Associations Between PET Parameters and Expression of Ki-67 in Breast Cancer

Prognostic significance of 68 Ga-FAPI PET/CT in patients with bone metastases in various cancers

OBJECTIVE

This study aimed to compare 18FDGPET/CT in patients who develop bone metastases due to various cancers and to investigate the prognostic significance of the 68FAPI-PET/CT SUVmax value for survival.

METHODS

Patients with bone metastases who underwent both 68 Ga-FAPI PET/CT and 18FDGPET/CT within a 1 week period were included in this retrospective study. The effect of the SUVmax value of bone lesions on overall survival was analyzed.

RESULTS

A total of 75 eligible patients with 139 bone lesions were included in this study. The median age of the patients was 55 (30-83) and 48(64%) patients were newly diagnosed. The primary lesion median 68 Ga-FAPI PET/CT SUVmax value was higher than the median 18FDGPET/CT SUVmax (10.75 versus 6.7). Bone lesions 68 Ga-FAPI PET/CT SUVmax median (IQR) were 7.8 (4.6-13.2), and 18FDGPET/CT SUVmax of bone lesions were 5.9 (3.8-8.2). More bone lesions were detected on 68 Ga-FAPI PET/CT than on 18FDGPET/CT(median IQR 4 [1-9] versus 2 [1-6] (p = 0.014). The extra lesions observed on 68 Ga-FAPI PET/CT were mostly sclerotic bone lesions (p = 0.001).68 Ga-FAPI PET/CT SUVmax was significantly higher in vertebra and thorax lesions (p = 0.011 and p = 0.018, respectively). While the bone lesion 68 Ga-FAPI PET/CT SUVmax affected the OS, the 18FDGPET/CT SUVmax value did not affect the OS (p < 0.001 and p = 0.079, respectively). In ROC analysis, a cut-off-off value of 68 Ga-FAPI PET/CT SUVmax > 7.7 was found for OS (AUC: 0.619). The median OS in the group above the cut-off value was worse than that in the group below the cut-off value (32 versus 45) months (p = 0.002). In the multivariate analysis for OS, the 68 Ga-FAPI PET/CT SUVmax of bone lesions was an important parameter, as well as cancer subtype, ALP level, and disease occurrence.

CONCLUSIONS

68 Ga-FAPI PET/CT detected more bone lesions and higher SUVmax values than 18FDGPET/CT in various cancers. The prognostic value of the SUVmax value of 68 Ga-FAPI PET/CT bone lesions was observed regardless of disease subtype.

Clinicopathological and molecular predictors of [18F]FDG-PET disease detection in HER2-positive early breast cancer: RESPONSE, a substudy of the randomized PHERGain trial

BACKGROUND

The PHERGain study (NCT03161353) is assessing early metabolic responses to neoadjuvant treatment with trastuzumab-pertuzumab and chemotherapy de-escalation using a [18Fluorine]fluorodeoxyglucose-positron emission tomography ([18F]FDG-PET) and a pathological complete response-adapted strategy in HER2-positive (HER2+) early breast cancer (EBC). Herein, we present RESPONSE, a PHERGain substudy, where clinicopathological and molecular predictors of [18F]FDG-PET disease detection were evaluated.

METHODS

A total of 500 patients with HER2 + EBC screened in the PHERGain trial with a tumor size > 1.5 cm by magnetic resonance imaging (MRI) were included in the RESPONSE substudy. PET[-] criteria entailed the absence of  ≥ 1 breast lesion with maximum standardized uptake value (SUVmax) ≥ 1.5 × SUVmean liver + 2 standard deviation. Among 75 PET[-] patients screened, 21 with SUVmax levels < 2.5 were randomly selected and matched with 21 PET[+] patients with SUVmax levels ≥ 2.5 based on patient characteristics associated with [18F]FDG-PET status. The association between baseline SUVmax and [18F]FDG-PET status ([-] or [+]) with clinicopathological characteristics was assessed. In addition, evaluation of stromal tumor-infiltrating lymphocytes (sTILs) and gene expression analysis using PAM50 and Vantage 3D™ Cancer Metabolism Panel were specifically compared in a matched cohort of excluded and enrolled patients based on the [18F]FDG-PET eligibility criteria.

RESULTS

Median SUVmax at baseline was 7.2 (range, 1-39.3). Among all analyzed patients, a higher SUVmax was associated with a higher tumor stage, larger tumor size, lymph node involvement, hormone receptor-negative status, higher HER2 protein expression, increased Ki67 proliferation index, and higher histological grade (p < 0.05). [18F]FDG-PET [-] criteria patients had smaller tumor size (p = 0.014) along with the absence of lymph node involvement and lower histological grade than [18F]FDG-PET [+] patients (p < 0.01). Although no difference in the levels of sTILs was found among 42 matched [18F]FDG-PET [-]/[+] criteria patients (p = 0.73), [18F]FDG-PET [-] criteria patients showed a decreased risk of recurrence (ROR) and a lower proportion of PAM50 HER2-enriched subtype than [18F]FDG-PET[+] patients (p < 0.05). Differences in the expression of genes involved in cancer metabolism were observed between [18F]FDG-PET [-] and [18F]FDG-PET[+] criteria patients.

