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Shropshire DB, Acosta FM, Fang K, Benavides J, Sun LZ, Jin VX, Jiang JX. Association of adenosine signaling gene signature with estrogen receptor-positive breast and prostate cancer bone metastasis. Front Med (Lausanne) 2022; 9:965429. [PMID: 36186774 PMCID: PMC9520286 DOI: 10.3389/fmed.2022.965429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/23/2022] [Indexed: 11/20/2022] Open
Abstract
Bone metastasis is a common and devastating consequence of several major cancer types, including breast and prostate. Osteocytes are the predominant bone cell, and through connexin (Cx) 43 hemichannels release ATP to the bone microenvironment that can be hydrolyzed to adenosine. Here, we investigated how genes related to ATP paracrine signaling are involved in two common bone-metastasizing malignancies, estrogen receptor positive (ER+) breast and prostate cancers. Compared to other sites, bone metastases of both cancer types expressed higher levels of ENTPD1 and NT5E, which encode CD39 and CD73, respectively, and hydrolyze ATP to adenosine. ADORA3, encoding the adenosine A3 receptor, had a similar expression pattern. In primary ER+ breast cancer, high levels of the triplet ENTPD1/NT5E/ADORA3 expression signature was correlated with lower overall, distant metastasis-free, and progression-free survival. In ER+ bone metastasis biopsies, this expression signature is associated with lower survival. This expression signature was also higher in bone-metastasizing primary prostate cancers than in those that caused other tumor events or did not lead to progressive disease. In 3D culture, a non-hydrolyzable ATP analog inhibited the growth of breast and prostate cancer cell lines more than ATP did. A3 inhibition also reduced spheroid growth. Large-scale screens by the Drug Repurposing Hub found ER+ breast cancer cell lines were uniquely sensitive to adenosine receptor antagonists. Together, these data suggest a vital role for extracellular ATP degradation and adenosine receptor signaling in cancer bone metastasis, and this study provides potential diagnostic means for bone metastasis and specific targets for treatment and prevention.
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Affiliation(s)
- Daniel Brian Shropshire
- Department of Biochemistry and Structural Biology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Francisca M. Acosta
- Department of Biochemistry and Structural Biology, University of Texas Health Science Center, San Antonio, TX, United States
| | - Kun Fang
- Division of Biostatistics and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jaime Benavides
- Department of Biochemistry and Structural Biology, University of Texas Health Science Center, San Antonio, TX, United States
- Department of Biomedical Engineering and Chemical Engineering, The University of Texas at San Antonio, San Antonio, TX, United States
| | - Lu-Zhe Sun
- Department of Cell Systems and Anatomy, University of Texas Health Science Center, San Antonio, TX, United States
| | - Victor X. Jin
- Division of Biostatistics and MCW Cancer Center, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Jean X. Jiang
- Department of Biochemistry and Structural Biology, University of Texas Health Science Center, San Antonio, TX, United States
- *Correspondence: Jean X. Jiang,
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Ong W, Zhu L, Zhang W, Kuah T, Lim DSW, Low XZ, Thian YL, Teo EC, Tan JH, Kumar N, Vellayappan BA, Ooi BC, Quek ST, Makmur A, Hallinan JTPD. Application of Artificial Intelligence Methods for Imaging of Spinal Metastasis. Cancers (Basel) 2022; 14:4025. [PMID: 36011018 PMCID: PMC9406500 DOI: 10.3390/cancers14164025] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/16/2022] Open
Abstract
Spinal metastasis is the most common malignant disease of the spine. Recently, major advances in machine learning and artificial intelligence technology have led to their increased use in oncological imaging. The purpose of this study is to review and summarise the present evidence for artificial intelligence applications in the detection, classification and management of spinal metastasis, along with their potential integration into clinical practice. A systematic, detailed search of the main electronic medical databases was undertaken in concordance with the PRISMA guidelines. A total of 30 articles were retrieved from the database and reviewed. Key findings of current AI applications were compiled and summarised. The main clinical applications of AI techniques include image processing, diagnosis, decision support, treatment assistance and prognostic outcomes. In the realm of spinal oncology, artificial intelligence technologies have achieved relatively good performance and hold immense potential to aid clinicians, including enhancing work efficiency and reducing adverse events. Further research is required to validate the clinical performance of the AI tools and facilitate their integration into routine clinical practice.
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Affiliation(s)
- Wilson Ong
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Lei Zhu
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Wenqiao Zhang
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Desmond Shi Wei Lim
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Xi Zhen Low
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Yee Liang Thian
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Ee Chin Teo
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E, Lower Kent Ridge Road, Singapore 119228, Singapore
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore
| | - Beng Chin Ooi
- Department of Computer Science, School of Computing, National University of Singapore, 13 Computing Drive, Singapore 117417, Singapore
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd., Singapore 119074, Singapore
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Azad H, Ahmed A, Zafar I, Bhutta MR, Rabbani MA, KC HR. X-ray and MRI Correlation of Bone Tumors Using Histopathology As Gold Standard. Cureus 2022; 14:e27262. [PMID: 36039258 PMCID: PMC9403219 DOI: 10.7759/cureus.27262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Bone tumors are a common pathology of the musculoskeletal system being frequently encountered by clinicians. Radiological workup is a mainstay in the diagnostic workup of bone tumors. This study aimed to highlight the importance of plain radiography and MRI in the diagnosis of bone tumors keeping histopathology as a gold standard. It is a descriptive validation study conducted in the Radiology Department of Pakistan Institute of Medical Sciences Islamabad. Methodology The study included 92 patients with suspected bone lesions. After taking a complete history and receiving informed written consent. X-rays radiographs and magnetic resonance imaging were performed. X-ray radiograph and magnetic resonance imaging parameters were recorded and compared with the histopathology of lesions as a standard. Results The mean age of patients was 30.50 ± 8.95 years. Of 92 patients examined on X-ray, 51 (55.4%) had lytic lesions, 34 (37.0%) had sclerotic lesions, and seven (7.6 %) had mixed lesions. MRI revealed the location of the lesion. There were 25 (27.2%) bone lesions in diaphysis, 19 (20.7%) in metaphysis, nine (9.8%) at meta-diaphysis, and 32 (34.8 %) in the meta-epiphyseal region. These findings were later on confirmed with histopathological results. Conclusion MRI can differentiate soft-tissue components and periosteal reactions. An X-ray radiograph can provide information about bony matrix and calcifications within tumors. After analysis of imaging findings and histopathological results, it is concluded that these modalities can be used to diagnose bone tumors with high diagnostic accuracy.
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Influence of Prior Imaging Information on Diagnostic Accuracy for Focal Skeletal Processes—A Retrospective Analysis of the Consistency between Biopsy-Verified Imaging Diagnoses. Diagnostics (Basel) 2022; 12:diagnostics12071735. [PMID: 35885639 PMCID: PMC9319824 DOI: 10.3390/diagnostics12071735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022] Open
Abstract
Introduction: Comparing imaging examinations with those previously obtained is considered mandatory in imaging guidelines. To our knowledge, no studies are available on neither the influence, nor the sequence, of prior imaging and reports on diagnostic accuracy using biopsy as the reference standard. Such data are important to minimize diagnostic errors and to improve the preparation of diagnostic imaging guidelines. The aim of our study was to provide such data. Materials and methods: A retrospective cohort of 216 consecutive skeletal biopsies from patients with at least 2 different imaging modalities (X-ray, CT and MRI) performed within 6 months of biopsy was identified. The diagnostic accuracy of the individual imaging modality was assessed. Finally, the possible influence of the sequence of imaging modalities was investigated. Results: No significant difference in the accuracy of the imaging modalities was shown, being preceded by another imaging modality or not. However, the sequence analyses indicate sequential biases, particularly if MRI was the first imaging modality. Conclusion: The sequence of the imaging modalities seems to influence the diagnostic accuracy against a pathology reference standard. Further studies are needed to establish evidence-based guidelines for the strategy of using previous imaging and reports to improve diagnostic accuracy.
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Kuah T, Vellayappan BA, Makmur A, Nair S, Song J, Tan JH, Kumar N, Quek ST, Hallinan JTPD. State-of-the-Art Imaging Techniques in Metastatic Spinal Cord Compression. Cancers (Basel) 2022; 14:cancers14133289. [PMID: 35805059 PMCID: PMC9265325 DOI: 10.3390/cancers14133289] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/24/2022] [Accepted: 06/28/2022] [Indexed: 12/23/2022] Open
Abstract
Metastatic Spinal Cord Compression (MSCC) is a debilitating complication in oncology patients. This narrative review discusses the strengths and limitations of various imaging modalities in diagnosing MSCC, the role of imaging in stereotactic body radiotherapy (SBRT) for MSCC treatment, and recent advances in deep learning (DL) tools for MSCC diagnosis. PubMed and Google Scholar databases were searched using targeted keywords. Studies were reviewed in consensus among the co-authors for their suitability before inclusion. MRI is the gold standard of imaging to diagnose MSCC with reported sensitivity and specificity of 93% and 97% respectively. CT Myelogram appears to have comparable sensitivity and specificity to contrast-enhanced MRI. Conventional CT has a lower diagnostic accuracy than MRI in MSCC diagnosis, but is helpful in emergent situations with limited access to MRI. Metal artifact reduction techniques for MRI and CT are continually being researched for patients with spinal implants. Imaging is crucial for SBRT treatment planning and three-dimensional positional verification of the treatment isocentre prior to SBRT delivery. Structural and functional MRI may be helpful in post-treatment surveillance. DL tools may improve detection of vertebral metastasis and reduce time to MSCC diagnosis. This enables earlier institution of definitive therapy for better outcomes.
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Affiliation(s)
- Tricia Kuah
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Correspondence: ; Tel.: +65-6779-5555
| | - Balamurugan A. Vellayappan
- Department of Radiation Oncology, National University Cancer Institute Singapore, National University Hospital, Singapore 119074, Singapore;
| | - Andrew Makmur
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - Shalini Nair
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Junda Song
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
| | - Jiong Hao Tan
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Naresh Kumar
- University Spine Centre, Department of Orthopaedic Surgery, National University Health System, 1E Lower Kent Ridge Road, Singapore 119228, Singapore; (J.H.T.); (N.K.)
| | - Swee Tian Quek
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
| | - James Thomas Patrick Decourcy Hallinan
- Department of Diagnostic Imaging, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074, Singapore; (A.M.); (S.N.); (J.S.); (S.T.Q.); (J.T.P.D.H.)
- Department of Diagnostic Radiology, Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597, Singapore
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Mitchell PD, Dittmar JM. Employing radiography (X-rays) to localize lesions in human skeletal remains from past populations to allow accurate biopsy, using examples of cancer metastases. INTERNATIONAL JOURNAL OF OSTEOARCHAEOLOGY 2022; 32:916-922. [PMID: 36247222 PMCID: PMC9541957 DOI: 10.1002/oa.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/11/2021] [Accepted: 12/28/2021] [Indexed: 06/16/2023]
Abstract
Clinical research into biomolecules from infectious diseases and cancers has advanced rapidly in recent years, with two key areas being DNA analysis and proteomics. If we wish to understand important diseases and their associated biomolecules in past populations, techniques are required that will allow accurate biopsy of lesions in excavated human skeletal remains. While locating lesions visible on the surface of a bone is simple, many lesions such as cancer metastases are located in the medulla of bones, unseen on visual inspection. Here, we use two novel image guided techniques to investigate how plain radiographs may improve accuracy in the localization of lesions within bones from medieval individuals. While both techniques were effective, we found the grid technique required fewer radiographs than the pointer technique to employ and so was responsible for a lower overall radiation dose. We then discuss methods available for biopsy in archeological bone and how the optimal location for the biopsy of malignant lesions will vary depending upon whether the tumor is blastic or lytic in nature. Limitations of this X-ray guided approach include that not all cancer metastases are visible on plain radiographs, as erosion of cortical bone is frequently required for visualization of lytic metastases using this imaging modality.
