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Spanoudaki VC, Lau FWY, Vandenbroucke A, Levin CS. Physical effects of mechanical design parameters on photon sensitivity and spatial resolution performance of a breast-dedicated PET system. Med Phys 2010; 37:5838-49. [PMID: 21158296 DOI: 10.1118/1.3484059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE This study aims to address design considerations of a high resolution, high sensitivity positron emission tomography scanner dedicated to breast imaging. METHODS The methodology uses a detailed Monte Carlo model of the system structures to obtain a quantitative evaluation of several performance parameters. Special focus was given to the effect of dense mechanical structures designed to provide mechanical robustness and thermal regulation to the minuscule and temperature sensitive detectors. RESULTS For the energies of interest around the photopeak (450-700 keV energy window), the simulation results predict a 6.5% reduction in the single photon detection efficiency and a 12.5% reduction in the coincidence photon detection efficiency in the case that the mechanical structures are interspersed between the detectors. However for lower energies, a substantial increase in the number of detected events (approximately 14% and 7% for singles at a 100-200 keV energy window and coincidences at a lower energy threshold of 100 keV, respectively) was observed with the presence of these structures due to backscatter. The number of photon events that involve multiple interactions in various crystal elements is also affected by the presence of the structures. For photon events involving multiple interactions among various crystal elements, the coincidence photon sensitivity is reduced by as much as 20% for a point source at the center of the field of view. There is no observable effect on the intrinsic and the reconstructed spatial resolution and spatial resolution uniformity. CONCLUSIONS Mechanical structures can have a considerable effect on system sensitivity, especially for systems processing multi-interaction photon events. This effect, however, does not impact the spatial resolution. Various mechanical structure designs are currently under evaluation in order to achieve optimum trade-off between temperature stability, accurate detector positioning, and minimum influence on system performance.
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Affiliation(s)
- V C Spanoudaki
- Department of Radiology and the Molecular Imaging Program at Stanford, Stanford University, Stanford, California 94305-5128, USA
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152
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Linden HM, Mankoff DA. Breast Cancer and Hormonal Stimulation: Is Glycolysis the First Sign of Response?: FIGURE 1. J Nucl Med 2010; 51:1663-4. [DOI: 10.2967/jnumed.110.078329] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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153
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Abstract
This paper summarises the current status of PET/CT in relation to breast cancer.
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Affiliation(s)
- C Hegarty
- St. Vincent's University Hospital, Dublin 4, Ireland
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154
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Functional oestrogen receptor α imaging in endometrial carcinoma using 16α-[¹⁸F]fluoro-17β-oestradiol PET. Eur J Nucl Med Mol Imaging 2010; 38:37-45. [PMID: 20717823 DOI: 10.1007/s00259-010-1589-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Accepted: 07/29/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To investigate the correlation between uptake of 16α-[(18)F]fluoro-17β-oestradiol (FES) and expression of oestrogen receptors as well as other related immunohistochemistry markers, positron emission tomography (PET) was performed in patients with endometrial carcinoma before surgery. METHODS Nineteen patients with endometrioid adenocarcinoma underwent preoperative PET studies with FES and 2-[(18)F]fluoro-2-deoxy-D: -glucose (FDG). Standardized uptake values (SUVs) for each tracer and the regional FDG to FES SUV ratio were calculated using images after coregistration. PET values were compared with postoperative stage, differentiation grade and immunohistochemical scores including oestrogen receptor subtypes (ERα, ERβ), progesterone receptor B (PR-B), Ki-67 and glucose transporter 1 (GLUT1). RESULTS FES uptake showed a significantly positive correlation with expression of ERα. The FDG to FES ratio showed a significantly negative correlation with expression of ERα and PR-B. The FES uptake and FDG to FES ratio did not correlate with expression of ERβ, Ki-67 or GLUT1. FDG uptake was not correlated with any of the immunohistochemical scores. The PR-B score was strongly correlated with the ERα score. Well-differentiated carcinoma (grade 1) showed a significantly higher FES uptake and significantly lower FDG to FES ratio than moderately or poorly differentiated carcinoma (grade 2-3). None of the PET parameters were significantly different between advanced-stage carcinoma (≥ stage IB) and early-stage carcinoma (IA) based on the Féderation International de Gynécologie et d'Obstétrique (FIGO) staging classification. Differentiation grade was the most closely correlated parameter to FES uptake and FDG to FES ratio by multivariate analyses. CONCLUSION FES PET combined with FDG would be useful for non-invasive evaluation of ERα distribution, as well as ERα function, which reflects differentiation grade in endometrial carcinoma.
