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Covington MF, Koppula BR, Fine GC, Salem AE, Wiggins RH, Hoffman JM, Morton KA. PET-CT in Clinical Adult Oncology: II. Primary Thoracic and Breast Malignancies. Cancers (Basel) 2022; 14:cancers14112689. [PMID: 35681669 PMCID: PMC9179296 DOI: 10.3390/cancers14112689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 05/20/2022] [Accepted: 05/26/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Positron emission tomography (PET), typically combined with computed tomography (CT), has become a critical advanced imaging technique in oncology. With PET-CT, a radioactive molecule (radiotracer) is injected in the bloodstream and localizes to sites of tumor because of specific cellular features of the tumor that accumulate the targeting radiotracer. The CT scan, performed at the same time, provides information to facilitate assessment of the amount of radioactivity from deep or dense structures, and to provide detailed anatomic information. PET-CT has a variety of applications in oncology, including staging, therapeutic response assessment, restaging, and surveillance. This series of six review articles provides an overview of the value, applications, and imaging and interpretive strategies of PET-CT in the more common adult malignancies. The second article in this series addresses the use of PET-CT in breast cancer and other primary thoracic malignancies. Abstract Positron emission tomography combined with x-ray computed tomography (PET-CT) is an advanced imaging modality with oncologic applications that include staging, therapy assessment, restaging, and surveillance. This six-part series of review articles provides practical information to providers and imaging professionals regarding the best use of PET-CT for the more common adult malignancies. The second article of this series addresses primary thoracic malignancy and breast cancer. For primary thoracic malignancy, the focus will be on lung cancer, malignant pleural mesothelioma, thymoma, and thymic carcinoma, with an emphasis on the use of FDG PET-CT. For breast cancer, the various histologic subtypes will be addressed, and will include 18F fluorodeoxyglucose (FDG), recently Food and Drug Administration (FDA)-approved 18F-fluoroestradiol (FES), and 18F sodium fluoride (NaF). The pitfalls and nuances of PET-CT in breast and primary thoracic malignancies and the imaging features that distinguish between subcategories of these tumors are addressed. This review will serve as a resource for the appropriate roles and limitations of PET-CT in the clinical management of patients with breast and primary thoracic malignancies for healthcare professionals caring for adult patients with these cancers. It also serves as a practical guide for imaging providers, including radiologists, nuclear medicine physicians, and their trainees.
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Affiliation(s)
- Matthew F. Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Bhasker R. Koppula
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Gabriel C. Fine
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Ahmed Ebada Salem
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
- Department of Radiodiagnosis and Intervention, Faculty of Medicine, Alexandria University, Alexandria 21526, Egypt
| | - Richard H. Wiggins
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - John M. Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
| | - Kathryn A. Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, UT 84132, USA; (M.F.C.); (B.R.K.); (G.C.F.); (A.E.S.); (R.H.W.); (J.M.H.)