CONCLUSIONS

These results highlight the clinical, biological, and metabolic heterogeneity of HER2+ breast cancer, which may facilitate the selection of HER2+ EBC patients likely to benefit from [18F]FDG-PET imaging as a tool to guide therapy.

TRIAL REGISTRATION

Clinicaltrials.gov; NCT03161353; registration date: May 15, 2017.

Towards a fast PET/MRI protocol for breast cancer imaging: maintaining diagnostic confidence while reducing PET and MRI acquisition times

OBJECTIVES

To investigate the diagnostic feasibility of a shortened breast PET/MRI protocol in breast cancer patients.

METHODS

Altogether 90 women with newly diagnosed T1tumor-staged (T1ts) and T2tumor-staged (T2ts) breast cancer were included in this retrospective study. All underwent a dedicated comprehensive breast [18F]FDG-PET/MRI. List-mode PET data were retrospectively reconstructed with 20, 15, 10, and 5 min for each patient to simulate the effect of reduced PET acquisition times. The SUVmax/mean of all malign breast lesions was measured. Furthermore, breast PET data reconstructions were analyzed regarding image quality, lesion detectability, signal-to-noise ratio (SNR), and image noise (IN). The simultaneously acquired comprehensive MRI protocol was then shortened by retrospectively removing sequences from the protocol. Differences in malignant breast lesion detectability between the original and the fast breast MRI protocol were evaluated lesion-based. The 20-min PET reconstructions and the original MRI protocol served as reference.

RESULTS

In all PET reconstructions, 127 congruent breast lesions could be detected. Group comparison and T1ts vs. T2ts subgroup comparison revealed no significant difference of subjective image quality between 20, 15, 10, and 5 min acquisition times. SNR of qualitative image evaluation revealed no significant difference between different PET acquisition times. A slight but significant increase of IN with decreasing PET acquisition times could be detected. Lesion SUVmax group comparison between all PET acquisition times revealed no significant differences. Lesion-based evaluation revealed no significant difference in breast lesion detectability between original and fast breast MRI protocols.

CONCLUSIONS

Breast [18F]FDG-PET/MRI protocols can be shortened from 20 to below 10 min without losing essential diagnostic information.

KEY POINTS

• A highly accurate breast cancer evaluation is possible by the shortened breast [18F]FDG-PET/MRI examination protocol. • Significant time saving at breast [18F]FDG-PET/MRI protocol could increase patient satisfaction and patient throughput for breast cancer patients at PET/MRI.

Prediction of Clinical Molecular Typing of Breast Invasive Ductal Carcinoma Using 18F-FDG PET/CT Dual-Phase Imaging

RATIONALE AND OBJECTIVES

To investigate the diagnostic value of Fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography and computed tomography (18F-FDG PET/CT) dual-phase imaging for the different molecular subtypes of invasive ductal carcinoma of the breast.

MATERIALS AND METHODS

Clinical imaging data of 164 women with invasive ductal carcinoma of the breast confirmed by pathology who underwent 18F-FDG PET/CT dual-phase imaging were retrospectively analyzed. The maximum standard uptake values (SUVmax) of the early and delayed phases of the lesion were measured and recorded as SUVmax1 and SUVmax2, respectively, and the retention index (RI) was calculated. We analyzed the change rule of SUVmax1, SUVmax2, and RI for the different molecular subtypes and molecular marker expression groups. The diagnostic threshold of different molecular marker expression status was determined using receiver operating characteristic curve analysis.

RESULTS

SUVmax1 and SUVmax2 were highest in the TNBC group and lowest in the luminal A group (p<0.001). TNBC and HER2 overexpression groups had higher RI than the luminal A and B groups (p<0.001), with no significant difference between the TNBC and HER2 overexpression groups or between the luminal A and B groups (p=0.640 and 0.345, respectively). The ER- and PR-negative groups had significantly higher SUVmax1, SUVmax2, and RI than the PR-positive group (p<0.001). The HER2-positive group had higher SUVmax1 and SUVmax2 than the negative group (p<0.001). The Ki67 overexpression group had higher SUVmax1 and SUVmax2 levels than the low expression group (p<0.001). There was no significant difference in RI between HER2-positive and negative groups or between Ki67 high and low expression groups (p=0.904 and 0.216, respectively). For ER-negative and positive expression status, the maximum area under the curve (AUC) of SUVmax2 was 0.852, diagnostic threshold was 10.87, sensitivity was 79.6%, and specificity was 74.5%. For PR-negative and positive expression status, the AUC of SUVmax2 was 0.858, diagnostic threshold was 10.45, sensitivity was 83.1%, and specificity was 75.3%. For HER2-negative and positive expression status, the AUC of SUVmax1 was 0.714, diagnostic threshold was 9.28, sensitivity was 79.6%, and specificity was 60.9%. For Ki67 high- and low expression status, the AUC of SUVmax2 was 0.915 at maximum, diagnostic threshold was 10.21, sensitivity was 83.4%, and specificity was 93.9%.