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Affiliation(s)
- Piers D. Mitchell
- McDonald Institute for Archaeological ResearchUniversity of CambridgeCambridgeUK
| | - Jenna M. Dittmar
- McDonald Institute for Archaeological ResearchUniversity of CambridgeCambridgeUK
- Department of ArchaeologyUniversity of AberdeenAberdeenUK
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Zeng W, Swee DS. Severe and refractory hypocalcaemia secondary to osteoblastic bone metastases in bladder signet ring carcinoma: A case report and literature review. Medicine (Baltimore) 2022; 101:e29731. [PMID: 35776989 PMCID: PMC9239603 DOI: 10.1097/md.0000000000029731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Symptomatic hypocalcaemia is uncommon, occurring in <2% of patients with malignancy. Osteoblastic bone metastasis as a cause of hypocalcaemia is rare and not reported in bladder cancer. PATIENT CONCERNS We report a case of refractory hypocalcaemia in a patient with bladder cancer with extensive osteoblastic bone metastases. A 64-year-old male with a history of signet ring bladder carcinoma with osteoblastic bone metastases presented with severe hypocalcaemia with corrected calcium of 1.64 (2.09-2.46) mmol/L as well as hypomagnesemia and hypophosphatemia. He was previously treated with chemotherapy and immunotherapy. Denosumab was also initiated for the prevention of skeletal-related events. DIAGNOSES Additional investigations showed significantly elevated bone formation markers N-terminal propeptide of type I procollagen and alkaline phosphatase. Chest radiography and computed tomography scan also demonstrated extensive areas of sclerotic bone lesions suggestive of osteoblastic bone metastases. He was diagnosed with severe hypocalcaemia secondary to osteoblastic bone metastases and partly to denosumab, vitamin D deficiency, and hypomagnesemia. INTERVENTIONS He was treated aggressively with calcium and vitamin D replacement. OUTCOMES Despite prolonged intravenous calcium replacement and high doses of oral calcium, cholecalciferol, and calcitriol replacement, he had persistent hypocalcaemia with calcium levels ranging from 1.8 to 1.9 mmol/L. He died 4 months after his admission. LESSONS Osteoblastic bone metastases lead to an increased influx of calcium and phosphate into the bone leading to hypocalcaemia and should be considered as a differential in severe and refractory hypocalcaemia. It is rare and has not been described in bladder cancer. Precaution should be taken upon the initiation of antiresorptive in patients with osteoblastic bone metastases.
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Affiliation(s)
- Wanling Zeng
- Department of Endocrinology, Singapore General Hospital, Singapore
| | - Du Soon Swee
- Department of Endocrinology, Singapore General Hospital, Singapore
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Feuerecker B, Chantadisai M, Allmann A, Tauber R, Allmann J, Steinhelfer L, Rauscher I, Wurzer A, Wester HJ, Weber WA, d'Alessandria C, Eiber M. Pretherapeutic Comparative Dosimetry of 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T in Patients with Metastatic Castration-Resistant Prostate Cancer. J Nucl Med 2022; 63:833-839. [PMID: 34531260 PMCID: PMC9157737 DOI: 10.2967/jnumed.121.262671] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/26/2021] [Indexed: 11/16/2022] Open
Abstract
Radiohybrid prostate-specific membrane antigen (rhPSMA) ligands allow for labeling with 18F and radiometals for endoradiotherapy. rhPSMA-7.3 has been designated as a lead compound with promising preclinical data for 177Lu-rhPSMA-7.3, which has shown higher tumor uptake than 177Lu-PSMA I&T. In this retrospective analysis, we compared pretherapeutic clinical dosimetry data of both PSMA ligands. Methods: Six patients with metastatic castration-resistant prostate cancer underwent both 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T pretherapeutic dosimetry. Whole-body scintigraphy was performed at 1 h, 4 h, 24 h, 48 h, and 7 d after injection. Regions of interest covering the whole body, organs, bone marrow, and tumor lesions were drawn for each patient. Absorbed doses for individual patients and pretherapeutic applications were calculated using OLINDA/EXM. To facilitate the comparison of both ligands, we introduced the therapeutic index (TI), defined as the ratio of mean pretherapeutic doses to tumor lesions over relevant organs at risk. Results: Mean whole-body pretherapeutic effective doses for 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T were 0.12 ± 0.07 and 0.05 ± 0.03 Sv/GBq, respectively. Mean absorbed organ doses for 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T were, for example, 1.65 ± 0.28 and 0.73 ± 0.18 Gy/GBq for the kidneys, 0.19 ± 0.09 and 0.07 ± 0.03 Gy/GBq for the liver, 2.35 ± 0.78 and 0.80 ± 0.41 Gy/GBq for the parotid gland, and 0.67 ± 0.62 and 0.30 ± 0.27 Gy/GBq for the bone marrow, respectively. Tumor lesions received mean absorbed doses of 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T of 6.44 ± 6.44 and 2.64 ± 2.24 Gy/GBq, respectively. The mean TIs for the kidneys were 3.7 ± 2.2 and 3.6 ± 2.2 for 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T, respectively, and those for the bone marrow were 15.2 ± 10.2 and 15.1 ± 10.2 for 177Lu-rhPSMA-7.3 and 177Lu-PSMA I&T, respectively. Conclusion: Pretherapeutic clinical dosimetry confirmed preclinical results of mean absorbed doses for tumors that were 2-3 times higher for 177Lu-rhPSMA-7.3 than for 177Lu-PSMA I&T. Absorbed doses to normal organs also tended to be higher for 177Lu-rhPSMA-7.3, resulting overall in similar average TIs for both radiopharmaceuticals with considerable interpatient variability. 177Lu-rhPSMA-7.3 has promise for a therapeutic efficacy similar to that of 177Lu-PSMA I&T at smaller amounts of injected activity, simplifying radiation safety measurements (especially for large patient numbers or dose escalation regimens).
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Affiliation(s)
- Benedikt Feuerecker
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany;
- Partnersite München, German Cancer Consortium (DKTK), Heidelberg, Germany
- Department of Radiology, School of Medicine, Technical University of Munich, München, Germany
| | - Maythinee Chantadisai
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Anne Allmann
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Robert Tauber
- Department of Urology, School of Medicine, Technical University of Munich, München, Germany; and
| | - Jakob Allmann
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Lisa Steinhelfer
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Isabel Rauscher
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Alexander Wurzer
- Department of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Hans-Jürgen Wester
- Department of Pharmaceutical Radiochemistry, Technical University of Munich, Garching, Germany
| | - Wolfgang A Weber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
- Partnersite München, German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Calogero d'Alessandria
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, München, Germany
- Partnersite München, German Cancer Consortium (DKTK), Heidelberg, Germany
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Shafiei M, Chalian M, Luna R, Ahlawat S, Fayad LM. Imaging in Musculoskeletal Oncology. Radiol Clin North Am 2022; 60:657-668. [DOI: 10.1016/j.rcl.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pagnotti GM, Trivedi T, Mohammad KS. Translational Strategies to Target Metastatic Bone Disease. Cells 2022; 11:cells11081309. [PMID: 35455987 PMCID: PMC9030480 DOI: 10.3390/cells11081309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 11/16/2022] Open
Abstract
Metastatic bone disease is a common and devastating complication to cancer, confounding treatments and recovery efforts and presenting a significant barrier to de-escalating the adverse outcomes associated with disease progression. Despite significant advances in the field, bone metastases remain presently incurable and contribute heavily to cancer-associated morbidity and mortality. Mechanisms associated with metastatic bone disease perpetuation and paralleled disruption of bone remodeling are highlighted to convey how they provide the foundation for therapeutic targets to stem disease escalation. The focus of this review aims to describe the preclinical modeling and diagnostic evaluation of metastatic bone disease as well as discuss the range of therapeutic modalities used clinically and how they may impact skeletal tissue.
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Affiliation(s)
- Gabriel M. Pagnotti
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Trupti Trivedi
- Department of Endocrine, Neoplasia and Hormonal Disorders, MD Anderson Cancer Center, University of Texas, Houston, TX 77030, USA; (G.M.P.); (T.T.)
| | - Khalid S. Mohammad
- Department of Anatomy and Genetics, Alfaisal University, Riyadh 11533, Saudi Arabia
- Correspondence: ; Tel.: +966-546-810-335
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Bone scan with technetium 99m-methyl diphosphonate, the missing link in the initial staging of muscle-invasive bladder carcinoma. Nucl Med Commun 2022; 43:675-679. [PMID: 35414637 DOI: 10.1097/mnm.0000000000001559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Accurate staging is crucial to determine the type of treatment for patients with bladder cancer (BCa), especially in high-risk cases. We aimed to assess the role of bone scan in the initial staging of muscle-invasive bladder carcinoma (MIBC). MATERIAL AND METHODS Forty-five patients with MIBC were referred to our tertiary clinic to perform a technetium 99m-methyl diphosphonate (Tc99m-MDP) bone scan from January 2019 to March 2020. The patients underwent bone scintigraphy with pelvic SPECT/CT before radical cystectomy. Whole-body scanning was performed 4 hours after Tc99m-MDP injection in both anterior and posterior views. Since the most common bone involvement site in these patients is the pelvic bones and the spine, pelvic SPECT/CT was performed in all patients. RESULTS Frequency of skeletal metastasis was 26.7%. Only 19% of the metastases were detected by previous pelvic CT/MRI images performed for routine staging. All the reported skeletal metastases by previous anatomical imaging methods were detected in the bone scan. There was no statistically significant correlation between bone metastasis and the patient's age, lymph nodes metastasis (LNM), hydronephrosis, and muscle-invasive type. The mean serum calcium level was 8.7 ± 0.57 in patients with bone metastasis and 8.87 ± 0.99 in patients without bone metastasis, which was not statistically significant. CONCLUSION Bone scan has higher diagnostic performance than conventional imaging methods for detecting bone metastases. It changed the management plan in 8.8% of our patients, so we conclude that performing a whole-body bone scan in the initial staging of MIBC would be helpful.
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Wei J, Cai H, Pi Y, Zhao Z, Yi Z. An automatic fine-grained skeleton segmentation method for whole-body bone scintigraphy using atlas-based registration. Int J Comput Assist Radiol Surg 2022; 17:673-681. [DOI: 10.1007/s11548-022-02579-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 02/07/2022] [Indexed: 11/28/2022]
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Imaging of Oligometastatic Disease. Cancers (Basel) 2022; 14:cancers14061427. [PMID: 35326586 PMCID: PMC8946296 DOI: 10.3390/cancers14061427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/03/2022] [Accepted: 03/08/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary The imaging of oligometastatic disease (OMD) is challenging as it requires precise loco-regional staging and whole-body assessment. The combination of imaging modalities is often required. The more accurate imaging tool will be selected according to tumor type, the timing with regard to measurement and treatment, metastatic location, and the patient’s individual risk for metastasis. The most commonly used modalities are contrast-enhanced computed tomography (CT), magnetic resonance imaging and metabolic and receptor-specific imaging, particularly, 18F-fluorodesoxyglucose positron emission tomography/CT, used alone or in combination. Abstract Oligometastatic disease (OMD) is an emerging state of disease with limited metastatic tumor burden. It should be distinguished from polymetastatic disease due the potential curative therapeutic options of OMD. Imaging plays a pivotal role in the diagnosis and follow-up of patients with OMD. The imaging tools needed in the case of OMD will differ according to different parameters, which include primary tumor type, timing between measurement and treatment, potential metastatic location and the patient’s individual risk for metastasis. In this article, OMD is defined and the use of different imaging modalities in several oncologic situations are described in order to better understand OMD and its specific implication for radiologists.
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Mitchell PD, Dittmar JM, Mulder B, Inskip S, Littlewood A, Cessford C, Robb JE. Assessing the relative benefits of imaging with plain radiographs and microCT scanning to diagnose cancer in past populations. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 36:24-29. [PMID: 34923213 DOI: 10.1016/j.ijpp.2021.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To determine the degree to which plain radiographs (x-rays) and microCT scans can improve accuracy in the diagnosis of cancer in human remains from past populations. MATERIALS The skeletal remains of 143 individuals from medieval Cambridgeshire, dating from 6th-16th century CE. METHODS Visual inspection of the skeletons for lesions compatible with malignancy, coupled with plain radiographs and microCT scans of the pelvis, femora and vertebra. RESULTS Three individuals had visually apparent metastases on their skeletons. Plain radiographs did not identify further individuals with cancer, but did show further lesions in bones with normal external appearance. MicroCT scans identified cancer in two further individuals with normal visual appearance and normal plain radiographs. CONCLUSIONS Imaging human skeletal remains increases the detection rate of cancer in human skeletal remains. We found microCT scanning to be a much more sensitive imaging modality than plain radiography. It improved our diagnostic accuracy and enabled us to more reliably distinguish between malignant lesions and taphonomic change. SIGNIFICANCE Future studies investigating the prevalence and nature of malignancy in past populations would benefit from systematic microCT scanning of pelvis, femora and vertebrae of skeletons to optimise their diagnostic accuracy. LIMITATIONS MicroCT scanning is more expensive than plain radiographs, and may not be easily accessible to biological anthropologists. SUGGESTIONS FOR FURTHER RESEARCH To apply this approach to skeletal series from different time periods and geographical regions, where the types of cancer existing in the local population may differ from those we studied in medieval Britain.