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155
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Abstract
Data on the use of PET in women with genetic or familial high-risk for breast or ovarian cancer are scarce. Open issues include the complementary use of dedicated breast-PET scanners in patients at high-risk for breast cancer, the relation between pathological characteristics of cancer diagnosed in BRCA carriers and (18)F-fluorodeoxyglucose ((18)F-FDG)-avidity, and the predictive value of PET in patients at high-risk for ovarian cancer presenting with a pelvic mass or potential chemical markers. Therefore, the use of PET in high-risk patients with unproven malignant disease needs to be investigated in well designed clinical trials. Once breast or ovarian cancer is diagnosed, indications for (18)F-FDG-PET or PET-CT imaging are similar for high-risk patients and patients with sporadic cancer. However, PET can provide data that are beyond tumour detection per se. Future directions of PET in high-risk patients might include monitoring the response of BRCA carriers to new treatments such as poly-ADP ribose polymerase (PARP) inhibitors, personalisation of treatment, and the use of new PET tracers to investigate the tissue changes related to increased risk for breast and ovarian cancer.
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Affiliation(s)
- Einat Even-Sapir
- Department of Nuclear Medicine, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
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156
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Oude Munnink TH, Nagengast WB, Brouwers AH, Schröder CP, Hospers GA, Lub-de Hooge MN, van der Wall E, van Diest PJ, de Vries EGE. Molecular imaging of breast cancer. Breast 2010; 18 Suppl 3:S66-73. [PMID: 19914546 DOI: 10.1016/s0960-9776(09)70276-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Molecular imaging of breast cancer can potentially be used for breast cancer screening, staging, restaging, response evaluation and guiding therapies. Techniques for molecular breast cancer imaging include magnetic resonance imaging (MRI), optical imaging, and radionuclide imaging with positron emission tomography (PET) or single photon emission computed tomography (SPECT). This review focuses on PET and SPECT imaging which can provide sensitive serial non invasive information of tumor characteristics. Most clinical data are gathered on the visualization of general processes such as glucose metabolism with the PET-tracer [(18)F]fluorodeoxyglucose (FDG) and DNA synthesis with [18F]fluoro-L-thymidine (FLT). Increasingly more breast cancer specific targets are imaged such as the estrogen receptor (ER), growth factors and growth factor receptors. Imaging of the ER with the PET tracer 16-alpha-[(18)F]fluoro-17-beta-estradiol (FES) has shown a good correlation between FES tumor uptake and ER density. (111)In-trastuzumab SPECT to image the human epidermal growth factor receptor 2 (HER2) showed that in most patients with metastatic HER2 overexpressing disease more lesions were detected than with conventional staging procedures. The PET tracer (89)Zr-trastuzumab showed excellent, quantifiable, and specific tumor uptake. (111)In-bevacizumab for SPECT and (89)Zr-bevacizumab for PET-imaging have been developed for vascular endothelial growth factor (VEGF) imaging as an angiogenic marker. Lastly, tracers for the receptors EGFR, IGF-1R, PDGF-betaR and the ligand TGFbeta are under development. Although molecular imaging of breast cancer is still not commonly used in daily clinical practice, its application portfolio is expanding rapidly.
