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Koltai T, Fliegel L. Dichloroacetate for Cancer Treatment: Some Facts and Many Doubts. Pharmaceuticals (Basel) 2024; 17:744. [PMID: 38931411 PMCID: PMC11206832 DOI: 10.3390/ph17060744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 05/23/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Rarely has a chemical elicited as much controversy as dichloroacetate (DCA). DCA was initially considered a dangerous toxic industrial waste product, then a potential treatment for lactic acidosis. However, the main controversies started in 2008 when DCA was found to have anti-cancer effects on experimental animals. These publications showed contradictory results in vivo and in vitro such that a thorough consideration of this compound's in cancer is merited. Despite 50 years of experimentation, DCA's future in therapeutics is uncertain. Without adequate clinical trials and health authorities' approval, DCA has been introduced in off-label cancer treatments in alternative medicine clinics in Canada, Germany, and other European countries. The lack of well-planned clinical trials and its use by people without medical training has discouraged consideration by the scientific community. There are few thorough clinical studies of DCA, and many publications are individual case reports. Case reports of DCA's benefits against cancer have been increasing recently. Furthermore, it has been shown that DCA synergizes with conventional treatments and other repurposable drugs. Beyond the classic DCA target, pyruvate dehydrogenase kinase, new target molecules have also been recently discovered. These findings have renewed interest in DCA. This paper explores whether existing evidence justifies further research on DCA for cancer treatment and it explores the role DCA may play in it.
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Affiliation(s)
- Tomas Koltai
- Hospital del Centro Gallego de Buenos Aires, Buenos Aires 2199, Argentina
| | - Larry Fliegel
- Department of Biochemistry, University Alberta, Edmonton, AB T6G 2H7, Canada;
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2
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Al-Fatlawi M, Pak F, Farzanefar S, Salehi Y, Monsef A, Sheikhzadeh P. Optimization of the Acquisition Time and Injected Dose of 18 F-Fluorodeoxyglucose Based on Patient Specifications for High-Sensitive Positron Emission Tomography/Computed Tomography Scanner. World J Nucl Med 2023; 22:196-202. [PMID: 37854082 PMCID: PMC10581753 DOI: 10.1055/s-0043-1771284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023] Open
Abstract
Background This study was aimed to optimize the fluorodeoxyglucose (FDG)-administered dose and scan time based on patient specifications using a highly sensitive five-ring bismuth germanium oxide (BGO)-based positron emission tomography/computed tomography (PET/CT) scanner (Discovery IQ). Methods We retrospectively analyzed 101 whole-body 18 F-FDG PET/CT images. Patient data were reconstructed using ordered subset expectation maximization with resolution recovery algorithms (OSEM + SharpIR). Signal-to-noise ratio (SNR) was calculated for each patient, standardized to SNR norm , and plotted against three body index parameters (weight, body mass index, and lean body mass). Two professional physicians blindly examined image quality at different patient time per bed positions to determine the minimum acceptable quality. To select images of acceptable quality, the noise index parameter was also measured. A new dose-time product (DTP) was established for each patient, and a predicted injected dose was assumed. Results We found an almost linear association between patient weight and normalized SNR, and patient weight had the highest R 2 in the fitting. The redesigned DTP can reduce results by approximately 74 and 38% compared with ordinary DTP for 80- and 160-s scan durations. The new dose regimen formula was found to be DTP = c/t × m 1.24 , where m is the patient weight, t is the scan time per bed position, and c is 1.8 and 4.3 for acceptable and higher confidence states, respectively, in Discovery IQ PET/CT. Conclusion Patient weight is the best clinical parameter for the implementation of 18 F-FDG PET/CT image quality assessment. A new dose-time regimen based on body weight was proposed for use in highly sensitive five-ring BGO PET-CT scanners to significantly reduce the injection dose and scan times while maintaining sufficient image quality for diagnosis.
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Affiliation(s)
- Murtadha Al-Fatlawi
- Radiological Techniques Department, AL-Mustaqbal University College, Babel, Iraq
| | - Farideh Pak
- Department of Radiation Oncology, Washington University in St. Louis, St. Louis, United States
| | - Saeed Farzanefar
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Yalda Salehi
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Monsef
- Department of Radiology, Center for Magnetic Resonance Research, University of Minnesota Medical School, Minneapolis, United States
- Department of Radiation Oncology, University of Minnesota Medical School, Minneapolis, United States
| | - Peyman Sheikhzadeh
- Department of Nuclear Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
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de Jong D, Desperito E, Al Feghali KA, Dercle L, Seban RD, Das JP, Ma H, Sajan A, Braumuller B, Prendergast C, Liou C, Deng A, Roa T, Yeh R, Girard A, Salvatore MM, Capaccione KM. Advances in PET/CT Imaging for Breast Cancer. J Clin Med 2023; 12:4537. [PMID: 37445572 PMCID: PMC10342839 DOI: 10.3390/jcm12134537] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/26/2023] [Accepted: 06/30/2023] [Indexed: 07/15/2023] Open
Abstract
One out of eight women will be affected by breast cancer during her lifetime. Imaging plays a key role in breast cancer detection and management, providing physicians with information about tumor location, heterogeneity, and dissemination. In this review, we describe the latest advances in PET/CT imaging of breast cancer, including novel applications of 18F-FDG PET/CT and the development and testing of new agents for primary and metastatic breast tumor imaging and therapy. Ultimately, these radiopharmaceuticals may guide personalized approaches to optimize treatment based on the patient's specific tumor profile, and may become a new standard of care. In addition, they may enhance the assessment of treatment efficacy and lead to improved outcomes for patients with a breast cancer diagnosis.
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Affiliation(s)
- Dorine de Jong
- Center for Cell Engineering, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA;
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | | | - Laurent Dercle
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Romain-David Seban
- Department of Nuclear Medicine and Endocrine Oncology, Institut Curie, 92210 Saint-Cloud, France;
- Laboratory of Translational Imaging in Oncology, Paris Sciences et Lettres (PSL) Research University, Institut Curie, 91401 Orsay, France
| | - Jeeban P. Das
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.D.); (R.Y.)
| | - Hong Ma
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Abin Sajan
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Brian Braumuller
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Conor Prendergast
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Connie Liou
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Aileen Deng
- Department of Hematology and Oncology, Novant Health, 170 Medical Park Road, Mooresville, NC 28117, USA;
| | - Tina Roa
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Randy Yeh
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA; (J.P.D.); (R.Y.)
| | - Antoine Girard
- Department of Nuclear Medicine, Centre Eugène Marquis, Université Rennes 1, 35000 Rennes, France;
| | - Mary M. Salvatore
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
| | - Kathleen M. Capaccione
- Department of Radiology, Columbia University Irving Medical Center, New York, NY 10032, USA; (E.D.); (L.D.); (H.M.); (A.S.); (B.B.); (C.P.); (C.L.); (T.R.); (M.M.S.)
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Morawitz J, Sigl B, Rubbert C, Bruckmann NM, Dietzel F, Häberle LJ, Ting S, Mohrmann S, Ruckhäberle E, Bittner AK, Hoffmann O, Baltzer P, Kapetas P, Helbich T, Clauser P, Fendler WP, Rischpler C, Herrmann K, Schaarschmidt BM, Stang A, Umutlu L, Antoch G, Caspers J, Kirchner J. Clinical Decision Support for Axillary Lymph Node Staging in Newly Diagnosed Breast Cancer Patients Based on 18F-FDG PET/MRI and Machine Learning. J Nucl Med 2023; 64:304-311. [PMID: 36137756 PMCID: PMC9902847 DOI: 10.2967/jnumed.122.264138] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/19/2022] [Accepted: 08/19/2022] [Indexed: 02/04/2023] Open
Abstract
In addition to its high prognostic value, the involvement of axillary lymph nodes in breast cancer patients also plays an important role in therapy planning. Therefore, an imaging modality that can determine nodal status with high accuracy in patients with primary breast cancer is desirable. Our purpose was to investigate whether, in newly diagnosed breast cancer patients, machine-learning prediction models based on simple assessable imaging features on MRI or PET/MRI are able to determine nodal status with performance comparable to that of experienced radiologists; whether such models can be adjusted to achieve low rates of false-negatives such that invasive procedures might potentially be omitted; and whether a clinical framework for decision support based on simple imaging features can be derived from these models. Methods: Between August 2017 and September 2020, 303 participants from 3 centers prospectively underwent dedicated whole-body 18F-FDG PET/MRI. Imaging datasets were evaluated for axillary lymph node metastases based on morphologic and metabolic features. Predictive models were developed for MRI and PET/MRI separately using random forest classifiers on data from 2 centers and were tested on data from the third center. Results: The diagnostic accuracy for MRI features was 87.5% both for radiologists and for the machine-learning algorithm. For PET/MRI, the diagnostic accuracy was 89.3% for the radiologists and 91.2% for the machine-learning algorithm, with no significant differences in diagnostic performance between radiologists and the machine-learning algorithm for MRI (P = 0.671) or PET/MRI (P = 0.683). The most important lymph node feature was tracer uptake, followed by lymph node size. With an adjusted threshold, a sensitivity of 96.2% was achieved by the random forest classifier, whereas specificity, positive predictive value, negative predictive value, and accuracy were 68.2%, 78.1%, 93.8%, and 83.3%, respectively. A decision tree based on 3 simple imaging features could be established for MRI and PET/MRI. Conclusion: Applying a high-sensitivity threshold to the random forest results might potentially avoid invasive procedures such as sentinel lymph node biopsy in 68.2% of the patients.