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Affiliation(s)
- Piers D Mitchell
- Department of Archaeology, University of Cambridge, Downing Street, Cambridge CB2 3DZ, UK.
| | - Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, UK
| | - Bram Mulder
- Department of Archaeology, University of Cambridge, Downing Street, Cambridge CB2 3DZ, UK
| | - Sarah Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, UK
| | - Alastair Littlewood
- Department of Radiology, Peterborough City Hospital, Bretton Gate, Peterborough PE3 6GZ, UK
| | - Craig Cessford
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge CB2 3ER, UK; Cambridge Archaeological Unit, University of Cambridge, Downing Street, Cambridge CB2 3DZ, UK
| | - John E Robb
- Department of Archaeology, University of Cambridge, Downing Street, Cambridge CB2 3DZ, UK
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Faiella E, Santucci D, Calabrese A, Russo F, Vadalà G, Zobel BB, Soda P, Iannello G, de Felice C, Denaro V. Artificial Intelligence in Bone Metastases: An MRI and CT Imaging Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031880. [PMID: 35162902 PMCID: PMC8834956 DOI: 10.3390/ijerph19031880] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/03/2022] [Accepted: 02/05/2022] [Indexed: 02/01/2023]
Abstract
(1) Background: The purpose of this review is to study the role of radiomics as a supporting tool in predicting bone disease status, differentiating benign from malignant bone lesions, and characterizing malignant bone lesions. (2) Methods: Two reviewers conducted the literature search independently. Thirteen articles on radiomics as a decision support tool for bone lesions were selected. The quality of the methodology was evaluated according to the radiomics quality score (RQS). (3) Results: All studies were published between 2018 and 2021 and were retrospective in design. Eleven (85%) studies were MRI-based, and two (15%) were CT-based. The sample size was <200 patients for all studies. There is significant heterogeneity in the literature, as evidenced by the relatively low RQS value (average score = 22.6%). There is not a homogeneous protocol used for MRI sequences among the different studies, although the highest predictive ability was always obtained in T2W-FS. Six articles (46%) reported on the potential application of the model in a clinical setting with a decision curve analysis (DCA). (4) Conclusions: Despite the variability in the radiomics method application, the similarity of results and conclusions observed is encouraging. Substantial limits were found; prospective and multicentric studies are needed to affirm the role of radiomics as a supporting tool.
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Affiliation(s)
- Eliodoro Faiella
- Department of Radiology, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (E.F.); (D.S.); (B.B.Z.)
| | - Domiziana Santucci
- Department of Radiology, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (E.F.); (D.S.); (B.B.Z.)
| | - Alessandro Calabrese
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico, 00161 Roma, Italy;
- Correspondence:
| | - Fabrizio Russo
- Department of Orthopaedic and Trauma Surgery, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (F.R.); (G.V.); (V.D.)
| | - Gianluca Vadalà
- Department of Orthopaedic and Trauma Surgery, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (F.R.); (G.V.); (V.D.)
| | - Bruno Beomonte Zobel
- Department of Radiology, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (E.F.); (D.S.); (B.B.Z.)
| | - Paolo Soda
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (P.S.); (G.I.)
| | - Giulio Iannello
- Unit of Computer Systems and Bioinformatics, Department of Engineering, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (P.S.); (G.I.)
| | - Carlo de Felice
- Department of Radiology, University of Rome “Sapienza”, Viale del Policlinico, 00161 Roma, Italy;
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, University of Rome “Campus Bio-Medico”, Via Alvaro del Portillo, 00128 Roma, Italy; (F.R.); (G.V.); (V.D.)
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Slouma M, Abbes M, Dhahri R, Gueddiche NE, Msekni I, Gharsallah I, Metoui L, Louzir B. Rectal carcinoma revealed by isolated mixed bone metastases. Clin Case Rep 2022; 10:e05380. [PMID: 35136609 PMCID: PMC8807882 DOI: 10.1002/ccr3.5380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 07/31/2021] [Accepted: 12/22/2021] [Indexed: 11/15/2022] Open
Abstract
Isolated bone metastases secondary to rectal neoplasia are scarce. Radiographic findings may include lytic, sclerotic, or mixed lesions. We presented a case of rectal carcinoma revealed by isolated osseous metastases. We emphasize the radiological features of mixed bone metastases with the differential diagnoses that may be raised.
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Affiliation(s)
- Maroua Slouma
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Maissa Abbes
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Rim Dhahri
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Nour Elhouda Gueddiche
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Issam Msekni
- Tunis El Manar UniversityTunisTunisia
- Department of PathologyMilitary HospitalTunisTunisia
| | - Imen Gharsallah
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Leila Metoui
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
| | - Bassem Louzir
- Department of Internal MedicineMilitary HospitalTunisTunisia
- Tunis El Manar UniversityTunisTunisia
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Jin Z, Zhang F, Wang Y, Tian A, Zhang J, Chen M, Yu J. Single-Photon Emission Computed Tomography/Computed Tomography Image-Based Radiomics for Discriminating Vertebral Bone Metastases From Benign Bone Lesions in Patients With Tumors. Front Med (Lausanne) 2022; 8:792581. [PMID: 35059418 PMCID: PMC8764284 DOI: 10.3389/fmed.2021.792581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Accepted: 11/22/2021] [Indexed: 12/31/2022] Open
Abstract
Purpose: The purpose of this study was to investigate the feasibility of Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) image-based radiomics in differentiating bone metastases from benign bone lesions in patients with tumors. Methods: A total of 192 lesions from 132 patients (134 in the training group, 58 in the validation group) diagnosed with vertebral bone metastases or benign bone lesions were enrolled. All images were evaluated and diagnosed independently by two physicians with more than 20 years of diagnostic experience for qualitative classification, the images were imported into MaZda software in Bitmap (BMP) format for feature extraction. All radiomics features were selected by least absolute shrinkage and selection operator (LASSO) regression and 10-fold cross-validation algorithms after the process of normalization and correlation analysis. Based on these selected features, two models were established: The CT model and SPECT model (radiomics features were derived from CT and SPECT images, respectively). In addition, a combination model (ComModel) combined CT and SPECT features was developed in order to better evaluate the predictive performance of radiomics models. Subsequently, the diagnostic performance between each model was separately evaluated by a confusion matrix. Results: There were 12, 13, and 18 features contained within the CT, SPECT, and ComModel, respectively. The constructed radiomics models based on SPECT/CT images to discriminate between bone metastases and benign bone lesions not only had high diagnostic efficacy in the training group (AUC of 0.894, 0.914, 0.951 for CT model, SPECT model, and ComModel, respectively), but also performed well in the validation group (AUC; 0.844, 0.871, 0.926). The AUC value of the human experts was 0.849 and 0.839 in the training and validation groups, respectively. Furthermore, both SPECT model and ComModel show higher classification performance than human experts in the training group (P = 0.021 and P = 0.001, respectively) and the validation group (P = 0.037 and P = 0.007, respectively). All models showed better diagnostic accuracy than human experts in the training group and the validation group. Conclusion: Radiomics derived from SPECT/CT images could effectively discriminate between bone metastases and benign bone lesions. This technique may be a new non-invasive way to help prevent unnecessary delays in diagnosis and a potential contribution in disease staging and treatment planning.
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Affiliation(s)
- Zhicheng Jin
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Fang Zhang
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yizhen Wang
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Aijuan Tian
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jianan Zhang
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Meiyan Chen
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
| | - Jing Yu
- Department of Nuclear Medicine, The Second Hospital of Dalian Medical University, Dalian, China
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Chang CY, Garner HW, Ahlawat S, Amini B, Bucknor MD, Flug JA, Khodarahmi I, Mulligan ME, Peterson JJ, Riley GM, Samim M, Lozano-Calderon SA, Wu JS. Society of Skeletal Radiology- white paper. Guidelines for the diagnostic management of incidental solitary bone lesions on CT and MRI in adults: bone reporting and data system (Bone-RADS). Skeletal Radiol 2022; 51:1743-1764. [PMID: 35344076 PMCID: PMC9283187 DOI: 10.1007/s00256-022-04022-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/21/2022] [Accepted: 02/21/2022] [Indexed: 02/02/2023]
Abstract
The purpose of this article is to present algorithms for the diagnostic management of solitary bone lesions incidentally encountered on computed tomography (CT) and magnetic resonance (MRI) in adults. Based on review of the current literature and expert opinion, the Practice Guidelines and Technical Standards Committee of the Society of Skeletal Radiology (SSR) proposes a bone reporting and data system (Bone-RADS) for incidentally encountered solitary bone lesions on CT and MRI with four possible diagnostic management recommendations (Bone-RADS1, leave alone; Bone-RADS2, perform different imaging modality; Bone-RADS3, perform follow-up imaging; Bone-RADS4, biopsy and/or oncologic referral). Two algorithms for CT based on lesion density (lucent or sclerotic/mixed) and two for MRI allow the user to arrive at a specific Bone-RADS management recommendation. Representative cases are provided to illustrate the usability of the algorithms.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Jim S. Wu
- Beth Israel Deaconess Medical Center, Boston, USA
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Review of imaging techniques for evaluating morphological and functional responses to the treatment of bone metastases in prostate and breast cancer. Clin Transl Oncol 2022; 24:1290-1310. [PMID: 35152355 PMCID: PMC9192443 DOI: 10.1007/s12094-022-02784-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
Bone metastases are very common complications associated with certain types of cancers that frequently negatively impact the quality of life and functional status of patients; thus, early detection is necessary for the implementation of immediate therapeutic measures to reduce the risk of skeletal complications and improve survival and quality of life. There is no consensus or universal standard approach for the detection of bone metastases in cancer patients based on imaging. Endorsed by the Spanish Society of Medical Oncology (SEOM), the Spanish Society of Medical Radiology (SERAM), and the Spanish Society of Nuclear Medicine and Molecular Imaging (SEMNIM) a group of experts met to discuss and provide an up-to-date review of our current understanding of the biological mechanisms through which tumors spread to the bone and describe the imaging methods available to diagnose bone metastasis and monitor their response to oncological treatment, focusing on patients with breast and prostate cancer. According to current available data, the use of next-generation imaging techniques, including whole-body diffusion-weighted MRI, PET/CT, and PET/MRI with novel radiopharmaceuticals, is recommended instead of the classical combination of CT and bone scan in detection, staging and response assessment of bone metastases from prostate and breast cancer.Clinical trial registration: Not applicable.
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70
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Kastler A, Cornelis FH, Kastler B. Patient's selection and evaluation for bone stabilization. Tech Vasc Interv Radiol 2022; 25:100797. [DOI: 10.1016/j.tvir.2022.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Altshuler E, Aryan M, King W, Otero R. Missed diagnosis of lymphoma presenting with humoral hypercalcemia of malignancy due to cessation of oncological workup after negative computed tomography scans. BMJ Case Rep 2021; 14:e246669. [PMID: 34969803 PMCID: PMC8719147 DOI: 10.1136/bcr-2021-246669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/04/2022] Open
Abstract
Malignancy is the most common cause of hypercalcemia among hospitalised patients and is frequently caused by elevations in parathyroid hormone-related peptide (PTHrP). The most common PTHrP-producing cancers are carcinomas of the head, neck and lung. Hypercalcemia can be the presenting sign of cancer and, in these cases, solid tumours are usually discovered on CT scan. In rare cases, lymphoma may also present with hypercalcemia. CT scan is less sensitive for lymphoma than for most solid tumours and the diagnosis may be missed. We present the case of a 69-year-old woman who presented with hypercalcemia in the setting of severe weight loss and elevated PTHrP. Oncological workup was stopped after unrevealing CT scans and an underlying lymphoma was missed. Our case emphasises the need for a comprehensive oncological workup for patients with unexplained hypercalcemia and elevated PTHrP, even when CT scans are unrevealing.
