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Peters HA, Weiss D, Boschheidgen M, Mamlins E, Giesel FL, Fluegen G, Kirchner J, Antoch G, Jannusch K. Prognostic potential of integrated morphologic and metabolic parameters of pre-therapeutic [18F]FDG-PET/CT regarding progression-free survival (PFS) and overall survival (OS) in NSCLC-patients. PLoS One 2024; 19:e0307998. [PMID: 39074093 DOI: 10.1371/journal.pone.0307998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/11/2024] [Indexed: 07/31/2024] Open
Abstract
PURPOSE This study aimed to evaluate the prognostic potential of pre-therapeutic [18F]FDG-PET/CT variables regarding prediction of progression-free survival (PFS) and overall survival (OS) in NSCLC-patients. METHOD NSCLC-patients who underwent pre-therapeutic [18F]FDG-PET/CT were retrospectively analyzed. The following imaging features were collected from the primary tumor: tumor size, tumor density, central necrosis, spicules and SUVmax. For standardization, an indexSUVmax was calculated (SUVmax primary tumor/SUVmax liver). Descriptive statistics and correlations of survival time analyses for PFS and OS were calculated using the Kaplan-Meier method and Cox regression including a hazard ratio (HR). A value of p < 0.05 was set as statistically significant. The 95%-confidence intervals (CI) were calculated. The median follow-up time was 63 (IQR 27-106) months. RESULTS This study included a total of 82 patients (25 women, 57 men; mean age: 66 ± 9 years). IndexSUVmax (PFS: HR = 1.0, CI: 1.0-1.1, p = 0.49; OS: HR = 1.0, CI: 0.9-1.2, p = 0.41), tumor size (PFS: HR = 1.0, CI: 0.9-1.0, p = 0.08; OS: HR = 1.0, CI: 0.9-1.0, p = 0.07), tumor density (PFS: HR = 0.9, CI: 0.6-1.4, p = 0.73; OS: HR = 0.3; CI: 0.1-1.1; p = 0.07), central necrosis (PFS: HR = 1.0, CI: 0.6-1.8, p = 0.98; OS: HR = 0.6, CI: 0.2-1.9, p = 0.40) and spicules (PFS: HR = 1.0, CI: 0.6-1.9, p = 0.91; OS: HR = 1.3, CI: 0.4-3.7, p = 0.65) did not significantly affect PFS and OS in the study population. An optimal threshold value for the indexSUVmax was determined by ROC analysis and Youden's index. There was no significant difference in PFS with an indexSUVmax-threshold of 3.8 (13 vs. 27 months; p = 0.45) and in OS with an indexSUVmax-threshold of 4.0 (113 vs. 106 months; p = 0.40). CONCLUSIONS SUVmax and morphologic parameters from pre-therapeutic [18F]FDG-PET/CT were not able to predict PFS and OS in NSCLC-patients.
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Affiliation(s)
- Helena A Peters
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Daniel Weiss
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Matthias Boschheidgen
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Eduards Mamlins
- Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Frederik L Giesel
- Department of Nuclear Medicine, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Georg Fluegen
- Department of Surgery, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), Düsseldorf, Germany
| | - Kai Jannusch
- Department of Diagnostic and Interventional Radiology, Medical Faculty and University Hospital Duesseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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Cheng YF, Huang JY, Lin CH, Lin SH, Wang BY. The Prognostic Value of Positron Emission Tomography/Computed Tomography in Clinical Stage I Lung Cancer Patients: A Propensity-Match Analysis. J Clin Med 2024; 13:2416. [PMID: 38673689 PMCID: PMC11051513 DOI: 10.3390/jcm13082416] [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: 03/14/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background: The application of positron emission tomography/computed tomography (PET/CT) helps provide accurate clinical staging for lung cancer patients. However, the effects and trends in early-stage lung cancer remain unclear. The aim of this study was to compare differences between clinical stage I lung cancer patients who received PET/CT for staging and those who did not. Methods: Data were obtained from the Taiwan Society of Cancer Registry. There were 6587 clinical stage I lung cancer patients between 2009 and 2014 analyzed in this study. We compared the characteristics of the PET/CT and no PET/CT groups. After propensity score matching, it resulted in both groups having 2649 patients. We measured the overall survival rates of all clinical stage I lung cancer patients and the overall survival rates of patients with PET/CT and without PET/CT. Results: The 1-, 3-, and 5-year survival rates of all clinical stage I lung cancer patients were 97.2%, 88.2%, and 79.0%, respectively. Patients with a larger tumor size tended to receive PET/CT for staging (stage Ib: 38.25% vs. 27.82%, p < 0.0001) and a larger resection (lobectomy: 74.62% vs. 66.61%, p < 0.0001). The 5-year survival rates were 79.8% in the PET/CT group and 78.2% in the no PET/CT group after propensity score matching (p = 0.6528). Conclusions: For clinical stage I lung cancer in Taiwan, patients with larger tumor sizes tend to have PET/CT for staging. Although PET/CT provided more precise clinical staging, these patients still received larger resections and had more pathological migration. However, there was no overall survival rate benefit after PET/CT.