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Affiliation(s)
- T H Oude Munnink
- Department of Medical Oncology, University Medical Center, Groningen, The Netherlands
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157
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158
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Les grands challenges de la prise en charge en phase métastatique aujourd’hui. ONCOLOGIE 2010. [DOI: 10.1007/s10269-010-1875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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159
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Osborne JR, Port E, Gonen M, Doane A, Yeung H, Gerald W, Cook JB, Larson S. 18F-FDG PET of locally invasive breast cancer and association of estrogen receptor status with standardized uptake value: microarray and immunohistochemical analysis. J Nucl Med 2010; 51:543-50. [PMID: 20237034 DOI: 10.2967/jnumed.108.060459] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
UNLABELLED PET imaging is useful for evaluating locally advanced primary breast cancer. Expression of specific molecular markers in these cancers, such as estrogen receptor (ER), progesterone receptor (PR), and HER2 status, has direct prognostic and therapeutic implications in patient management. This study aimed to determine whether a relationship exists between tumor glucose use and important molecular markers in invasive breast cancer. For our purposes, tumor glucose use is quantified by the PET-derived parameter maximum standardized uptake value (SUV). METHODS Breast tumors from 36 patients were excised and examined histologically after PET. ER, PR, and HER2 status were determined for all lesions histopathologically. In addition, genomewide expression for a subset of 20 tumors was analyzed using the human genome U133A oligonucleotide microarray. RESULTS A significant association was found between estrogen ER status and lesion SUV. ER-negative tumors (n = 17; median SUV, 8.5) demonstrated a significantly higher maximum SUV than did ER-positive tumors (n = 19; median SUV, 4.0) (P < 0.001). No significant association existed between SUV and PR status, HER2/neu status, lymph node involvement, or tumor size. Unsupervised hierarchic clustering of the 20 genetically profiled cancers segregated tumor samples into 2 primary groups of 10 patients each, largely corresponding to ER status. CONCLUSION In locally invasive primary breast cancer, ER-negative tumors display higher (18)F-FDG uptake than ER-positive tumors. Microarray analysis confirms these data and identifies genes associated with increased glucose use as measured by PET. These genes significantly overlap those of a previously validated ER-status molecular phenotype. These preliminary data support a growing body of evidence that ER-positive and ER-negative breast cancers have distinct disease-specific patterns. Further validation prospectively and with larger numbers will be required to establish a robust molecular signature for metabolic uptake and patterns of aggressive behavior in advanced breast cancer.
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Affiliation(s)
- Joseph R Osborne
- Department of Radiology, Weill Cornell Medical College, New York, New York 10021, USA.
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160
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161
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162
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Should a biopsy be recommended to confirm metastatic disease in women with breast cancer? Lancet Oncol 2009; 10:933-5. [DOI: 10.1016/s1470-2045(09)70295-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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163
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Bénard F, Mavi A. Receptor Imaging in Patients with Breast Cancer. PET Clin 2009; 4:329-41. [DOI: 10.1016/j.cpet.2009.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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164
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Affiliation(s)
- David A Mankoff
- Seattle Cancer Care Alliance and University of WashingtonSeattle, Washington, USA
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165
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Peterson TE, Manning HC. Molecular imaging: 18F-FDG PET and a whole lot more. J Nucl Med Technol 2009; 37:151-61. [PMID: 19692452 DOI: 10.2967/jnmt.109.062729] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
The intention of this review is to provide information about the rapidly evolving field of molecular imaging and its potential impact on the clinical practice of nuclear medicine. On completing this article the reader should be able to define molecular imaging, describe the ways in which molecular imaging can be used, identify some of the biologic processes that can be targeted with molecular imaging agents, and list the modalities that can be used for molecular imaging, along with the strengths and weaknesses of each.
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Affiliation(s)
- Todd E Peterson
- Institute of Imaging Science, Departments of Radiology and Radiological Sciences, Vanderbilt University, Nashville, Tennessee, USA.
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166
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Riley LB, Desai DC. The molecular basis of cancer and the development of targeted therapy. Surg Clin North Am 2009; 89:1-15, vii. [PMID: 19186227 DOI: 10.1016/j.suc.2008.09.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The sequencing of the human genome and the ability to rapidly identify genes and proteins, both normal and mutant, that are involved in tumorigenesis and malignant phenotypes, have changed the ability to understand malignant cells. Understanding and applying this information to the diagnosis and treatment of cancer are facilitated best with a multidisciplinary team. The cancer surgeon plays a pivotal role in this team. This article briefly summarizes: (1) the clinically relevant applications of molecular biology to the cancer surgeon, (2) the current understanding of the molecular basis for cancer, and (3) the current targeted agents and their clinical applications.