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Affiliation(s)
- Janna Morawitz
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany;
| | - Benjamin Sigl
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Christian Rubbert
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Nils-Martin Bruckmann
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Frederic Dietzel
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Lena J. Häberle
- Institute of Pathology, Medical Faculty, Heinrich Heine University and University Hospital Duesseldorf, Duesseldorf, Germany
| | - Saskia Ting
- Institute of Pathology, University Hospital Essen, West German Cancer Center, University of Duisburg–Essen and the German Cancer Consortium (DKTK), Essen, Germany
| | - Svjetlana Mohrmann
- Department of Gynecology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Eugen Ruckhäberle
- Department of Gynecology, University of Duesseldorf, Medical Faculty, Duesseldorf, Germany
| | - Ann-Kathrin Bittner
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
| | - Oliver Hoffmann
- Department of Gynecology and Obstetrics, University Hospital Essen, University of Duisburg–Essen, Essen, Germany
| | - Pascal Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Helbich
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General Radiology, Medical University of Vienna, Vienna, Austria
| | - Wolfgang P. Fendler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Christoph Rischpler
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Ken Herrmann
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg–Essen and German Cancer Consortium (DKTK), Essen, Germany
| | - Benedikt M. Schaarschmidt
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
| | - Andreas Stang
- Institute of Medical Informatics, Biometry, and Epidemiology, Essen University Medical Center, Essen, Germany
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University of Duisburg–Essen, Essen, Germany; and
| | - Gerald Antoch
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Julian Caspers
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Julian Kirchner
- Department of Diagnostic and Interventional Radiology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
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Baltz AP, Siegel ER, Kamal AH, Siegel R, Kozlik MM, Crist STS, Makhoul I. Clinical Impact of ASCO Choosing Wisely Guidelines on Staging Imaging for Early-Stage Breast Cancers: A Time Series Analysis Using SEER-Medicare Data. JCO Oncol Pract 2023; 19:e274-e285. [PMID: 36375114 PMCID: PMC9970287 DOI: 10.1200/op.22.00500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/15/2022] [Indexed: 11/16/2022] Open
Abstract
PURPOSE American Society for Clinical Oncology released the Choosing Wisely list in 2012, highlighting low-value procedures that lack evidence, advising against the use of positron emission tomography, computerized tomography, and radionuclide bone scans for the staging of early-stage breast cancer at low risk for metastasis. The objective of the study was to assess the impact of the American Society of Clinical Oncology Choosing Wisely guidelines on inappropriate staging imaging among early-stage breast cancers. METHODS The Surveillance, Epidemiology, and End Results Program-Medicare data set was used to identify 50,004 women age 66 years and older with new incident diagnosis of early-stage breast cancer (stage 0 through stage 2a; T < 4, N = 0, and M = 0). The primary outcome was the incidence of patients with inappropriate imaging following an early-stage breast cancer diagnosis. The primary outcome was identified within 6 months of the first diagnosis. An interrupted time series analysis using negative binomial regression was performed for outpatient claims for these diagnostic studies versus the two interruptions of guidelines release and guidelines reinforcement. Mean images per patient, percent change for the study period, and rate of change per year were calculated. RESULTS Imaging rates fell by a modest 2.32% following guidelines release in April 2012 (point estimate = -2.32%; 95% CI, -6.34% to 1.88%). By contrast, imaging rates fell by a four-fold larger amount (point estimate = -9.36%; 95% CI, -13.20% to -5.35%) following guidelines published reminders in journals (or reinforcement) in October 2013. Mean imaging studies per patient (95% CI) declined from 1.80 (1.76 to 1.84) in January 2012 to 1.50 (1.48 to 1.53) by January 2015, representing a 16% decline in imaging overuse in 2015 compared with 3 years earlier. The rate of change (95% CI) in images per patient was initially small at -0.47% (-4.27% to 3.33%) per year between April 2012 and October 2013, but almost eight times faster at -3.70% (-5.81% to -1.60%) per year after October 2013. CONCLUSION This analysis demonstrates a substantial decrease in the prevalence of imaging overuse in early-stage breast cancers correlating with the 2013 reinforcement of American Society of Clinical Oncology's 2012 Choosing Wisely guidelines. The creation and dissemination of such resources serves as a powerful tool to improve clinical practice, cost-effectiveness, and patient safety from secondary malignancies, anxiety, and overdiagnosis.
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Affiliation(s)
- Alan P. Baltz
- Department of Internal Medicine, CARTI, Little Rock, AK
| | - Eric R. Siegel
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Robert Siegel
- Bon Secours St Francis Cancer Center, Greenville, SC
| | | | | | - Issam Makhoul
- Department of Internal Medicine, CARTI, Little Rock, AK
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Ligand-Specific Nano-Contrast Agents Promote Enhanced Breast Cancer CT Detection at 0.5 mg Au. Int J Mol Sci 2022; 23:ijms23179926. [PMID: 36077324 PMCID: PMC9456125 DOI: 10.3390/ijms23179926] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/24/2022] [Accepted: 08/25/2022] [Indexed: 11/16/2022] Open
Abstract
For many cancer types, being undetectable from early symptoms or blood tests, or often detected at late stages, medical imaging emerges as the most efficient tool for cancer screening. MRI, ultrasound, X-rays (mammography), and X-ray CT (CT) are currently used in hospitals with variable costs. Diagnostic materials that can detect breast tumors through molecular recognition and amplify the signal at the targeting site in combination with state-of-the-art CT techniques, such as dual-energy CT, could lead to a more precise detection and assist significantly in image-guided intervention. Herein, we have developed a ligand-specific X-ray contrast agent that recognizes α5β1 integrins overexpressed in MDA-MB-231 breast cancer cells for detection of triple (−) cancer, which proliferates very aggressively. In vitro studies show binding and internalization of our nanoprobes within those cells, towards uncoated nanoparticles (NPs) and saline. In vivo studies show high retention of ~3 nm ligand-PEG-S-AuNPs in breast tumors in mice (up to 21 days) and pronounced CT detection, with statistical significance from saline and iohexol, though only 0.5 mg of metal were utilized. In addition, accumulation of ligand-specific NPs is shown in tumors with minimal presence in other organs, relative to controls. The prolonged, low-metal, NP-enhanced spectral-CT detection of triple (−) breast cancer could lead to breakthrough advances in X-ray cancer diagnostics, nanotechnology, and medicine.
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A Simultaneous Multiparametric 18F-FDG PET/MRI Radiomics Model for the Diagnosis of Triple Negative Breast Cancer. Cancers (Basel) 2022; 14:cancers14163944. [PMID: 36010936 PMCID: PMC9406327 DOI: 10.3390/cancers14163944] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 08/12/2022] [Accepted: 08/13/2022] [Indexed: 11/29/2022] Open
Abstract
Simple Summary In this study, we aimed to build a machine-learning predictive model for the identification of triple negative breast cancer, the most aggressive subtype, using quantitative parameters and radiomics features extracted from tumor lesions on hybrid PET/MRI. The good performance of the model supports the hypothesis that hybrid PET/MRI can provide quantitative data able to non-invasively detect tumor biological characteristics using artificial intelligence software and further encourages the conduction of additional studies for this purpose. Abstract Purpose: To investigate whether a machine learning (ML)-based radiomics model applied to 18F-FDG PET/MRI is effective in molecular subtyping of breast cancer (BC) and specifically in discriminating triple negative (TN) from other molecular subtypes of BC. Methods: Eighty-six patients with 98 BC lesions (Luminal A = 10, Luminal B = 51, HER2+ = 12, TN = 25) were included and underwent simultaneous 18F-FDG PET/MRI of the breast. A 3D segmentation of BC lesion was performed on T2w, DCE, DWI and PET images. Quantitative diffusion and metabolic parameters were calculated and radiomics features extracted. Data were selected using the LASSO regression and used by a fine gaussian support vector machine (SVM) classifier with a 5-fold cross validation for identification of TNBC lesions. Results: Eight radiomics models were built based on different combinations of quantitative parameters and/or radiomic features. The best performance (AUROC 0.887, accuracy 82.8%, sensitivity 79.7%, specificity 86%, PPV 85.3%, NPV 80.8%) was found for the model combining first order, neighborhood gray level dependence matrix and size zone matrix-based radiomics features extracted from ADC and PET images. Conclusion: A ML-based radiomics model applied to 18F-FDG PET/MRI is able to non-invasively discriminate TNBC lesions from other BC molecular subtypes with high accuracy. In a future perspective, a “virtual biopsy” might be performed with radiomics signatures.