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Affiliation(s)
- Ya-Fu Cheng
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
| | - Jing-Yang Huang
- Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan
| | - Ching-Hsiung Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (C.-H.L.)
| | - Sheng-Hao Lin
- Division of Chest Medicine, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan; (C.-H.L.)
| | - Bing-Yen Wang
- Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, Changhua 500, Taiwan;
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Cheng Y, Chen ZY, Huang JJ, Shao D. Efficacy evaluation of neoadjuvant immunotherapy plus chemotherapy for non-small-cell lung cancer: comparison of PET/CT with postoperative pathology. Eur Radiol 2023; 33:6625-6635. [PMID: 37515634 DOI: 10.1007/s00330-023-09922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 04/16/2023] [Accepted: 05/29/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVES To assess the value of positron emission tomography/computed tomography (PET/CT) in the efficacy evaluation of patients undergoing neoadjuvant immunotherapy plus chemotherapy, and to analyze its correlation with postoperative pathology. METHODS The PET/CT metabolic parameters and CT size were retrospectively analyzed before and after neoadjuvant immunotherapy plus chemotherapy in 67 patients with resectable stage II/IIIA non-small-cell lung cancer (NSCLC). CT assessment based on immune response evaluation criteria in solid tumor criteria ((i)RECIST) was compared with PET/CT assessment based on the response criteria in solid tumors (PERCIST). The correlations between PET/CT metabolic parameters and postoperative pathology were analyzed. The value of PET/CT in the efficacy evaluation was assessed. RESULTS The PET/CT assessment showed high consistency with postoperative pathological evaluation, yet the CT assessment showed low consistency with postoperative pathological evaluation. The (i)RECIST and PERCIST criteria showed statistically significant differences (p < 0.001). The postoperative pathological response was negatively associated with ΔSUVmax (%) (r = - 0.812, p < 0.001), ΔSUVmean (%) (r = - 0.805, p < 0.001), and ΔSUVpeak (%) (r = - 0.800, p < 0.001). The cut-off values of 75.8 for ΔSUVmax (%), 67.8 for ΔSUVmean (%), and 74.6 for ΔSUVpeak (%) had the highest sensitivity and specificity. CONCLUSION The PERCIST criteria are more sensitive and accurate than (i)RECIST criteria to identify more responders when evaluating the response of neoadjuvant immunotherapy plus chemotherapy for NSCLC. PET/CT shows high accuracy in predicting postoperative pathological response. Our study shows the important role PET/CT plays in the efficacy evaluation of NSCLC patients undergoing neoadjuvant immunotherapy plus chemotherapy, as well as in predicting the prognosis and guiding postoperative treatment. CLINICAL RELEVANCE STATEMENT Neoadjuvant immunotherapy plus chemotherapy is highly effective in the treatment of non-small-cell lung cancer. And PET/CT played an important role in the efficacy evaluation following neoadjuvant immunotherapy plus chemotherapy for non-small-cell lung cancer. KEY POINTS • Neoadjuvant immunotherapy plus chemotherapy is highly effective in the treatment of NSCLC. • The PERCIST criteria are more sensitive and accurate than (i)RECIST criteria to identify more responders when evaluating the response of neoadjuvant immunotherapy plus chemotherapy for NSCLC. • PET/CT played an important role in the efficacy evaluation; ΔSUVmax (%), ΔSUVmean (%), and ΔSUVpeak (%) following neoadjuvant immunotherapy plus chemotherapy for NSCLC had high consistency and strong correlations with postoperative pathology.