- Intermountain Healthcare Hospitals, Summit Physician Specialists, Murray, UT 84123, USA
- Correspondence: ; Tel.: +1-801-581-7553
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Tumor-to-liver standard uptake ratio using fluorine-18 fluorodeoxyglucose positron emission tomography computed tomography effectively predict occult lymph node metastasis of non-small cell lung cancer patients. Nucl Med Commun 2021; 41:459-468. [PMID: 32187163 DOI: 10.1097/mnm.0000000000001173] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES We aimed to investigate predictive factors of occult lymph node metastasis and to explore the diagnostic value of various standardized uptake value (SUV) parameters using fluorine-18 fluorodeoxyglucose (F-FDG) positron emission tomography computed tomography (PET/CT) in predicting occult lymph node metastasis of clinical N0 non-small cell lung cancer patients. METHODS We retrospectively analyzed PET/computed tomography parameters of tumor and clinical data of 124 clinical N0 non-small cell lung cancer patients who underwent both preoperative F-FDG PET/computed tomography and anatomical pulmonary resection with systematic lymph node dissections. The SUVmax, SUVmean, metabolic total volume, and total lesion glycolysis of the primary tumor was automatically measured on the PET/computed tomography workstation. Standardized uptake ratio (SUR) were derived from tumor standardized uptake value divided by blood SUVmean (B-SUR) or liver SUVmean (L-SUR), respectively. RESULTS According to postoperative pathology, 19 (15%) were diagnosed as occult lymph node metastasis among 124 clinical N0 non-small cell lung cancer patients. On univariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, lobulation, and all PET parameters were associated with occult lymph node metastasis. The area under the receiver operating characteristic curve, sensitivity, and negative predictive value of L-SURmax were the highest among all PET parameters (0.778, 94.7%, and 98.4%, respectively). On multivariate analysis, carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax were independent risk factors for predicting occult lymph node metastasis. Compared to L-SURmax alone and the combination of carcinoembryonic antigen and cytokeratin 19 fragment, the model consisting of three independent risk factors achieved a greater area under the receiver operating characteristic curve (0.901 vs. 0.778 vs. 0.780, P = 0.021 and 0.0141). CONCLUSIONS L-SURmax showed the most powerful predictive performance than the other PET parameters in predicting occult lymph node metastasis. The combination of three independent risk factors (carcinoembryonic antigen, cytokeratin 19 fragment, and L-SURmax) can effectively predict occult lymph node metastasis in clinical N0 non-small cell lung cancer patients.
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Giesel FL, Adeberg S, Syed M, Lindner T, Jiménez-Franco LD, Mavriopoulou E, Staudinger F, Tonndorf-Martini E, Regnery S, Rieken S, El Shafie R, Röhrich M, Flechsig P, Kluge A, Altmann A, Debus J, Haberkorn U, Kratochwil C. FAPI-74 PET/CT Using Either 18F-AlF or Cold-Kit 68Ga Labeling: Biodistribution, Radiation Dosimetry, and Tumor Delineation in Lung Cancer Patients. J Nucl Med 2020; 62:201-207. [PMID: 32591493 PMCID: PMC8679591 DOI: 10.2967/jnumed.120.245084] [Citation(s) in RCA: 149] [Impact Index Per Article: 37.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/27/2020] [Indexed: 12/14/2022] Open
Abstract
68Ga-fibroblast activation protein inhibitors (FAPIs) 2, 4, and 46 have already been proposed as promising PET tracers. However, the short half-life of 68Ga (68 min) creates problems with manufacture and delivery. 18F (half-life, 110 min) labeling would result in a more practical large-scale production, and a cold-kit formulation would improve the spontaneous availability. The NOTA chelator ligand FAPI-74 can be labeled with both 18F-AlF and 68Ga. Here, we describe the in vivo evaluation of 18F-FAPI-74 and a proof of mechanism for 68Ga-FAPI-74 labeled at ambient temperature. Methods: In 10 patients with lung cancer, PET scans were acquired at 10 min, 1 h, and 3 h after administration of 259 ± 26 MBq of 18F-FAPI-74. Physiologic biodistribution and tumor uptake were semiquantitatively evaluated on the basis of SUV at each time point. Absorbed doses were evaluated using OLINDA/EXM, version 1.1, and QDOSE dosimetry software with the dose calculator IDAC-Dose, version 2.1. Identical methods were used to evaluate one examination after injection of 263 MBq of 68Ga-FAPI-74. Results: The highest contrast was achieved in primary tumors, lymph nodes, and distant metastases at 1 h after injection, with an SUVmax of more than 10. The effective dose per a 100-MBq administered activity of 18F-FAPI-74 was 1.4 ± 0.2 mSv, and for 68Ga-FAPI-74 it was 1.6 mSv. Thus, the radiation burden of a diagnostic 18F-FAPI-74 PET scan is even lower than that of PET scans with 18F-FDG and other 18F tracers; 68Ga-FAPI-74 is comparable to other 68Ga ligands. FAPI PET/CT supported target volume definition for guiding radiotherapy. Conclusion: The high contrast and low radiation burden of FAPI-74 PET/CT favor multiple clinical applications. Centralized large-scale production of 18F-FAPI-74 or decentralized cold-kit labeling of 68Ga-FAPI-74 allows flexible routine use.