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Affiliation(s)
- Ellery Altshuler
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Mahmoud Aryan
- Internal Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA
| | - William King
- Internal Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Rolando Otero
- University of Florida College of Medicine, Gainesville, Florida, USA
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Cheung H, Yechoor A, Behnia F, Abadi AB, Khodarahmi I, Soltanolkotabi M, Shafiei M, Chalian M. Common Skeletal Neoplasms and Nonneoplastic Lesions at 18F-FDG PET/CT. Radiographics 2021; 42:250-267. [PMID: 34919467 DOI: 10.1148/rg.210090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Numerous primary and metastatic osseous lesions and incidental osseous findings are encountered at fluorine 18 (18F) fluorodeoxyglucose (FDG) PET/CT. These lesions show varying degrees of FDG uptake. Malignancies are generally more FDG avid than are benign lesions, but many exceptions exist. Although aggressive lesions tend to be more FDG avid than nonaggressive lesions, this concept holds true particularly for lesions of the same histologic subtype. In addition, some benign osseous processes such as Paget disease have variable degrees of FDG avidity on the basis of disease metabolic activity. This creates a diagnostic dilemma for radiologists and clinicians, especially in patients with known malignancies, and can result in unnecessary diagnostic imaging or interventions for incidental osseous lesions. Evaluation of morphologic CT characteristics of osseous lesions at FDG PET/CT can be a valuable adjunct to metabolic analysis to further characterize lesions, enhance diagnostic and staging accuracy, and avoid unnecessary invasive biopsy procedures. The authors review the common primary and metastatic bone lesions at FDG PET/CT, with an emphasis on morphologic CT assessment of lesions to help narrow the differential diagnosis. Imaging manifestations of common incidental nonneoplastic bone lesions at FDG PET/CT are discussed to provide information on differentiation of these lesions from osseous neoplasms. The guidelines of the National Comprehensive Cancer Network (NCCN) for common primary osseous malignancies are also summarized. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Hoiwan Cheung
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Alekhya Yechoor
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Fatemeh Behnia
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Alireza Behrad Abadi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Iman Khodarahmi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Maryam Soltanolkotabi
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Mehrzad Shafiei
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
| | - Majid Chalian
- From the Department of Radiology, Divisions of Musculoskeletal Imaging and Intervention (H.C., A.Y., A.B.A., M. Shafiei, M.C.) and Nuclear Medicine (F.B.), University of Washington, UW Radiology-Roosevelt Clinic, 4245 Roosevelt Way NE, Box 354755, Seattle, WA 98105; Department of Radiology, Division of Musculoskeletal Imaging, NYU Langone Health, New York, NY (I.K.); and Department of Radiology, Division of Musculoskeletal Imaging, University of Utah, Salt Lake City, Utah (M. Soltanolkotabi)
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Park S, Huh JD. Bone metastases with post-treatment intralesional fatty content of the spine: imaging features from T1-weighted imaging with CT finding correlations. Acta Radiol 2021; 64:153-163. [PMID: 34851180 DOI: 10.1177/02841851211058930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite post-treatment intralesional fatty content (PIFAT) in bone metastases indicating a healing processes after treatment, the imaging features of PIFAT have not been studied in detail. PURPOSE To analyze imaging features from T1-weighted (T1W) imaging with computed tomography (CT) finding correlations in bone metastases with PIFAT of the spine. MATERIAL AND METHODS A total of 29 bone metastases with PIFAT were analyzed with T1W and CT images before and after treatment. On T1W imaging after treatment, the lesions were categorized into three types according to fat distribution patterns. CT attenuation changes after treatment were also evaluated. According to the MD Anderson (MDA) criteria, response types for all lesions were obtained on magnetic resonance (MR) and CT images. RESULTS The types from T1W imaging in bone metastases with PIFAT were as follows: 14 with a return to totally normal marrow signal intensity within the lesion; 13 with an inhomogeneous patchy pattern in the lesion; and two with a peripheral halo of fatty marrow or peripheral fat signal intensity foci in the lesion. Among bone metastases with PIFAT, 93.1% showed osteosclerotic changes in this study. According to the MDA criteria, the concordance between the response types of the MR and CT images was 57.2%. CONCLUSION Knowledge of imaging features from T1W imaging with CT correlation in bone metastases with PIFAT is important for the accurate interpretation of post-treatment MR and CT studies. Both MR and CT images have a complementary value regarding the post-treatment evaluation of bone metastases with PIFAT.
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Affiliation(s)
- Sekyoung Park
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Jin Do Huh
- Department of Radiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
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Kapsoritakis N, Stathaki M, Bourogianni O, Tsaroucha A, Papadaki E, Simos P, Koukouraki S. Clinical impact of targeted single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy on the assessment of bone metastasis in cancer patients. Nucl Med Commun 2021; 42:1202-1208. [PMID: 34149007 DOI: 10.1097/mnm.0000000000001455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated the clinical impact of single-photon emission computed tomography/computed tomography (SPECT/CT) bone scintigraphy combined with 16-slice CT on metastatic workup and treatment planning in a large cancer patient series. METHODS Between January 2019 and January 2020, a total of 600 cancer patients were prospectively evaluated with whole-body planar bone scan (wbPBS) for staging or restaging purposes. 272/600 had equivocal lesions on wbPBS and 265/272 underwent additionally a targeted SPECT/CT bone scintigraphy on designated regions. Findings were classified as benign (score 1), metastatic (score 2) and inconclusive (score 3). Findings from SPECT/CT bone scintigraphy were compared with the results of wbPBS. RESULTS A total of 668 lesions were considered as unclear οn wbPBS and were re-evaluated through targeted SPECT/CT bone scintigraphy. Definite diagnostic findings on SPECT/CT bone scintigraphy were obtained in 227/265 (85.7%) patients and in 592/668 (88.6%) lesions vs. 15.4% of wbPBS alone. On per-patient analyses, 38.9% of patients were considered definitely nonmetastatic and 46.8% as definitely metastatic. On per lesion analyses using SPECT/CT bone scintigraphy, corresponding diagnostic rates were 47.5 and 41.2%. Although the addition of SPECT/CT bone scintigraphy significantly reduced the rate of equivocal wbPBS results (83.1%), it failed to provide a conclusive diagnosis in a relatively small proportion of lesions 76/668 (11.4%) in 38 patients. CONCLUSIONS SPECT/CT bone scintigraphy afforded a significant reduction of the number of patients with equivocal findings who needed further evaluation with other imaging modalities, preventing unnecessary delays in diagnosis and potential changes in disease staging and treatment planning. Moreover, SPECT/CT bone scintigraphy slightly increased diagnostic sensitivity.
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Affiliation(s)
| | - Maria Stathaki
- Department of Nuclear Medicine, School of Medicine, University of Crete
| | - Olga Bourogianni
- Department of Nuclear Medicine, School of Medicine, University of Crete
| | | | | | - Panagiotis Simos
- Department of Psychiatry, School of Medicine, University of Crete &Institute of Computer Science, Foundation for Research and Technology-Hellas, Crete, Greece
| | - Sophia Koukouraki
- Department of Nuclear Medicine, School of Medicine, University of Crete
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Moon JB, Yoo SW, Lee C, Kim DY, Pyo A, Kwon SY. Multimodal Imaging-Based Potential Visualization of the Tumor Microenvironment in Bone Metastasis. Cells 2021; 10:cells10112877. [PMID: 34831100 PMCID: PMC8616082 DOI: 10.3390/cells10112877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/11/2021] [Accepted: 10/22/2021] [Indexed: 11/16/2022] Open
Abstract
Bone metastasis (BM) is the most common malignant bone tumor and a significant cause of morbidity and mortality for patients with cancer. Compared to other metastatic organs, bone has unique characteristics in terms of the tumor microenvironment (TME). Precise assessments of the TME in BM could be an important step for developing an optimized management plan for patient care. Imaging approaches for BM have several advantages, such as biopsy not being required, multiple site evaluation, and serial assessment in the same sites. Owing to the developments of new imaging tracers or imaging modalities, bone TME could be visualized using multimodal imaging techniques. In this review, we describe the BM pathophysiology, diagnostic principles of major imaging modalities, and clinically available imaging modalities to visualize the TME in BM. We also discuss how the interactions between various factors affecting the TME could be visualized using multimodal imaging techniques.
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Affiliation(s)
- Jang Bae Moon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Su Woong Yoo
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Changho Lee
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
| | - Dong-Yeon Kim
- College of Pharmacy and Research Institute of Pharmaceutical Science, Gyeongsang National University, Jinju 52828, Korea;
| | - Ayoung Pyo
- Accelerator & RI Development Team, Korea Atomic Energy Research Institute, Daejeon 56212, Korea;
| | - Seong Young Kwon
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun-gun 58128, Korea; (J.B.M.); (S.W.Y.); (C.L.)
- Correspondence: ; Tel.: +82-61-379-7273
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Saini VK, Mammoottil AE, Ora M, Gambhir S, Nazar AH. Contiguous Multilevel Vertebral Metastasis in Carcinoma Breast Mimicking Spondylodiscitis. Indian J Nucl Med 2021; 36:316-318. [PMID: 34658560 PMCID: PMC8481853 DOI: 10.4103/ijnm.ijnm_30_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/06/2021] [Indexed: 12/02/2022] Open
Abstract
A 59-year old female presented with a lump in the right breast for 6 months. She developed progressively increasing backache for 3 months. Magnetic resonance imaging spine was suggestive of hypointense heterogeneous signal intensity in multiple dorsal vertebrae (D3–D8) and suggestive of Pott's spine. Sonomammography suggested a lesion with irregular margin in the retro-areolar region. Fine-needle aspiration cytology was infiltrating duct carcinoma. Fluorodeoxyglucose (FDG) positron-emission tomography–computed tomography revealed mass in the right breast with axillary lymph node. FDG-avid lytic destructive contiguous lesion was noted in mid-dorsal vertebrae. Apart from it, FDG-avid lytic lesion was also noted in the right iliac bone. The patient underwent vertebral lesion biopsy consistent with metastatic breast carcinoma. This case report demonstrates rare contiguous involvement of multiple vertebrae masquerading Pott's spine.
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Affiliation(s)
- Vivek Kumar Saini
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | | | - Manish Ora
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, SGPGIMS, Lucknow, Uttar Pradesh, India
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Multimodality imaging of greater trochanter lesions. Pol J Radiol 2021; 86:e401-e414. [PMID: 34429787 PMCID: PMC8369823 DOI: 10.5114/pjr.2021.107814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/07/2020] [Indexed: 12/05/2022] Open
Abstract
Purpose Greater trochanter (GT) lesions are relatively uncommon. They can be traumatic, infective including tuber-culosis, inflammatory, and neoplastic (primary and metastatic osseous lesions). Although imaging of greater trochanter lesions remains essential for differential diagnoses, an image-guided biopsy is a mainstay for diagnosis and to guide subsequent management. Material and methods A retrospective search for the word ‘greater trochanter’ was performed of a computerised radiology information system (CRIS) of a tertiary referral centre for orthopaedic oncology over a period of 12 years (2007-2019). This revealed 6019 reports with 101 neoplasms. The imaging, histology, and demography were reviewed by a dedicated musculoskeletal radiologist. Results We identified 101 GT neoplasms with a mean age of 51.5 years (range 6 to 85 years) and a slight female predominance of 1.2 : 1 (46 males and 55 females). Using 30 years of age as a cut-off, we further segregated the patient cohort into 2 groups: 26 (25.74%) lesions in patients less than 30 years age and the remaining 75 (74.26%) lesions in patients over 30 years old. Chondroblastoma was the most common neoplasm in patients below 30 years of age, and metastases were the most common neoplasms in patients over 30 years of age. Conclusions Greater trochanter pathologies show a broad spectrum of aetiologies. Imaging including radiographs, computed tomography, magnetic resonance imaging, and nuclear medicine scans help to narrow down the differen-tials diagnosis.
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McCormick JP, Trueick R, Connaughton J, McDonnell N. First recurrence of small cell lung cancer presenting as subacute monoarticular arthritis. BMJ Case Rep 2021; 14:e243382. [PMID: 34417237 PMCID: PMC8381322 DOI: 10.1136/bcr-2021-243382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2021] [Indexed: 11/03/2022] Open
Abstract
We describe a case of recurrent small cell lung cancer presenting as an acute monoarticular arthritis. This patient had recently undergone comprehensive review and surveillance imaging under a local oncology unit, 18 months after undergoing chemoradiotherapy for limited disease small cell lung cancer. He had presented to the emergency department on multiple occasions and been managed as an outpatient for a provisional diagnosis of spontaneous haemarthrosis in the setting of rivaroxaban therapy. Subsequent investigation revealed occult fracture of the distal femur with joint effusion, secondary to isolated metastatic disease from recurrent small cell lung cancer. This case demonstrates the importance of reconsidering differential diagnoses when a patient's symptoms do not respond to appropriate treatment as expected. It also highlights the limitations of surveillance protocols and the influence that recent specialist input can have on diagnostic processes.