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Affiliation(s)
- You Cheng
- Department of PET Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Room 526, 5/F, Weilun Building, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, People's Republic of China
| | - Zhi-Yong Chen
- Department of Radiation Oncology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Jian-Jiang Huang
- Department of Pathology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, People's Republic of China
| | - Dan Shao
- Department of PET Center, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Room 526, 5/F, Weilun Building, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong, People's Republic of China.
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Wang Q, Zhang X, Yang D, Bai L, Bai C. Criteria for lung cancer screening and standardized management in China. Chin Med J (Engl) 2023:00029330-990000000-00645. [PMID: 37265386 DOI: 10.1097/cm9.0000000000002733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Indexed: 06/03/2023] Open
Affiliation(s)
- Qi Wang
- Department of Pulmonary and Critical Care Medicine, Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116000, China
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Xiaoju Zhang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Pulmonary and Critical Care Medicine, Zhengzhou University People's Hospital, Zhengzhou, Henan 450053, China
| | - Dawei Yang
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Engineer & Technology Research Center of Internet of Things for Respiratory Medicine, Shanghai 200032, China
- Shanghai Respiratory Research Institution, Shanghai 200032, China
| | - Li Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Department of Pulmonary and Critical Care Medicine, Xinqiao Hospital, Army Medical University, Third Military Medical University, Chongqing 400037, China
| | - Chunxue Bai
- Department of Pulmonary and Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Shanghai Engineer & Technology Research Center of Internet of Things for Respiratory Medicine, Shanghai 200032, China
- Shanghai Respiratory Research Institution, Shanghai 200032, China
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Liu X, Li M, Yu X, Shen L, Li W. Silent region barcode particle arrays for ultrasensitive multiplexed SERS detection. Biosens Bioelectron 2023; 219:114804. [PMID: 36272345 DOI: 10.1016/j.bios.2022.114804] [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] [Received: 05/14/2022] [Revised: 09/30/2022] [Accepted: 10/10/2022] [Indexed: 11/19/2022]
Abstract
Suspension arrays are a critical components of next generation multiplexed detection technologies. Current fluorescence suspension arrays are limited by a multiplexed coding ceiling and difficulties with ultrasensitive detection. Raman mode is a promising substitute, but the complex spectral peak distributions and extremely weak intrinsic signal intensity severely diminish Raman signal performance in suspension arrays. To address these limitations, we constructed a Raman suspension array system using plasmonic microbeads as barcode substrates and Au nanoflowers as reporter carriers. The well-designed shell morphology and plasmonic microbead composition enabled significant surface enhancement Raman scattering (SERS) such that we were able to adjust silent region Raman-coding intensity levels. Due to synergistic SERS effects from the plasmonic shell and the multi-branched Au nanoflower nanostructure, the reporting signal was greatly improved, enabling ultrasensitive detection of 5-plexed lung cancer markers. Detection in patient serum samples demonstrated good consistency with the standard electrochemiluminescence method. Thus, this silent region SERS barcode-based suspension array is a developmental advance for modern multiplexed biodetection, potentially providing a powerful early disease screening and diagnosis tool.
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Affiliation(s)
- Xinyi Liu
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Zhangjiang Institute for Advanced Study, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, PR China
| | - Meng Li
- Zhejiang Orient Gene Biotech Co., Ltd., 3787 East Yangguang Avenue, Anji, 313300, Zhejiang, PR China
| | - Xujiang Yu
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Zhangjiang Institute for Advanced Study, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, PR China
| | - Lisong Shen
- Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, PR China
| | - Wanwan Li
- State Key Lab of Metal Matrix Composites, School of Materials Science and Engineering, Zhangjiang Institute for Advanced Study, Shanghai Jiao Tong University, 800 Dongchuan Road, Shanghai, 200240, PR China.
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Shaheen AA, Mohammed AM, Elshimy A, Shalaby MH. Role of PET/CT in post-therapeutic assessment of bronchogenic carcinoma. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2021. [DOI: 10.1186/s43055-021-00503-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Lung cancer is the most common among all kinds of cancers. It still constitutes the leading cause of cancer-related deaths worldwide, even with major advancements in prevention and treatments available. More than 85% of the cases are of non-small cell lung cancer (NSCLC), while less than 15% are of small cell lung cancers (SCLCs).