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Affiliation(s)
- Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Adeberg
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Mustafa Syed
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Thomas Lindner
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Eleni Mavriopoulou
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Fabian Staudinger
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Eric Tonndorf-Martini
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Regnery
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Rieken
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Göttingen, Göttingen, Germany; and
| | - Rami El Shafie
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Manuel Röhrich
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Paul Flechsig
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Andreas Kluge
- ABX-CRO Advanced Pharmaceutical Services Forschungsgesellschaft mbH, Dresden, Germany
| | - Annette Altmann
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jürgen Debus
- Heidelberg Institute of Radiation Oncology, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center, Heidelberg, Germany
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany .,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center, Heidelberg, Germany
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, Heidelberg, Germany
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Sha X, Gong G, Qiu Q, Duan J, Li D, Yin Y. Discrimination of mediastinal metastatic lymph nodes in NSCLC based on radiomic features in different phases of CT imaging. BMC Med Imaging 2020; 20:12. [PMID: 32024469 PMCID: PMC7003415 DOI: 10.1186/s12880-020-0416-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/27/2020] [Indexed: 12/13/2022] Open
Abstract
Background We aimed to develop radiomic models based on different phases of computed tomography (CT) imaging and to investigate the efficacy of models for diagnosing mediastinal metastatic lymph nodes (LNs) in non-small cell lung cancer (NSCLC). Methods Eighty-six NSCLC patients were enrolled in this study, and we selected 231 mediastinal LNs confirmed by pathology results as the subjects which were divided into training (n = 163) and validation cohorts (n = 68). The regions of interest (ROIs) were delineated on CT scans in the plain phase, arterial phase and venous phase, respectively. Radiomic features were extracted from the CT images in each phase. A least absolute shrinkage and selection operator (LASSO) algorithm was used to select features, and multivariate logistic regression analysis was used to build models. We constructed six models (orders 1–6) based on the radiomic features of the single- and dual-phase CT images. The performance of the radiomic model was evaluated by the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV). Results A total of 846 features were extracted from each ROI, and 10, 9, 5, 2, 2, and 9 features were chosen to develop models 1–6, respectively. All of the models showed excellent discrimination, with AUCs greater than 0.8. The plain CT radiomic model, model 1, yielded the highest AUC, specificity, accuracy and PPV, which were 0.926 and 0.925; 0.860 and 0.769; 0.871 and 0.882; and 0.906 and 0.870 in the training and validation sets, respectively. When the plain and venous phase CT radiomic features were combined with the arterial phase CT images, the sensitivity increased from 0.879 and 0.919 to 0.949 and 0979 and the NPV increased from 0.821 and 0.789 to 0.878 and 0.900 in the training group, respectively. Conclusions All of the CT radiomic models based on different phases all showed high accuracy and precision for the diagnosis of LN metastasis (LNM) in NSCLC patients. When combined with arterial phase CT, the sensitivity and NPV of the model was be further improved.
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Affiliation(s)
- Xue Sha
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China
| | - Guanzhong Gong
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Qingtao Qiu
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Jinghao Duan
- Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China
| | - Dengwang Li
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China
| | - Yong Yin
- Shandong Key Laboratory of Medical Physics and Image Processing & Shandong Provincial Engineering and Technical Center of Light Manipulations, School of Physics and Electronics, Shandong Normal University, Jinan, 250358, China. .,Department of Radiation Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, No.440, Jiyan Road, Jinan, 250117, Shandong, China.
