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Liang J, Jiang S, Song J, Chen D, Weng S, Li S, Peng H, Liu Z, Zhang J, Chen Y, Rao S, Chen H, Zhang R, Liu H, Zhang L. Role of [ 18F]FAPI-04 in staging and therapeutic management of intrahepatic cholangiocarcinoma: prospective comparison with [ 18F]FDG PET/CT. EJNMMI Res 2024; 14:81. [PMID: 39256297 PMCID: PMC11387567 DOI: 10.1186/s13550-024-01145-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Fluorine-18 fluorodeoxyglucose ([18F]FDG) positron emission tomography/computed tomography (PET/CT) has some limitations in diagnosis of Intrahepatic cholangiocarcinoma (ICC). MATERIALS AND METHODS Patients with histologically confirmed ICC who underwent both [18F]FDG and 18F-labeled fibroblast-activation protein inhibitors ([18F]FAPI)-04 PET/CT were prospectively analyzed. The maximum standard uptake value (SUVmax), tumor-to-background ratio (TBR), metabolic tumor volume (MTV), total lesion glycolysis (TLG), [18F]FAPI-avid tumor volume (FTV), total lesion fibroblast activation protein expression (TLF) were compared between the two modalities by paired Wilcoxon signed-rank test and Mann-Whitney U test, and McNemar's test was used to assess the diagnostic accuracy between the two techniques. RESULTS In total, 23 patients with 389 lesions were included. Compared to [18F]FDG, [18F]F-FAPI-04 PET/CT demonstrated a higher detection rate for intrahepatic lesions (86.3% vs. 78.2% P = 0.040), lymph node metastases (85.2% vs. 68.2%, P = 0.007), peritoneal metastases (100% vs. 93.8%), and bone metastases (100% vs. 70.5%, P < 0.001). [18F]FAPI-04 PET showed higher SUVmax, TBR and greater tumor burden values than [18F]FDG PET in non-cholangitis intrahepatic lesions (SUVmax: 8.7 vs. 6.4, P < 0.001; TBR: 8.0 vs. 3.5, P < 0.001; FTV vs. MTV: 41.3 vs. 12.4, P < 0.001; TLF vs. TLG: 223.5 vs. 57.0, P < 0.001), lymph node metastases (SUVmax: 6.5 vs. 5.5, P = 0.042; TBR: 5.4 vs. 3.9, P < 0.001; FTV vs. MTV: 2.0 vs. 1.5, P = 0.026; TLF vs. TLG: 9.0 vs. 7.8 P = 0.024), and bone metastases (SUVmax: 9.7 vs. 5.25, P < 0.001; TBR: 10.8 vs. 3.0, P < 0.001; TLF vs. TLG: 9.8 vs. 4.2, P < 0.001). However, [18F]FDG showed higher radiotracer uptake (SUVmax: 14.7 vs. 8.4, P < 0.001; TBR: 7.4 vs. 2.8, P < 0.001) than [18F]FAPI-04 PET/CT for 6 patients with obstructive cholangitis. [18F]FAPI-04 PET/CT yielded a change in planned therapy in 6 of 23 (26.1%) patients compared with [18F]FDG. CONCLUSIONS [18F]FAPI-04 PET/CT had higher detection rate and radiotracer uptake than [18F]FDG PET/CT in intrahepatic lesions, lymph node metastases, and distant metastases, especially in bone. Therefore, [18F]FAPI-04 PET/CT may be a promising technique for diagnosis and staging of ICC. TRIAL REGISTRATION Clinical Trials, NCT05485792. Registered 1 August 2022, retrospectively registered, https//clinicaltrials.gov/study/NCT05485792?cond=NCT05485792&rank=1.
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Affiliation(s)
- Jiucen Liang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Shuqin Jiang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Jingjing Song
- Department of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Danyang Chen
- Tumor Research Institute, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Shaojuan Weng
- Tumor Research Institute, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Shuyi Li
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Hao Peng
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Zhidong Liu
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Jing Zhang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Yuanlin Chen
- Department of Pathology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Songquan Rao
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Haipeng Chen
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China
| | - Rusen Zhang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China.
| | - Hao Liu
- Tumor Research Institute, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China.
| | - Linqi Zhang
- Department of Nuclear Medicine, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, 78 Hengzhigang Road, Guangzhou, Guangdong, 510095, P.R. China.
