1
|
Susam S, Çinkooğlu A, Ceylan KC, Gürsoy S, Kömürcüoğlu BE, Mertoğlu A, Çırak AK, Tuksavul F, Gayaf M, Güldaval F, Polat G, Yıldırım E, Koparal H, Yücel N. Diagnostic success of transthoracic needle biopsy and PET-CT for 1 to 2 cm solid indeterminate pulmonary nodules. CLINICAL RESPIRATORY JOURNAL 2020; 14:453-461. [PMID: 31922654 DOI: 10.1111/crj.13152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 10/25/2019] [Accepted: 01/05/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P < .001). The 2.5 SUVmax cutoff value had sensitivity of 91%, specificity of 35.6%, accuracy of 75% (P = .034). The cutoff value of 49 years of age, nodule size of 16.4 mm, gender and 2.5 SUVmax value had high accuracy for benign-malignant differentiation. No statistically significant difference was found in the upper lobe localization of nodule. CONCLUSION A positive result from TTNB is a reliable finding; however, a negative result is not definitive. The high negative predictive value of PET-CT is effective in preventing the unnecessary biopsies and surgical procedures.
Collapse
Affiliation(s)
- Seher Susam
- Radiology Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Akın Çinkooğlu
- Radiology Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Kenan Can Ceylan
- Thorasic Surgery Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Soner Gürsoy
- Thorasic Surgery Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Berna Eren Kömürcüoğlu
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Aydan Mertoğlu
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Ali Kadri Çırak
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Fevziye Tuksavul
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Mine Gayaf
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Filiz Güldaval
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Gülru Polat
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Eylem Yıldırım
- Chest Disease Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Hakan Koparal
- Nuclear Medicine Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| | - Nur Yücel
- Pathology Department, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, Health Sciences University, Izmir, Turkey
| |
Collapse
|
2
|
Živković NP, Petrovečki M, Lončarić ČT, Nikolić I, Waeg G, Jaganjac M, Žarković K, Žarković N. Positron emission tomography-computed tomography and 4-hydroxynonenal-histidine immunohistochemistry reveal differential onset of lipid peroxidation in primary lung cancer and in pulmonary metastasis of remote malignancies. Redox Biol 2017; 11:600-605. [PMID: 28110216 PMCID: PMC5256674 DOI: 10.1016/j.redox.2017.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 01/22/2023] Open
Abstract
The Aim of the study was to reveal if PET-CT analysis of primary and of secondary lung cancer could be related to the onset of lipid peroxidation in cancer and in surrounding non-malignant lung tissue. METHODS Nineteen patients with primary lung cancer and seventeen patients with pulmonary metastasis were involved in the study. Their lungs were analyzed by PET-CT scanning before radical surgical removal of the cancer. Specific immunohistochemistry for the major bioactive marker of lipid peroxidation, 4-hydroxynonenal (HNE), was done for the malignant and surrounding non-malignant lung tissue using genuine monoclonal antibody specific for the HNE-histidine adducts. RESULTS Both the intensity of the PET-CT analysis and the HNE-immunohistochemistry were in correlation with the size of the tumors analyzed, while primary lung carcinomas were larger than the metastatic tumors. The intensity of the HNE-immunohistochemistry in the surrounding lung tissue was more pronounced in the metastatic than in the primary tumors, but it was negatively correlated with the cancer volume determined by PET-CT. The appearance of HNE was more pronounced in non-malignant surrounding tissue than in cancer or stromal cells, both in case of primary and metastatic tumors. CONCLUSIONS Both PET-CT and HNE-immunohistochemistry reflect the size of the malignant tissue. However, lipid peroxidation of non-malignant lung tissue in the vicinity of cancer is more pronounced in metastatic than in primary malignancies and might represent the mechanism of defense against cancer, as was recently revealed also in case of human liver cancer.