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Affiliation(s)
- John Peter McCormick
- Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland
- Cardiology, St James's Hospital, Dublin, Dublin, Ireland
| | - Robert Trueick
- Medical Oncology, Tullamore General Hospital, Tullamore, Offaly, Ireland
| | - John Connaughton
- Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland
| | - Niamh McDonnell
- Internal Medicine, Midland Regional Hospital Portlaoise, Portlaoise, Laois, Ireland
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An Iterative Algorithm for Semisupervised Classification of Hotspots on Bone Scintigraphies of Patients with Prostate Cancer. J Imaging 2021; 7:jimaging7080148. [PMID: 34460784 PMCID: PMC8404946 DOI: 10.3390/jimaging7080148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 08/12/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
Prostate cancer (PCa) is the second most diagnosed cancer in men. Patients with PCa often develop metastases, with more than 80% of this metastases occurring in bone. The most common imaging technique used for screening, diagnosis and follow-up of disease evolution is bone scintigraphy, due to its high sensitivity and widespread availability at nuclear medicine facilities. To date, the assessment of bone scans relies solely on the interpretation of an expert physician who visually assesses the scan. Besides this being a time consuming task, it is also subjective, as there is no absolute criteria neither to identify bone metastases neither to quantify them by a straightforward and universally accepted procedure. In this paper, a new algorithm for the false positives reduction of automatically detected hotspots in bone scintigraphy images is proposed. The motivation relies in the difficulty of building a fully annotated database. In this way, our algorithm is a semisupervised method that works in an iterative way. The ultimate goal is to provide the physician with a fast, precise and reliable tool to quantify bone scans and evaluate disease progression and response to treatment. The algorithm is tested in a set of bone scans manually labeled according to the patient's medical record. The achieved classification sensitivity, specificity and false negative rate were 63%, 58% and 37%, respectively. Comparison with other state-of-the-art classification algorithms shows superiority of the proposed method.
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80
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Prospective comparison of simultaneous [ 68Ga]Ga-PSMA-11 PET/MR versus PET/CT in patients with biochemically recurrent prostate cancer. Eur Radiol 2021; 32:901-911. [PMID: 34374802 DOI: 10.1007/s00330-021-08140-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 05/25/2021] [Accepted: 06/12/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES PSMA-PET has become the PET technique of choice to localise the site of biochemically recurrent prostate cancer (PCa). With hybrid PET/MRI, the advantages of MRI are added to molecular characteristic of PET. The aim of this study was to investigate the incremental value of PET/MR versus PET/CT in patients with biochemically recurrent PCa by head-to-head comparison. METHODS Thirty-four patients with biochemically recurrent PCa were prospectively included. They underwent [68Ga]Ga-PSMA-11 PET/CT, followed by simultaneous PET/MR. All PET (PETCT, PETMR), CT and MR images were evaluated for number of lesions and location. The number of lesions at specific sites was compared using Wilcoxon-sign-rank test. For PET, the maximum and mean standardised uptake values (SUVs) were calculated for each lesion compared using a two-sided paired t test. RESULTS PETCT and PETMR scans were positive in 19 and 20 patients, detecting 73 and 79 lesions respectively. All lesions detected on PETCT were also detected on PETMR. CT and MRI only were positive in 14 and 17 patients, detecting 38 and 50 lesions, respectively, which was significantly lower than PETCT and PETMR respectively. Combined interpretation showed more lesions on PET/MR than on PET/CT (88 vs 81). No significant difference in detection of presence of local recurrence nor distant metastases was found. SUVmean and SUVmax values were significantly higher on PETMR than on PETCT in local recurrence and lymph node metastases. CONCLUSIONS [68Ga]Ga-PSMA-11 PET/MR was able to detect biochemically recurrent PCa at least as accurately as PET/CT for local recurrence, lymph node metastasis and distant metastasis. KEY POINTS • PSMA PET/MRI detects the location of biochemical recurrence at least as accurately as PET/CT. • Substitution of PET/CT by PET/MRI adds sensitivity in PSMA lesion detection also in the setting of distant recurrence due to both the MR and TOF PET components.
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81
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Lange MB, Petersen LJ, Nielsen MB, Zacho HD. Validity of negative bone biopsy in suspicious bone lesions. Acta Radiol Open 2021; 10:20584601211030662. [PMID: 34377541 PMCID: PMC8323434 DOI: 10.1177/20584601211030662] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Background The presence of malignant cells in bone biopsies is considered gold standard to verify occurrence of cancer, whereas a negative bone biopsy can represent a false negative, with a risk of increasing patient morbidity and mortality and creating misleading conclusions in cancer research. However, a paucity of literature documents the validity of negative bone biopsy as an exclusion criterion for the presence of skeletal malignancies. Purpose To investigate the validity of a negative bone biopsy in bone lesions suspicious of malignancy. Material and Method A retrospective cohort of 215 consecutive targeted non-malignant skeletal biopsies from 207 patients (43% women, 57% men, median age 64, and range 94) representing suspicious focal bone lesions, collected from January 1, 2011, to July 31, 2013, was followed over a 2-year period to examine any additional biopsy, imaging, and clinical follow-up information to categorize the original biopsy as truly benign, malignant, or equivocal. Standard deviations and 95% confidence intervals were calculated. Results 210 of 215 biopsies (98%; 95% CI 0.94-0.99) showed to be truly benign 2 years after initial biopsy. Two biopsies were false negatives (1%; 95% CI 0.001-0.03), and three were equivocal (lack of imaging description). Conclusion Our study documents negative bone biopsy as a valid criterion for the absence of bone metastasis. Since only 28% had a confirmed diagnosis of prior cancer and not all patients received adequately sensitive imaging, our results might not be applicable to all cancer patients with suspicious bone lesions.
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Affiliation(s)
- Mine B Lange
- Department of Radiology, Department of Diagnostic Imaging, University Hospital of North Zealand, Hilleroed, Denmark.,Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark
| | - Lars J Petersen
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael B Nielsen
- Department of Radiology, National University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Helle D Zacho
- Department of Nuclear Medicine, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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82
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Keeling GP, Sherin B, Kim J, San Juan B, Grus T, Eykyn TR, Rösch F, Smith GE, Blower PJ, Terry SYA, T M de Rosales R. [ 68Ga]Ga-THP-Pam: A Bisphosphonate PET Tracer with Facile Radiolabeling and Broad Calcium Mineral Affinity. Bioconjug Chem 2021; 32:1276-1289. [PMID: 32786371 PMCID: PMC7611355 DOI: 10.1021/acs.bioconjchem.0c00401] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Calcium minerals such as hydroxyapatite (HAp) can be detected noninvasively in vivo using nuclear imaging agents such as [18F]NaF (available from cyclotrons), for positron emission tomography (PET) and 99mTc-radiolabeled bisphosphonates (BP; available from 99mTc generators for single photon emission computed tomography (SPECT) or scintigraphy). These two types of imaging agents allow detection of bone metastases (based on the presence of HAp) and vascular calcification lesions (that contain HAp and other calcium minerals). With the aim of developing a cyclotron-independent PET radiotracer for these lesions, with broad calcium mineral affinity and simple one-step radiolabeling, we developed [68Ga]Ga-THP-Pam. Radiolabeling with 68Ga is achieved using a mild single-step kit (5 min, room temperature, pH 7) to high radiochemical yield and purity (>95%). NMR studies demonstrate that Ga binds via the THP chelator, leaving the BP free to bind to its biological target. [68Ga]Ga-THP-Pam shows high stability in human serum. The calcium mineral binding of [68Ga]Ga-THP-Pam was compared in vitro to two other 68Ga-BPs which have been successfully evaluated in humans, [68Ga]Ga-NO2APBP and [68Ga]Ga-BPAMD, as well as [18F]NaF. Interestingly, we found that all 68Ga-BPs have a high affinity for a broad range of calcium minerals implicated in vascular calcification disease, while [18F]NaF is selective for HAp. Using healthy young mice as a model of metabolically active growing calcium mineral in vivo, we compared the pharmacokinetics and biodistribution of [68Ga]Ga-THP-Pam with [18F]NaF as well as [68Ga]NO2APBP. These studies revealed that [68Ga]Ga-THP-Pam has high in vivo affinity for bone tissue (high bone/muscle and bone/blood ratios) and fast blood clearance (t1/2 < 10 min) comparable to both [68Ga]NO2APBP and [18F]NaF. Overall, [68Ga]Ga-THP-Pam shows high potential for clinical translation as a cyclotron-independent calcium mineral PET radiotracer, with simple and efficient radiochemistry that can be easily implemented in any radiopharmacy.
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Affiliation(s)
- George P Keeling
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Billie Sherin
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Jana Kim
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Belinda San Juan
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Tilmann Grus
- Department of Nuclear Chemistry, Johannes Gutenberg University Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Thomas R Eykyn
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Frank Rösch
- Department of Nuclear Chemistry, Johannes Gutenberg University Mainz, Fritz-Strassmann-Weg 2, D-55128 Mainz, Germany
| | - Gareth E Smith
- Theragnostics Ltd, 2 Arlington Square, Bracknell, Berkshire RG12 1WA, U.K
| | - Philip J Blower
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Samantha Y A Terry
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
| | - Rafael T M de Rosales
- School of Biomedical Engineering & Imaging Sciences, King's College London, St Thomas' Hospital, London SE1 7EH, U.K
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Fracture Risk of Long Bone Metastases: A Review of Current and New Decision-Making Tools for Prophylactic Surgery. Cancers (Basel) 2021; 13:cancers13153662. [PMID: 34359563 PMCID: PMC8345078 DOI: 10.3390/cancers13153662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/16/2021] [Accepted: 07/18/2021] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Long bone metastases are frequently a pivotal point in the oncological history of patients. Weakening of the bone results in pathologic fractures that not only compromise patient function but also their survival. Therefore, the main issue for tumor boards remains timely assessment of the risk of fracture, as this is a key consideration in providing preventive surgery while also avoiding overtreatment. As the Mirels scoring system takes into account both the radiological and the clinical criteria, it has been used worldwide since the 1990s. However, due to increasing concern regarding the lack of accuracy, new thresholds have been defined for the identification of impending fractures that require prophylactic surgery, on the basis of axial cortical involvement and biomechanical models involving quantitative computed tomography. The aim of this review is to establish a state-of-the-art of the risk assessment of long bone metastases fractures, from simple radiologic scores to more complex multidimensional bone models, in order to define new decision-making tools. Abstract Long bone pathological fractures very much reflect bone metastases morbidity in many types of cancer. Bearing in mind that they not only compromise patient function but also survival, identifying impending fractures before the actual event is one of the main concerns for tumor boards. Indeed, timely prophylactic surgery has been demonstrated to increase patient quality of life as well as survival. However, early surgery for long bone metastases remains controversial as the current fracture risk assessment tools lack accuracy. This review first focuses on the gold standard Mirels rating system. It then explores other unique imaging thresholds such as axial or circumferential cortical involvement and the merits of nuclear imaging tools. To overcome the lack of specificity, other fracture prediction strategies have focused on biomechanical models based on quantitative computed tomography (CT): computed tomography rigidity analysis (CT-RA) and finite element analysis (CT-FEA). Despite their higher specificities in impending fracture assessment, their limited availability, along with a need for standardization, have limited their use in everyday practice. Currently, the prediction of long bone pathologic fractures is a multifactorial process. In this regard, machine learning could potentially be of value by taking into account clinical survival prediction as well as clinical and improved CT-RA/FEA data.
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84
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Automatic Diagnosis of Coronary Artery Disease in SPECT Myocardial Perfusion Imaging Employing Deep Learning. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11146362] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Focusing on coronary artery disease (CAD) patients, this research paper addresses the problem of automatic diagnosis of ischemia or infarction using single-photon emission computed tomography (SPECT) (Siemens Symbia S Series) myocardial perfusion imaging (MPI) scans and investigates the capabilities of deep learning and convolutional neural networks. Considering the wide applicability of deep learning in medical image classification, a robust CNN model whose architecture was previously determined in nuclear image analysis is introduced to recognize myocardial perfusion images by extracting the insightful features of an image and use them to classify it correctly. In addition, a deep learning classification approach using transfer learning is implemented to classify cardiovascular images as normal or abnormal (ischemia or infarction) from SPECT MPI scans. The present work is differentiated from other studies in nuclear cardiology as it utilizes SPECT MPI images. To address the two-class classification problem of CAD diagnosis, achieving adequate accuracy, simple, fast and efficient CNN architectures were built based on a CNN exploration process. They were then employed to identify the category of CAD diagnosis, presenting its generalization capabilities. The results revealed that the applied methods are sufficiently accurate and able to differentiate the infarction or ischemia from healthy patients (overall classification accuracy = 93.47% ± 2.81%, AUC score = 0.936). To strengthen the findings of this study, the proposed deep learning approaches were compared with other popular state-of-the-art CNN architectures for the specific dataset. The prediction results show the efficacy of new deep learning architecture applied for CAD diagnosis using SPECT MPI scans over the existing ones in nuclear medicine.