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Affiliation(s)
- Lee B Riley
- St. Luke's Hospital and Health Network, 801 Ostrum Street, Bethlehem, PA 18015, USA.
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167
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Dunphy MPS, Lewis JS. Radiopharmaceuticals in preclinical and clinical development for monitoring of therapy with PET. J Nucl Med 2009; 50 Suppl 1:106S-21S. [PMID: 19380404 DOI: 10.2967/jnumed.108.057281] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This review article discusses PET agents, other than (18)F-FDG, with the potential to monitor the response to therapy before, during, or after therapeutic intervention. This review deals primarily with non-(18)F-FDG PET tracers that are in the final stages of preclinical development or in the early stages of clinical application for monitoring the therapeutic response. Four sections related to the nature of the tracers are included: radiotracers of DNA synthesis, such as the 2 most promising agents, the thymidine analogs 3'-(18)F-fluoro-3'-deoxythymidine and (18)F-1-(2'-deoxy-2'-fluoro-beta-d-arabinofuranosyl)thymine; agents for PET imaging of hypoxia within tumors, such as (60/62/64)Cu-labeled diacetyl-bis(N(4)-methylthiosemicarbazone) and (18)F-fluoromisonidazole; amino acids for PET imaging, including the most popular such agent, l-[methyl-(11)C]methionine; and agents for the imaging of tumor expression of androgen and estrogen receptors, such as 16beta-(18)F-fluoro-5alpha-dihydrotestosterone and 16alpha-(18)F-fluoro-17beta-estradiol, respectively.
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Affiliation(s)
- Mark P S Dunphy
- Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA
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168
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Lee JH, Rosen EL, Mankoff DA. The Role of Radiotracer Imaging in the Diagnosis and Management of Patients with Breast Cancer: Part 2—Response to Therapy, Other Indications, and Future Directions. J Nucl Med 2009; 50:738-48. [DOI: 10.2967/jnumed.108.061416] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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169
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Saga T, Koizumi M, Furukawa T, Yoshikawa K, Fujibayashi Y. Molecular imaging of cancer: evaluating characters of individual cancer by PET/SPECT imaging. Cancer Sci 2009; 100:375-81. [PMID: 19154408 PMCID: PMC11158650 DOI: 10.1111/j.1349-7006.2008.01060.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The present status of cancer molecular imaging (MI) with nuclear medicine techniques is reviewed, highlighting the Japanese activities in this field. With the progress in MI research, including significant contributions from Japanese studies, it has become possible to noninvasively evaluate various important characters of cancer in clinical patients, such as metabolism, cellular proliferation, tumor hypoxia, and receptor expression. Tumor metabolic information is used for tumor characterization, treatment response evaluation, and prognosis prediction. Hypoxia imaging is used for treatment planning and predicting treatment response. Receptor imaging can be used for the selection of the candidate for receptor-targeted treatment. Various novel probes that can target cancer-associated antigens, various cellular growth factor receptors, tumor angiogenesis, and so on, are under development, aiming for clinical evaluation. Application of radiolabeled ligands for treatment (targeted internal radiation therapy) is another important field in which MI technique can play a critical role. MI, which can deliver the outcome of basic oncological research to the bedside, is essential translational research for improved individualized patient management, and further advances in MI studies are eagerly awaited.
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Affiliation(s)
- Tsuneo Saga
- Molecular Imaging Center, National Institute of Radiological Sciences, Anagawa, Chiba, Japan.