Patients and methods
This is a prospective study of 20 patients confirmed histopathologically to have bronchogenic carcinoma, who came for assessment of therapeutic response. All patients underwent positron emission tomography/computed tomography (PET/CT) before and after therapy. Semiquantitative assessment was used to determine maximum standardized uptake value (SUVmax). Treatment response evaluation was assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.
Results
Comparison of the pre- and post-treatment SUVmax in the responder and non-responder groups revealed that the post-treatment SUV was significantly lower than the baseline SUV in the responder group (P = 0.008). The responder post-treatment SUV and ∆ SUV were significantly lower than the non-responder values (P = 0.014 and 0.0004 respectively). The optimum threshold values of post-treatment SUV and ∆ SUV threshold defined by the receiver operating characteristic (ROC) curve analysis were ≤ 8 and ≤ −48.3 respectively. The sensitivity, specificity, PPV, NPV, and AUC of post-treatment SUV for predicting tumor response were 100%, 66.67%, 66.7%, 100%, and 0.833 respectively. The sensitivity, specificity, PPV, NPV, and AUC of ∆ SUV for predicting tumor response were 100%, 91.67%, 88.9%, 100%, and 0.979% respectively.
Conclusion
PET/CT proved itself as useful, efficient, and reliable tool in follow-up of lung cancer patients as it gives an early and accurate metabolic response assessment before any CT changes, leading to early modification of therapy or confirmation of its efficiency.
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Kucuker M, Kucuker KA, Guney IB, Durgun B. The importance of anatomical localization of non-small cell lung carcinoma in predicting mediastinal lymph node metastasis. Clin Anat 2021; 35:136-142. [PMID: 34537983 DOI: 10.1002/ca.23786] [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: 06/27/2021] [Revised: 08/28/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
Bronchopulmonary segmental location of non-small lung carcinomas is closely related to metastatic lymph node foci in the mediastinum. Our aim was to investigate the relationship between the anatomical locations of pulmonary masses on the bronchopulmonary segmental base and metastatic lymph node regions in non-small cell lung cancer using preoperative 18F-FDG PET/CT images. Ninety patients newly diagnosed with non-small cell lung carcinoma and referred to PET/CT imaging for staging were included in the study. Tumoral masses that could be evaluated visually and mediastinal node metastases were identified in 18F-FDG PET/CT images, then the relationship between them was investigated statistically. The diagnostic power of 18F-FDG PET/CT of mediastinal nodes was also revealed. Seventy-four males (82.2%) and sixteen females (17.8%) were enrolled in the study. Half of the patients were diagnosed as adenocarcinoma (50%). Investigation of the tumor location and mediastinal metastatic nodes revealed a statistically significant relationship between the apicoposterior segment of the left superior lobe and the left upper and lower paratracheal, subaortic, paraaortic, and left hilar regions according to the IASLC map. The sensitivity, specificity and accuracy of 18F-FDG PET/CT in the mediastinal nodes were 69.2%, 66.6%, and 68%, respectively. There was no statistically significant relationship between tumor location and 8th TNM Stage. Anatomical locations of non-small cell lung carcinomas can affect the disease stage and prognosis because of their tendency to metastasize to some mediastinal regions. However, this relationship needs to be investigated in larger study groups.
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Affiliation(s)
- Merve Kucuker
- Department of Anatomy, Katip Celebi University, Faculty of Medicine, Izmır, Turkey
| | - Kadir Alper Kucuker
- Department of Nuclear Medicine, Cukurova University, Balcali Hospital, Adana, Turkey
| | - Isa Burak Guney
- Department of Nuclear Medicine, Cukurova University, Balcali Hospital, Adana, Turkey
| | - Behice Durgun
- Department of Anatomy, Cukurova University, Faculty of Medicine, Adana, Turkey
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Osman AM, Korashi HI. PET/CT implication on bronchogenic carcinoma TNM staging and follow-up using RECIST/PERCIST criteria: a comparative study with CT. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-0133-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the role of PET/CT on bronchogenic carcinoma staging as well as treatment response evaluation on follow-up compared to CT study alone.