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Nishioka E, Tsurusaki M, Kozuki R, Im SW, Kono A, Kitajima K, Murakami T, Ishii K. Comparison of Conventional Imaging and 18F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in the Diagnostic Accuracy of Staging in Patients with Intrahepatic Cholangiocarcinoma. Diagnostics (Basel) 2022; 12:diagnostics12112889. [PMID: 36428949 PMCID: PMC9689116 DOI: 10.3390/diagnostics12112889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 11/14/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022] Open
Abstract
We aimed to examine the accuracy of tumor staging of intrahepatic cholangiocarcinoma (ICC) by using 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET-CT). From January 2001 to December 2021, 202 patients underwent PET-CT, CT, and MRI for the initial staging of ICC in two institutions. Among them, 102 patients had undergone surgical treatment. Ninety patients who had a histopathological diagnosis of ICC were retrospectively reviewed. The sensitivity and specificity of 18F-FDG PET-CT, CT, and magnetic resonance imaging (MRI) in detecting tumors, satellite focus, vascular invasion, and lymph node metastases were analyzed. Ninety patients with histologically diagnosed ICC were included. PET-CT demonstrated no statistically significant advantage over CT and MR in the diagnosis of multiple tumors and macrovascular invasion, and bile duct invasion. The overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PET-CT in lymph node metastases were 84%, 86%, 91%, 84%, and 86%, respectively. PET-CT revealed a significantly higher accuracy compared to CT or MRI (86%, 67%, and 76%, p < 0.01, respectively) in the diagnosis of regional lymph node metastases. The accuracy of tumor staging by PET-CT was higher than that by CT/MRI (PET-CT vs. CT vs. MRI: 68/90 vs. 47/90 vs. 51/90, p < 0.05). 18F-FDG PET-CT had sensitivity and specificity values for diagnosing satellite focus and vascular and bile duct invasion similar to those of CT or MRI; however, PET-CT showed higher accuracy in diagnosing regional lymph node metastases. 18F-FDG PET-CT exhibited higher tumor staging accuracy than that of CT/MRI. Thus, 18FDG PET-CT may support tumor staging in ICC.
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Affiliation(s)
- Eiko Nishioka
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Masakatsu Tsurusaki
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Osaka, Japan
- Correspondence: ; Tel.: +81-72-366-0221; Fax: +81-72-367-1685
| | - Ryohei Kozuki
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Osaka, Japan
| | - Sung-Woon Im
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Osaka, Japan
| | - Atsushi Kono
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Kazuhiro Kitajima
- Department of Radiology, Hyogo Medical University Faculty of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Takamichi Murakami
- Department of Radiology, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
| | - Kazunari Ishii
- Department of Radiology, Kindai University Faculty of Medicine, Osaka-Sayama 589-8511, Osaka, Japan
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Lan L, Zhang S, Xu T, Liu H, Wang W, Feng Y, Wang L, Chen Y, Qiu L. Prospective Comparison of 68Ga-FAPI versus 18F-FDG PET/CT for Tumor Staging in Biliary Tract Cancers. Radiology 2022; 304:648-657. [PMID: 35579524 DOI: 10.1148/radiol.213118] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Gallium 68-labeled fibroblast-activation protein inhibitor (68Ga-FAPI), an imaging agent for detecting tumors, represents a promising alternative to fluorine 18 fluorodeoxyglucose (18F-FDG). Purpose To compare the potential efficacy of 68Ga-FAPI PET/CT with that of 18F-FDG PET/CT for detecting primary tumor and nodal and distant metastases in biliary tract cancer (BTC) and to explore the impact (tumor staging) of 68Ga-FAPI compared with 18F-FDG on clinical management of BTC. Materials and Methods This single-center prospective clinical study was performed at the Affiliated Hospital of Southwest Medical University between June 2020 and June 2021. Participants with BTC underwent both 68Ga-FAPI and 18F-FDG PET/CT. Histopathologic examination, morphologic imaging, and/or follow-up imaging served as the reference standard. The maximum standardized uptake value (SUVmax) of the primary tumor and nodal and distant metastases between 18F-FDG and 68Ga-FAPI PET/CT were compared using the paired-sample t test. Results Eighteen participants with primary or recurrent BTC were evaluated (mean age, 61 years ± 10 [SD]). The sensitivity of 68Ga-FAPI PET/CT was higher than that of 18F-FDG PET/CT for detecting primary tumors (16 of 16 [100%] vs 13 of 16 [81%]), nodal metastases (41 of 42 [98%] vs 35 of 42 [83%]), and distant metastases (99 of 99 [100%] vs 78 of 99 [79%]). 