Collapse
Affiliation(s)
| | | | | | | | - Georg Waeg
- Karl Franzen's University of Graz, Institute of Molecular Biosciences, Austria
| | - Morana Jaganjac
- Toxicology and Multipurpose Dept., Anti-Doping Lab, Doha, Qatar
| | - Kamelija Žarković
- University of Zagreb School of Medicine, Department of Pathology, Clinical Hospital Center, Zagreb, Croatia
| | | |
Collapse
|
3
|
Galgiani JN, Ampel NM, Blair JE, Catanzaro A, Geertsma F, Hoover SE, Johnson RH, Kusne S, Lisse J, MacDonald JD, Meyerson SL, Raksin PB, Siever J, Stevens DA, Sunenshine R, Theodore N. 2016 Infectious Diseases Society of America (IDSA) Clinical Practice Guideline for the Treatment of Coccidioidomycosis. Clin Infect Dis 2016; 63:e112-46. [PMID: 27470238 DOI: 10.1093/cid/ciw360] [Citation(s) in RCA: 319] [Impact Index Per Article: 39.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 05/26/2016] [Indexed: 12/17/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. Infectious Diseases Society of America considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.Coccidioidomycosis, also known as San Joaquin Valley fever, is a systemic infection endemic to parts of the southwestern United States and elsewhere in the Western Hemisphere. Residence in and recent travel to these areas are critical elements for the accurate recognition of patients who develop this infection. In this practice guideline, we have organized our recommendations to address actionable questions concerning the entire spectrum of clinical syndromes. These can range from initial pulmonary infection, which eventually resolves whether or not antifungal therapy is administered, to a variety of pulmonary and extrapulmonary complications. Additional recommendations address management of coccidioidomycosis occurring for special at-risk populations. Finally, preemptive management strategies are outlined in certain at-risk populations and after unintentional laboratory exposure.
Collapse
Affiliation(s)
| | - Neil M Ampel
- Division of Infectious Diseases, University of Arizona, Tucson
| | - Janis E Blair
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Antonino Catanzaro
- Division of Pulmonary and Critical Care, University of California, San Diego
| | - Francesca Geertsma
- Department of Pediatrics, Infectious Diseases, Stanford University School of Medicine, California
| | | | - Royce H Johnson
- David Geffen School of Medicine at UCLA, Department of Medicine, Kern Medical Center, Bakersfield, California
| | - Shimon Kusne
- Division of Infectious Diseases, Mayo Clinic, Scottsdale, Arizona
| | - Jeffrey Lisse
- Department of Rheumatology, University of Arizona, Tucson
| | - Joel D MacDonald
- Department of Neurosurgery School of Medicine, University of Utah, Salt Lake City
| | - Shari L Meyerson
- Division of Thoracic Surgery, Northwestern University, Feinberg School of Medicine
| | - Patricia B Raksin
- Division of Neurosurgery, John H. Stroger Jr Hospital of Cook County, Chicago, Illinois
| | | | - David A Stevens
- Division of Infectious Diseases, Stanford University School of Medicine, California
| | - Rebecca Sunenshine
- Career Epidemiology Field Officer Program, Division of State and Local Readiness, Office of Public Health Preparedness and Response, Centers for Disease Control and Prevention Maricopa County Department of Public Health
| | - Nicholas Theodore
- Department of Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona
| |
Collapse
|
4
|
Fussner LA, Midthun DE. Characteristics and management strategies for the incidental pulmonary nodule. Lung Cancer Manag 2014. [DOI: 10.2217/lmt.14.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY: Pulmonary nodules are frequent, unanticipated findings on imaging studies obtained for other purposes across all areas of medical practice. As nodule detection raises concern for malignancy, evaluation and follow-up of an incidental nodule is imperative. Clinicians are charged with counseling patients and directing further evaluation amid uncertainty and anxiety. The goals of follow-up and management are to identify malignant lesions at an early stage, while avoiding unnecessary procedures and potential harm to patients with benign nodules. In this review, we aim to outline the clinical and radiographic characteristics that can aid in likelihood stratification, to identify gaps in our current knowledge, and to present a logical approach to nodule management, based on the available evidence.