Methods
A prospective study of 60 patients confirmed histopathologically to have non-small cell bronchogenic carcinoma, 30 of them came for staging (group T) while the rest 30 came for follow-up (group F) to assess therapy response. All patients underwent PET/CT with data analysis done using the eighth edition tumor, nodal, metastatic staging (TNM) staging for group T and RECIST/PERCIST criteria for group F. The CT data alone transferred to a blind radiologist for analysis using the same parameters. The results were collected and compared.
Results
Regarding group T, 12 patients showed different TNM staging between PET/CT and CT alone, 5 cases with different T stagings, 4 cases with different N stagings, and 5 cases with different M stagings. Also, 8 cases showed different surgical stagings. Regarding group F, 9 cases showed a difference between RECIST obtained by CT and PERCIST obtained by PET/CT with most of the cases (6 cases) showed change from partial or stable response to progressive response.
Conclusion
PET/CT has a significant role in TNM staging of bronchogenic carcinoma more at T2 staging due to its ability to differentiate the tumoral mass from the nearby pulmonary reaction. Also, PET/CT makes a difference in tumoral follow-up by its ability to detect the functional changes even before structural changes. Finally, PET/CT is a very important tool in management strategy.
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Recent and Current Advances in FDG-PET Imaging within the Field of Clinical Oncology in NSCLC: A Review of the Literature. Diagnostics (Basel) 2020; 10:diagnostics10080561. [PMID: 32764429 PMCID: PMC7459495 DOI: 10.3390/diagnostics10080561] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/29/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths around the world, the most common type of which is non-small-cell lung cancer (NSCLC). Computed tomography (CT) is required for patients with NSCLC, but often involves diagnostic issues and large intra- and interobserver variability. The anatomic data obtained using CT can be supplemented by the metabolic data obtained using fluorodeoxyglucose F 18 (FDG) positron emission tomography (PET); therefore, the use of FDG-PET/CT for staging NSCLC is recommended, as it provides more accuracy than either modality alone. Furthermore, FDG-PET/magnetic resonance imaging (MRI) provides useful information on metabolic activity and tumor cellularity, and has become increasingly popular. A number of studies have described FDG-PET/MRI as having a high diagnostic performance in NSCLC staging. Therefore, multidimensional functional imaging using FDG-PET/MRI is promising for evaluating the activity of the intratumoral environment. Radiomics is the quantitative extraction of imaging features from medical scans. The chief advantages of FDG-PET/CT radiomics are the ability to capture information beyond the capabilities of the human eye, non-invasiveness, the (virtually) real-time response, and full-field analysis of the lesion. This review summarizes the recent advances in FDG-PET imaging within the field of clinical oncology in NSCLC, with a focus on surgery and prognostication, and investigates the site-specific strengths and limitations of FDG-PET/CT. Overall, the goal of treatment for NSCLC is to provide the best opportunity for long-term survival; therefore, FDG-PET/CT is expected to play an increasingly important role in deciding the appropriate treatment for such patients.
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Zhao W, Liu H, Leader JK, Wilson D, Meng X, Wang L, Chen LA, Pu J. Computerized identification of the vasculature surrounding a pulmonary nodule. Comput Med Imaging Graph 2019; 74:1-9. [PMID: 30903961 DOI: 10.1016/j.compmedimag.2019.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/01/2019] [Accepted: 03/06/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The idea of inferring the prognosis of lung tumor via its surrounding vasculature is novel, but not supported by available technology. In this study, we described and validated a computerized method to identify the vasculature surrounding a pulmonary nodule depicted on low-dose computed tomography (LDCT). MATERIALS AND METHODS The proposed computerized scheme identified the vessels surrounding a lung nodule by using novel computational geometric solutions and quantified them by decomposing the vessels into independent vessel branches. We validated this scheme by testing it on a dataset consisting of 100 chest CT examinations, with 50-paired benign and malignant nodules. Two experienced pulmonologists were asked to measure the vessel branches associated with a nodule under the aid of a visualization tool. We used the Bland-Altman plots and the concordance correlation coefficient (CCC) to assess the agreement between the results of the computer algorithm and two experienced pulmonologists. RESULTS Bland-Altman different analysis demonstrated a mean bias of 0.61 ± 4.17 in terms of vessel branches between the computer results and the human experts, while the inter-rater mean bias was -0.61 ± 1.60. The CCC-based agreements between the computer and the two raters were 0.90 / 0.86, 0.79 / 0.83 for benign and malignant nodules, respectively. CONCLUSION The small width of the limits of agreement between the computer algorithm and the human experts suggests that the results from the computer and the pulmonologist experts were relatively consistent, namely the computerized scheme is capable of reliably identifying the vasculature surrounding a nodule.