CONCLUSION

18F-FDG PET/CT dual-phase imaging facilitates the prediction of the expression of molecular markers and subtypes of invasive ductal carcinoma of the breast and the development of more tailored treatment plans for patients with this disease.

The Correlation Between 18F-Fluorodeoxyglucose-Positron Emission Tomography/Computed Tomography Semiquantitative Parameters and the Clinical Features and Pathological Biological Indexes of Gastric Cancer

Objective: This study explored the application value of the maximum standard uptake value (SUVmax) of 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (18F-FDG PET/CT) in gastric cancer. Materials and Methods: Data of 164 patients with gastric cancer who had undergone18F-FDG PET/CT before a biopsy were collected, and the correlation of SUVmax with clinical stage, pathological differentiation degree, human epidermal growth factor receptor-2 (HER-2) status, and Ki-67 index of gastric cancer was analyzed. Results: The SUVmax of poorly differentiated adenocarcinoma was significantly higher than that of moderately differentiated adenocarcinoma and signet-ring cell carcinoma (p < 0.01), and SUVmax in the well-differentiated adenocarcinoma group was higher than that in the signet-ring cell carcinoma group (p < 0.01). The SUVmax in the HER-2 negative group was higher than that in the HER-2 positive group (p < 0.01). The SUVmax was higher in the Ki-67 high expression group than in the low expression group (p < 0.01), and there was a significant positive correlation between the two (p < 0.01). Conclusion: 18F-FDG PET/CT SUVmax can, to some extent, predict the degree of differentiation, HER-2 status, and Ki-67 index of gastric cancer patients.

Correlation between Imaging Markers Derived from PET/MRI and Invasive Acquired Biomarkers in Newly Diagnosed Breast Cancer

PURPOSE

Evaluate the diagnostic potential of [¹⁸F]FDG-PET/MRI data compared with invasive acquired biomarkers in newly diagnosed early breast cancer (BC).

METHODS

Altogether 169 women with newly diagnosed BC were included. All underwent a breast- and whole-body [¹⁸F]FDG-PET/MRI for initial staging. A tumor-adapted volume of interest was placed in the primaries and defined bone regions on each standard uptake value (SUV)/apparent diffusion coefficient (ADC) dataset. Immunohistochemical markers, molecular subtype, tumor grading, and disseminated tumor cells (DTCs) of each patient were assessed after ultrasound-guided biopsy of the primaries and bone marrow (BM) aspiration. Correlation analysis and group comparisons were assessed.

RESULTS

A significant inverse correlation of estrogen-receptor (ER) expression and progesterone-receptor (PR) expression towards SUV_max was found (ER: r = 0.27, p < 0.01; PR: r = 0.19, p < 0.05). HER2-receptor expression showed no significant correlation towards SUV and ADC values. A significant positive correlation between Ki67 and SUVmax and SUV_mean (r = 0.42 p < 0.01; r = 0.19 p < 0.05) was shown. Tumor grading significantly correlated with SUV_max and SUV_mean (ρ = 0.36 and ρ = 0.39, both p's < 0.01). There were no group differences between SUV/ADC values of DTC-positive/-negative patients.

CONCLUSIONS

[¹⁸F]FDG-PET/MRI may give a first impression of BC-receptor status and BC-tumor biology during initial staging by measuring glucose metabolism but cannot distinguish between DTC-positive/-negative patients and replace biopsy.

Is there a potential biomarker in distinguishing invasive breast carcinomas with elevated Ki-67 levels among 2D-SWE, SMI, and 18F-FDG PET-CT/MRI-derived parameters?: A single-center data

PURPOSE

To investigate the strength of quantitative imaging and metabolic parameters in differentiating invasive breast carcinomas with elevated Ki-67 levels.

MATERIALS AND METHODS

A total of 123 patients with 129 breast lesions confirmed as invasive breast carcinoma underwent shear wave elastography (SWE), superb microvascular imaging (SMI) and positron emission tomography (PET)/CT or MRI. Adler's grade (classifying the microvascularity into four types) and Vascular Index (VI) was obtained by SMI as microvascular parameters. In addition, the stiffness value (E_mean ) was evaluated in kilopascal by SWE. The average of consecutive measurements was recorded as mean VI and mean E_mean . PET scan parameters were obtained as SUV_max and SUL_peak . Lesions were divided into two groups according to the Ki-67 expression, low as ≤ 14 and high as >14.

RESULTS

Adler's grading was the most correlated imaging parameter with high Ki-67 expression (p < 0.05), while VI and E_mean had poor correlation (p > 0.05). SUV_max and SUL_peak indicated a significant linear correlation with Ki-67 but a moderate correlation with the high levels of Ki-67 (p < 0,001). The sensitivity of VI, E_mean , SUV_max and SUL_peak was 64.6%, 66.7%, 65.7%, and 66.7% when the cut-off point was set to 5.25, 102.5, 6.59, and 2.63, respectively. SUV_max had the highest AUC value of 0.740, according to the ROC curve analysis.

CONCLUSIONS

Our results suggest that the quantitative parameters obtained by advanced imaging methods may be useful in predicting the high proliferation in invasive breast carcinomas. But none of them is eligible to be used as an independent biomarker in distinguishing aggressive behavior. Nevertheless, as a noninvasive method, visual assessment of microvascular morphology using SMI increases the prognostic efficiency in invasive breast carcinomas.