Collapse
Affiliation(s)
- Lynn A Fussner
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - David E Midthun
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| |
Collapse
|
5
|
Mohamed A, Deng X, Khuri FR, Owonikoko TK. Altered glutamine metabolism and therapeutic opportunities for lung cancer. Clin Lung Cancer 2014; 15:7-15. [PMID: 24377741 PMCID: PMC3970234 DOI: 10.1016/j.cllc.2013.09.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Revised: 09/04/2013] [Accepted: 09/10/2013] [Indexed: 12/16/2022]
Abstract
Disordered cancer metabolism was described almost a century ago as an abnormal adaptation of cancer cells to glucose utilization especially in hypoxic conditions; the so-called Warburg effect. Greater research interest in this area in the past two decades has led to the recognition of the critical coupling of specific malignant phenotypes such as increased proliferation and resistance to programmed cell death (apoptosis) with altered metabolic handling of key molecules that are essential for normal cellular metabolism. The altered glucose metabolism frequently encountered in cancer cells has already been exploited for cancer diagnosis and treatment. The role of other glycolytic pathway intermediates and alternative pathways for energy generation and macromolecular synthesis in cancer cells has only become recognized more recently. Especially, the important role of altered glutamine metabolism in the malignant behavior of cancer cells and the potential exploitation of this cellular adaptation for therapeutic targeting has now emerged as an important area of cancer research. Expectedly, attempts to exploit this understanding for diagnostic and therapeutic ends are running apace with the elucidation of the complex metabolic alterations that accompany neoplastic transformation. Because lung cancer is a leading cause of cancer death with limited curative therapy options, careful elucidation of the mechanism and consequences of disordered cancer metabolism in lung cancer is warranted. This review provides a concise, systematic overview of the current understanding of the role of altered glutamine metabolism in cancer, and how these findings intersect with current and future approaches to lung cancer management.
Collapse
Affiliation(s)
- Amr Mohamed
- Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Xingming Deng
- Department of Radiation Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Fadlo R Khuri
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA
| | - Taofeek K Owonikoko
- Department of Hematology and Medical Oncology, Emory University School of Medicine and Winship Cancer Institute, Atlanta, GA.
| |
Collapse
|
6
|
Perera NK, Knight SR. Outcomes after pulmonary metastasectomy for colorectal cancer. ANZ J Surg 2013; 84:556-9. [PMID: 24103011 DOI: 10.1111/ans.12387] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2013] [Indexed: 01/18/2023]
Abstract
BACKGROUND Surgical resection offers the greatest likelihood of cure for appropriately selected patients with pulmonary colorectal carcinoma metastases. We hereby report our experience over the last 19 years at the Austin Hospital, Thoracic Surgery Unit. METHODS This is a retrospective study of a consecutive series of patients with pulmonary colorectal cancer metastases. From 1994 to 2012, 66 patients underwent 83 pulmonary metastasectomies for colorectal cancer at the Austin Hospital. RESULTS Seventy per cent of patients were operated on for single pulmonary metastases. The most common procedure performed was a video-assisted thoracoscopic surgery wedge resection. Median follow-up duration was 25 months. Three-, five-, seven- and ten-year survival was 53.4, 39.6, 34.6 and 23.1%, respectively. CONCLUSION Pulmonary metastasectomy for metastatic colorectal carcinoma continues to offer the greatest survival advantage for appropriately selected patients.