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Affiliation(s)
- Wei Zhao
- Respiratory Department, Chinese PLA General Hospital, Beijing, China
| | - Han Liu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Joseph K Leader
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - David Wilson
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Xin Meng
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Lei Wang
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA
| | - Liang-An Chen
- Respiratory Department, Chinese PLA General Hospital, Beijing, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, USA.
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Wang X, Leader JK, Wang R, Wilson D, Herman J, Yuan JM, Pu J. Vasculature surrounding a nodule: A novel lung cancer biomarker. Lung Cancer 2017; 114:38-43. [PMID: 29173763 PMCID: PMC5880279 DOI: 10.1016/j.lungcan.2017.10.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 10/16/2017] [Accepted: 10/22/2017] [Indexed: 12/19/2022]
Abstract
PURPOSE To investigate whether the vessels surrounding a nodule depicted on non-contrast, low-dose computed tomography (LDCT) can discriminate benign and malignant screen detected nodules. MATERIALS AND METHODS We collected a dataset consisting of LDCT scans acquired on 100 subjects from the Pittsburgh Lung Screening study (PLuSS). Fifty subjects were diagnosed with lung cancer and 50 subjects had suspicious nodules later proven benign. For the lung cancer cases, the location of the malignant nodule in the LDCT scans was known; while for the benign cases, the largest nodule in the LDCT scan was used in the analysis. A computer algorithm was developed to identify surrounding vessels and quantify the number and volume of vessels that were connected or near the nodule. A nonparametric receiver operating characteristic (ROC) analysis was performed based on a single nodule per subject to assess the discriminability of the surrounding vessels to provide a lung cancer diagnosis. Odds ratio (OR) were computed to determine the probability of a nodule being lung cancer based on the vessel features. RESULTS The areas under the ROC curves (AUCs) for vessel count and vessel volume were 0.722 (95% CI=0.616-0.811, p<0.01) and 0.676 (95% CI=0.565-0.772), respectively. The number of vessels attached to a nodule was significantly higher in the lung cancer group 9.7 (±9.6) compared to the non-lung cancer group 4.0 (±4.3) CONCLUSION: Our preliminary results showed that malignant nodules are often surrounded by more vessels compared to benign nodules, suggesting that the surrounding vessel characteristics could serve as lung cancer biomarker for indeterminate nodules detected during LDCT lung cancer screening using only the information collected during the initial visit.
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Affiliation(s)
- Xiaohua Wang
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Joseph K Leader
- Department of Radiology, Peking University Third Hospital, Beijing, China
| | - Renwei Wang
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - David Wilson
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James Herman
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jian-Min Yuan
- University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA; Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jiantao Pu
- Department of Radiology, Peking University Third Hospital, Beijing, China; Department of Bioengineering, University of Pittsburgh, Pittsburgh, USA.
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Werner L, Keller FA, Bhure U, Roos JE, Tornquist K, Del Sol Pèrez-Lago M, Gautschi O, Strobel K. The value of ultrasound-guided biopsy of fluorodeoxy-glucose positron emission tomography (FDG-PET)-positive supraclavicular lymph nodes in patients with suspected lung cancer. BMC Med Imaging 2017; 17:41. [PMID: 28693444 PMCID: PMC5504721 DOI: 10.1186/s12880-017-0214-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
Background Accurate lymph node staging is essential for adequate prognostication and therapy planning in patients with non-small cell lung cancer (NSCLC). FDG-PET/CT is a sensitive tool for the detection of metastases, including non-palpable supraclavicular lymph node (SCLN) metastases. Histological proof of metastatic spread and mutation analysis is crucial for optimal staging and therapy. The aim of this study was to investigate the value of ultrasound-guided fine needle aspiration cytology (FNAC) and core biopsy (CB) of FDG active, non-palpable SCLN’s in patients with suspicion for lung cancer. Methods Twelve consecutive patients with suspected lung cancer and FDG-positive SCLN underwent FNAC (n = 11) and/or CB (n = 10) and were included and evaluated retrospectively in this study. Cytologic and/or histologic evaluation was performed to confirm initially suspected diagnosis (lung cancer), to confirm N3 stage, and to screen for driver mutations in lung adenocarcinoma. Results FNAC alone showed diagnostic success in 11/11 cases (100%), CB alone in 9/10 patients (90%), and the combination of both procedures was successful in 12/12 cases (100%). Lymph node metastases from NSCLC (7 adenocarcinoma, 2 squamous cell carcinoma) could be confirmed in 9 patients. Other diagnoses were small cell lung cancer (SCLC), breast cancer and sarcoidosis. There was enough material for immunhistochemistry in all patients. For molecular testing, material from this lymph node biopsies and lung biopsy was used. In two patients with adenocarcinoma of the lung driver mutations were detected (EGFR Exon 19 deletion and ALK rearrangement) out of the lymph node metastasis. Conclusions US-guided combined FNAC and CB of FDG positive supraclavicular lymph nodes in patients with suspected lung cancer is a safe and effective procedure to confirm N3-stage and to obtain representative material for molecular testing.