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85
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Afkari H, Makrufardi F, Hidayat B, Budiawan H, Sundawa Kartamihardja AH. Correlation between ER, PR, HER-2, and Ki-67 with the risk of bone metastases detected by bone scintigraphy in breast cancer patients: A cross sectional study. Ann Med Surg (Lond) 2021; 67:102532. [PMID: 34257962 PMCID: PMC8256177 DOI: 10.1016/j.amsu.2021.102532] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/24/2021] [Accepted: 06/27/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers in women. About 30%-85% of breast cancers will metastasize to the bone during the course of the illness. Many studies have shown that molecular marker/subtypes can be useful in determining incidence of different and inconsistent bone metastases. This study aimed to determine the correlation of the risk of bone metastases in breast cancer based on the expression of molecular markers. METHODS The research was conducted retrospectively by searching patients' medical record data. The target population of this study was all patients diagnosed with breast cancer who came to our tertiary hospital in the Nuclear Medicine and Molecular Imaging Department from January 2012 to December 2016. RESULTS One hundred and thirty patients (n = 130) were enrolled during the study period with characteristics of sex, age, and immunohistochemical/molecular subtype examination that underwent bone scintigraphy. Mean of age was 50.2 (23-79) years. There were no significant correlations between ER, PR, and HER-2 expressions with bone metastases in breast cancer patients. Ki-67 was showed to be correlated with bone metastases in breast cancer patients in our bivariate analysis. Molecular subtype/markers had no statistically significant correlation with bone metastases in patients with breast cancer. CONCLUSION Ki-67 with high proliferation index was the most powerful molecular marker to determine the risk of bone metastases. The prevalence of bone metastases in the group with Ki-67 expression with high proliferation (≥20) was 1.8 times greater than the prevalence of bone metastases in the weakest HER-2 group.
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Affiliation(s)
- Hanif Afkari
- Nuclear Medicine and Molecular Imaging Division, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Firdian Makrufardi
- Nuclear Medicine and Molecular Imaging Division, Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital, Yogyakarta, Indonesia
| | - Basuki Hidayat
- Department of Nuclear Medicine and Molecular Imaging, Universitas Padjajaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Hendra Budiawan
- Department of Nuclear Medicine and Molecular Imaging, Universitas Padjajaran/Dr. Hasan Sadikin General Hospital, Bandung, Indonesia
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Kabunda J, Gabela L, Kalinda C, Aldous C, Pillay V, Nyakale N. Comparing 99mTc-PSMA to 99mTc-MDP in Prostate Cancer Staging of the Skeletal System. Clin Nucl Med 2021; 46:562-568. [PMID: 34028421 PMCID: PMC8174142 DOI: 10.1097/rlu.0000000000003702] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/23/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This prospective study was aimed at assessing the ability of 99mTc-PSMA scan to detect bone metastases in prostate cancer (PCa) against 99mTc-MDP scan as a standard and assess the correlation of these modalities in PCa staging of bone involvement. PATIENTS AND METHODS Forty-one patients (41) with histologically confirmed PCa were scanned using both methods. Planar imaging was performed with additional regional SPECT/CT 3 to 4 hours posttracer injection. Scans were reported as positive, negative, or equivocal. In the case of positive scans, lesions were quantified by each of the 3 reporters separately. Planar and SPECT/CT images were reported together to obtain the final report on each scan. RESULTS Our preliminary results showed no significant difference in the detection of bone metastases between the 2 scans. 99mTc-PSMA detected 52 of the 55 bone lesions detected on 99mTc-MDP. However, 99mTc-PSMA provided extra information by reporting lymph nodal metastases in 7 patients and residual disease in the prostate in 2 patients with biochemical progression after radical therapy. In 1 patient, the PSMA scan resulted in change in management with patient now on 177Lu-PSMA radioligand therapy. Equivocal findings were reported in 4 patients on 99mTc-MDP and none on 99mTc-PSMA. CONCLUSIONS 99mTc-PSMA was comparable to 99mTc-MDP in detection of bone metastases and demonstrated an additional benefit of providing information on visceral disease. 99mTc-PSMA may be a better alternative to 99mTc-MDP in staging, restaging, and assessment of patients with biochemical progression after radical therapy of PCa in a resource-limited setup like ours while also assisting to detect patients eligible for PSMA-labeled radioligand therapy.
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Affiliation(s)
- Joseph Kabunda
- From the University of KwaZulu-Natal, Durban, South Africa
| | - Lerato Gabela
- From the University of KwaZulu-Natal, Durban, South Africa
| | | | - Colleen Aldous
- From the University of KwaZulu-Natal, Durban, South Africa
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87
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Pirasteh A, Lovrec P, Pedrosa I. Imaging and its Impact on Defining the Oligometastatic State. Semin Radiat Oncol 2021; 31:186-199. [PMID: 34090645 DOI: 10.1016/j.semradonc.2021.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Successful treatment of oligometastatic disease (OMD) is facilitated through timely detection and localization of disease, both at the time of initial diagnosis (synchronous OMD) and following the initial therapy (metachronous OMD). Hence, imaging plays an indispensable role in management of patients with OMD. However, the challenges and complexities of OMD management are also reflected in the imaging of this entity. While innovations and advances in imaging technology have made a tremendous impact in disease detection and management, there remain substantial and unaddressed challenges for earlier and more accurate establishment of OMD state. This review will provide an overview of the available imaging modalities and their inherent strengths and weaknesses, with a focus on their role and potential in detection and evaluation of OMD in different organ systems. Furthermore, we will review the role of imaging in evaluation of OMD for malignancies of various primary organs, such as the lung, prostate, colon/rectum, breast, kidney, as well as neuroendocrine tumors and gynecologic malignancies. We aim to provide a practical overview about the utilization of imaging for clinicians who play a role in the care of those with, or at risk for OMD.
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Affiliation(s)
- Ali Pirasteh
- Departments of Radiology and Medical Physics, University of Wisconsin-Madison, Madison, WI
| | - Petra Lovrec
- Department of Radiology, University of Wisconsin-Madison, Madison, WI
| | - Ivan Pedrosa
- Departments of Radiology, Urology, and Advanced Imaging Research Center. University of Texas Southwestern, Dallas, TX.
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88
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Recent advances in the targeted fluorescent probes for the detection of metastatic bone cancer. Sci China Chem 2021. [DOI: 10.1007/s11426-021-9990-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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89
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Staging Investigations in Asymptomatic Early Breast Cancer Patients at the Cancer Centre of Southeastern Ontario. ACTA ACUST UNITED AC 2021; 28:2190-2198. [PMID: 34204717 PMCID: PMC8293210 DOI: 10.3390/curroncol28030203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/17/2022]
Abstract
Background: In 2012, the American Society for Clinical Oncology (ASCO) identified five key opportunities in oncology to improve patient care, recommending against imaging tests for the staging of patients with early breast cancer (EBC) at low risk for metastases. Similarly, the European Society of Medical Oncology (ESMO) guideline does not support radiological staging in asymptomatic EBC (aEBC). The purpose of this study was to assess local practice and outcomes of staging investigations (SIs) in aEBC at the Cancer Centre of Southeastern Ontario (CCSEO). Methods: A retrospective electronic and paper chart review was undertaken to identify all aEBC patients treated at our institution between January 2012 and December 2014. Patients with pathological staging of T1-T2 and N0-1 with any receptor status were included. We collected patient demographics, treatment and pathologic tumor characteristics. The use and outcomes of initial and follow-up SIs were recorded. Data were analyzed to determine associations between the use of SIs and clinical characteristics (chi-square tests, independent samples t-tests and Mann–Whitney U tests). Results: From 2012 to 2014, 295 asymptomatic EBC patients were identified. The mean age was 64, 81% were postmenopausal and 76% had breast conserving surgery. Stage distribution was as follows: stage I 42%, stage IIA 37% and stage IIB 21%. Receptor status was as follows: ER+ 84%, HER2+ 13% and triple negative 12%. Adjuvant chemotherapy was received by 36%, Trastuzumab by 10% and endocrine therapy by 76% of patients. Baseline SIs were performed in 168 patients (57%) for a total of 332 tests. Overt metastatic disease was found in five patients (one bone scan and four CT scans). Seventy-one out of the 168 patients (42%) who received initial staging imaging underwent 138 follow-up imaging tests, none of which were diagnostic for metastases. Nine patients with suspicious CT findings underwent biopsies, of which four were malignant (one metastatic breast cancer and three new primaries). Factors significantly associated with SI were as follows: younger age (p = 0.001), premenopausal status (p = 0.01), T2 stage (p < 0.001), N1 stage (p < 0.001), HER2 positive (p < 0.001), triple negative status (p = 0.007) and use of adjuvant chemotherapy (p < 0.001). Conclusions: Over a 3-year period at our institution, more than 50% of aEBC patients underwent a total of 470 initial and follow-up staging tests, yielding a cancer diagnosis (metastatic breast cancer or second primary cancer) in four patients. We, therefore, conclude that routine-staging investigations in aEBC patients have low diagnostic value, supporting current guidelines that recommend against the routine use of SI in this population.
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90
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Ariyasu R, Uchibori K, Sasaki T, Tsukahara M, Kiyotani K, Yoshida R, Ono Y, Kitazono S, Ninomiya H, Ishikawa Y, Mizukami Y, Yanagitani N, Fujita N, Nishio M, Katayama R. Monitoring epidermal growth factor receptor C797S mutation in Japanese non-small cell lung cancer patients with serial cell-free DNA evaluation using digital droplet PCR. Cancer Sci 2021; 112:2371-2380. [PMID: 33686722 PMCID: PMC8177776 DOI: 10.1111/cas.14879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/13/2021] [Accepted: 03/07/2021] [Indexed: 12/25/2022] Open
Abstract
Osimertinib is a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI) that is effective in treating both naïve and T790M-mutated EGFR-TKI-resistant non-small cell lung cancer patients. The EGFR C797S mutation is the major osimertinib resistance mechanism. The present study monitored the EGFR C797S mutation during osimertinib treatment in Japanese patients using droplet digital PCR (ddPCR). In our first cohort, C797S detection was validated with tumor specimens and/or plasma samples from 26 patients using ddPCR with custom-designed probes detecting and discriminating T790M and C797S in cis and trans positions. In our second cohort, 18 patients with EGFR-T790M who were going to start osimertinib were analyzed using ddPCR by collecting the plasma samples every month from the beginning of the course of osimertinib. In the first cohort, C797S was detected in 15.4% of patients. C797S and T790M in cis and trans positions were distinguished using ddPCR. In the second cohort, serial cfDNA evaluation revealed that the rate of EGFR mutation changes with disease state. Increases of EGFR mutation were detected, including C797S several months before the diagnosis of disease progression. As with the first cohort, C797S and T790M in cis and trans position were distinguished by ddPCR at disease progression. Coincidentally, in the first cohort, next generation sequencing detected NRAS Q61K mutation and the resistance with NRAS Q61K mutation was overcome by trametinib. In the second cohort, serial cfDNA analysis was useful for evaluating bone oligo-progression and local radiation therapy.