Collapse
Affiliation(s)
- Nisal K Perera
- Department of Thoracic Surgery, Austin Hospital, The University of Melbourne, Heidelberg, Victoria, Australia
| | | |
Collapse
|
7
|
Horne ZD, Clump DA, Heron DE. Can metabolic activity predict response in early-stage lung cancer treated with stereotactic body radiation therapy? Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Zachary D Horne
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA.
| | - David A Clump
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| |
Collapse
|
8
|
Cano Alonso R, Herráiz Hidalgo L, Álvarez Moreno E, Paniagua Correa C, Martínez de Vega V. Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma. RADIOLOGIA 2012. [DOI: 10.1016/j.rxeng.2011.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
9
|
Milano MT, Zhang H, Usuki KY, Singh DP, Chen Y. Definitive radiotherapy for stage I nonsmall cell lung cancer. Cancer 2012; 118:5572-9. [DOI: 10.1002/cncr.27589] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2012] [Revised: 03/06/2012] [Accepted: 03/06/2012] [Indexed: 12/25/2022]
|
10
|
A review of noninvasive staging of the mediastinum for non-small cell lung carcinoma. Surg Oncol Clin N Am 2012; 20:681-90. [PMID: 21986265 DOI: 10.1016/j.soc.2011.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Lung cancer and bronchogenic carcinoma are malignancies originating from the airways and pulmonary parenchyma. Most (approximately 90%) lung cancers are classified as non-small cell lung cancer. This distinction carries important differences for staging, treatment, and prognosis. This article presents a review of mediastinal staging for patients with non-small cell lung cancer.
Collapse
|
11
|
Cano Alonso R, Herráiz Hidalgo L, Álvarez Moreno E, Paniagua Correa C, Martínez de Vega V. [Role of imaging techniques in the TNM classification of non-small cell bronchogenic carcinoma]. RADIOLOGIA 2012; 54:306-20. [PMID: 22226376 DOI: 10.1016/j.rx.2011.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2010] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 10/14/2022]
Abstract
The Seventh Edition of the TNM Classification for non-small cell bronchogenic carcinomas include a series of changes in the T and M descriptor, in particular a re-classification of malignant pleural and pericardial effusions and of separated tumour nodes, new tumour size cut-off values and sub-divisions of the T1-T2 and M1 categories. We review these corrections that led to the changes in the staging system that affects stages II-III. Furthermore, we describe and illustrate the role of the different imaging techniques in tumour staging (CT, PET, PET-CT and MRI), highlighting their respective indications, advantages and disadvantages, as well their complementary function.
Collapse
Affiliation(s)
- R Cano Alonso
- Departamento de Diagnóstico por la Imagen, Hospital Universitario Quirón, Madrid, España.
| | | | | | | | | |
Collapse
|
12
|
Van Tassel D, Tassel LV, Gotway MB, Korn RL. Imaging Evaluation of the Solitary Pulmonary Nodule. ACTA ACUST UNITED AC 2011. [DOI: 10.1097/cpm.0b013e318234d5f5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
13
|
Shimoji M, Nakajima T, Yamatani C, Yamamoto M, Saishou S, Isaka M, Maniwa T, Ode Y, Nakagawa K, Okumura T, Watanabe R, Ito I, Kameya T, Endo M, Kondo H. A clinicopathological and immunohistological re-evaluation of adenosquamous carcinoma of the lung. Pathol Int 2011; 61:717-22. [PMID: 22126378 DOI: 10.1111/j.1440-1827.2011.02730.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Since the World Health Organization histological criteria were published in 1999, several studies have focused on adenosquamous carcinoma of the lung. Therefore, we aimed to clinicopathologically re-evaluate this tumor using immunohistochemical methods. In our hospital, there have been 21 surgically resected adenosquamous carcinomas. The frequency of adenosquamous carcinoma was 1.9% and the clinical data including the patient prognosis data obtained in this study were similar to those reported previously. A fluorodeoxyglucose positron emission tomography study first revealed that the median maximum standardized uptake value of adenosquamous carcinoma was 9.3 and ranged from 2.0 to 24.5. According to the results of immunohistochemical staining for thyroid transcription factor-1 (TTF-1) and p63, adenosquamous carcinomas were divided into four subgroups: group 1, TTF-1+ and p63+ (10 cases); group 2, TTF-1- and p63+ (six cases); group 3, TTF-1+ and p63- (three cases); and group 4, TTF-1- and p63- (two cases). Of the six group 2 tumors, three were composed of unique solid nests with mucin-filled cysts and showed characteristic p63 expression, which might suggest a special type of adenosquamous carcinoma. Immunohistochemical analysis of TTF-1 and p63 expression shows that adenosquamous carcinoma is composed of diverse tumor groups, for which the biological and histogenetic nature further needs to be clarified.