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Affiliation(s)
- Lennart Werner
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland
| | | | - Ujwal Bhure
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland
| | - Justus Egidius Roos
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland
| | - Katharina Tornquist
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland
| | - Maria Del Sol Pèrez-Lago
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland
| | - Oliver Gautschi
- Department of Pathology, Cantonal Hospital, Lucerne, Switzerland.,Department of Medical Oncology, Cantonal Hospital, Lucerne, Switzerland
| | - Klaus Strobel
- Department of Radiology and Nuclear Medicine, Cantonal Hospital, Spitalstrasse 13, 6000, Lucerne, Switzerland.
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14
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岳 宁, 袁 双, 杨 国. [Status and advances of RGD molecular imaging in lung cancer]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:855-9. [PMID: 25539611 PMCID: PMC6000408 DOI: 10.3779/j.issn.1009-3419.2014.12.06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 08/18/2014] [Indexed: 11/05/2022]
Abstract
Lung cancer has been one of the most common and the highest mortality rates malignant tumors at home and abroad. Sustained angiogenesis was not only the characteristic of malignant tumors, but also the foundation of tumor proliferation, invasion, recurrence and metastasis, it was also one of the hot spots of treatments in lung cancer biology currently. Integrins played an important part in tumor angiogenesis. Arg-Gly-Asp (RGD) peptides could combine with integrins specifically, and the application of radionuclide-labeled RGD molecular probes enabled imaging of tumor blood vessels to reflect its changes. The lung cancer imaging of RGD peptides at home and abroad in recent years was reviewed in this article.
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Affiliation(s)
- 宁 岳
- />250117 济南,山东省医学科学院,山东省肿瘤医院核医学科Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - 双虎 袁
- />250117 济南,山东省医学科学院,山东省肿瘤医院核医学科Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
| | - 国仁 杨
- />250117 济南,山东省医学科学院,山东省肿瘤医院核医学科Department of Nuclear Medicine, Shandong Cancer Hospital, Shandong Academy of Medical Sciences, Jinan 250117, China
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15
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Rakheja R, Chandarana H, Ponzo F, Seltzer AL, Beltran LS, Geppert C, Friedman KP. Fluorodeoxyglucose positron emission tomography/magnetic resonance imaging: current status, future aspects. PET Clin 2013; 9:237-52. [PMID: 25030285 DOI: 10.1016/j.cpet.2013.10.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Simultaneous positron emission tomography (PET)/magnetic resonance (MR) imaging is a promising novel technology for oncology diagnosis and staging and neurologic and cardiac applications. Our institution's current research protocol results in a total imaging time of approximately 45 to 70 minutes with simultaneous PET/MR imaging, making this a feasible total body imaging protocol. Further development of MR-based attenuation correction will improve PET quantification. Quantitatively accurate multiparametric PET/MR data sets will likely improve diagnosis of disease and help guide and monitor the therapies for individualized patient care.