Evaluating the Accuracy of FUCCI Cell Cycle In Vivo Fluorescent Imaging to Assess Tumor Proliferation in Preclinical Oncology Models

PURPOSE

The primary goal of this study is to evaluate the accuracy of the fluorescence ubiquitination cell cycle indicator (FUCCI) system with fluorescence in vivo imaging compared to 3'-deoxy-3'-[18F]fluorothymidine ([18F]-FLT) positron emission tomography (PET)/computed tomography (CT) and biological validation through histology. Imaging with [18F]-FLT PET/CT can be used to noninvasively assess cancer cell proliferation and has been utilized in both preclinical and clinical studies. However, a cost-effective and straightforward method for in vivo, cell cycle targeted cancer drug screening is needed prior to moving towards translational imaging methods such as PET/CT.

PROCEDURES

In this study, fluorescent MDA-MB-231-FUCCI tumor growth was monitored weekly with caliper measurements and fluorescent imaging. Seven weeks post-injection, [18F]-FLT PET/CT was performed with a preclinical PET/CT, and tumors samples were harvested for histological analysis.

RESULTS

RFP fluorescent signal significantly correlated with tumor volume (r = 0.8153, p < 0.0001). Cell proliferation measured by GFP fluorescent imaging was correlated with tumor growth rate (r = 0.6497, p < 0.001). Also, GFP+ cells and [18F]-FLT regions of high uptake were both spatially located in the tumor borders, indicating that the FUCCI-IVIS method may provide an accurate assessment of tumor heterogeneity of cell proliferation. The quantification of total GFP signal was correlated with the sum of tumor [18F]-FLT standard uptake value (SUV) (r = 0.5361, p = 0.0724). Finally, histological analysis confirmed viable cells in the tumor and the correlation of GFP + and Ki67 + cells (r = 0.6368, p = 0.0477).

CONCLUSION

Fluorescent imaging of the cell cycle provides a noninvasive accurate depiction of tumor progression and response to therapy, which may benefit in vivo testing of novel cancer therapeutics that target the cell cycle.

Comparison of 18F-fluorothymidine Positron Emission Tomography/Computed Tomography and 18F-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Patients with Breast Cancer

The uptake of ¹⁸F-fluorothymidine (¹⁸F-FLT) depends on cells' proliferative rates. We compared the characteristics of ¹⁸F-FLT positron emission tomography/computed tomography (PET/CT) with those of ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) PET/CT for breast cancer. We prospectively diagnosed patients with breast cancer who underwent ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT. Subsequently, significant differences and correlation coefficients of the maximum standardized uptake value (SUVmax) in primary breast cancer and axillary lymph nodes were statistically evaluated. We enrolled eight patients with breast cancer. In six treatment-naive patients, the SUVmax for primary lesions showed a significant difference (mean, 2.1 vs. 4.1, p = 0.031) and a strong correlation (r = 0.969) between ¹⁸F-FLT and ¹⁸F-FDG. Further, although the SUVmax for the axillary lymph nodes did not show a significant difference between ¹⁸F-FLT and ¹⁸F-FDG (P = 0.246), there was a strong correlation between the two (r = 0.999). In a patient-by-patient study, there were cases in which only ¹⁸F-FDG uptake was observed in lymph nodes and normal breasts. Bone metastases demonstrated lower accumulation than bone marrow on the ¹⁸F-FLT PET/CT. In conclusion, a strong correlation was observed between the ¹⁸F-FLT PET/CT and ¹⁸F-FDG PET/CT uptake. Differences in the biochemical characteristics of ¹⁸F-FLT and ¹⁸F-FDG were reflected in the accumulation differences for breast cancer, metastatic lesions, and normal organs.

The role of 18F-FDG PET/CT in diagnosis and treatment evaluation for ocular adnexal mucosa-associated lymphoid tissue lymphoma

OBJECTIVE

The purpose of this study is to evaluate the value of fluorine-18-fludeoxyglucose positron emission tomography (¹⁸F-FDG PET)/CT in the diagnosis and treatment evaluation of ocular adnexal mucosa-associated lymphoid tissue (MALT) lymphoma.

METHODS

70 patients with OAML who received radiotherapy were recruited in our study. All the patients had the ¹⁸F-FDG PET/CT examination before the treatment. We retrospectively reviewed the medical records, pathological reports, laboratory results, and imaging features of all patients. The associations between ¹⁸F-FDG PET/CT parameters and Epstein-Barr virus antibodies, treatment response, MRI data, and Ki-67 expression were investigated.