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170
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Noninvasive prediction of tumor responses to gemcitabine using positron emission tomography. Proc Natl Acad Sci U S A 2009; 106:2847-52. [PMID: 19196993 DOI: 10.1073/pnas.0812890106] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Gemcitabine (2',2'-difluorodeoxycytidine, dFdC) and cytosine arabinoside (cytarabine, ara-C) represent a class of nucleoside analogs used in cancer chemotherapy. Administered as prodrugs, dFdC and ara-C are transported across cell membranes and are converted to cytotoxic derivatives through consecutive phosphorylation steps catalyzed by endogenous nucleoside kinases. Deoxycytidine kinase (DCK) controls the rate-limiting step in the activation cascade of dFdC and ara-C. DCK activity varies significantly among individuals and across different tumor types and is a critical determinant of tumor responses to these prodrugs. Current assays to measure DCK expression and activity require biopsy samples and are prone to sampling errors. Noninvasive methods that can detect DCK activity in tumor lesions throughout the body could circumvent these limitations. Here, we demonstrate an approach to detecting DCK activity in vivo by using positron emission tomography (PET) and (18)F-labeled 1-(2'-deoxy-2'-fluoroarabinofuranosyl) cytosine] ([(18)F]FAC), a PET probe recently developed by our group. We show that [(18)F]FAC is a DCK substrate with an affinity similar to that of dFdC. In vitro, accumulation of [(18)F]FAC in murine and human leukemia cell lines is critically dependent on DCK activity and correlates with dFdC sensitivity. In mice, [(18)F]FAC accumulates selectively in DCK-positive vs. DCK-negative tumors, and [(18)F]FAC microPET scans can predict responses to dFdC. We suggest that [(18)F]FAC PET might be useful for guiding treatment decisions in certain cancers by enabling individualized chemotherapy.
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171
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Beauregard JM, Croteau É, Ahmed N, van Lier JE, Bénard F. Assessment of Human Biodistribution and Dosimetry of 4-Fluoro-11β-Methoxy-16α-18F-Fluoroestradiol Using Serial Whole-Body PET/CT. J Nucl Med 2008; 50:100-7. [DOI: 10.2967/jnumed.108.057000] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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172
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Abstract
The ability to measure biochemical and molecular processes underlies progress in breast cancer biology and treatment. These assays have traditionally been performed by analysis of cell culture or tissue samples. More recently, functional and molecular imaging has allowed the in vivo assay of biochemistry and molecular biology, which is highly complementary to tissue-based assays. This review briefly describes different imaging modalities used in molecular imaging and then reviews applications of molecular imaging to breast cancer, with a focus on translational work. It includes sections describing work in functional and physiological tumor imaging, imaging gene product expression, imaging the tumor microenvironment, reporter gene imaging, and cell labeling. Work in both animal models and human is discussed with an eye towards studies that have relevance to breast cancer treatment in patients.
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Affiliation(s)
- David A Mankoff
- Seattle Cancer Care Alliance and University of Washington, Radiology, Seattle, WA 98109, USA.
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173
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Mankoff DA, Link JM, Linden HM, Sundararajan L, Krohn KA. Tumor receptor imaging. J Nucl Med 2008; 49 Suppl 2:149S-63S. [PMID: 18523071 DOI: 10.2967/jnumed.107.045963] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Tumor receptors play an important role in carcinogenesis and tumor growth and have been some of the earliest targets for tumor-specific therapy, for example, the estrogen receptor in breast cancer. Knowledge of receptor expression is key for therapy directed at tumor receptors and traditionally has been obtained by assay of biopsy material. Tumor receptor imaging offers complementary information that includes evaluation of the entire tumor burden and characterization of the heterogeneity of tumor receptor expression. The nature of the ligand-receptor interaction poses a challenge for imaging--notably, the requirement for a low molecular concentration of the imaging probe to avoid saturating the receptor and increasing the background because of nonspecific uptake. For this reason, much of the work to date in tumor receptor imaging has been done with radionuclide probes. In this overview of tumor receptor imaging, aspects of receptor biochemistry and biology that underlie tumor receptor imaging are reviewed, with the estrogen-estrogen receptor system in breast cancer as an illustrative example. Examples of progress in radionuclide receptor imaging for 3 receptor systems--steroid receptors, somatostatin receptors, and growth factor receptors-are highlighted, and recent investigations of receptor imaging with other molecular imaging modalities are reviewed.
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Affiliation(s)
- David A Mankoff
- Division of Nuclear Medicine, University of Washington, Seattle, Washington, USA.
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