Collapse
Affiliation(s)
- Masaki Shimoji
- Division of Thoracic Surgery, Shizuoka Cancer Center, Shimonagakubo, Nagaizumi, Shizuoka, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
14
|
Should CT Play a Greater Role in Preventing the Resection of Granulomas in the Era of PET? AJR Am J Roentgenol 2011; 196:795-800. [DOI: 10.2214/ajr.10.5190] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
15
|
Miziara JM, da Rocha ET, Miziara JEA, Garcia GF, Simões MIP, Lopes MA, Kerr LM, Buchpiguel CA. Preoperative nodal staging of non-small cell lung cancer using 99mTc-sestamibi spect/ct imaging. Clinics (Sao Paulo) 2011; 66:1901-9. [PMID: 22086520 PMCID: PMC3203962 DOI: 10.1590/s1807-59322011001100009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2011] [Accepted: 07/18/2011] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES The proper nodal staging of non-small cell lung cancer is important for choosing the best treatment modality. Although computed tomography remains the first-line imaging test for the primary staging of lung cancer, its limitations for mediastinum nodal staging are well known. The aim of this study is to evaluate the accuracy of hybrid single-photon emission computed tomography and computed tomography using 99mTc-sestamibi in the nodal staging of patients with non-small cell lung cancer and to identify potential candidates for surgical treatment. METHODS Prospective data were collected for 41 patients from December 2006 to February 2009. The patients underwent chest computed tomography and single-photon emission computed tomography/computed tomography examinations with 99mTc-sestamibi within a 30-day time period before surgery. Single-photon emission computed tomography/computed tomography was considered positive when there was focal uptake of sestamibi in the mediastinum, and computed tomography scan when there was lymph nodes larger than 10 mm in short axis. The results of single-photon emission computed tomography and computed tomography were correlated with pathology findings after surgery. RESULTS Single-photon emission computed tomography/computed tomography correctly identified six out of 19 cases involving hilar lymph nodes and one out of seven cases involving nodal metastases in the mediastinum. The sensitivity, specificity, positive predictive value, and negative predictive value for 99mTc-sestamibi single-photon emission computed tomography/computed tomography in the hilum assessment were 31.6%, 95.5%, 85.7%, and 61.8%, respectively. The same values for the mediastinum were 14.3%, 97.1%, 50%, and 84.6%, respectively. For the hilar and mediastinal lymph nodes, chest tomography showed sensitivity values of 47.4% and 57.1%, specificity values of 95.5% and 91.2%, positive predictive values of 90% and 57.1% and negative predictive values of 67.7% and 91.2%, respectively. CONCLUSION Single-photon emission computed tomography/computed tomography with 99mTc-sestamibi showed very low sensitivity and accuracy for the nodal staging of patients with non-small cell lung cancer, despite its high level of specificity. In addition, the performance of single-photon emission computed tomography/computed tomography added no relevant information compared to computed tomography that would justify its use in the routine preoperative staging of non-small cell lung carcinoma.
