclusions: The overall diagnostic performance of the three protocols showed minimal differences. For lesions assessed as being category 3 using the biparametric MRI protocol, PI-RADS v2, or PA PI-RADS v2, it was thought prostate cancer detection could be improved. Attention should be paid to false positive results when PI-RADS v2 or PA PI-RADS v2 are used.     

The Utility of Combined Target and Systematic Prostate Biopsies in the Diagnosis of Clinically Significant Prostate Cancer Using Prostate Imaging Reporting and Data System Version 2 Based on Biparametric Magnetic Resonance Imaging

This study aimed to determine the predictive value of the Prostate Imaging Reporting and Data System version 2 (PI-RADS v2) based on biparametric magnetic resonance imaging (bpMRI) with combined target biopsy (TBx) and systematic biopsy (SBx) in patients with suspicion of having clinically significant prostate cancer (csPCa). In this retrospective study, we reviewed the clinical and pathological records of 184 consecutive patients who underwent bpMRI before prostate biopsy. We focused on patients with PI-RADS v2 scores ≥ 3. MRI was performed using a 3-Tesla clinical scanner with a 32-channel phased-array receiver coil. PI-RADS v2 was used to describe bpMRI findings based on T2-weighted imaging and diffusion-weighted imaging scores. The primary endpoint was the diagnostic accuracy rate of PI-RADS v2 based on bpMRI for patients with prostate cancer (PCa) who underwent combined TBx and SBx. A total of 104 patients were enrolled in this study. Combined TBx and SBx was significantly superior to either method alone for PCa detection in patients with suspicious lesions according to PI-RADS v2. TBx and SBx detected concordant csPCa in only 24.1% of the patients. In addition, the rate of increase in the Gleason score was similar between SBx (41.5%) and TBx (34.1%). The diagnostic accuracy of bpMRI is comparable to that of standard multiparametric MRI for the detection of csPCa. Moreover, combined TBx and SBx may be optimal for the accurate determination of csPCa diagnosis, the International Society of Urological Pathology grade, and risk classification.     

CT与MRI对直肠癌术前诊断与分期的临床价值对比

目的 探讨CT与MRI在直肠癌术前诊断与分期中的临床价值.方法 收取直肠癌患者81例作为研究对象,对其CT与MRI影像学资料进行回顾性分析,对2种方法在直肠癌术前诊断及分期中的诊断效能进行考察与比较.结果 CT与病理T分期诊断符合57例,其中T1 ～2期11例、T3期28例、T4期18例,高估11例,低估13例;MRI与病理T分期诊断符合68例,其中T1 ～2期15例,T3期31例,T4期22例,高估7例,低估6例.CT与病理淋巴结诊断符合51例,MRI与术后病理淋巴结诊断符合65例.MRI诊断符合率显著高于CT检查,差异有统计学意义(P＜0.05).结论 与CT相比,MRI在直肠癌术前诊断与分期中具有更高的准确率,具有更高的诊断价值.     

Utility of a New Bolus-Injectable Nanoparticle for Clinical Cancer Staging

Background

In this study, we report on the use of a new, bolus-injectable, carboxymethyl dextran-based magnetic nanoparticle (MNP), ferumoxytol, to improve detection in loco-regional lymph nodes by magnetic resonance imaging (MRI).

Methods

This preliminary study was performed as a prospective, single-center, open label pilot study to determine the magnitude of nodal MRI signal changes and to determine the optimal time points for imaging following intravenous (IV) bolus injection of the MNP. The study group consisted of 10 patients, all of whom were diagnosed with prostate cancer before any systemic therapy.

Results

All 10 patients had lymph nodes evaluated by histopathology. Of the evaluated 26 lymph nodes, 20 were benign and 6 were malignant. The mean short-axis diameter of benign lymph nodes was 6 mm and the mean short-axis diameter of malignant lymph nodes was 7 mm. Following IV administration, there was a significant change in mean signal-to-noise ratio (SNR) of benign lymph nodes (P < .0001) whereas there was little change in the mean SNR of malignant nodes (P = .1624). No adverse events were encountered.

Conclusion

Ferumoxytol is safe and, at the appropriate circulation interval, modulates nodal signal intensity, allowing for identification of malignant nodal involvement by MRI.