68Ga-FAPI PET/CT resulted in new oncologic findings in 10 of 18 participants and upgraded tumor staging or restaging in five of 18 participants compared with 18F-FDG PET/CT. 68Ga-FAPI PET/CT demonstrated higher sensitivity than 18F-FDG PET/CT in inflammatory processes secondary to tumor-related obstruction (seven of eight [88%] vs one of eight [13%]). 68Ga-FAPI showed lower average SUVmax in inflammatory processes than in oncologic lesions (4.9 ± 2.6 vs 10.0 ± 4.6, respectively; P = .003). Conclusion Gallium 68-labeled fibroblast-activation protein inhibitor PET/CT for tumor staging showed potential for more accurate staging of biliary tract cancer, thereby improving treatment decision making. Clinical trial registration no. ChiCTR2100044131 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Choyke in this issue.
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Affiliation(s)
- Lianjun Lan
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Shumao Zhang
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Tingting Xu
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Huipan Liu
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Wei Wang
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Yue Feng
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Li Wang
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Yue Chen
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
| | - Lin Qiu
- From the Departments of Radiology (L.L.) and Nuclear Medicine (S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.), The Affiliated Hospital of Southwest Medical University, No. 25 Taiping St, Jiangyang District, Luzhou 646000, People's Republic of China; Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.); and Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China (L.L., S.Z., T.X., H.L., W.W., Y.F., L.W., Y.C., L.Q.)
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Obesity is a risk factor for intrahepatic cholangiocarcinoma progression associated with alterations of metabolic activity and immune status. Sci Rep 2021; 11:5845. [PMID: 33712681 PMCID: PMC7955092 DOI: 10.1038/s41598-021-85186-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Body mass index (BMI) is well known to be associated with poor prognosis in several cancers. The relationship between BMI and the long-term outcomes of patients with intrahepatic cholangiocarcinoma (ICC) is incompletely understood. This study investigated the relationships of BMI with clinicopathological characteristics and patient outcomes, focusing on metabolic activity and immune status. The relationship between BMI and the maximum standardized uptake value (SUVmax) on fluorine-18 fluorodeoxyglucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) was analyzed. In addition, immunohistochemistry was performed for programmed cell death-ligand 1 (PD-L1), cluster of differentiation 8 (CD8), and forkhead box protein P3 (Foxp3). Seventy-four patients with ICC were classified into normal weight (BMI < 25.0 kg/m2, n = 48) and obesity groups (BMI ≥ 25.0 kg/m2, n = 26), respectively. Serum carbohydrate antigen 19–9 levels were higher in the obesity group than in the normal weight group. Tumor size and the intrahepatic metastasis rate were significantly larger in the obesity group. Patients in the obesity group had significantly worse prognoses than those in the normal weight group. Moreover, BMI displayed a positive correlation with SUVmax on 18F-FDG PET/CT (n = 46, r = 0.5152). Patients with high 18F-FDG uptake had a significantly higher rate of PD-L1 expression, lower CD8 + tumor-infiltrating lymphocyte (TIL) counts, and higher Foxp3 + TIL counts. The elevated BMI might predict the outcomes of patients with ICC. Obesity might be associated with ICC progression, possibly through alterations in metabolic activity and the immune status.