RESULTS

The PET/CT scan indicated that 80% (56/70) of the patients showed orbital FDG avidity. The median level of maximum standardized uptake value (SUVmax) of the lesions was 4.65 ± 3.00 (range:1.2-13.5). 92.0% (46/50) of the mass-forming lesions showed ¹⁸F-FDG avidity, while only 50.0% (10/20) of the non-massive lesions had ¹⁸F-FDG avidity (χ² = 13.23, p=0.01). The SUVmax in orbit, conjunctiva, and lacrimal gland lymphoma were 5.6, 2.9, and 3.7, respectively. A significant difference was identified of SUVmax among the three locations' lymphoma using one-way ANOVA analysis (F = 5.039, p = 0.01). After completion of radiotherapy, the complete remission rate was achieved in 30.8% (4/13) of the patients without ¹⁸F-FDG avidity, and 70.4% (38/54) in cases with ¹⁸F-FDG avidity (χ² = 5.43, p = 0.02). The correlation between high Ki-67 score and ¹⁸F-FDG avidity was confirmed (χ² = 3.916, p = 0.048); however, no significant correlation was found between the SUVmax and Ki-67 score of the lesions (p = 0.971). Three patients (3/70, 4.3%) were upregulated the stage via PET/CT.

CONCLUSION

¹⁸F-FDG PET/CT had some potential values in the diagnosis and assessment of treatment response in patients with OAML.

ADVANCES IN KNOWLEDGE

The value of ¹⁸F-FDG PET/CT for patients with OAML.

Ultrasonographic morphological characteristics determined using a deep learning-based computer-aided diagnostic system of breast cancer

To investigate the correlations between ultrasonographic morphological characteristics quantitatively assessed using a deep learning-based computer-aided diagnostic system (DL-CAD) and histopathologic features of breast cancer.This retrospective study included 282 women with invasive breast cancer (<5 cm; mean age, 54.4 [range, 29-85] years) who underwent surgery between February 2016 and April 2017. The morphological characteristics of breast cancer on B-mode ultrasonography were analyzed using DL-CAD, and quantitative scores (0-1) were obtained. Associations between quantitative scores and tumor histologic type, grade, size, subtype, and lymph node status were compared.Two-hundred and thirty-six (83.7%) tumors were invasive ductal carcinoma, 18 (6.4%) invasive lobular carcinoma, and 28 (9.9%) micropapillary, apocrine, and mucinous. The mean size was 1.8 ± 1.0 (standard deviation) cm, and 108 (38.3%) cases were node positive. Irregular shape score was associated with tumor size (P < .001), lymph nodes status (P = .001), and estrogen receptor status (P = .016). Not-circumscribed margin (P < .001) and hypoechogenicity (P = .003) scores correlated with tumor size, and non-parallel orientation score correlated with histologic grade (P = .024). Luminal A tumors exhibited more irregular features (P = .048) with no parallel orientation (P = .002), whereas triple-negative breast cancer showed a rounder/more oval and parallel orientation.Quantitative morphological characteristics of breast cancers determined using DL-CAD correlated with histopathologic features and could provide useful information about breast cancer phenotypes.

Correlation of primary tumor metabolic parameters with clinical, histopathological and molecular characteristics in breast cancer patients at pre-operative staging FDG-PET/CT study

Background

The aim of this prospective study was to evaluate the correlation of primary tumor metabolic activity parameters; maximum standardized uptake value (SUVmax) and tumor SUVmax/liver average SUV ratio (TLR) with clinical, histopathological and molecular characteristics of initial staging breast cancer (BC) patients using 18F-fluorodeoxyglucose (FDG) positron emission tomography / computerized tomography (PET/CT) scan.

Results

Forty female patients with newly diagnosed BC were enrolled in our study, age ranging from 31-78 years (mean 50.5 +/- SD11.7).

All the primary tumors were detected with mean SUVmax 10.8(+/-SD 7.9). The mean /median SUVmax values of primary tumor was higher in premenopausal , stage III and IV, Estrogen Receptors negative( ER-), Progesterone Receptors negative(PR-), Human epidermal growth factor receptor 2 positive ( Her2neu+) patients, high nuclear grade (GIII), triple negative molecular subgroup (TN) and positive axillary lymph node (ALNs) metastasis,(P= 0.003, 0.017, 0.113, 0.089 0.01 ,0.002 , 0.007 and 0.016 respectively).

The mean/median TLR values was higher in premenopausal ,Her2neu+, GIII, TN molecular subtype patients, stage III and IV and in patients with positive ALNs , ER- and PR - patients (P= 0.002, 0.0476 , 0.005 , 0.018 , 0.039 and 0.022, 0.095 and 0.129 respectively).

SUVmax of the primary lesion and TLR were moderately negatively correlated with the age of the patients (P= 0.005 and 0.008 respectively), also they were moderately positively correlated with the size of the primary tumor (P= 0.019 and 0.036 respectively). TLR was predictive of nodal involvement AUC= 0.612 (95% CI: 0.431-792). The overall sensitivity and specificity of PET/CT for axillary staging was 100 % and 60 %, respectively (P= 0.006).

Conclusion

The SUVmax of the primary tumor and TLR values had similar significant associations with different prognostic factors in BC but only TLR can predict nodal involvement.

Prognostic Prediction of BRCA Mutations by 18F-FDG PET/CT SUVmax in Breast Cancer

Objectives:

This study aimed to investigate the prognostic prediction of germline BRCA1 and BRCA2 mutations by comparing the maximum standardized uptake value (SUV_max) obtained from ¹⁸fluoride-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT), which is considered a prognostic factor in breast cancer (BC).