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Gradishar WJ, Moran MS, Abraham J, Aft R, Agnese D, Allison KH, Anderson B, Burstein HJ, Chew H, Dang C, Elias AD, Giordano SH, Goetz MP, Goldstein LJ, Hurvitz SA, Isakoff SJ, Jankowitz RC, Javid SH, Krishnamurthy J, Leitch M, Lyons J, Mortimer J, Patel SA, Pierce LJ, Rosenberger LH, Rugo HS, Sitapati A, Smith KL, Smith ML, Soliman H, Stringer-Reasor EM, Telli ML, Ward JH, Wisinski KB, Young JS, Burns J, Kumar R. Breast Cancer, Version 3.2022, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2022; 20:691-722. [PMID: 35714673 DOI: 10.6004/jnccn.2022.0030] [Citation(s) in RCA: 363] [Impact Index Per Article: 181.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The therapeutic options for patients with noninvasive or invasive breast cancer are complex and varied. These NCCN Clinical Practice Guidelines for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget disease, phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of ductal carcinoma in situ and the workup and locoregional management of early stage invasive breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.
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Affiliation(s)
| | | | - Jame Abraham
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Rebecca Aft
- Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Doreen Agnese
- The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | - Chau Dang
- Memorial Sloan Kettering Cancer Center
| | | | | | | | | | | | | | | | - Sara H Javid
- Fred Hutchinson Cancer Research Center/University of Washington
| | | | | | - Janice Lyons
- Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | | | | | - Hope S Rugo
- UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | | | | | - John H Ward
- Huntsman Cancer Institute at the University of Utah
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9
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Pham-Nguyen OV, Shin J, Park Y, Jin S, Kim SR, Jung YM, Yoo HS. Fluorescence-Shadowing Nanoparticle Clusters for Real-Time Monitoring of Tumor Progression. Biomacromolecules 2022; 23:3130-3141. [PMID: 35451812 PMCID: PMC9364936 DOI: 10.1021/acs.biomac.2c00169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Monitoring tumor progression is important for elucidating appropriate therapeutic strategies in response to anticancer therapeutics. To fluorescently monitor the in vivo levels of tumor-specific enzymes, we prepared matrix metalloprotease (MMP)-responsive gold nanoparticle (AuNP) clusters to sense tumor microenvironments. Specifically, AuNPs and quantum dots (QDs) were surface-engineered with two poly(ethylene glycol) [PEG] shells and cyclooctyne moieties, respectively, for the copper-free click reaction. Upon "peeling off" of the secondary shell from the double-PEGylated AuNPs under MMP-rich conditions, shielded azide moieties of the AuNPs were displayed toward the QD, and those two particles were clicked into nanoparticle clusters. This consequently resulted in a dramatic size increase and fluorescence quenching of QDs via fluorescence energy transfer (FRET) due to the molecular proximity of the particles. We observed that FRET efficiency was modulated via changes in MMP levels and exposure time. Cancer cell numbers exhibited a strong correlation with FRET efficiency, and in vivo studies that employed solid tumor models accordingly showed that FRET efficiency was dependent on the tumor size. Thus, we envision that this platform can be tailored and optimized for tumor monitoring based on MMP levels in solid tumors.
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Affiliation(s)
- Oanh-Vu Pham-Nguyen
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - JiUn Shin
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Yeonju Park
- Kangwon Radiation Convergence Research Support Center, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Sila Jin
- Department of Chemistry, Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Song Rae Kim
- Korea Basic Science Institute, Chuncheon Center, Chuncheon 24341, Republic of Korea
| | - Young Mee Jung
- Kangwon Radiation Convergence Research Support Center, Kangwon National University, Chuncheon 24341, Republic of Korea.,Department of Chemistry, Kangwon National University, Chuncheon 24341, Republic of Korea.,Kangwon Institute of Inclusive Technology (KIIT), Kangwon National University, Chuncheon 24341, Republic of Korea
| | - Hyuk Sang Yoo
- Department of Biomedical Materials Engineering, Kangwon National University, Chuncheon 24341, Republic of Korea.,Kangwon Radiation Convergence Research Support Center, Kangwon National University, Chuncheon 24341, Republic of Korea.,Kangwon Institute of Inclusive Technology (KIIT), Kangwon National University, Chuncheon 24341, Republic of Korea
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10
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Kong E, Choi J. The new perspective of PET/CT for axillary nodal staging in early breast cancer patients according to ACOSOG Z0011 trial PET/CT axillary staging according to Z0011. Nucl Med Commun 2021; 42:1369-1374. [PMID: 34392296 DOI: 10.1097/mnm.0000000000001466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Post Z0011 trial, axillary lymph node dissections (ALNDs) can be performed in patients with ≥3 positive axillary lymph nodes (ALNs). We investigated the diagnostic performance of 18F-fluorodeoxyglucose PET/computed tomography (FDG PET/CT) to predict ≥3 metastasis [high nodal burden (HNB)]. METHODS We retrospectively analyzed preoperative FDG PET/CT from January 2010 to June 2012. Patients had clinical T1-2N0 primary invasive breast cancer and underwent breast-conserving surgery with sentinel lymph node biopsy ± ALND. All suspicious ALNs were counted considering FDG-avidity with morphologic changes. Images were considered positive if the axillary basin took up more FDG than the surrounding tissue. On CT, abnormal ALNs were round/ovoid or had cortical thickening with contrast enhancement. PET/CT results were compared with the histology and follow-up findings. RESULTS In total, 221 females with 224 axillae were enrolled; 161 had negative, 53 had 1-2 metastasis [low nodal burden (LNB)] and 10 had HNB. The sensitivity, specificity, negative predictive value and positive predictive value of PET/CT for HNB were 70, 100, 98.6 and 100%, respectively. There was a correlation between the number of suspicious ALNs on PET/CT and the metastatic nodes on final histology. There were no significant differences in age, tumor size and FDG-avidity between patients with negative or LNB and HNB. During follow-up, 25 patients had a recurrence. The three false-negative patients did not show recurrence. CONCLUSION Preoperative PET/CT predicts HNB with high accuracy and is useful for evaluating clinical T1-2N0 invasive breast cancer.
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Affiliation(s)
| | - Jungeun Choi
- Department of Surgery, Yeungnam University College of Medicine, Daegu, Republic of Korea
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11
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Park CKS, Bax JS, Gardi L, Knull E, Fenster A. Development of a mechatronic guidance system for targeted ultrasound-guided biopsy under high-resolution positron emission mammography localization. Med Phys 2021; 48:1859-1873. [PMID: 33577113 DOI: 10.1002/mp.14768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 01/20/2021] [Accepted: 02/05/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Image-guided needle biopsy of small, detectable lesions is crucial for early-stage diagnosis, treatment planning, and management of breast cancer. High-resolution positron emission mammography (PEM) is a dedicated functional imaging modality that can detect breast cancer independent of breast tissue density, but anatomical context and real-time needle visualization are not yet available to guide biopsy. We propose a mechatronic guidance system integrating an ultrasound (US)-guided core-needle biopsy (CNB) with high-resolution PEM localization to improve the spatial sampling of breast lesions. This paper presents the benchtop testing and phantom studies to evaluate the accuracy of the system and its constituent components for targeted PEM-US-guided biopsy under simulated high-resolution PEM localization. METHODS A mechatronic guidance system was developed to operate with the Radialis PEM system and a conventional US system. The system includes a user-operated guidance arm and end-effector biopsy device, integrating a US transducer and CNB gun, with its needle focused on a remote center of motion (RCM). Custom software modules were developed to track, display, and guide the end-effector biopsy device. Registration of the mechatronic guidance system to a simulated PEM detector plate was performed using a landmark-based method. Testing was performed with fiducials positioned in the peripheral and central regions of the simulated detector plate and registration error was quantified. Breast phantom experiments were performed under ideal detection and localization to evaluate for bias in the end-effector biopsy device. The accuracy of the complete mechatronic guidance system to perform targeted breast biopsy was assessed using breast phantoms with simulated lesions. Three-dimensional positioning error was quantified, and principal component analysis assessed for directional trends in 3D space within 95% prediction intervals. Targeted breast biopsies with test phantoms were performed and an overall in-plane needle targeting error was quantified. RESULTS The mean registration errors were 0.63 mm (N = 44) and 0.73 mm (N = 72) in the peripheral and central regions of the simulated PEM detector plate, respectively. A 3D 95% prediction ellipsoid shows an error volume <2.0 mm in diameter, centered on the mean registration error. Under ideal detection and localization, targets <1.0 mm in diameter can be sampled with 95% confidence. The complete mechatronic guidance system was able to successfully spatially sample simulated breast lesions, 4 mm and 6 mm in diameter and height (N = 20) in known 3D positions in the PEM image coordinate space. The 3D positioning error was 0.85 mm (N = 20) with 0.64 mm in-plane and 0.44 mm cross-plane component errors. Targeted breast biopsies resulted in a mean in-plane needle targeting error of 1.08 mm (N = 15) allowing for targets 1.32 mm in radius to be sampled with 95% confidence. CONCLUSIONS We demonstrated the utility of our mechatronic guidance system for targeted breast biopsy under high-resolution PEM localization. Breast phantom studies showed the ability to accurately guide, position, and target breast lesions with the accuracy to spatially sample targets <3.0 mm in diameter with 95% confidence. Future work will integrate the developed system with the Radialis PEM system toward combined PEM-US-guided breast biopsy.