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Kim NH, Lee SR, Kim YH, Kim HJ. Diagnostic Performance and Prognostic Relevance of FDG Positron Emission Tomography/Computed Tomography for Patients with Extrahepatic Cholangiocarcinoma. Korean J Radiol 2020; 21:1355-1366. [PMID: 32767862 PMCID: PMC7689144 DOI: 10.3348/kjr.2019.0891] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 03/10/2020] [Accepted: 04/23/2020] [Indexed: 12/25/2022] Open
Abstract
Objective We aimed to evaluate the diagnostic value and prognostic relevance of FDG positron emission tomography/computed tomography (PET-CT) in extrahepatic cholangiocarcinoma patients. Materials and Methods This study included 234 extrahepatic cholangiocarcinoma patients who underwent FDG PET-CT between June 2008 and February 2016. The diagnostic performance of FDG PEG-CT was compared to that of contrast-enhanced multidetector row CT (MDCT) and MRI. Independent prognosticators for poor survival were also assessed. Results The sensitivity of FDG PET-CT for detecting primary tumor and regional lymph node metastases was lower than that of MDCT or MRI (p < 0.001), whereas the specificity and positive predictive value for detecting regional lymph nodes metastases was significantly better in FDG PET-CT compared to MDCT and MRI (all p < 0.001). There was no significant difference in the diagnostic yield of distant metastases detection among three diagnostic imaging techniques. In a multivariate analysis, maximum standardized uptake values (SUVmax) of the primary tumor (adjusted hazard ratio [HR], 1.75; 95% confidence interval [CI], 1.13–2.69) and of the metastatic lesions ≥ 5 (adjusted HR, 8.10; 95% CI, 1.96–33.5) were independent contributors to poor overall survival in extrahepatic cholangiocarcinoma patients. In a subgroup analysis of 187 patients with periductal infiltrating type of cholangiocarcinoma, an SUVmax of the primary tumor ≥ 5 was associated with an increased risk of regional lymph node (adjusted odds ratio [OR], 1.60; 95% CI, 0.55–4.63) and distant metastases (adjusted OR, 100.57; 95% CI, 3.94–2567.43) at diagnosis as well as with poor overall survival (adjusted HR, 1.81; 95% CI, 1.04–3.15). Conclusion FDG PET-CT showed lower sensitivity for detecting primary tumor and regional lymph node involvement than MDCT and MRI. However, the SUVmax of primary tumors and metastatic lesions derived from FDG PET-CT could have significant implications for predicting prognoses in extrahepatic cholangiocarcinoma patients.
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Affiliation(s)
- Nam Hee Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung Ryol Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Hwan Kim
- Department of Nuclear Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hong Joo Kim
- Division of Gastroenterology, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Lamarca A, Barriuso J, Chander A, McNamara MG, Hubner RA, ÓReilly D, Manoharan P, Valle JW. 18F-fluorodeoxyglucose positron emission tomography ( 18FDG-PET) for patients with biliary tract cancer: Systematic review and meta-analysis. J Hepatol 2019; 71:115-129. [PMID: 30797051 DOI: 10.1016/j.jhep.2019.01.038] [Citation(s) in RCA: 72] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 01/10/2019] [Accepted: 01/30/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND & AIMS The role of 18F-fluorodeoxyglucose positron emission tomography (18FDG-PET) in the diagnosis and staging of patients with biliary tract cancers (BTCs) remains controversial, so we aimed to provide robust information on the utility of 18FDG-PET in the diagnosis and management of BTC. METHODS This systematic review and meta-analysis explored the diagnostic test accuracy of 18FDG-PET as a diagnostic tool for diagnosis of primary tumour, lymph node invasion, distant metastases and relapsed disease. Subgroup analysis by study quality and BTC subtype were performed. Changes in management based on 18FDG-PET and impact of maximum standardised uptake values (SUVmax) on prognosis were also assessed. A random effects model was used for meta-analyses. RESULTS A total of 2,125 patients were included from 47 eligible studies. The sensitivity (Se) and specificity (Sp) of 18FDG-PET for the diagnosis of primary tumour were 91.7% (95% CI 