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Vaghjiani RG, Takahashi Y, Eguchi T, Lu S, Kameda K, Tano Z, Dozier J, Tan KS, Jones DR, Travis WD, Adusumilli PS. Tumor Spread Through Air Spaces Is a Predictor of Occult Lymph Node Metastasis in Clinical Stage IA Lung Adenocarcinoma. J Thorac Oncol 2020; 15:792-802. [PMID: 32007599 DOI: 10.1016/j.jtho.2020.01.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 01/02/2020] [Accepted: 01/14/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION In patients with stage IA lung adenocarcinoma (ADC), sublobar resection and tumor spread through air spaces (STAS) are associated with high rates of locoregional recurrence, half of which occur within the regional lymph nodes (LNs). Our objectives were to investigate the association between occult LN metastasis (ONM) and STAS and to assess their prognostic value in patients with clinical stage IA lung ADC. METHODS The association between STAS and ONM was analyzed in patients who underwent lobectomy and LN dissection for clinical stage IA lung ADC (n = 809). Multivariable logistic regression analysis was carried out to identify predictors of ONM. Site-specific recurrence by surgical procedure was investigated in patients with pathologic node-negative disease (n = 1055) using a competing risk approach. RESULTS ONM was identified in 129 patients (16%)-one-third of ONMs were located only in intrapulmonary nodes. STAS was more common in patients with ONM than in those without ONM (67% versus 39%; p < 0.001) and in patients with multiple ONMs than in those with a single ONM (86%-89% versus 60%-67%). STAS was a significant predictor of ONM (p = 0.004) on multivariable analysis, independent of tumor size, maximum standardized uptake value, and lymphovascular invasion. In patients with STAS-positive ADC (high ONM risk), the risk of recurrence in the treated lobe and regional LNs increased as the extent of resection decreased (recurrence risk: lobectomy < segmentectomy < wedge resection). In patients with STAS-negative ADC, the risk of locoregional recurrence did not differ by procedure type. CONCLUSIONS Presence of STAS predicts ONM in patients with clinical stage IA lung ADC and can help stratify risk of recurrence by extent and type of resection.
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Affiliation(s)
- Raj G Vaghjiani
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Yusuke Takahashi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of General Thoracic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Eguchi
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Division of Thoracic Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan
| | - Shaohua Lu
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Koji Kameda
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Thoracic Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Zachary Tano
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jordan Dozier
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kay See Tan
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Prasad S Adusumilli
- Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York; Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, New York.
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Czarnecka-Kujawa K, de Perrot M, Keshavjee S, Yasufuku K. Endobronchial ultrasound-guided transbronchial needle aspiration mediastinal lymph node staging in malignant pleural mesothelioma. J Thorac Dis 2019; 11:602-612. [PMID: 30963005 DOI: 10.21037/jtd.2019.01.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background Given poor survival of patients with malignant pleural mesothelioma (MPM) and extrapleural nodal metastasis, pre-operative mediastinal lymph node (LN) staging has been advocated. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) may be a useful pre-operative adjunct in patients with MPM. This study aims to assess performance of EBUS-TBNA for mediastinal LN staging in MPM. Methods A retrospective chart review of patients with diagnosis of MPM referred to the mesothelioma program at a tertiary Canadian cancer center between January 1, 2012 and December 31, 2014 who received mediastinal LN staging with EBUS-TBNA. Results Forty-eight patients were included. Average age was 70 years (range, 48-84 years). Mesothelioma subtypes were as follows: epithelioid 34/48 (70.8%), sarcomatoid 4/48 (8.3%), biphasic 7/48 (14.6%) and other 3/48 (6.3%). Stage distribution was as follows: I 18.8%, II 10.4%, III 47.9%, and IV 22.9%. On average 3.4 LNs were sampled per patient (range, 1-5). The mean short axis of a sampled LN was 6.8±3.8 mm. Rapid on Site Evaluation (ROSE) was available in 75.0% (36/48) of the assessments. Prevalence of N2/N3 disease was 35.4% (17/48). EBUS-TBNA sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy were: 16.7%, 100%, 100%, 68.8%, and 70.6%, respectively. EBUS-TBNA mediastinal LN staging prevented unnecessary surgery in 18.8% (9/48 patients) by detection of N2/N3 disease (8 patients) and metastatic secondary malignancy (1 patient). There were no EBUS-TBNA related complications. Conclusions EBUS-TBNA mediastinal LN staging may impact significantly management of patients with MPM by detecting mediastinal metastatic disease, therefore, preventing morbidity and mortality of surgical management.