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Affiliation(s)
- Claire Keun Sun Park
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 3K7, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Jeffrey Scott Bax
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Lori Gardi
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada
| | - Eric Knull
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, N6A 3K7, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, N6A 3K7, Canada.,Imaging Research Laboratories, Robarts Research Institute, London, Ontario, N6A 5B7, Canada.,School of Biomedical Engineering, Faculty of Engineering, Western University, London, Ontario, N6A 3K7, Canada
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12
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Bhoriwal S, Deo SVS, Kumar R, Thulkar S, Gogia A, Sharma DN, Mathur S. A Prospective Study Comparing the Role of 18 FDG PET-CT with Contrast-Enhanced Computed Tomography and Tc99m Bone Scan for Staging Locally Advanced Breast Cancer. Indian J Surg Oncol 2021; 12:266-271. [PMID: 34295069 DOI: 10.1007/s13193-021-01299-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/24/2021] [Indexed: 11/27/2022] Open
Abstract
Locally advanced breast cancer (LABC) patients require an accurate staging of the disease to rule out distant metastases. Various imaging investigations are used to stage LABC patients. The present study is a prospective comparison of conventional imaging (CI) with fusion positron-emission tomography and computed tomography (PET-CT) scans in the staging of LABC patients. Seventy-three consecutive LABC patients presenting to the breast cancer clinic of the tertiary care cancer institute were included in the study. All patients underwent contrast-enhanced computed tomography, Tv99m bone scintigraphy, and fusion PET-CT. Histology of the metastatic site was confirmed wherever possible. The disparity between the two imaging findings was compared. Doubtful lesions were observed clinically for at least 2 years to confirm their nature. PET-CT detected a higher number of lymph nodes in the axilla, internal mammary, and supraclavicular region as compared to CI. PET-CT upstaged 36.98% and downstaged 5.4% of the patients respectively leading to a change in the management in 30.13% of the patients. Sensitivity, specificity, positive predictive value, and negative predictive value of CI and PET-CT were 71.87%, 87.80%, 82.14%, and 80%, and 90.90%, 90%, 88.23%, and 92.30% respectively. PET-CT was more accurate in staging the LABC patients as compared to CI. PET-CT is more accurate then contrast-enhanced CT and bone scintigraphy for staging locally advanced breast carcinoma patients. It can replace multiple organ-directed imaging in staging breast cancer. It can provide accurate staging of the disease so that patients can be prognosticated and can be directed to the most appropriate treatment plans.
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Affiliation(s)
- Sandeep Bhoriwal
- Department of Surgical Oncology, All India Institute of Medical Science, New Delhi, India
| | - S V S Deo
- Department of Surgical Oncology, All India Institute of Medical Science, New Delhi, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Science, New Delhi, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, All India Institute of Medical Science, New Delhi, India
| | - Ajay Gogia
- Department of Medical Oncology, All India Institute of Medical Science, New Delhi, India
| | - D N Sharma
- Department of Radiation Oncology, All India Institute of Medical Science, New Delhi, India
| | - Sandeep Mathur
- Department of Pathology, All India Institute of Medical Science, New Delhi, India
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13
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Aide N, Elie N, Blanc-Fournier C, Levy C, Salomon T, Lasnon C. Hormonal Receptor Immunochemistry Heterogeneity and 18F-FDG Metabolic Heterogeneity: Preliminary Results of Their Relationship and Prognostic Value in Luminal Non-Metastatic Breast Cancers. Front Oncol 2021; 10:599050. [PMID: 33511077 PMCID: PMC7837029 DOI: 10.3389/fonc.2020.599050] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 11/12/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction We aimed to investigate whether 18F-FDG PET metabolic heterogeneity reflects the heterogeneity of estrogen receptor (ER) and progesterone receptor (PR) expressions within luminal non-metastatic breast tumors and if it could help in identifying patients with worst event-free survival (EFS). Materials and methods On 38 PET high-resolution breast bed positions, a single physician drew volumes of interest encompassing the breast tumors to extract SUVmax, histogram parameters and textural features. High-resolution immunochemistry (IHC) scans were analyzed to extract Haralick parameters and descriptors of the distribution shape. Correlation between IHC and PET parameters were explored using Spearman tests. Variables of interest to predict the EFS status at 8 years (EFS-8y) were sought by means of a random forest classification. EFS-8y analyses were then performed using univariable Kaplan-Meier analyses and Cox regression analysis. When appropriate, Mann-Whitney tests and Spearman correlations were used to explore the relationship between clinical data and tumoral PET heterogeneity variables. Results For ER expression, correlations were mainly observed with 18F-FDG histogram parameters, whereas for PR expression correlations were mainly observed with gray-level co-occurrence matrix (GLCM) parameters. The strongest correlations were observed between skewness_ER and uniformity_HISTO (ρ = −0.386, p = 0.017) and correlation_PR and entropy_GLCM (ρ = 0.540, p = 0.001), respectively. The median follow-up was 6.5 years and the 8y-EFS was 71.0%. Random forest classification found age, clinical stage, SUVmax, skewness_ER, kurtosis_ER, entropy_HISTO, and uniformity_HISTO to be variables of importance to predict the 8y-EFS. Univariable Kaplan-Meier survival analyses showed that skewness_ER was a predictor of 8y-EFS (66.7 ± 27.2 versus 19.1 ± 15.2, p = 0.018 with a cut-off value set to 0.163) whereas other IHC and PET parameters were not. On multivariable analysis including age, clinical stage and skewness_ER, none of the parameters were independent predictors. Indeed, skewness_ER was significantly higher in youngest patients (ρ = −0.351, p = 0.031) and in clinical stage III tumors (p = 0.023). Conclusion A heterogeneous distribution of ER within the tumor in IHC appeared as an EFS-8y prognosticator in luminal non-metastatic breast cancers. Interestingly, it appeared to be correlated with PET histogram parameters which could therefore become potential non-invasive prognosticator tools, provided these results are confirmed by further larger and prospective studies.
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Affiliation(s)
- Nicolas Aide
- Nuclear Medicine Department, University Hospital, Caen, France.,INSERM 1086 ANTICIPE, Normandy University, Caen, France
| | - Nicolas Elie
- Université de Caen Normandie, UNICAEN, SF 4206 ICORE, CMABIO3, Caen, France
| | | | - Christelle Levy
- Breast Cancer Unit, François Baclesse Cancer Centre, Caen, France
| | - Thibault Salomon
- Nuclear Medicine Department, Hospital Centre, Versailles, France
| | - Charline Lasnon
- INSERM 1086 ANTICIPE, Normandy University, Caen, France.,Nuclear Medicine Department, François Baclesse Cancer Centre, Caen, France
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14
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Abouzied MM, Fathala A, AlMuhaideb A, Al Qahtani MH. Role of 18F-fluorodeoxyglucose positron emission tomography/computed tomography in the evaluation of breast carcinoma: Indications and pitfalls with illustrative case examples. World J Nucl Med 2020; 19:187-196. [PMID: 33354172 PMCID: PMC7745850 DOI: 10.4103/wjnm.wjnm_88_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/15/2020] [Accepted: 03/02/2020] [Indexed: 11/04/2022] Open
Abstract
Whole-body 18F-fluorodeoxyglucose positron emission tomography (PET) has been used extensively in the last decade for the primary staging and restaging and to assess response to therapy in these patients. We aim to discuss the diagnostic performance of PET/computed tomography in the initial staging of breast carcinoma including the locally advanced disease and to illustrate its role in restaging the disease and in the assessment of response to therapy, particularly after the neoadjuvant chemotherapy. Causes of common pitfalls during image interpretations will be also discussed.