89.8-93.2) and 51.3% (95% CI 46.4-56.2), respectively, with an area under the curve (AUC) of 0.8668. For lymph node invasion, Se was 88.4% (95% CI82.6-92.8) and Sp was 69.1% (95% CI 63.8-74.1); AUC 0.8519. For distant metastases, Se was 85.4% (95% CI 79.5-90.2) and Sp was 89.7% (95% CI86.0-92.7); AUC 0.9253. For relapse, Se was 90.1% (95% CI 84.4-94.3) and Sp was 83.5% (95% CI 74.4-90.4); AUC 0.9592. No diagnostic threshold effect was identified. Meta-regression did not identify significant sources of heterogeneity. Sensitivity analysis revealed no change in results when analyses were limited to studies with low risk of bias/concern. The pooled proportion of change in management was 15% (95% CI 11-20); the majority (78%) due to disease upstaging. Baseline high SUVmax was associated with worse survival (pooled hazard ratio of 1.79; 95% CI 1.37-2.33; p <0.001). CONCLUSIONS There is evidence to support the incorporation of 18FDG-PET into the current standard of care for the staging (lymph node and distant metastases) and identification of relapse in patients with BTC to guide treatment selection; especially if the identification of occult sites of disease would change management, or if diagnosis of relapse remains unclear following standard of care imaging. The role for diagnosis of the primary tumour remains controversial due to low sensitivity and 18FDG-PET should not be considered as a replacement for pathological confirmation in this setting. LAY SUMMARY A positron emission tomography (PET scan), using 18F-fluorodeoxyglucose (18FDG), can help doctors identify areas of cancer in the body by highlighting "hot spots". These hotspots may be cancerous (true positive) but may also be non-cancerous, like inflammation (false positive). We show that PET scans are useful to assess how far advanced the cancer is (by assessing spread to lymph glands and to other organs) and also to identify if the cancer has recurred (for example after surgery), thus helping doctors to make treatment decisions. However, a biopsy is still needed for the initial diagnosis of a biliary tract cancer, because of the high chance of a "false positive" with PET scans.
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Affiliation(s)
- Angela Lamarca
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK.
| | - Jorge Barriuso
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Amarjot Chander
- Radiology and Nuclear Medicine Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Mairéad G McNamara
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Richard A Hubner
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK
| | - Derek ÓReilly
- HPB Surgery Department, Manchester Royal Infirmary, Central Manchester University Hospitals, Manchester, UK
| | - Prakash Manoharan
- Radiology and Nuclear Medicine Department, The Christie NHS Foundation Trust, Manchester, UK
| | - Juan W Valle
- Medical Oncology Department, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, University of Manchester, UK.
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Donati M, Stang A, Stavrou GA, Basile F, Oldhafer KJ. Extending resectability of hilar cholangiocarcinomas: how can it be assessed and improved? Future Oncol 2018; 15:193-205. [PMID: 30378439 DOI: 10.2217/fon-2018-0413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Until the 1980's, Klatskin tumors were considered 'desperate cases' and most of them were not resected; almost no oncologic concept was available. After many improvements, today, extended hepatectomy, including caudate lobe resection and lymphoadenectomy, have become a standard of care for oncologicaly radical resection of Klatskin tumors. Portal vein en bloc resection, if necessary, is a diffused standard assuring R0-resection without any improvement of survival in most series. Arterial resection remains episodical and controversial in its oncologic impact. Arterial resection-reconstruction was demonstrated to be feasible with many different technical possibilities. Neoadjuvant chemotherapy, refinement of associating liver partition and portal vein ligation for staged hepatectomy and liver transplantations are some possible future resources for treatment of those aggressive tumors that could be able to expand the pool of treatable patients.