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Affiliation(s)
- Kasia Czarnecka-Kujawa
- Division of Respirology, Toronto General Hospital, University Health Network, ON, Canada.,Division of Thoracic Surgery, Toronto General Hospital, University Health Network, ON, Canada
| | - Marc de Perrot
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, ON, Canada
| | - Shaf Keshavjee
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, ON, Canada
| | - Kazuhiro Yasufuku
- Division of Thoracic Surgery, Toronto General Hospital, University Health Network, ON, Canada
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Yang X, Pan X, Liu H, Gao D, He J, Liang W, Guan Y. A new approach to predict lymph node metastasis in solid lung adenocarcinoma: a radiomics nomogram. J Thorac Dis 2018; 10:S807-S819. [PMID: 29780627 DOI: 10.21037/jtd.2018.03.126] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Lymph node metastasis (LNM) of lung cancer is an important factor related to survival and recurrence. The association between radiomics features of lung cancer and LNM remains unclear. We developed and validated a radiomics nomogram to predict LNM in solid lung adenocarcinoma. Methods A total of 159 eligible patients with solid lung adenocarcinoma were divided into training (n=106) and validation cohorts (n=53). Radiomics features were extracted from venous-phase CT images. We built a radiomics nomogram using a multivariate logistic regression model combined with CT-reported lymph node (LN) status. The performance of the radiomics nomogram was evaluated using the area under curve (AUC) of receiver operating characteristic curve. We performed decision curve analysis (DCA) within training and validation cohorts to assess the clinical usefulness of the nomogram. Results Fourteen radiomics features were chosen from 94 candidate features to build a radiomics signature that significantly correlated with LNM. The model showed good calibration and discrimination in the training cohort, with an AUC of 0.871 (95% CI: 0.804-0.937), sensitivity of 85.71% and specificity of 77.19%. In the validation cohort, AUC was 0.856 (95% CI: 0.745-0.966), sensitivity was 91.66%, and specificity was 82.14%. DCA demonstrated that the nomogram was clinically useful. The nomogram also showed good predictive ability in patients at high risk for LNM in the CT-reported LN negative (cN0) subgroup. Conclusions The radiomics nomogram, based on preoperative CT images, can be used as a noninvasive method to predict LNM in patients with solid lung adenocarcinoma.
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Affiliation(s)
- Xinguan Yang
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
| | - Xiaohuan Pan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
| | - Hui Liu
- 12 Sigma Technologies, Shanghai 200000, China
| | - Dashan Gao
- 8910 University Center Ln, #420, San Diego, CA, USA.,12 Sigma Technologies, San Diego, CA, USA
| | - Jianxing He
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China.,Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Wenhua Liang
- National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China.,Department of Thoracic Surgery and Oncology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China
| | - Yubao Guan
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou 510120, China.,National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, State Key Laboratory of Respiratory Diseases, Guangzhou 510000, China
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Volpi S, Ali JM, Tasker A, Peryt A, Aresu G, Coonar AS. The role of positron emission tomography in the diagnosis, staging and response assessment of non-small cell lung cancer. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:95. [PMID: 29666818 DOI: 10.21037/atm.2018.01.25] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lung cancer is a common disease and the leading cause of cancer-related mortality, with non-small cell lung cancer (NSCLC) accounting for the majority of cases. Following diagnosis of lung cancer, accurate staging is essential to guide clinical management and inform prognosis. Positron emission tomography (PET) in conjunction with computed tomography (CT)-as PET-CT has developed as an important tool in the multi-disciplinary management of lung cancer. This article will review the current evidence for the role of 18F-fluorodeoxyglucose (FDG) PET-CT in NSCLC diagnosis, staging, response assessment and follow up.