Methods:

Retrospective interdisciplinary laboratory results of 92 patients with BC who had germline BRCA1 or BRCA2 mutation profiles and underwent ¹⁸F-FDG PET/CT were compared. Genotyping was made by next-generation sequencing, and PET/CT scans were re-evaluated. The histopathological data, genetic results, and clinical demographics of all patients were recorded. Patients were divided into two groups in accordance with the presence of germline BRCA1 and/or BRCA2 mutations. Between-group statistical comparison was performed.

Results:

In PET/CT performed for primary staging, patients with BRCA-positive BC had significantly higher SUV_max (p=0.039), larger tumor size (p=0.025), and presence of axillary nodal metastases (p=0.023) than patients with BRCA-negative BC. Although the Ki-67 index was higher in the BRCA-positive group than BRCA-negative group, this difference was not significant (p=0.157). Moreover, in the BRCA-positive and negative groups, SUV_max, Ki-67 index, and tumor size, grade, and stage were significantly correlated with each other.

Conclusion:

The results of this study showed a strong association between BRCA mutations and SUV_max, which indicates the poor prognosis of BC.

Can High b Value Diffusion Be a Surrogate Marker for PET-A MR/PET Study in Neurooncology Set Up

Purpose: Hybrid whole-body magnetic resonance/positron emission tomography (MR/PET) systems are new diagnostic tools enabling the simultaneous acquisition of morphologic and multiparametric functional data, which allow for a diversified characterization of oncological diseases. This study aimed to compare the diagnostic ability of MRI with the diffusion-weighted image (DWI), and simultaneous integrated positron emission tomography MR/PET to detect malignant lesions and elucidate the utility and limitations of these imaging modalities in preoperative and postoperative follow up in cancer patients. Material and Methods: A total of 45 patients undergoing simultaneous MR/PET for CNS ICSOL in our institution between January 2016 and July 2020 were considered in this study. Post-processing was done in Siemens syngo software to generate a b2000 image. This image was then inverted to grayscale and compared with the NAC image of PET. Results: The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for DWI were 92.3, 83.3, 97.3, and 62.5%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity, specificity, positive predictive value, and negative predictive value for PET were 97.4, 71.4, 94.9, and 83.3%, respectively (at 95% CI and p was 0.000). The lesion-based sensitivity and specificity of DWI were comparable with those of PET. Conclusions: Although DWI and FDG-PET reflect different tissue properties, there is an association between the measures of both methods in CNS tumors probably because of the coupling of cellularity with tumor metabolism as seen on FDG and other PET tracers. Our study shows that DWI acts as a surrogate biomarker for FDG PET and other tracers in tumors. The method of DWI image generation is simple, radiation-free, and cost-effective in a clinical setup. The simultaneous DWI-PET study provides evidence and confirms the role of DWI in surveillance imaging of tumors.

Correlation between semiquantitative and volumetric 18F-FDG PET/computed tomography parameters and Ki-67 expression in breast cancer

OBJECTIVES

To evaluate the relationship between semiquantitative and volumetric parameters on 18F-FDG PET/computed tomography (CT), including maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), metabolic tumor volume (MTV), total lesion glycolysis (TLG), tumor to liver ratio (TLR) and tumor to mediastinum ratio (TMR) with the level of Ki-67 expression in breast cancer.

PATIENT AND METHODS

We retrospectively reviewed 105 female patients with newly diagnosed breast cancer who underwent baseline 18F-FDG PET/CT and had immunohistochemical staining to determine the level of Ki-67 expression. The following PET parameters were measured (SUVmax, SUVmean, MTV, TLG, TLR and TMR) and correlated with level of Ki-67 expression.

RESULTS

Significant moderate positive correlations were found between the PET parameters (primary SUVmax, SUVmean, TLG, TLR and TMR) and level of Ki-67 expression. The primary SUVmax had the highest correlation coefficient (r = 0.461) followed by TMR (r = 0.455) and P value of <0.001 for both. In ROC analysis, primary SUVmax had the largest area under the curve (0.806, P = 0.0001), with sensitivity of 76.5 % and specificity of 75% for prediction of high Ki-67 level. In univariate analysis, all PET parameters, patient age, tumor grade, molecular subtype, estrogen receptor and progesterone receptor status were significantly associated with Ki-67 level. In multivariate regression analysis, only tumor grade [odds ratio (OR) = 20.460, 95% confidence interval (CI): 11.360-29.559, P = <0.0001], molecular subtype (OR = -21.894, 95% CI: -37.921 to -5.866, P = 0.008), SUVmax (OR = 2.299, 95% CI: 0.703-3.895, P = 0.005) and TLR (OR = -4.908, 95% CI: -9.476 to -0.340, P = 0.035) were found to be the strongest independent predictor factors for the level of Ki-67 expression and hence proliferative activity of malignant cells in breast cancer.

CONCLUSION

The semiquantitative parameters and volumetric 18F-FDG PET/CT parameter, that is, TLG correlated well with proliferation marker Ki-67 in breast cancer. 18F-FDG PET/CT imaging can be used as a useful noninvasive diagnostic tool in imaging cellular proliferation and hence may substitute for in vitro testing of molecular markers in the diagnoses and staging of breast cancer.