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Affiliation(s)
- Moheieldin M Abouzied
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmed Fathala
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Ahmad AlMuhaideb
- Department of Radiology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Mohammed H Al Qahtani
- Department of Cyclotron and Radiopharmaceuticals, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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15
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Onal C, Findikcioglu A, Guler OC, Reyhan M. The use of 18F-FDG positron emission tomography to detect mediastinal lymph nodes in metastatic breast cancer. Breast 2020; 54:197-202. [PMID: 33125983 PMCID: PMC7593617 DOI: 10.1016/j.breast.2020.10.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/22/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND To assess the predictive value of 18F-fluorodeoxyglucose positron-emission tomography (FDG-PET/CT) in detecting mediastinal lymph node metastasis with histopathologic verification in breast cancer (BC) patients. MATERIALS AND METHODS Between February 2012 and October 2019, 37 BC patients who underwent histopathological verification for FDG-PET positive mediastinal lymph nodes were retrospectively analyzed. Nine patients (24%) were screened before beginning treatment, while 27 (76%) were screened at the time of disease progression, an average of 39 months after completion of initial treatment. RESULTS The histopathologic diagnosis revealed lymph node metastasis from BC in 15 patients (40%) and benign disease in 22 patients (60%). The standardized uptake value (SUVmax) of mediastinal lymph nodes was significantly higher in patients with lymph node metastasis compared to those with benign histology (9.0 ± 3.5 vs. 5.9 ± 2.4; P = 0.007). The cut-off value of SUVmax after the ROC curve analysis for pathological lymph node metastasis was 6.4. Two of the 15 patients with mediastinal SUVmax ≤ 6.4 and 13 of the 22 patients with SUVmax > 6.4 had lymph node metastasis. Age and pathological findings were prognostic factors for overall survival in univariate analysis. The treatment decision was changed in 19 patients (51%) after mediastinoscopic evaluation of the entire cohort. CONCLUSIONS This is the first study to support the need for pathologic confirmation of a positive PET/CT result following evaluation of mediastinal lymph nodes for staging BC, either at initial diagnosis or at the time of progression. Treatment decisions were consequently altered for nearly half of the patients.
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Affiliation(s)
- Cem Onal
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey.
| | - Alper Findikcioglu
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Thoracic Surgery, Adana, Turkey
| | - Ozan Cem Guler
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Radiation Oncology, Adana, Turkey
| | - Mehmet Reyhan
- Baskent University Faculty of Medicine, Adana Dr Turgut Noyan Research and Treatment Center, Department of Nuclear Medicine, Adana, Turkey
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16
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Nissan N, Sandler I, Eifer M, Eshet Y, Davidson T, Bernstine H, Groshar D, Sklair-Levy M, Domachevsky L. Physiologic and hypermetabolic breast 18-F FDG uptake on PET/CT during lactation. Eur Radiol 2020; 31:163-170. [PMID: 32749586 DOI: 10.1007/s00330-020-07081-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate the patterns of breast cancer-related and lactation-related 18F-FDG uptake in breasts of lactating patients with pregnancy-associated breast cancer (PABC) and without breast cancer. METHODS 18F-FDG-PET/CT datasets of 16 lactating patients with PABC and 16 non-breast cancer lactating patients (controls) were retrospectively evaluated. Uptake was assessed in the tumor and non-affected lactating tissue of the PABC group, and in healthy lactating breasts of the control group, using maximum and mean standardized uptake values (SUVmax and SUVmean, respectively), and breast-SUVmax/liver-SUVmean ratio. Statistical tests were used to evaluate differences and correlations between the groups. RESULTS Physiological uptake in non-breast cancer lactating patients' breasts was characteristically high regardless of active malignancy status other than breast cancer (SUVmax = 5.0 ± 1.7, n = 32 breasts). Uptake correlated highly between the two breasts (r = 0.61, p = 0.01), but was not correlated with age or lactation duration (p = 0.24 and p = 0.61, respectively). Among PABC patients, the tumors demonstrated high 18F-FDG uptake (SUVmax = 7.8 ± 7.2, n = 16), which was 326-643% higher than the mostly low physiological FDG uptake observed in the non-affected lactating parenchyma of these patients (SUVmax = 2.1 ± 1.1). Overall, 18F-FDG uptake in lactating breasts of PABC patients was significantly decreased by 59% (p < 0.0001) compared with that of lactating controls without breast cancer. CONCLUSION 18F-FDG uptake in lactating tissue of PABC patients is markedly lower compared with the characteristically high physiological uptake among lactating patients without breast cancer. Consequently, breast tumors visualized by 18F-FDG uptake in PET/CT were comfortably depicted on top of the background 18F-FDG uptake in lactating tissue of PABC patients. KEY POINTS • FDG uptake in the breast is characteristically high among lactating patients regardless of the presence of an active malignancy other than breast cancer. • FDG uptake in non-affected lactating breast tissue is significantly lower among PABC patients compared with that in lactating women who do not have breast cancer. • In pregnancy-associated breast cancer patients, 18F-FDG uptake is markedly increased in the breast tumor compared with uptake in the non-affected lactating tissue, enabling its prompt visualization on PET/CT.
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Affiliation(s)
- Noam Nissan
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel. .,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Israel Sandler
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Eifer
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Yael Eshet
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Tima Davidson
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
| | - Hanna Bernstine
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - David Groshar
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Nuclear Medicine, Assuta Medical Centers, Tel Aviv, Israel
| | - Miri Sklair-Levy
- Department of Radiology, Sheba Medical Center, Emek Ha-Ella 1 st., Tel Hashomer, 5265601, Ramat Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Domachevsky
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Institute of Nuclear Medicine, Sheba Medical Center, Ramat Gan, Israel
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17
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Xu B, Hu X, Feng J, Geng C, Jin F, Li H, Li M, Li Q, Liao N, Liu D, Liu J, Liu Q, Lu J, Liu Z, Ma F, Ouyang Q, Pan Y, Shen K, Sun T, Teng Y, Tong Z, Wang B, Wang H, Wang S, Wang S, Wang T, Wang X, Wang X, Wang Y, Wang Z, Wu J, Yan M, Yang J, Yin Y, Yuan P, Zhang J, Zhang P, Zhang Q, Zheng H. Chinese expert consensus on the clinical diagnosis and treatment of advanced breast cancer (2018). Cancer 2020; 126 Suppl 16:3867-3882. [PMID: 32710660 DOI: 10.1002/cncr.32832] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 12/18/2019] [Indexed: 12/19/2022]
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18
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Shang LW, Ma DY, Fu JJ, Lu YF, Zhao Y, Xu XY, Yin JH. Fluorescence imaging and Raman spectroscopy applied for the accurate diagnosis of breast cancer with deep learning algorithms. BIOMEDICAL OPTICS EXPRESS 2020; 11:3673-3683. [PMID: 33014559 PMCID: PMC7510916 DOI: 10.1364/boe.394772] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/16/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
Deep learning is usually combined with a single detection technique in the field of disease diagnosis. This study focused on simultaneously combining deep learning with multiple detection technologies, fluorescence imaging and Raman spectroscopy, for breast cancer diagnosis. A number of fluorescence images and Raman spectra were collected from breast tissue sections of 14 patients. Pseudo-color enhancement algorithm and a convolutional neural network were applied to the fluorescence image processing, so that the discriminant accuracy of test sets, 88.61%, was obtained. Two different BP-neural networks were applied to the Raman spectra that mainly comprised collagen and lipid, so that the discriminant accuracy of 95.33% and 98.67% of test sets were gotten, respectively. Then the discriminant results of fluorescence images and Raman spectra were counted and arranged into a characteristic variable matrix to predict the breast tissue samples with partial least squares (PLS) algorithm. As a result, the predictions of all samples are correct, with minor error of predictive value. This study proves that deep learning algorithms can be applied into multiple diagnostic optics/spectroscopy techniques simultaneously to improve the accuracy in disease diagnosis.
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Affiliation(s)
- Lin-Wei Shang
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Dan-Ying Ma
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Juan-Juan Fu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Yan-Fei Lu
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Yuan Zhao
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
| | - Xin-Yu Xu
- Department of Pathology, Jiangsu Cancer Hospital, Nanjing 210009, China
| | - Jian-Hua Yin
- Department of Biomedical Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing 210016, China
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Yu P, Lei J, Xu B, Wang R, Shen Z, Tian J. Correlation Between 18F-FDG PET/CT Findings and BI-RADS Assessment Using Ultrasound in the Evaluation of Breast Lesions: A Multicenter Study. Acad Radiol 2020; 27:682-688. [PMID: 31311773 DOI: 10.1016/j.acra.2019.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 05/26/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE AND OBJECTIVES To analyze the correlation between ultrasound breast imaging reporting and data system (BI-RADS) category and fluorodeoxyglucose [18F] (18F-FDG) positron emission tomography/computed tomography (PET/CT) findings and their value in breast lesion diagnosis. MATERIALS AND METHODS Cases involving hypermetabolic lesions identified by 18F-FDG PET/CT and ultrasound were retrospectively analyzed. The correlation between the maximum standardized uptake values (SUVmax) of the lesions and the BI-RADS grades was calculated. Histologic diagnosis or evidence at the end of a 2-year follow-up as the standard of truth were analyzed to determine the sensitivity, specificity, positive predictive values (PPV), and negative predictive values (NPV) of the diagnostic methods. Area under the curve (AUC) of BI-RADS, SUVmax, and BI-RADS/SUVmax combined were obtained using receiver-operating characteristic curve (ROC) analysis. RESULTS Of 206 cases, 92 were benign and 114 were malignant. The difference between the SUVmax and the BI-RADS grades was statistically significant (p < 0.001). The critical value of the optimal SUVmax was 2.325, and the accuracy, sensitivity, specificity, PPV, and NPV were 84.5%, 91.2%, 76.1%, 82.5%, and 87.5%, respectively. For diagnosis using BI-RADS, these values were 85.9%, 98.2%, 70.7%, 80.6%, and 97.0%, respectively. ROC analysis of 206 breast lesions for distinguishing benign from malignant lesions yielded AUCs of 0.948, 0.896, and 0.977 for BI-RADS, SUVmax, and BI-RADS/SUVmax combined, respectively. The critical value of the optimal SUVmax in grade 3 and 4 lesions (as determined using BI-RADS) was 2.705, and the accuracy, sensitivity, specificity, PPV, and NPV were 82.6%, 77.8%, 85.7%, 77.8%, and 85.7%, respectively. For diagnosis using BI-RADS in cases with grade 3 and 4 lesions, these values were 68.5%, 94.4%, 51.8%, 55.7%, and 93.5%, respectively. In ROC analysis for distinguishing benign from malignant for BI-RADS grade 3-4 lesions, the AUC of BI-RADS, SUVmax, and BI-RADS/SUVmax combined were 0.731, 0.859, and 0.882, respectively. CONCLUSION Both 18F-FDG PET/CT and ultrasound-dependent BI-RADS grading are effective for diagnosing breast lesions. However, in cases of BI-RADS grades 3 and 4, 18F-FDG PET/CT has better specificity and may be useful for further differential diagnosis.