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Affiliation(s)
- Marcello Donati
- Department of Surgery & Medical-Surgical Specialties, Surgical Clinic Unit, University Hospital of Catania (CAST), University of Catania, 95122 Catania, Italy.,Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany
| | - Axel Stang
- Oncology Unit, Asklepios Barmbek Hospital, Hamburg, Germany
| | - Gregor A Stavrou
- Department of General, Visceral, Thoracic & Pediatric Surgery, Saarbrucken Hospital, Saarbrucken-Saarland, Germany
| | - Francesco Basile
- Department of Surgery & Medical-Surgical Specialties, Surgical Clinic Unit, University Hospital of Catania (CAST), University of Catania, 95122 Catania, Italy
| | - Karl J Oldhafer
- Semmelweiss University of Budapest, Asklepios Campus Hamburg, Germany.,Department of General & Abdominal Surgery, Asklepios Barmbek Hospital, Hamburg, Germany
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Inverse Prognostic Relationships of 18F-FDG PET/CT Metabolic Parameters in Patients with Distal Bile Duct Cancer Undergoing Curative Surgery. Nucl Med Mol Imaging 2018; 52:334-341. [PMID: 30344781 DOI: 10.1007/s13139-018-0542-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/05/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose As there were few previous studies with a small number of subjects, the purpose of this was to evaluate the prognostic significance of 18F-FDG PET/CT in patients with distal bile duct cancer undergoing curative surgery. Methods The study included 40 patients (M/F = 24:16; age 68.0 ± 8.0 years) who underwent preoperative 18F-FDG PET/CT followed by curative surgical resection. The participant's age, sex, Eastern Cooperative Oncology Group performance-status score, baseline serum CA 19-9 level, stage, pathologic T and N stages, tumor size, tumor grade, tumor growth pattern, R0 resection, and adjuvant therapy were included as clinicopathological variables for predicting overall survival. The PET variables were maximum standardized uptake value (SUVmax), average SUV (SUVavg), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) of the tumor. The Kaplan-Meyer method and Cox proportional hazards model were used for the survival analysis. Results A total of 15 of 40 patients (37.5%) died during the follow-up period. In univariate analysis, low SUVmax (≤ 2.7, p = 0.0005) and low SUVavg (≤ 2.6, p = 0.0034) were significant predictors of poor overall survival. In multivariate analyses, only low SUVmax (HR = 6.7016, 95% CI 1.9961-22.4993, p = 0.0047) was an independent prognostic factor associated with poor overall survival. Conclusion The SUVmax of the primary tumor measured by 18F-FDG PET/CT was an independent significant prognostic factor for overall survival in patients with distal bile duct cancer. However, different results from a previous study warrant further large sample-sized study.
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Evaluation of 18F-FDG PET-CT as a prognostic marker in advanced biliary tract cancer. Nucl Med Commun 2018; 39:252-259. [DOI: 10.1097/mnm.0000000000000810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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10
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Pak K, Kim SJ, Kim IJ, Kim DU, Kim K, Kim H, Kim SJ. Splenic FDG uptake predicts poor prognosis in patients with unresectable cholangiocarcinoma. Nuklearmedizin 2018; 53:26-31. [DOI: 10.3413/nukmed-0566-13-03] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/14/2013] [Indexed: 12/18/2022]
Abstract
Summary
Aim: Diffuse splenic 18F-Fluorodeoxyglucose (FDG) uptake has shown to be associated with concurrent inflammation. We evaluated the prognostic value of diffuse splenic FDG uptake for predicting prognosis in cholangiocarcinoma patients. Patients, methods: Sixty-four patients with unresectable cholangiocarcinoma performed Positron emission tomography/computed tomography (PET/CT) using FDG between July 2009 and April 2012. Patients were divided into two groups according to splenic FDG uptake relative to hepatic FDG uptake. Eleven patients showing splenic FDG uptake exceeding hepatic uptake were included in group A, while 53 patients with hepatic FDG uptake exceeding splenic uptake were included in group B. Prognostic factors for overall survival were evaluated using log-rank test. Variables with a probability of less than or equal to 0.1 on univariate analysis were considered as possible independent factors. Cox-proportional hazards Cholangiocarcinoma, a malignant neoplasm of biliary epithelium, is a rare disease with an increasing incidence worldwide (19). The chances of survival with cholan- giocarcinoma depend on its location and model was used to analyze univariate and multivariate analysis. Results: Mean standardized uptake value of the liver (Liver SUVmean)/ Spleen SUVmean (L/S) ratio <1 (p = 0.0034), WBC > 10 000 (p = 0.1155) and CEA >30 (p = 0.0946) were predictors of overall survival on univariate analysis. In a subsequent multivariate analysis, L/S ratio <1 remained a significant independent predictor of poor prognosis (HR 6.0153, 95% CI, 1.7193-21.0460, p = 0.0052). Conclusion: Our study has shown that splenic FDG uptake could be a predictor of overall survival of unresectable cholangiocarcinoma patients.