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Affiliation(s)
- Ryo Ariyasu
- Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
- Department of Thoracic Medical OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Ken Uchibori
- Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
- Department of Thoracic Medical OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Takaaki Sasaki
- Respiratory CenterAsahikawa Medical University HospitalAsahikawaJapan
| | - Mika Tsukahara
- Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Kazuma Kiyotani
- Immunopharmacogenomics GroupCancer Precision Medicine CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Ryohei Yoshida
- Respiratory CenterAsahikawa Medical University HospitalAsahikawaJapan
| | - Yusuke Ono
- Institute of Biomedical ResearchSapporo Higashi Tokushukai HospitalSapporoJapan
| | - Satoru Kitazono
- Department of Thoracic Medical OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Hironori Ninomiya
- Division of PathologyCancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yuichi Ishikawa
- Division of PathologyCancer InstituteJapanese Foundation for Cancer ResearchTokyoJapan
| | - Yusuke Mizukami
- Institute of Biomedical ResearchSapporo Higashi Tokushukai HospitalSapporoJapan
| | - Noriko Yanagitani
- Department of Thoracic Medical OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Naoya Fujita
- Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
| | - Makoto Nishio
- Department of Thoracic Medical OncologyThe Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyoJapan
| | - Ryohei Katayama
- Cancer Chemotherapy CenterJapanese Foundation for Cancer ResearchTokyoJapan
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91
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Mitchell PD, Dittmar JM, Mulder B, Inskip S, Littlewood A, Cessford C, Robb JE. The prevalence of cancer in Britain before industrialization. Cancer 2021; 127:3054-3059. [PMID: 33942897 DOI: 10.1002/cncr.33615] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND To plan for cancer services in the future, the long view of cancer prevalence is essential. It might be suspected that cancer prevalence before tobacco and industrial revolution pollutants was quite different to today. METHODS To quantify the degree to which cancer prevalence may be changing over time, the authors analyzed 143 skeletons from 6 cemeteries from the Cambridge area (6th-16th centuries). Visual inspection coupled with screening using both plain radiographs and computed tomography scans was used to detect malignant lesions. RESULTS A total of 3.5% of individuals showed evidence for metastases. Factoring in modern data for the proportion of those with cancer that die with bone metastases, this suggests a minimum prevalence of all cancers at the time of death in medieval Britain to be approximately 9% to 14% of adults. CONCLUSIONS This figure compares with a 40% to 50% prevalence of cancer at the time of death for modern Britain. The difference may be explained by the effects of modern carcinogens, the spread of viruses that trigger malignancy, industrial pollutants, and longer life expectancy. LAY SUMMARY Until now, no one has been able to work out how common cancer was before the time people were exposed to tumor-inducing chemicals from tobacco and industrial factories. In this novel study, the authors have determined the percentage of people living in medieval Britain who had cancer metastases to bone at the time of their death and then compared that with modern data. It was found that cancer was approximately 25% as common in medieval times as it is today. This article suggests cancer was much more widespread in medieval times than was previously realized.
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Affiliation(s)
- Piers D Mitchell
- Department of Archaeology, University of Cambridge, Cambridge, United Kingdom
| | - Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, United Kingdom
| | - Bram Mulder
- Department of Archaeology, University of Cambridge, Cambridge, United Kingdom
| | - Sarah Inskip
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, United Kingdom
| | - Alastair Littlewood
- Department of Radiology, Peterborough City Hospital, Peterborough, United Kingdom
| | - Craig Cessford
- McDonald Institute for Archaeological Research, University of Cambridge, Cambridge, United Kingdom.,Cambridge Archaeological Unit, University of Cambridge, Cambridge, United Kingdom
| | - John E Robb
- Department of Archaeology, University of Cambridge, Cambridge, United Kingdom
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92
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Gonzalez-Galofre ZN, Alcaide-Corral CJ, Tavares AAS. Effects of administration route on uptake kinetics of 18F-sodium fluoride positron emission tomography in mice. Sci Rep 2021; 11:5512. [PMID: 33750874 PMCID: PMC7970902 DOI: 10.1038/s41598-021-85073-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/19/2021] [Indexed: 12/01/2022] Open
Abstract
18F-sodium fluoride (18F-NaF) is a positron emission tomography (PET) radiotracer widely used in skeletal imaging and has also been proposed as a biomarker of active calcification in atherosclerosis. Like most PET radiotracers, 18F-NaF is typically administered intravenously. However in small animal research intravenous administrations can be challenging, because partial paravenous injection is common due to the small calibre of the superficial tail veins and repeat administrations via tail veins can lead to tissue injury therefore limiting the total number of longitudinal scanning points. In this paper, the feasibility of using intra-peritoneal route of injection of 8F-NaF to study calcification in mice was studied by looking at the kinetic and uptake profiles of normal soft tissues and bones versus intra-vascular injections. Dynamic PET was performed for 60 min on nineteen isoflurane-anesthetized male Swiss mice after femoral artery (n = 7), femoral vein (n = 6) or intraperitoneal (n = 6) injection of 8F-NaF. PET data were reconstructed and the standardised uptake value (SUV) and standardised uptake value ratio (SUVr) were estimated from the last three frames between 45- and 60-min and 8F-NaF uptake constant (Ki) was derived by Patlak graphical analysis. In soft tissue, the 18F-NaF perfusion phase changes depending on the type on injection route, whereas the uptake phase is similar regardless of the administration route. In bone tissue SUV, SUVr and Ki measures were not significantly different between the three administration routes. Comparison between PET and CT measures showed that bones that had the highest CT density displayed the lowest PET activity and conversely, bones where CT units were low had high 8F-NaF uptake. Intraperitoneal injection is a valid and practical alternative to the intra-vascular injections in small-animal 18F-NaF PET imaging providing equivalent pharmacokinetic data. CT outcome measures report on sites of stablished calcification whereas PET measures sites of higher complexity and active calcification.
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Affiliation(s)
- Zaniah N Gonzalez-Galofre
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute (QMRI), Little France Campus, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Edinburgh Imaging, University of Edinburgh, Little France Campus, Edinburgh, EH16 4TJ, UK
| | - Carlos J Alcaide-Corral
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute (QMRI), Little France Campus, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.,Edinburgh Imaging, University of Edinburgh, Little France Campus, Edinburgh, EH16 4TJ, UK
| | - Adriana A S Tavares
- British Heart Foundation/University of Edinburgh Centre for Cardiovascular Science, Queen's Medical Research Institute (QMRI), Little France Campus, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK. .,Edinburgh Imaging, University of Edinburgh, Little France Campus, Edinburgh, EH16 4TJ, UK.
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93
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Bhoriwal S, Deo SVS, Kumar R, Thulkar S, Gogia A, Sharma DN, Mathur S. A Prospective Study Comparing the Role of 18 FDG PET-CT with Contrast-Enhanced Computed Tomography and Tc99m Bone Scan for Staging Locally Advanced Breast Cancer. Indian J Surg Oncol 2021; 12:266-271. [PMID: 34295069 DOI: 10.1007/s13193-021-01299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/24/2021] [Indexed: 11/27/2022] Open
Abstract
Locally advanced breast cancer (LABC) patients require an accurate staging of the disease to rule out distant metastases. Various imaging investigations are used to stage LABC patients. The present study is a prospective comparison of conventional imaging (CI) with fusion positron-emission tomography and computed tomography (PET-CT) scans in the staging of LABC patients. Seventy-three consecutive LABC patients presenting to the breast cancer clinic of the tertiary care cancer institute were included in the study. All patients underwent contrast-enhanced computed tomography, Tv99m bone scintigraphy, and fusion PET-CT. Histology of the metastatic site was confirmed wherever possible. The disparity between the two imaging findings was compared. Doubtful lesions were observed clinically for at least 2 years to confirm their nature. PET-CT detected a higher number of lymph nodes in the axilla, internal mammary, and supraclavicular region as compared to CI. PET-CT upstaged 36.98% and downstaged 5.4% of the patients respectively leading to a change in the management in 30.13% of the patients. Sensitivity, specificity, positive predictive value, and negative predictive value of CI and PET-CT were 71.87%, 87.80%, 82.14%, and 80%, and 90.90%, 90%, 88.23%, and 92.30% respectively. PET-CT was more accurate in staging the LABC patients as compared to CI. PET-CT is more accurate then contrast-enhanced CT and bone scintigraphy for staging locally advanced breast carcinoma patients. It can replace multiple organ-directed imaging in staging breast cancer. It can provide accurate staging of the disease so that patients can be prognosticated and can be directed to the most appropriate treatment plans.
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Affiliation(s)
- Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Science, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Science, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Science, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Science, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Science, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Science, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
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94
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Phelps TE, Roy J, Green MV, Seidel J, Baidoo KE, Adler S, Edmondson EF, Butcher D, Matta JL, Ton AT, Wong K, Huang S, Ren L, LeBlanc AK, Choyke PL, Jagoda EM. Sodium Fluoride-18 and Radium-223 Dichloride Uptake Colocalize in Osteoblastic Mouse Xenograft Tumors. Cancer Biother Radiopharm 2021; 36:133-142. [PMID: 33646017 DOI: 10.1089/cbr.2020.4068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: Patients with osteoblastic bone metastases are candidates for radium-223 (223RaCl2) therapy and may undergo sodium fluoride-18 (18F-NaF) positron emission tomography-computed tomography imaging to identify bone lesions. 18F-NaF has been shown to predict 223RaCl2 uptake, but intratumor distributions of these two agents remain unclear. In this study, the authors evaluate the spatial distribution and relative uptakes of 18F-NaF and 223RaCl2 in Hu09-H3 human osteosarcoma mouse xenograft tumors at macroscopic and microscopic levels to better quantify their correlation. Materials and Methods: 18F-NaF and 223RaCl2 were co-injected into Hu09-H3 xenograft tumor severe combined immunodeficient mice. Tumor content was determined from in vivo biodistributions and visualized by PET, single photon emission computed tomography, and CT imaging. Intratumor distributions were visualized by quantitative autoradiography of tumor tissue sections and compared to histology of the same or adjacent sections. Results: 18F and 223Ra accumulated in proportional amounts in whole Hu09-H3 tumors (r2 = 0.82) and in microcalcified regions within these tumors (r2 = 0.87). Intratumor distributions of 18F and 223Ra were spatially congruent in these microcalcified regions. Conclusions: 18F-NaF and 223RaCl2 uptake are strongly correlated in heterogeneously distributed microcalcified regions of Hu09-H3 xenograft tumors, and thus, tumor accumulation of 18F is predictive of 223Ra accumulation. Hu09-H3 xenograft tumors appear to possess certain histopathological features found in patients with metastatic bone disease and may be useful in clarifying the relationship between administered 223Ra dose and therapeutic effect.
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Affiliation(s)
- Tim E Phelps
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jyoti Roy
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Michael V Green
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Jurgen Seidel
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA.,Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Kwamena E Baidoo
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Stephen Adler
- Clinical Research Directorate, Frederick National Laboratory for Cancer Research sponsored by the National Cancer Institute, Bethesda, Maryland, USA
| | - Elijah F Edmondson
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Donna Butcher
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Jennifer L Matta
- Molecular Histopathology Laboratory, Frederick National Laboratory for Cancer Research, NCI, Frederick, Maryland, USA
| | - Anita T Ton
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Karen Wong
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Shan Huang
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Ling Ren
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Amy K LeBlanc
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Peter L Choyke
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Elaine M Jagoda
- Molecular Imaging Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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95
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Crooks C, Randall E, Griffin L. The use of fluorine-18-fluorodeoxyglucose-positron emission tomography/computed tomography as an effective method for staging in dogs with primary appendicular osteosarcoma. Vet Radiol Ultrasound 2021; 62:350-359. [PMID: 33629412 DOI: 10.1111/vru.12959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/16/2020] [Accepted: 12/16/2020] [Indexed: 11/29/2022] Open
Abstract
Fluorine-18-fluorodeoxyglucose (18 F-FDG) positron emission tomography/computed tomography (PET/CT) has been utilized in veterinary medicine to improve the detection and characterization of primary, recurrent, and secondary neoplasms; but its use as a staging tool for dogs diagnosed with appendicular osteosarcoma has not been published. The purpose of this retrospective, case series, descriptive study was to detail the use of 18 F-FDG PET/CT for staging a population of dogs with appendicular osteosarcoma, report the detection rate of secondary neoplastic lesions, and compare findings with published detection rates for other historically used imaging modalities. Seventy-one client-owned dogs with a confirmed diagnosis of appendicular osteosarcoma and staged with a whole-body 18 F-FDG PET/CT scan near the time of initial diagnosis were included. Each PET/CT study was re-evaluated for malignancy distinct from the primary disease entity based on a collective qualitative and quantitative assessment of 18 F-FDG uptake, CT appearance, and contrast enhancement characteristics. Following re-evaluation of each study, information pertaining to tissue sampling performed on identified lesions was retrieved from the medical record when available. Staging with 18 F-FDG PET/CT identified 17 of 71 (23.9%) and 12 of 71 (16.3%) dogs with a high suspicion or confirmation of a metastatic or comorbid malignant neoplasm respectively, with eight of 71 (11.3%) having both metastatic and comorbid lesions. The results of this study are suggestive that 18 F-FDG PET/CT is effective in identifying both osseous and soft tissue secondary neoplastic lesions in dogs afflicted with appendicular osteosarcoma, yielding an increased detection rate of all lesions compared those previously reported for skeletal scintigraphy or whole-body CT.