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Affiliation(s)
- Peng Yu
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China; Department of Nuclear Medicine, Affiliated Hospital of Logistic University of PAP, Tianjin, China
| | - Jixiao Lei
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China; Department of Nuclear Medicine, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Ruimin Wang
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Zhihui Shen
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China
| | - Jiahe Tian
- Department of Nuclear Medicine, Chinese PLA General Hospital, No. 28, Fuxing Road, Beijing 100853, China.
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20
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Rahman WT, Neal CH, Nees AV, Brown RKJ. Management of Incidental Breast Lesions Detected at Nuclear Medicine Examinations. Radiol Imaging Cancer 2020; 2:e190037. [PMID: 33778704 DOI: 10.1148/rycan.2020190037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/03/2019] [Accepted: 10/16/2019] [Indexed: 11/11/2022]
Abstract
Nuclear medicine studies are often performed in patients with breast cancer; however, incidental radiotracer uptake in the breasts can be observed in patients with nonbreast malignancies. Benign and malignant lesions can be identified on planar, SPECT, and PET scans. This review will outline the molecular and radiographic imaging appearance of benign and malignant breast lesions on sestamibi scans, bone scans, radioiodine studies, as well as PET studies using fluorine 18 (18F) fluorodeoxyglucose, gallium 68 (68Ga) tetraazacyclododecane tetraacetic acid octreotate (or DOTATATE), 68Ga prostate-specific membrane antigen, and 18F-fluciclovine radiotracers. Recognizing these lesions at molecular and anatomic imaging is important to ensure accurate diagnosis and appropriate management. Keywords: Breast, Mammography, Molecular Imaging, PET/CT, Radionuclide Studies, SPECT/CT © RSNA, 2020.
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Affiliation(s)
- W Tania Rahman
- Division of Breast Imaging, Department of Radiology (W.T.R., C.H.N., A.V.N.), and Division of Nuclear Medicine, Department of Radiology (R.K.J.B.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Colleen H Neal
- Division of Breast Imaging, Department of Radiology (W.T.R., C.H.N., A.V.N.), and Division of Nuclear Medicine, Department of Radiology (R.K.J.B.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Alexis Virginia Nees
- Division of Breast Imaging, Department of Radiology (W.T.R., C.H.N., A.V.N.), and Division of Nuclear Medicine, Department of Radiology (R.K.J.B.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Richard K J Brown
- Division of Breast Imaging, Department of Radiology (W.T.R., C.H.N., A.V.N.), and Division of Nuclear Medicine, Department of Radiology (R.K.J.B.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48109
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Yao D, Wang Y, Zou R, Bian K, Liu P, Shen S, Yang W, Zhang B, Wang D. Molecular Engineered Squaraine Nanoprobe for NIR-II/Photoacoustic Imaging and Photothermal Therapy of Metastatic Breast Cancer. ACS APPLIED MATERIALS & INTERFACES 2020; 12:4276-4284. [PMID: 31896256 DOI: 10.1021/acsami.9b20147] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Various squaraine dyes have been developed for biological imaging. Nevertheless, squaraine dyes with emission in the second window (NIR-II, 1000-1700 nm) have few reports largely due to the short of a simple and universal design strategy. In this contribution, molecular engineering strategy is explored to develop squaraine dyes with NIR-II emission. First, NIR-I squaraine dye SQ2 is constructed by the ethyl-grafted 1,8-naphtholactam as donor units and square acid as acceptor unit in a donor-acceptor-donor (D-A-D) structure. To red-shift the fluorescence emission into NIR-II window, malonitrile, as a forceful electron-withdrawing group, is introduced to strengthen square acid acceptor. As a result, the fluorescence spectrum of acceptor-engineered squaraine dye SQ1 exhibits a significant red-shift into NIR-II window. To translate NIR-II fluorophores SQ1 into effective theranostic agents, fibronectin-targeting SQ1 nanoprobe was constructed and showed excellent NIR-II imaging performance in angiography and tumor imaging, including lung metastatic foci in deep tissue. Furthermore, SQ1 nanoprobe can be used for photoacoustic imaging and photothermal ablation of tumors. This research demonstrates that the donor-acceptor engineering strategy is feasible and effective to develop NIR-II squaraine dyes.
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Affiliation(s)
- Defan Yao
- Department of Radiology, Xinhua Hospital , Shanghai Jiao Tong University School of Medicine , 200092 Shanghai , China
- State Key Laboratory of Molecular Engineering of Polymers , Fudan University , 200433 Shanghai , China
| | - Yanshu Wang
- Department of Radiology, Xinhua Hospital , Shanghai Jiao Tong University School of Medicine , 200092 Shanghai , China
| | - Rongfeng Zou
- Division of Theoretical Chemistry and Biology, School of Biotechnology , KTH Royal Institute of Technology, AlbaNova University Center , 10691 Stockholm , Sweden
| | - Kexin Bian
- The Institute for Translational Nanomedicine, Shanghai East Hospital; The Institute for Biomedical Engineering & Nano Science , Tongji University School of Medicine , 200092 Shanghai , China
| | - Pei Liu
- The Institute for Translational Nanomedicine, Shanghai East Hospital; The Institute for Biomedical Engineering & Nano Science , Tongji University School of Medicine , 200092 Shanghai , China
| | - Shuzhan Shen
- The Institute for Translational Nanomedicine, Shanghai East Hospital; The Institute for Biomedical Engineering & Nano Science , Tongji University School of Medicine , 200092 Shanghai , China
| | - Weitao Yang
- The Institute for Translational Nanomedicine, Shanghai East Hospital; The Institute for Biomedical Engineering & Nano Science , Tongji University School of Medicine , 200092 Shanghai , China
| | - Bingbo Zhang
- The Institute for Translational Nanomedicine, Shanghai East Hospital; The Institute for Biomedical Engineering & Nano Science , Tongji University School of Medicine , 200092 Shanghai , China
| | - Dengbin Wang
- Department of Radiology, Xinhua Hospital , Shanghai Jiao Tong University School of Medicine , 200092 Shanghai , China
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Srour MK, Amersi F. Response to Letter to the Editor: "18FDG-PET/CT Imaging in Breast Cancer Patients with Clinical Stage IIB or Higher". Ann Surg Oncol 2020; 27:1710-1711. [PMID: 31907750 DOI: 10.1245/s10434-019-08194-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Indexed: 11/18/2022]
Affiliation(s)
- Marissa K Srour
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Farin Amersi
- Division of Surgical Oncology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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Korhonen KE, Pantel AR, Mankoff DA. 18F-FDG-PET/CT in Breast and Gynecologic Cancer. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ali N, Quansah E, Köhler K, Meyer T, Schmitt M, Popp J, Niendorf A, Bocklitz T. Automatic label‐free detection of breast cancer using nonlinear multimodal imaging and the convolutional neural network ResNet50. TRANSLATIONAL BIOPHOTONICS 2019. [DOI: 10.1002/tbio.201900003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Nairveen Ali
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
| | - Elsie Quansah
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
| | - Katarina Köhler
- Institut für Histologie, Zytologie und molekulare Diagnostik, Pathologie Hamburg‐West GmbH Hamburg Germany
| | - Tobias Meyer
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
| | - Michael Schmitt
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
| | - Jürgen Popp
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
- Center for Sepsis Control and Care (CSCC)Jena University Hospital Jena Germany
- InfectoGnostics, Forschungscampus Jena Jena Germany
| | - Axel Niendorf
- Institut für Histologie, Zytologie und molekulare Diagnostik, Pathologie Hamburg‐West GmbH Hamburg Germany
| | - Thomas Bocklitz
- Institute of Physical Chemistry and Abbe Center of Photonics (IPC)Friedrich‐Schiller‐University Jena Germany
- Leibniz Institute of Photonic Technology (Leibniz‐IPHT), Member of Leibniz Research Alliance 'Health Technologies' Jena Germany
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Srour MK, Lee M, Walcott-Sapp S, Luu M, Chung A, Giuliano AE, Amersi F. Overuse of Preoperative Staging of Patients Undergoing Neoadjuvant Chemotherapy for Breast Cancer. Ann Surg Oncol 2019; 26:3289-3294. [DOI: 10.1245/s10434-019-07543-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Indexed: 08/30/2023]
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26