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Affiliation(s)
- Rajan Rakheja
- Department of Nuclear Medicine/Radiology, Royal University Hospital, Saskatoon, Saskatchewan, Canada.
| | - Hersh Chandarana
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Fabio Ponzo
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Alexandra L Seltzer
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | - Luis S Beltran
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
| | | | - Kent P Friedman
- Department of Radiology, New York University School of Medicine, 550 First Avenue, New York, NY, USA
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Rakheja R, Ko JP, Friedman K. Lung cancer: positron emission tomography/computed tomography and the new staging system. Semin Roentgenol 2013; 48:308-22. [PMID: 24034263 DOI: 10.1053/j.ro.2013.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Rajan Rakheja
- Division of Nuclear Medicine, New York University Langone Medical Center, New York, NY
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Prognostic value of volumetric parameters measured by F-18 FDG PET/CT in surgically resected non-small-cell lung cancer. Nucl Med Commun 2012; 33:613-20. [PMID: 22407127 DOI: 10.1097/mnm.0b013e328351d4f5] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the usefulness of the tumor burden as characterized by the metabolic tumor volume (MTV) and total lesion glycolysis (TLG) measured by F-18 fluoro-2-deoxyglucose (F-18 FDG) PET-computed tomography (CT) in predicting recurrence-free survival (RFS) and overall survival (OS) in surgically resected non-small-cell lung cancer (NSCLC) patients. METHODS We retrospectively reviewed 91 patients with pathologically documented stages I-IIIA NSCLC. MTV and TLG were obtained according to various thresholds of the standard uptake value (SUV) of primary tumor using preoperative F-18 FDG PET-CT. We used comparison receiver-operating characteristic curve analysis to test the statistical significance of the differences among the multiple volumetric parameters calculated by various SUV cutoff values. RFS and OS were evaluated with the Kaplan-Meier method and Cox regression analysis. RESULTS On comparison receiver-operating characteristic curve analysis, no significant difference was found among the volumetric parameters calculated using various thresholds of SUV. Regardless of the thresholds, patients with smaller MTV and lower TLG showed longer RFS and OS. MTV and TLG measured by F-18 FDG PET-CT were found to have better predictive performance than SUVmax for recurrence and death. According to multivariate analyses, MTV2.5 was revealed as a significant prognostic factor for RFS. Tumor size over 3 cm was selected as a significant prognostic indicator of OS. CONCLUSION Volume-based parameters of F-18 FDG PET-CT may have a role in providing prognostic information in NSCLC patients who have received surgical treatment.
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PET/CT in the staging of the non-small-cell lung cancer. J Biomed Biotechnol 2012; 2012:783739. [PMID: 22577296 PMCID: PMC3346692 DOI: 10.1155/2012/783739] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 01/20/2012] [Indexed: 12/25/2022] Open
Abstract
Lung cancer is a common disease and the leading cause of cancer-related death in many countries. Precise staging of patients with non-small-cell lung cancer plays an important role in determining treatment strategy and prognosis. Positron emission tomography/computed tomography (PET/CT), combining anatomic information of CT and metabolic information of PET, is emerging as a potential diagnosis and staging test in patients with non-small-cell lung cancer (NSCLC). The purpose of this paper is to discuss the value of integrated PET/CT in the staging of the non-small-cell lung cancer and its health economics.
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Sukerkar PA, MacRenaris KW, Meade TJ, Burdette JE. A steroid-conjugated magnetic resonance probe enhances contrast in progesterone receptor expressing organs and tumors in vivo. Mol Pharm 2011; 8:1390-400. [PMID: 21736390 DOI: 10.1021/mp200219e] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Progesterone receptor (PR) is a significant biomarker in diseases such as endometriosis and breast, ovarian, and uterine cancers that is associated with disease prognosis and therapeutic efficacy. While receptor status is currently determined by immunohistochemistry assays, the development of noninvasive PR imaging agents could improve molecular characterization, treatment decisions, and disease monitoring. ProGlo, a progesterone-conjugated magnetic resonance imaging (MRI) contrast agent, was evaluated in vivo to determine whether it targets and enhances signal intensity in organs and tumors that express high PR levels. A tissue distribution study indicated that ProGlo accumulates in the PR-rich uterus, which was confirmed by in vivo imaging studies. Ex vivo images of these organs revealed that ProGlo was distributed in the substructures that express high PR levels. In xenograft tumor models, ProGlo was taken up to a greater extent than the nonfunctionalized Gd-DO3A in tumors, particularly in PR(+) tumors. The ability to accumulate and enhance signal intensity in PR(+) organs and tumors suggests that ProGlo may be a promising MRI probe for PR(+) diseases.
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Affiliation(s)
- Preeti A Sukerkar
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208, USA
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