[89Zr]-Pertuzumab PET Imaging Reveals Paclitaxel Treatment Efficacy Is Positively Correlated with HER2 Expression in Human Breast Cancer Xenograft Mouse Models

Paclitaxel (PTX) treatment efficacy varies in breast cancer, yet the underlying mechanism for variable response remains unclear. This study evaluates whether human epidermal growth factor receptor 2 (HER2) expression level utilizing advanced molecular positron emission tomography (PET) imaging is correlated with PTX treatment efficacy in preclinical mouse models of HER2+ breast cancer. HER2 positive (BT474, MDA-MB-361), or HER2 negative (MDA-MB-231) breast cancer cells were subcutaneously injected into athymic nude mice and PTX (15 mg/kg) was administrated. In vivo HER2 expression was quantified through [89Zr]-pertuzumab PET/CT imaging. PTX treatment response was quantified by [18F]-fluorodeoxyglucose ([18F]-FDG) PET/CT imaging. Spearman's correlation, Kendall's tau, Kolmogorov-Smirnov test, and ANOVA were used for statistical analysis. [89Zr]-pertuzumab mean standard uptake values (SUVmean) of BT474 tumors were 4.9 ± 1.5, MDA-MB-361 tumors were 1.4 ± 0.2, and MDA-MB-231 (HER2-) tumors were 1.1 ± 0.4. [18F]-FDG SUVmean changes were negatively correlated with [89Zr]-pertuzumab SUVmean (r = -0.5887, p = 0.0030). The baseline [18F]-FDG SUVmean was negatively correlated with initial [89Zr]-pertuzumab SUVmean (r = -0.6852, p = 0.0002). This study shows PTX treatment efficacy is positively correlated with HER2 expression level in human breast cancer mouse models. Molecular imaging provides a non-invasive approach to quantify biological interactions, which will help in identifying chemotherapy responders and potentially enhance clinical decision-making.

New Insight into Triple-Negative Breast Cancer Therapy: The Potential Roles of Endoplasmic Reticulum Stress and Autophagy Mechanisms

BACKGROUND

Breast cancer is accounted as the fifth leading cause of mortality among the other cancers. Notwithstanding, Triple Negative Breast Cancer (TNBC) is responsible for 15-20% of breast cancer mortality. Despite many investigations, it remains incurable in part due to insufficient understanding of its exact mechanisms.

METHODS

A literature search was performed in PubMed, SCOPUS and Web of Science databases using the keywords autophagy, Endoplasmic Reticulum (ER) stress, apoptosis, TNBC and the combinations of these keywords.

RESULTS

It was found that autophagy plays a dual role in cancer, so that it may decrease the viability of tumor cells or act as a cytoprotective mechanism. It then appears that using compounds having modulatory effects on autophagy is of importance in terms of induction of autophagic cell death and diminishing the proliferation and metastasis of tumor cells. Also, ER stress can be modulated in order to stimulate apoptotic and autophagic cell death in tumor cells.

CONCLUSION

Perturbation in the signaling pathways related to cell survival leads to the initiation and progression of cancer. Regarding the advancement in the cancer pathology, it seems that modulation of autophagy and ER stress are promising.

Usefulness of Hybrid PET/MRI in Clinical Evaluation of Head and Neck Cancer Patients

(1) Background: The novel hybrid of positron emission tomography/magnetic resonance (PET/MR) examination has been introduced to clinical practice. The aim of our study was to evaluate PET/MR usefulness in preoperative staging of head and neck cancer (HNC) patients (pts); (2) Methods: Thirty eight pts underwent both computed tomography (CT) and PET/MR examination, of whom 21 pts underwent surgical treatment as first-line therapy and were further included in the present study. Postsurgical tissue material was subjected to routine histopathological (HP) examination with additional evaluation of p16, human papillomavirus (HPV), Epstein-Barr virus (EBV) and Ki67 status. Agreement of clinical and pathological T staging, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) of CT and PET/MR in metastatic lymph nodes detection were defined. The verification of dependences between standardized uptake value (SUV value), tumor geometrical parameters, number of metastatic lymph nodes in PET/MR and CT, biochemical parameters, Ki67 index, p16, HPV and EBV status was made with statistical analysis of obtained results; (3) Results: PET/MR is characterized by better agreement in T staging, higher specificity, sensitivity, PPV and NPV of lymph nodes evaluation than CT imaging. Significant correlations were observed between SUVmax and maximal tumor diameter from PET/MR, between SUVmean and CT tumor volume, PET/MR tumor volume, maximal tumor diameter assessed in PET/MR. Other correlations were weak and insignificant; (4) Conclusions: Hybrid PET/MR imaging is useful in preoperative staging of HNC. Further studies are needed.

Dual time point 18F-fluorodeoxyglucose positron emission tomography/computed tomography fusion imaging (18F-FDG PET/CT) in primary breast cancer

BACKGROUND

To evaluate the clinicopathological and prognostic significance of the percentage change between maximum standardized uptake value (SUV_max) at 60 min (SUV_max1) and SUV_max at 120 min (SUV_max2) (ΔSUV_max%) using dual time point ¹⁸F-fluorodeoxyglucose emission tomography/computed tomography (¹⁸F-FDG PET/CT) in breast cancer.