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Arslan E, Çermik TF, Didem Can Trabulus F, Canan Kelten Talu E, Başaran Ş. Diagnostic impact of 18F-FDG PET/CT on the management of rare breast carcinomas: Apocrine and neuroendocrine carcinomas. Rev Esp Med Nucl Imagen Mol 2019; 38:147-153. [PMID: 30914287 DOI: 10.1016/j.remn.2018.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE We aimed to evaluate the diagnostic impact of 18F-FDG PET/CT in staging apocrine breast carcinoma (ABC) and primary breast neuroendocrine carcinoma (PBNEC) and to demonstrate possible alterations of the 18F-FDG uptake in these histopathologic subtypes. In addition, we aimed to compare 18F-FDG PET/CT findings between ABC, PBNEC and invasive ductal carcinoma. MATERIAL AND METHODS A total of 570 patients and 585 breast lesions were retrospectively included in this study. After patients were classified into molecular subtypes according to the histopathological analysis, 18F-FDG PET/CT imaging was performed. The SUVmax findings of primary tumors obtained from 18F-FDG PET/CT were compared between the groups. RESULTS Invasive ductal carcinoma was the most prevalent breast carcinoma (77.7%, n=446), with a low proportion of ABC (4.1%, n=24) and PBNEC (2.4%; n=14) diagnosed. The highest mean SUVmax was calculated in HER2 subtype of ABC and 18F-FDG uptake ratio in HER2 and TN subtypes were found statistically higher than Luminal B type of ABC (p=0.038 and p=0.019, respectively). Although 18F-FDG uptake in Luminal B subtype of PBNEC was higher than Luminal A subtype, difference was not statistically significant. Additionally, the axillary metastasis rate was significantly higher in the ABC group (p=0.015). CONCLUSIONS The histopathological ABC subtype group showed different 18F-FDG uptake than the invasive ductal carcinoma group. Even if 18F-FDG uptake was lower in the PBNEC group than in the other groups, PET/CT showed and adequate performance in detecting primary tumors and metastases. The 18F-FDG PET/CT scan results may contribute to the initial staging and management of ABC and PBNEC patients.
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Affiliation(s)
- E Arslan
- University of Health Sciences, Istanbul Training and Research Hospital, Clinic of Nuclear Medicine, Estambul, Turquía.
| | - T F Çermik
- University of Health Sciences, Istanbul Training and Research Hospital, Clinic of Nuclear Medicine, Estambul, Turquía
| | - F Didem Can Trabulus
- University of Health Sciences, Istanbul Training and Research Hospital, Clinic of Surgery, Estambul, Turquía
| | - E Canan Kelten Talu
- University of Health Sciences, Istanbul Training and Research Hospital, Clinic of Pathology, Estambul, Turquía
| | - Ş Başaran
- University of Health Sciences, Haseki Training and Research Hospital, Clinic of Pathology, Estambul, Turquía
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Arslan E, Çermik TF, Can Trabulus FD, Kelten Talu EC, Başaran Ş. Diagnostic impact of 18F-FDG PET/CT on the management of rare breast carcinomas: apocrine and neuroendocrine carcinomas. Rev Esp Med Nucl Imagen Mol 2019. [DOI: 10.1016/j.remnie.2018.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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Poodt IGM, Schipper RJ, de Greef BTA, Vugts G, Maaskant-Braat AJG, Jansen FH, Wyndaele DNJ, Voogd AC, Nieuwenhuijzen GAP. Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval. Breast Cancer Res Treat 2019; 175:419-428. [PMID: 30955183 PMCID: PMC6533220 DOI: 10.1007/s10549-019-05205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N = 168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging techniques. Electronic supplementary material The online version of this article (10.1007/s10549-019-05205-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dirk N J Wyndaele
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands.,Utrecht Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Bakhshayeshkaram M, Salehi Y, Abbasi M, Hashemi Beni R, Seifi S, Hassanzad M, Jamaati HR, Aghahosseini F. A preliminary study to propose a diagnostic algorithm for PET/CT-detected incidental breast lesions: application of BI-RADS lexicon for US in combination with SUVmax. Eur Radiol 2019; 29:5507-5516. [PMID: 30887201 DOI: 10.1007/s00330-019-06106-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 12/22/2018] [Accepted: 02/12/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To develop a diagnostic algorithm for positron emission tomography (PET)-detected incidental breast lesions using both breast imaging reporting and data system (BI-RADS) and maximum standardized uptake value (SUVmax) criteria. METHODS Fifty-six PET-detected incidental breast lesions from 51 patients, which were subsequently investigated by breast ultrasound within 1 month of the PET study, constituted the study cohort and they were finally verified by tissue diagnosis or a 2-year follow-up. Based on the maximum specificity with sensitivity > 60.0% and maximum sensitivity with specificity > 60.0%, two SUVmax cutoff values were calculated at 2 and 3.7. BI-RADS ≥ 4 was considered as highly suspicious for malignancy. The diagnostic accuracies were estimated for SUVmax levels above or below the cutoff points combined with the BI-RADS suspicion level. RESULTS Overall, 46 benign and 10 malignant lesions were studied. The diagnostic characteristics of SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4 were 80.0%, 60.0%, and 80.0% for sensitivity, 73.9%, 95.7%, and 92.7% for specificity, and 75.0%, 89.3%, and 90.2% for accuracy, respectively. When the SUVmax threshold was set at 2, combined with BI-RADS suspicion level, the sensitivity, specificity, and accuracy were 100.0%, 69.6%, and 75.0%, respectively. The results for SUVmax threshold set at 3.7 combined with BI-RADS were 90.0%, 91.3%, and 91.1% for the sensitivity, specificity, and accuracy, respectively. A diagnostic algorithm was accordingly generated. CONCLUSION The need for biopsy should be justified in low BI-RADS lesions presenting with high SUVmax at 3.7 or higher. The biopsy of patients with high B-IRADS and low SUVmax could be preserved. KEY POINTS • A diagnostic algorithm was developed for PET-detected incidental breast lesions using both BI-RADS and SUVmax criteria. • Diagnostic performance was calculated separately and conjunctively for SUVmax ≥ 2, SUVmax ≥ 3.7, and BI-RADS ≥ 4. • The need for biopsy can be justified in BI-RADS < 4 lesions with SUVmax ≥ 3.7. Lesions with BI-RADS < 4 and indeterminate SUVmax (2 < SUVmax < 3.7) benefit from a short-interval follow-up. BI-RADS < 4 lesions with SUVmax < 2 may confidently be scheduled for routine screening.
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Affiliation(s)
- Mehrdad Bakhshayeshkaram
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran
| | - Yalda Salehi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrshad Abbasi
- Department of Nuclear Medicine, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Razieh Hashemi Beni
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran
| | - Sharareh Seifi
- Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Hassanzad
- Pediatric Respiratory Diseases Research Centre, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Paediatrics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reza Jamaati
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Pulmonology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farahnaz Aghahosseini
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Department of Radiology, Shahid Beheshti University of Medical Sciences, Daar-Abad, Niavaran Ave., 19575-154, Tehran, 1956944413, Iran.
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Omofoye TS, Parikh JR. How to survive and thrive as a new breast imager: what they don't teach in fellowship. Clin Imaging 2018; 54:121-125. [PMID: 30639522 DOI: 10.1016/j.clinimag.2018.12.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 11/03/2018] [Accepted: 12/27/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE To provide practical tips to assist new breast imagers succeed in their first job after fellowship training. METHODS Transitioning from fellowship to a practicing breast radiologist is daunting for the new radiologist. There is a void in the literature addressing this transition. Practical tips are described based on various roles a new breast radiologist must navigate and highlights skills that can help ensure a successful transition and career. RESULTS Proficiency in clinical acumen may be assisted by becoming familiar with sentinel works and feedback based on the medical outcome audit. Noninterpretive skills that can assist the transition include communication skills, delegation of tasks, and implementing hanging protocols. Depending on the practice, skills in research, education, administration, teamwork, and community engagement may also assist the successful transition. CONCLUSION Practical strategies can assist the new breast radiologist to become proficient at essential skills that will assist the radiologist to survive and thrive in clinical practice.