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Affiliation(s)
- Sara Volpi
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Jason M Ali
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Angela Tasker
- Department of Radiology, Papworth Hospital, Cambridge, UK
| | - Adam Peryt
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Giuseppe Aresu
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
| | - Aman S Coonar
- Department of Thoracic Surgery, Papworth Hospital, Cambridge, UK
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Zhou Z, Zhan P, Jin J, Liu Y, Li Q, Ma C, Miao Y, Zhu Q, Tian P, Lv T, Song Y. The imaging of small pulmonary nodules. Transl Lung Cancer Res 2017; 6:62-67. [PMID: 28331825 DOI: 10.21037/tlcr.2017.02.02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Lung cancer is the leading cause of cancer death worldwide. The major goal in lung cancer research is the improvement of long-term survival. Pulmonary nodules have high clinical importance, they may not only prove to be an early manifestation of lung cancer, but decide to choose the right therapy. This review will introduce the development and current situation of several imaging examination methods: computed tomography (CT), positron emission tomography/computed tomography (PET/CT), endobronchial ultrasound (EBUS).
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Affiliation(s)
- Zejun Zhou
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Ping Zhan
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Jiajia Jin
- Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China
| | - Yafang Liu
- Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| | - Qian Li
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Chenhui Ma
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Yingying Miao
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Qingqing Zhu
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China
| | - Panwen Tian
- Department of Respiratory and Critical Care Medicine, Lung Cancer Treatment Center, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Tangfeng Lv
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
| | - Yong Song
- Department of Respiratory Medicine, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southeast University School of Medicine, Nanjing 210002, China;; Department of Respiratory Medicine, Jinling Hospital, Southern Medical University, Nanjing 210002, China
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10
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Serra Fortuny M, Gallego M, Berna L, Montón C, Vigil L, Masdeu MJ, Fernández-Villar A, Botana MI, Cordovilla R, García-Luján R, Cases E, Monsó E. FDG-PET parameters predicting mediastinal malignancy in lung cancer. BMC Pulm Med 2016; 16:177. [PMID: 27931198 PMCID: PMC5146847 DOI: 10.1186/s12890-016-0338-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 11/24/2016] [Indexed: 12/25/2022] Open
Abstract
Background Staging of mediastinal lymph nodes in non-small cell lung cancer (NSCLC) is mandatory. The maximum Standard Uptake Value (SUVmax) obtained using F-18 fluorodeoxyglucose positron emission tomography (FDG-PET) is the best non-invasive technique available for this evaluation, but its performance varies from center to center. The aim of the present study was to identify FDG-PET predictors of mediastinal malignancy that are able to minimize intercenter variability and improve the selection of subsequent staging procedures. Method A multicenter study of NSCLC patients staged through FDG-PET and endobronchial ultrasonography with needle aspiration (EBUS-NA) was performed using therapeutic surgery with systematic nodal dissection as gold standard. Intercenter variability and predictive power for mediastinal malignancy of different FDG-PET measures were assessed, as well as the role of these measures for selecting additional staging procedures. Results One hundred and twenty-one NSCLC patients, of whom 94 (72%) had ≥1 hypermetabolic spots in the mediastinum, were included in the study. Mean SUVmax of the primary tumor was 12.3 (SD 6.3), and median SUVmax of the highest hypermetabolic spots in the mediastinum was 3.9 (IQR 2.4-7). Variability of FDG-PET measures between hospitals was statistically significant (p = 0.016 and p < 0.001 respectively), but lost significance when SUVmax in the mediastinum was expressed as a ratio or a subtraction from the primary tumor (SUVmax mediastinum/tumor, p = 0.083; and SUVmax mediastinum - tumor, p = 0.428 respectively). SUVmax mediastinum/tumor showed higher accuracy in the ROC analysis (AUC 0.77 CI 0.68-0.85, p < 0.001), and showed predictive power for mediastinal malignancy when using a 0.4 cutoff (OR 6.62, 95%CI 2.98-14.69). Sensitivities and negative predictive values of clinical staging through EBUS-NA attained values ranging between 57% and 92% after FDG-PET, which improved with additional techniques when the tumor had a diameter >3 cm and/or a SUVmax mediastinum/tumor ratio >0.4. Conclusion The SUVmax mediastinum/tumor ratio is a good predictor of regional tumor extension in NSCLC. This measure is not influenced by intercenter variability and has an accuracy of over 70% for the identification of malignancy when using a 0.4 cutoff.