Collapse
|
16
|
Nielsen CH, Kimura RH, Withofs N, Tran PT, Miao Z, Cochran JR, Cheng Z, Felsher D, Kjær A, Willmann JK, Gambhir SS. PET imaging of tumor neovascularization in a transgenic mouse model with a novel 64Cu-DOTA-knottin peptide. Cancer Res 2010; 70:9022-30. [PMID: 21062977 DOI: 10.1158/0008-5472.can-10-1338] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Due to the high mortality of lung cancer, there is a critical need to develop diagnostic procedures enabling early detection of the disease while at a curable stage. Targeted molecular imaging builds on the positive attributes of positron emission tomography/computed tomography (PET/CT) to allow for a noninvasive detection and characterization of smaller lung nodules, thus increasing the chances of positive treatment outcome. In this study, we investigate the ability to characterize lung tumors that spontaneously arise in a transgenic mouse model. The tumors are first identified with small animal CT followed by characterization with the use of small animal PET with a novel 64Cu-1,4,7,10-tetra-azacylododecane-N,N',N'',N'''-tetraacetic acid (DOTA)-knottin peptide that targets integrins upregulated during angiogenesis on the tumor associated neovasculature. The imaging results obtained with the knottin peptide are compared with standard 18F-fluorodeoxyglucose (FDG) PET small animal imaging. Lung nodules as small as 3 mm in diameter were successfully identified in the transgenic mice by small animal CT, and both 64Cu-DOTA-knottin 2.5F and FDG were able to differentiate lung nodules from the surrounding tissues. Uptake and retention of the 64Cu-DOTA-knottin 2.5F tracer in the lung tumors combined with a low background in the thorax resulted in a statistically higher tumor to background (normal lung) ratio compared with FDG (6.01±0.61 versus 4.36±0.68; P<0.05). Ex vivo biodistribution showed 64Cu-DOTA-knottin 2.5F to have a fast renal clearance combined with low nonspecific accumulation in the thorax. Collectively, these results show 64Cu-DOTA-knottin 2.5F to be a promising candidate for clinical translation for earlier detection and improved characterization of lung cancer.
Collapse
Affiliation(s)
- Carsten H Nielsen
- Molecular Imaging Program at Stanford, Department of Radiology, Division of Oncology, Stanford University, Stanford, California 94305-5427, USA
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
INTRODUCTION Positron emission tomography (PET) with 18F-FDG has become an important tool for the characterization of solitary pulmonary nodules (SPN). BACKGROUND The results of the main meta-analyses show that the sensitivity and specificity of 18F-FDG PET for determining malignancy of SPN are close to 95% and 80% respectively. The limits of the technology are now well known. False negative results are mainly due to certain histological types with low metabolic activity (such as bronchiolo-alveolar carcinoma and typical carcinoid), or small size (nodules less than 8 mm). False positives are mainly represented by granulomatous and infectious processes. VIEWPOINTS A gain in accuracy occurred with the advent of hybrid PET/CT machines that combine the functional data from 18FDG-PET and the morphological data of computed tomography. Improved imaging protocols (eg. injection of iodinated contrast media) could further enhance the performance of PET-CT. Further improvements will rely on respiratory synchronization protocols and on the advent of new PET tracers. CONCLUSION 18F-FDG PET-CT should be performed for any nodule over 8 mm in size when the pre-test probability of malignancy is not deemed negligible.