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Capobianco I, Rolinger J, Nadalin S. Resection for Klatskin tumors: technical complexities and results. Transl Gastroenterol Hepatol 2018; 3:69. [PMID: 30363698 PMCID: PMC6182019 DOI: 10.21037/tgh.2018.09.01] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Accepted: 08/27/2018] [Indexed: 12/18/2022] Open
Abstract
Klatskin's tumors, actually-redefined as perihilar cholangiocarcinoma (phCCA) do represent 50-70% of all CCAs and develop in a context of chronic inflammation and cholestasis of bile ducts. Surgical resection provides the only chance of cure for this disease but is technically challenging because of the complex, intimate and variable relationship between biliary and vascular structures at this location. Five years survival rates range between 25-45% (median 27-58 months) in case of R0 resection and 0-23% (median 12-21 months) in case of R1 resection respectively. It should be noted that the major costs of high radicality are represented by relative high morbidity and mortality rates (i.e., 20-66% and 0-9% respectively). Considering the fact that radical resection may represent the only curative treatment of phCCA, we focused our review on surgical planning and techniques that may improve resectability rates and outcomes for locally advanced phCCA. The surgical treatment of phCCA can be successful when following aspects have been fulfilled: (I) accurate preoperative diagnostic aimed to identify the tumor in all its details (localization and extension) and to study all the risk factors influencing a posthepatectomy liver failure (PHLF): i.e., liver volume, liver function, liver quality, haemodynamics and patient characteristics; (II) High end surgical skills taking in consideration the local extension of the tumor and the vascular invasion which usually require an extended hepatic resection and often a vascular resection; (III) adequate postoperative management aimed to avoid major complications (i.e., PHLF and biliary complications). These are technically challenging operations and must be performed in a high volume centres by hepato-biliary-pancreas (HBP)-surgeons with experience in microsurgical vascular techniques.
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Affiliation(s)
- Ivan Capobianco
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Jens Rolinger
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
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Cassani L, Lee JH. Management of malignant distal biliary obstruction. GASTROINTESTINAL INTERVENTION 2015. [DOI: 10.1016/j.gii.2015.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Predictability of preoperative 18F-FDG PET for histopathological differentiation and early recurrence of primary malignant intrahepatic tumors. Nucl Med Commun 2015; 36:319-27. [DOI: 10.1097/mnm.0000000000000254] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Teixera SR, Kohan AA, Paspulati RM, Rong R, Herrmann KA. Potential Role of Positron Emission Tomography/Magnetic Resonance Imaging in Gastrointestinal and Abdominal Malignancies: Preliminary Experience. Semin Roentgenol 2014; 49:321-33. [DOI: 10.1053/j.ro.2014.07.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Catheter Tract Implantation Metastasis Diagnosed by F-18 FDG PET/CT After Percutaneous Transhepatic Biliary Drainage for Hilar Cholangiocarcinoma. Nucl Med Mol Imaging 2014; 48:326-7. [PMID: 26396641 DOI: 10.1007/s13139-014-0269-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/14/2014] [Accepted: 02/17/2014] [Indexed: 10/25/2022] Open
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Choi MK, Choi JY, Lee J, Heo JS, Choi SH, Choi DW, Lee KT, Lee JK, Lee KH, Park JO, Park YS, Lim HY. Prognostic and predictive value of metabolic tumor volume on 18F-FDG PET/CT in advanced biliary tract cancer treated with gemcitabine/oxaliplatin with or without erlotinib. Med Oncol 2014; 31:23. [DOI: 10.1007/s12032-014-0023-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 05/02/2014] [Indexed: 12/22/2022]
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Intérêt de l’imagerie fonctionnelle TEP dans les tumeurs hépatobiliaires primitives malignes. ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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