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Affiliation(s)
- M Serra Fortuny
- Hospital Universitari Parc Taulí, Sabadell, Spain. .,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | - M Gallego
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
| | - Ll Berna
- Hospital Universitari Parc Taulí, Sabadell, Spain
| | - C Montón
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Health Services Research on Chronic Diseases Network- REDISSEC, Madrid, Spain
| | - L Vigil
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
| | - M J Masdeu
- Hospital Universitari Parc Taulí, Sabadell, Spain
| | | | - M I Botana
- Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - R Cordovilla
- Complejo Asistencial de Salamanca, Salamanca, Spain
| | - R García-Luján
- Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain.,Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Cases
- Hospital Universitari La Fe, Valencia, Spain
| | - E Monsó
- Hospital Universitari Parc Taulí, Sabadell, Spain.,Departament de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.,Ciber de Enfermedades Respiratorias - Ciberes, Madrid, Spain
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11
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Liu Y, Tang Y, Xue Z, Yang P, Ma K, Ma G, Chu X. Ratio of lymph node to primary tumor SUVmax multiplied by maximal tumor diameter on positron emission tomography/integrated computed tomography may be a predictor of mediastinal lymph node malignancy in lung cancer. Medicine (Baltimore) 2016; 95:e5457. [PMID: 27861398 PMCID: PMC5120955 DOI: 10.1097/md.0000000000005457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Positron emission tomography/integrated computed tomography (PET/CT) provides the most accurate imaging modality for preoperative lung cancer staging. However, the diagnostic accuracy of maximum standardized uptake value (SUVmax) for mediastinal (N2) lymph nodes (LN) is unclear. We compared SUVmax, the ratio of LN to primary tumor SUVmax (SUVn/t), and SUVn/t multiplied by maximal tumor diameter (SUVindex) in terms of their abilities to predict mediastinal LN malignancy.We retrospectively analyzed 170 mediastinal LN stations from 73 consecutive patients who underwent systemic LN resection and PET/CT within 27 days. The SUVmax of the primary tumors was >2.0 and the SUVmax of the mediastinal LN stations ranged from 2.0 to 7.0 on PET/CT. Receiver-operating characteristic curves (ROCs) of SUVmax, SUVn/t, and SUVindex were calculated separately and the areas under the curves (AUCs) were used to assess the abilities of the parameters to predict LN malignancy. The optimal cutoff values were calculated from each ROC curve and the diagnostic abilities were also compared. The diagnostic accuracies of the 3 methods were also assessed separately in smoking and nonsmoking patients.Twenty-eight LN stations were malignancy-positive and the remaining 142 were malignancy-negative. The AUCs for SUVindex, SUVn/t, and SUVmax were 0.709, 0.590, and 0.673, respectively, and the optimal cutoff values for SUVindex, SUVn/t, and SUVmax were 1.11, 0.34, and 3.6, respectively. The differences between SUVindex and SUVn/t were significant, but there was no significant difference between SUVindex and SUVmax. There were no significant differences between smokers and nonsmokers in the AUCs for any of the methods for predicting LN malignancy (P values >0.05).SUVindex may be a predictor of mediastinal LN malignancy in lung cancer patients.