Collapse
|
18
|
Prognostic Value of Fluorodeoxyglucose Uptake in Non-small Cell Lung Cancer: Time for Standardization and Validation. J Thorac Oncol 2010; 5:583-4. [DOI: 10.1097/jto.0b013e3181d95cc8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Affiliation(s)
- Wilfried E E Eberhardt
- Department of Medicine (Cancer Research), West German Tumor Centre, University Hospital of University Duisburg-Essen, Essen, Germany
| | | |
Collapse
|
20
|
Honda O, Johkoh T, Sekiguchi J, Tomiyama N, Mihara N, Sumikawa H, Inoue A, Yanagawa M, Daimon T, Okumura M, Nakamura H. Doubling time of lung cancer determined using three-dimensional volumetric software: comparison of squamous cell carcinoma and adenocarcinoma. Lung Cancer 2009; 66:211-7. [PMID: 19250697 DOI: 10.1016/j.lungcan.2009.01.018] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2008] [Revised: 12/29/2008] [Accepted: 01/23/2009] [Indexed: 12/21/2022]
Abstract
The aim of the present study was to investigate the difference in doubling time between squamous cell carcinoma (SCC) and adenocarcinoma of solid pulmonary cancer using three-dimensional volumetric software. We included 40 patients with adenocarcinoma and 11 patients with SCC, who underwent CT examinations more than once before surgical treatment. Tumor volumes and doubling times were obtained using three-dimensional volumetric computer software. Statistical analysis was performed using Mann-Whitney's U-test except for negative doubling times (doubling times less than 0 day). Negative doubling time was found in 5 of the 40 adenocarcinomas (13%), but not in any of the patients with SCC. Doubling time was beyond 400 days in 11 of the 40 adenocarcinomas (28%), but was always less than 400 days in SCC. The mean doubling time of SCC was 126+/-58 days (range, 39-221 days; median, 131 days), while that of adenocarcinomas, except for the negative doubling times, was 976+/-3134 days (range, 69-18,678 days; median, 258 days). Doubling time differed significantly between adenocarcinomas and SCC (p<0.01). In conclusion, the median doubling time of SCC lung cancers is less than that of adenocarcinomas, as measured with automated volumetric measurement software.
Collapse
Affiliation(s)
- Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Jiang F, Todd NW, Qiu Q, Liu Z, Katz RL, Stass SA. Combined genetic analysis of sputum and computed tomography for noninvasive diagnosis of non-small-cell lung cancer. Lung Cancer 2009; 66:58-63. [PMID: 19181417 DOI: 10.1016/j.lungcan.2009.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 12/19/2008] [Accepted: 01/03/2009] [Indexed: 01/29/2023]
Abstract
CT plays an important role in diagnosis of lung cancer, however has been limited by uncertain detection rate for early stage of non-small-cell lung cancer (NSCLC), particularly central tumors. Genetic analysis of sputum has proven to be useful in diagnosis of NSCLC. We proposed to evaluate efficacy of combing CT and genetic analysis of sputum for noninvasive diagnosis of stage I NSCLC. Genomic copy changes of a panel of lung cancer-related genes, HYAL2, FHIT, p16, and SP-A were analyzed by a mini-chip in sputum from 33 patients with stage I NSCLC and 49 cancer-free controls. The genetic and CT diagnoses were compared with surgical-pathologic stage. CT had higher sensitivity (85%) in detection of lung cancer compared with the mini-chip (70%) (p<0.05), while there was no significant difference in specificity between the two tests (89% vs. 92%, p=0.09). Similarly, CT showed considerably higher sensitivity (93%) in identifying peripheral tumors than did the mini-chip (64%) (p<0.05), whereas there was no difference in specificity between them (98% vs. 96%, p=0.28). However, in detecting central tumors, CT had lower specificity (90%) compared with the mini-chip (98%) (p<0.05), although its sensitivity (79%) was higher than that of the mini-chip (73%) (p=0.05). Combining both tests offered higher sensitivity (91%) than did any single one (85%, 70%, all <0.05), while still keeping 92% sensitivity. In particular, this combined approach yielded higher sensitivity, specificity, and accuracy for diagnosing central cancers compared with CT alone (all p<0.05). The integration of the genetic assay with CT led to improvements in noninvasive diagnosis of stage I NSCLCs, especially central tumors.
Collapse
Affiliation(s)
- Feng Jiang
- Department of Pathology, University of Maryland School of Medicine, Baltimore, MD 21201-1192, USA.
| | | | | | | | | | | |
Collapse
|
22
|
Abstract
Molecular imaging of tumor metabolism has gained considerable interest, since preclinical studies have indicated a close relationship between the activation of various oncogenes and alterations of cellular metabolism. Furthermore, several clinical trials have shown that metabolic imaging can significantly impact patient management by improving tumor staging, restaging, radiation treatment planning, and monitoring of tumor response to therapy. In this review, we summarize recent data on the molecular mechanisms underlying the increased metabolic activity of cancer cells and discuss imaging techniques for studies of tumor glucose, lipid, and amino acid metabolism.