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Affiliation(s)
- Clifton Crooks
- Department of Environmental and Radiological Health Sciences (ERHS), Colorado State University, Fort Collins, Colorado, USA
| | - Elissa Randall
- Department of Environmental and Radiological Health Sciences (ERHS), Colorado State University, Fort Collins, Colorado, USA
| | - Lynn Griffin
- Department of Environmental and Radiological Health Sciences (ERHS), Colorado State University, Fort Collins, Colorado, USA
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96
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Mínguez P, Rodeño E, Fernández I, Esteban A, Martínez-Indart L, Gómez de Iturriaga A. A retrospective study on the potential of 99m Tc-HDP imaging before therapy for individualizing treatments with 223 Ra-Cl 2 for metastatic castration resistant prostate cancer. Med Phys 2021; 48:1395-1403. [PMID: 33372286 DOI: 10.1002/mp.14683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 12/02/2020] [Accepted: 12/17/2020] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Research on dose-effect correlation is necessary to move toward an individualization of treatments of metastatic castration resistant prostate cancer (mCRPC) with 223 Ra-Cl2 . We first looked for a possible correlation of 99m Tc-HDP lesion uptake in pretreatment whole-body scans (WBSs) with lesion absorbed dose. Moreover, we looked for a possible correlation of 99m Tc-HDP lesion uptake in pretreatment WBSs and of lesion absorbed dose with relative change in the 99m Tc-HDP lesion uptake obtained from pre- and post-treatment WBSs in patients treated for mCRPC with six cycles of 223 Ra-Cl2 . METHODS Eleven patients received six cycles of 55 kBq/kg of 223 Ra-Cl2 separated by 4 weeks. In addition, one patient received concomitant treatment with abiraterone and two patients with enzalutamide. The 99m Tc-HDP WBSs were acquired before the first cycle and after the sixth cycle of the treatment. For the lesions with the higher 99m Tc-HDP uptake, the absorbed dose was calculated for the first cycle. Lesion volume was determined from 99m Tc-HDP SPECT/CT images before the first cycle and 223 Ra-Cl2 activity in the lesions was determined from 223 Ra-Cl2 planar images after the first cycle. The effect of the treatment was evaluated from the relative change of the mean and the maximum counts in the lesions, both estimated from the WBSs acquired before the first cycle and after the sixth cycle. RESULTS The absorbed dose was calculated for 30 lesions, with values ranging between 0.4 and 3.8 Gy (mean 1.5 Gy). A significant (P < 0.05) high positive linear correlation was found between the lesion absorbed dose in the first treatment cycle and the mean and maximum counts in the lesions in the WBSs acquired before the first cycle (R = 0.75 and 0.76, respectively). The relative change of the mean and the maximum counts in the lesions in the 99m Tc-HDP WBSs showed a significant (P < 0.05) high positive logarithmic correlation with the 99m Tc-HDP mean and maximum counts in the lesions before the first cycle (R = 0.79 and 0.78, respectively). Lastly, a significant (P < 0.05) high positive logarithmic correlation was also found between the relative change of the mean and the maximum counts in the lesions in the 99m Tc-HDP WBSs and the lesion absorbed dose (R = 0.86 and 0.85, respectively). For this correlation the influence of the administered activity and of the concomitant treatments was not found to be significant (P > 0.05). CONCLUSIONS The high correlations found for the 99m Tc-HDP lesion uptake before the first cycle lesion with the relative change in the 99m Tc-HDP lesion uptake after the six cycles of 223 Ra-Cl2 , and with the lesion absorbed dose in the first cycle show the potential of pretreatment 99m Tc-HDP imaging in order to personalize the performance of these treatments.
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Affiliation(s)
- Pablo Mínguez
- Department of Medical Physics and Radiation Protection, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain.,Department of Applied Physics I, Faculty of Engineering, UPV/EHU, Bilbao, 48013, Spain
| | - Emilia Rodeño
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain.,Department of Surgery, Radiology and Surgical Medicine, Faculty of Medicine, UPV/EHU, Baralkaldo, 48903, Spain
| | - Irache Fernández
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain.,Department of Surgery, Radiology and Surgical Medicine, Faculty of Medicine, UPV/EHU, Baralkaldo, 48903, Spain
| | - Alba Esteban
- Department of Nuclear Medicine, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain
| | - Lorea Martínez-Indart
- Department of Bioinformatics and Statistics, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain
| | - Alfonso Gómez de Iturriaga
- Department of Surgery, Radiology and Surgical Medicine, Faculty of Medicine, UPV/EHU, Baralkaldo, 48903, Spain.,Department of Radiation Oncology, Gurutzeta-Cruces University Hospital/Biocruces Health Research Institute, Barakaldo, 48903, Spain
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Hong L, Cristiano L, Peters E, Ioffe Y. Detection of bone metastases in uterine cancer: How common are they and should PET/CT be the standard for diagnosis? Gynecol Oncol Rep 2021; 35:100698. [PMID: 33521220 PMCID: PMC7820478 DOI: 10.1016/j.gore.2021.100698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/19/2020] [Accepted: 01/01/2021] [Indexed: 12/01/2022] Open
Abstract
Osseous metastasis (OM) were found in 5% of endometrial cancers (EMCA), with predilection for type II histologies. Patients with serous EMCA had significantly higher odds of developing OM when compared to all other histologies. PET/CT appeared superior to conventional CT scans in diagnosing OM.
Objectives Osseous metastases (OM) in endometrial cancer (EMCA) are thought to be rare. This study aimed to address the gap in present knowledge by defining the rate of OM in endometrial cancer (EMCA) as stratified by histology and ascertaining the best diagnostic modality for detection. Methods 435 consecutive cases of EMCA evaluated in tertiary care setting were reviewed. Clinico-pathologic data were abstracted and analyzed. Results 18/403 patients were found to have OM (4.6%). Majority were detected by PET/CT (13/18 (72%)), with conventional CT scans missing the diagnoses otherwise made by PET/CT scans in 2/9 patients. Patients with type II EMCA were at higher risk of developing OM compared with patients with type I EMCA; 2/234 patients with type I EMCA (0.85%) developed OM, as compared to 16/167 patients with type II EMCA (9.58%), OR = 12.3. Patients with serous histology had significantly higher odds of developing OM when compared to patients with non-serous histologies (OR 4, p = 0.001, 95% CI 1.54 to 10.76). Kaplan Myer survival function and log-rank analysis showed that the presence of OM was a significant negative prognosticator of survival, with median overall survival (mOS) of 16 months in OM patients vs. mOS undefined in non-OM patients (p < 0.0001). Discussion Incidence of detected OM was clinically significant, with most cases identified by PET/CT scans. Patients with type II EMCA, and in particular serous histology, were at a significantly higher risk of developing OM. OM when present, is an indicator of aggressive cancer biology and poor prognosis. Further studies are needed to ascertain the mechanism of predisposition to OM formation in serous EMCA and to confirm PET/CT as modality of choice for detection of OM.
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Affiliation(s)
- Linda Hong
- Department of Gynecology and Obstetrics, Division of Gynecologic Oncology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Laurin Cristiano
- Department of Gynecology and Obstetrics, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Eric Peters
- Department of Radiology, Loma Linda University School of Medicine, Loma Linda, CA, USA
| | - Yevgeniya Ioffe
- Department of Gynecology & Obstetrics, Loma Linda University School of Medicine, 11175 Campus Street, Coleman Pavilion, Room 11105, Loma Linda, CA 92350, USA
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Manohar PR, Rather TA, Khan SH. Determination of the optimal cut-off value of serum prostate-specific antigen in the prediction of skeletal metastases on technetium-99m whole-body bone scan by receiver operating characteristic curve analysis. World J Nucl Med 2020; 19:255-259. [PMID: 33354181 PMCID: PMC7745856 DOI: 10.4103/wjnm.wjnm_77_19] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 02/10/2020] [Indexed: 12/24/2022] Open
Abstract
Radionuclide whole-body bone scan is a useful investigation of choice to detect the skeletal metastases in prostate cancer. It is indicated in patients having elevated serum prostate-specific antigen (Sr. PSA) or patients with bone pain. Elevated Sr. PSA levels have high predictive value for skeletal metastases; however, there is no consensus regarding cut-off value of Sr. PSA above which bone scan is indicated. This study was performed to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with high sensitivity and specificity in the prediction of skeletal metastases on bone scan in prostate cancer patients. A retrospective analysis of medical records of 307 prostate cancer patients referred to the department of nuclear medicine for bone scan between June 2009 and June 2014 was done. Of 307 patients, 15 cases were excluded due to nonavailability of Sr. PSA. Bone scan was performed 3 h after administration of 20 mCi Tc-99m methylene diphosphonate intravenously. Whole-body sweep imaging was performed and spot views were taken wherever required. Of 292 cases, 174 (59.58%) patients had positive bone scan for metastases and 118 (40.41%) patients had negative bone scan for metastases. Maximum and minimum Sr. PSA levels in positive and negative bone scan patients were 1260 and 0.02 ng/ml and 198.34 ng/ml and 0.01 ng/ml, respectively. On comparison of the mean Sr. PSA levels between positive and negative groups, we found significant Sr. PSA levels (P < 0.05). We used receiver operating characteristic (ROC) curve analyses to find out the accuracy of Sr. PSA test and to know the optimal cut-off value of Sr. PSA with maximum sensitivity and specificity in the prediction of skeletal metastases on bone scan. Area under ROC curve was 0.878 (87%). This indicates that the accuracy of Sr. PSA test in the prediction of skeletal metastases on bone scan was good. The optimal cut-off value of Sr. PSA in the prediction of positive bone scan for skeletal metastases in the management of prostate cancer was 29.16 ng/ml, with sensitivity and specificity of 89.0% and 74.6%, respectively. In this study, we conclude that the accuracy of Sr. PSA test in the prediction of skeletal metastases is good. ROC-derived optimal cut-off value of Sr. PSA for positive skeletal metastases on bone scan is >29.16 ng/ml; thus, the chances of getting positive bone scan for skeletal metastasis are less in prostate cancer patients with Sr. PSA <29.16 ng/ml. ROC-derived sensitivity and specificity of different possible cut-off points of Sr. PSA help reduce the false positive results and increase the diagnostic accuracy of bone scan in the detection of skeletal metastases in prostate cancer patients.
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Affiliation(s)
- P Ram Manohar
- Department of Nuclear Medicine, SKIMS, Srinagar, Jammu and Kashmir, India
| | | | - Shoukat H Khan
- Department of Nuclear Medicine, SKIMS, Srinagar, Jammu and Kashmir, India
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Nam SY, Ahn SJ, Jang YR, Chun YS, Park HK, Choi SJ, Choi HY, Kim JH. Diagnostic accuracy of non-contrast abdominopelvic computed tomography scans in follow-up of breast cancer patients. Br J Radiol 2020; 94:20201087. [PMID: 33306919 DOI: 10.1259/bjr.20201087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of follow-up with non-enhanced CT (NECT) in patients with breast cancer. METHODS The present retrospective study included 1396 patients with breast cancer. Group A included patients with no metastasis to evaluate the diagnostic performance of NECT in detecting newly developed metastasis. Group B included patients with known hepatic metastasis to evaluate the accuracy of NECT for the assessment of hepatic metastasis. RESULTS Group A included 895 patients (mean age 52.8 years). Among them, 145 patients had 160 metastases. The per-patient sensitivities for diagnosing newly developed metastasis were 68.3 and 53.8% according to the two reviewers, while the per-lesion sensitivities were 89.4 and 85.0%. Sensitivities for bone metastasis were 98.9 and 95.9%, while sensitivities for hepatic metastasis were 73.7 and 68.4%. In group B, the accuracy of hepatic metastasis response evaluation according to the RECIST criteria was 70.8% for reviewer 1 and 63.8% for reviewer 2. CONCLUSIONS NECT showed inadequate diagnostic performance in detecting newly developed metastasis and in evaluating the response of hepatic metastasis. However, NECT can be utilized as a follow-up modality in patients with decreased renal function or hypersensitivity to iodinated contrast media. ADVANCES IN KNOWLEDGE The risk of side effects of contrast media should be considered as important when NECT can be utilized as a follow-up modality in decreased renal function patients.
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Affiliation(s)
- Sang Yu Nam
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Su Joa Ahn
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Young Rock Jang
- Department of Internal Medicine, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Yong Soon Chun
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Heung Kyu Park
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Hye Young Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
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