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Affiliation(s)
- Yi Liu
- Department of Thoracic surgery, The Chinese People's Liberation Army (PLA) General Hospital
| | - Yanhua Tang
- Department of Radiology, Beijing Chao-Yang Hospital
| | - Zhiqiang Xue
- Department of Thoracic surgery, The Chinese People's Liberation Army (PLA) General Hospital
| | - Ping Yang
- Department of Health Sciences Research, Division of Epidemiology, Mayo Clinic College of Medicine, Rochester, MN
| | - Kefeng Ma
- Department of Thoracic surgery, The Chinese People's Liberation Army (PLA) General Hospital
| | - Guangyu Ma
- Department of Nuclear medicine, Chinese PLA General Hospital, Beijing, China
| | - Xiangyang Chu
- Department of Thoracic surgery, The Chinese People's Liberation Army (PLA) General Hospital
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12
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Hochhegger B, Alves GRT, Irion KL, Fritscher CC, Fritscher LG, Concatto NH, Marchiori E. PET/CT imaging in lung cancer: indications and findings. J Bras Pneumol 2016; 41:264-74. [PMID: 26176525 PMCID: PMC4541763 DOI: 10.1590/s1806-37132015000004479] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 02/27/2015] [Indexed: 12/25/2022] Open
Abstract
The use of PET/CT imaging in the work-up and management of patients with lung cancer has greatly increased in recent decades. The ability to combine functional and anatomical information has equipped PET/CT to look into various aspects of lung cancer, allowing more precise disease staging and providing useful data during the characterization of indeterminate pulmonary nodules. In addition, the accuracy of PET/CT has been shown to be greater than is that of conventional modalities in some scenarios, making PET/CT a valuable noninvasive method for the investigation of lung cancer. However, the interpretation of PET/CT findings presents numerous pitfalls and potential confounders. Therefore, it is imperative for pulmonologists and radiologists to familiarize themselves with the most relevant indications for and limitations of PET/CT, seeking to protect their patients from unnecessary radiation exposure and inappropriate treatment. This review article aimed to summarize the basic principles, indications, cancer staging considerations, and future applications related to the use of PET/CT in lung cancer.
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Affiliation(s)
| | | | - Klaus Loureiro Irion
- Radiology Department, Royal Liverpool and Broadgreen University Hospital, Liverpool, United Kingdom
| | | | | | | | - Edson Marchiori
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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13
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Zaric B, Eberhardt R, Herth F, Stojsic V, Carapic V, Popovic ZP, Perin B. Linear and radial endobronchial ultrasound in diagnosis and staging of lung cancer. Expert Rev Med Devices 2014; 10:685-95. [DOI: 10.1586/17434440.2013.827512] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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14
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Dhaliwal CA, Andrews TD, Walker WS, Wallace WA. Histological evaluation of preoperative mediastinoscopy lymph node biopsies in non-small cell lung cancer. J Clin Pathol 2013; 67:76-80. [PMID: 23969273 DOI: 10.1136/jclinpath-2013-201702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite the advent of PET scanning and endoscopic minimally invasive methods of sampling mediastinal lymph nodes, surgical assessment, particularly by mediastinoscopy, remains an important tool for staging non-small cell lung cancer. METHODS We carried out a retrospective review of mediastinoscopic lymph node biopsies taken at The Royal Infirmary of Edinburgh between 1996 and 2006 and performed additional histological investigations on select cases. RESULTS In total, 89/802 (11%) patients had a negative mediastinoscopy but final resection stage of N2/N3. Within this group, 41/89 (46%) patients had positive resection lymph nodes in stations potentially accessible to biopsy at mediastinoscopy. Of these, 30 (34%) patients had had the metastatic station sampled at mediastinoscopy. Further histopathological examination (multiple levels and pancytokeratin immunohistochemistry) of these original biopsies detected micrometastases in two cases, one of which, in retrospect, had been missed on the original section at the time of reporting. Isolated tumour cells were detected by immunohistochemistry in another two cases. CONCLUSIONS Routine examination of additional levels and immunohistochemical staining of mediastinal lymph nodes biopsies is not required and would not improve the overall negative predictive value of the procedure.
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