METHODS

Four hundred and sixty-four patients with primary breast cancer underwent ¹⁸F-FDG PET/CT for preoperative staging. ΔSUV_max% was defined as (SUV_max2 - SUV_max1) / SUV_max1 × 100. We explored the optimal cutoff value of SUV_max parameters (SUV_max1 and ΔSUV_max%) referring to the event of relapse by using receiver operator characteristic curves. The clinicopathological and prognostic significances of the SUV_max1 and ΔSUV_max% were analyzed by Cox's univariate and multivariate analyses.

RESULTS

The optimal cutoff values of SUV_max1 and ΔSUV_max% were 3.4 and 12.5, respectively. Relapse-free survival (RFS) curves were significantly different between high and low SUV_max1 groups (P = 0.0003) and also between high and low ΔSUV_max% groups (P = 0.0151). In Cox multivariate analysis for RFS, SUV_max1 was an independent prognostic factor (P = 0.0267) but ΔSUV_max% was not (P = 0.152). There was a weak correlation between SUV_max1 and ΔSUV_max% (P < 0.0001, R² = 0.166). On combining SUV_max1 and ΔSUV_max%, the subgroups of high SUV_max1 and high ΔSUV_max% showed significantly worse prognosis than the other groups in terms of RFS (P = 0.0002).

CONCLUSION

Dual time point ¹⁸F-FDG PET/CT evaluation can be a useful method for predicting relapse in patients with breast cancer. The combination of SUV_max1 and ΔSUV_max% was able to identify subgroups with worse prognosis more accurately than SUV_max1 alone.

Radiogenomics of breast cancer using dynamic contrast enhanced MRI and gene expression profiling

Background

Imaging techniques can provide information about the tumor non-invasively and have been shown to provide information about the underlying genetic makeup. Correlating image-based phenotypes (radiomics) with genomic analyses is an emerging area of research commonly referred to as “radiogenomics” or “imaging-genomics”. The purpose of this study was to assess the potential for using an automated, quantitative radiomics platform on magnetic resonance (MR) breast imaging for inferring underlying activity of clinically relevant gene pathways derived from RNA sequencing of invasive breast cancers prior to therapy.

Methods

We performed quantitative radiomic analysis on 47 invasive breast cancers based on dynamic contrast enhanced 3 Tesla MR images acquired before surgery and obtained gene expression data by performing total RNA sequencing on corresponding fresh frozen tissue samples. We used gene set enrichment analysis to identify significant associations between the 186 gene pathways and the 38 image-based features that have previously been validated.

Results

All radiomic size features were positively associated with multiple replication and proliferation pathways and were negatively associated with the apoptosis pathway. Gene pathways related to immune system regulation and extracellular signaling had the highest number of significant radiomic feature associations, with an average of 18.9 and 16 features per pathway, respectively. Tumors with upregulation of immune signaling pathways such as T-cell receptor signaling and chemokine signaling as well as extracellular signaling pathways such as cell adhesion molecule and cytokine-cytokine interactions were smaller, more spherical, and had a more heterogeneous texture upon contrast enhancement. Tumors with higher expression levels of JAK/STAT and VEGF pathways had more intratumor heterogeneity in image enhancement texture. Other pathways with robust associations to image-based features include metabolic and catabolic pathways.

Conclusions

We provide further evidence that MR imaging of breast tumors can infer underlying gene expression by using RNA sequencing. Size and shape features were appropriately correlated with proliferative and apoptotic pathways. Given the high number of radiomic feature associations with immune pathways, our results raise the possibility of using MR imaging to distinguish tumors that are more immunologically active, although further studies are necessary to confirm this observation.

Electronic supplementary material

The online version of this article (10.1186/s40644-019-0233-5) contains supplementary material, which is available to authorized users.

Laparoscopy-assisted extended right hepatectomy for giant hemorrhagic hepatic cyst mimicking biliary cystadenocarcinoma: a case report

BACKGROUND

Hemorrhagic hepatic cysts infrequently involve several iconographic changes requiring a differential diagnosis, primarily with a cystic malignancy. We herein report a case of laparoscopy-assisted extended right hepatectomy for a giant hemorrhagic hepatic cyst with an enhancing mural nodule that was clinically suspected of being biliary cystadenocarcinoma.

CASE PRESENTATION

A 73-year-old woman was followed up for giant hepatic cyst occupying the right lobe of the liver. During the follow-up, an enhancing mural nodule was newly noted on computed tomography in 2016. Based on additional clinical examinations, biliary cystadenocarcinoma was undeniable, and laparoscopy-assisted extended right hepatectomy was performed for diagnostic and therapeutic purposes. She had no perioperative complications and was discharged on postoperative day 13. A histological examination of the mural nodule showed neovascularization within an organized hematoma.

CONCLUSION

We herein report a rare case of giant hemorrhagic hepatic cyst mimicking biliary cystadenocarcinoma that was successfully treated with laparoscopy-assisted extended right hepatectomy. Laparoscopic surgery in our case was an effective procedure performed with the utmost care.