Collapse
Affiliation(s)
- Christian Plathow
- Department of Nuclear Medicine, University of Freiburg, Freiburg, Germany
| | | |
Collapse
|
23
|
Jacot W, Colinet B, Bertrand D, Lacombe S, Bozonnat MC, Daurès JP, Pujol JL. Quality of life and comorbidity score as prognostic determinants in non-small-cell lung cancer patients. Ann Oncol 2008; 19:1458-1464. [DOI: 10.1093/annonc/mdn064] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
24
|
Beer AJ, Lorenzen S, Metz S, Herrmann K, Watzlowik P, Wester HJ, Peschel C, Lordick F, Schwaiger M. Comparison of integrin alphaVbeta3 expression and glucose metabolism in primary and metastatic lesions in cancer patients: a PET study using 18F-galacto-RGD and 18F-FDG. J Nucl Med 2007; 49:22-9. [PMID: 18077538 DOI: 10.2967/jnumed.107.045864] [Citation(s) in RCA: 139] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
UNLABELLED The expression of alpha(v)beta(3) and glucose metabolism are upregulated in many malignant lesions, and both are known to correlate with an aggressive phenotype. We evaluated whether assessment of alpha(v)beta(3) expression and of glucose metabolism with PET using (18)F-galacto-RGD and (18)F-FDG provides complementary information in cancer patients. METHODS Eighteen patients with primary or metastatic cancer (non-small cell lung cancer [NSCLC], n = 10; renal cell carcinoma, n = 2; rectal cancer, n = 2; others, n = 4) were examined with PET using (18)F-galacto-RGD and (18)F-FDG. Standardized uptake values (SUVs) were derived by volume-of-interest analysis. (18)F-Galacto-RGD and (18)F-FDG PET results were compared using linear regression analysis for all lesions (n = 59; NSCLC, n = 39) and for primaries (n = 14) and metastases to bone (n = 11), liver (n = 10), and other organs (n = 24) separately. RESULTS The sensitivity of (18)F-galacto-RGD PET compared with clinical staging was 76%. SUVs for (18)F-FDG ranged from 1.3 to 23.2 (mean +/- SD, 7.6 +/- 4.9) and were significantly higher than SUVs for (18)F-galacto-RGD (range, 0.3-6.8; mean +/- SD, 2.7 +/- 1.5; P < 0.001). There was no significant correlation between the SUVs for (18)F-FDG and (18)F-galacto-RGD for all lesions (r = 0.157; P = 0.235) or for primaries, osseous or soft-tissue metastases separately (P > 0.05). For the subgroup of lesions in NSCLC, there was a weak correlation between (18)F-FDG and (18)F-galacto-RGD uptake (r = 0.353; P = 0.028). CONCLUSION Tracer uptake of (18)F-galacto-RGD and (18)F-FDG does not correlate closely in malignant lesions. Whereas (18)F-FDG PET is more sensitive for tumor staging, (18)F-galacto-RGD PET warrants further evaluation for planning and response evaluation of targeted molecular therapies with antiangiogenic or alpha(v)beta(3)-targeted drugs.
Collapse
Affiliation(s)
- Ambros J Beer
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Hoh CK. Clinical use of FDG PET. Nucl Med Biol 2007; 34:737-42. [DOI: 10.1016/j.nucmedbio.2007.07.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Revised: 06/28/2007] [Accepted: 07/02/2007] [Indexed: 10/22/2022]
|
26
|
Abenhardt W. FDG-PET: an important tool in the diagnosis of lung cancer. Oncol Res Treat 2007; 30:352. [PMID: 17596742 DOI: 10.1159/000103379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
27
|
|