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Affiliation(s)
- Toma S Omofoye
- Department of Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd., CPB 5.3208, Houston, TX 77030, USA
| | - Jay R Parikh
- Department of Radiology, MD Anderson Cancer Center, 1515 Holcombe Blvd., CPB 5.3208, Houston, TX 77030, USA.
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Cetin Avci N, Hatipoglu F, Alacacıoglu A, Bayar EE, Bural GG. FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning. Nucl Med Mol Imaging 2018; 52:438-444. [PMID: 30538775 DOI: 10.1007/s13139-018-0544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP). Methods A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up. Results The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients. Conclusion FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.
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Affiliation(s)
- Neslihan Cetin Avci
- 1Department of Nuclear Medicine, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Filiz Hatipoglu
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Ahmet Alacacıoglu
- 3Department of Internal Medicine and Oncology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Emine Ebru Bayar
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Gonca Gul Bural
- 4Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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Zhang J, Liu X, Knopp MI, Ramaswamy B, Knopp MV. How Long of a Dynamic 3'-Deoxy-3'-[ 18F]fluorothymidine ([ 18F]FLT) PET Acquisition Is Needed for Robust Kinetic Analysis in Breast Cancer? Mol Imaging Biol 2018; 21:382-390. [PMID: 29987617 DOI: 10.1007/s11307-018-1231-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE To quantitatively evaluate the minimally required scanning time of 3'-deoxy-3'-[18F]fluorothymidine ([18F]FLT) positron emission tomography (PET) dynamic acquisition for accurate kinetic assessment of the proliferation in breast cancer tumors. PROCEDURES Within a therapeutic intervention trial, 26 breast tumors of 8 breast cancer patients were analyzed from 30-min dynamic [18F]FLT-PET acquisitions. PET/CT was acquired on a Gemini TF 64 system (Philips Healthcare) and reconstructed into 26 frames (8 × 15 s, 6 × 30 s, 5 × 1 min, 5 × 2 min, and 2 × 5 min). Maximum activity concentrations (Bq/ml) of volume of interests over tumors and plasma in descending aorta were obtained over time frames. Kinetic parameters were estimated using in-house developed software with the two-tissue three-compartment irreversible model (2TCM) (K1, k2, k3, and Ki; k4 = 0) and Patlak model (Ki) based on different acquisition durations (Td) (10, 12, 14, 16, 20, 25, and 30 min, separately). Different linear regression onset time (T0) points (1, 2, 3, 4, and 5 min) were applied in Patlak analysis. Ki of the 30-min data set was taken as the gold standard for comparison. Pearson product-moment correlation coefficient (R) of 0.9 was chosen as a limit for the correlation. RESULTS The correlation of kinetic parameters between the gold standard and the abbreviated dynamic data series increased with longer Td from 10 to 30 min. k2 and k3 using 2TCM and Ki using Patlak model revealed poor correlations for dynamic PET with Td ≤ 14 min (k2: R = 0.84, 0.85, 0.86; k3: R = 0.67, 0.67, 0.67; Ki: R = 0.72, 0.78, 0.87 at Td = 10, 12, and 14 min, respectively). Excellent correlations were shown for all kinetic parameters when Td ≥ 16 min regardless of the kinetic model and T0 value (R > 0.9). CONCLUSIONS This study indicates that a 16-min dynamic PET acquisition appears to be sufficient to provide accurate [18F]FLT kinetics to quantitatively assess the proliferation in breast cancer lesions.
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Affiliation(s)
- Jun Zhang
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Xiaoli Liu
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Michelle I Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA
| | - Bhuvaneswari Ramaswamy
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Michael V Knopp
- Wright Center of Innovation in Biomedical Imaging, Department of Radiology, The Ohio State University Wexner Medical Center, 395 W. 12th Avenue, Room 430, Columbus, OH, 43210-1228, USA.
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Role of 18F-FDG PET/CT in evaluating molecular subtypes and clinicopathological features of primary breast cancer. Nucl Med Commun 2018; 39:680-690. [DOI: 10.1097/mnm.0000000000000856] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Soldevilla-Gallardo I, Villaseñor-Navarro Y, Medina-Ornelas SS, Villarreal-Garza C, Bargalló-Rocha E, Caro-Sánchez CH, Gallardo-Alvarado LN, Hernández-Ramírez R, Arela-Quispe LM, García-Pérez FO. Positron emission mammography in the evaluation of interim response to neoadjuvant chemotherapy in patients with locally advanced breast cancer. Cancer Treat Res Commun 2018; 16:24-31. [PMID: 31298999 DOI: 10.1016/j.ctarc.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 04/22/2018] [Accepted: 05/07/2018] [Indexed: 11/28/2022]
Abstract
Neoadjuvant chemotherapy (NAC) has an important role in patients with locally advanced cancers, treating distant micrometastases, downstaging tumors, improving operability, and sometimes allowing breast-conserving surgery to take place. We studied the association between two Positron Emission Mammography with 18F-FDG (18F-FDG-PEM) semi-quantitative parameters in 108 patients and correlated with pathologic response in each of the following breast cancer subtype: Triple negative breast cancer (TPN), HER2-positive, and ER-positive/HER2-negative cancers. AIM Examine the association between two Positron Emission Mammography (PEM) semi-quantitative parameters: PUVmax (maximum uptake value) and LTB (lesion to background) baseline and the end of NAC with pathologic response in each breast cancer subtype. METHODS 108 patients, 71 with invasive ductal carcinoma and 37 with infiltrating lobular carcinoma were evaluate with 18F-FDG-PEM scans baseline and after end of NAC. We assessed the impact of 2 PEM semi-quantitative parameters for molecular subtype correlated with pathologic response according Miller-Payne grade (MPG). RESULTS After NAC, an overall reduction of 2 PEM semi-quantitative parameters was found. Neither breast cancer subtypes nor Ki67 modified chemotherapy responses. Compared to PUVmax, an overall increase of LTB was found in baseline condition, independent of the expressed immunophenotype. Post-treatment values of PUVmax revealed a significant reduction compared to baseline values (4.8 ± 0.26 vs. 1.9 ± 0.18; p < 0.001) and LTB exhibited a significant decay after the first course of NACT (15.8 ± 1.36 vs. 5.5 ± 0.49; p < 0.001). Using the Kruskal-Wallis H test which showed no correlation between the different molecular subtypes and the MPG and PUVmax and LTB (p = 0.52), but if a correlation was found between the response rate by MPG and both semiquantitative parameters (p = 0.05). CONCLUSION 2 PEM semi-quantitative parameters demonstrated a statically significant correlation and equivalence across the different breast cancer subtypes correlated with pathologic response according to MPG. PEM did not allow for prediction of NAC response in terms of breast cancer biomarkers, it is not discarded that this technology might be helpful for individual treatment stratification in breast cancer.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Liz M Arela-Quispe
- Nuclear Medicine Department, Instituto Nacional de Cancerología, Mexico City, Mexico
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Liu H, Han Y, Li J, Qin M, Fu Q, Wang C, Liu Z. 18F-Alanine Derivative Serves as an ASCT2 Marker for Cancer Imaging. Mol Pharm 2018; 15:947-954. [DOI: 10.1021/acs.molpharmaceut.7b00884] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Hui Liu
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Yuxiang Han
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Jiyuan Li
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Ming Qin
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Qunfeng Fu
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Chunhong Wang
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
| | - Zhibo Liu
- Radiochemistry and Radiation Chemistry Key Laboratory of Fundamental Science, Beijing National Laboratory for Molecular Sciences, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, China
- Peking-Tsinghua Center for Life Sciences, Peking University, Beijing 100871, China
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Garg PK, Deo SVS, Kumar R, Shukla NK, Thulkar S, Gogia A, Sharma DN, Mathur SR. Staging PET-CT Scanning Provides Superior Detection of Lymph Nodes and Distant Metastases than Traditional Imaging in Locally Advanced Breast Cancer. World J Surg 2017; 40:2036-42. [PMID: 27220508 DOI: 10.1007/s00268-016-3570-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND This study was designed to evaluate the role of a single 18-FDG positron emission tomography and computed tomography (PET-CT) scan in comparison to multiple organ-directed conventional investigations (CI) as a staging tool in locally advanced breast cancer (LABC) to detect regional and distant metastasis. METHODS All eligible patients were subjected to CI (chest X-ray, abdominal sonography, and bone scintigraphy) followed by a single 18-FDG PET-CT scan. Standard imaging criteria were used for diagnosis of metastasis. Histopathological confirmation was undertaken for suspicious lesions. An exploratory analysis was done to assess the impact of PET-CT on the staging of LABC and how it resulted in a change in management. RESULT The study included 79 patients of LABC. PET-CT detected distant metastasis in 36 (45.5 %) patients while CI could identify distant metastasis in 20 (25.3 %) patients. Two of the 36 patients in whom PET-CT detected distant metastasis were false positive. Overall PET-CT upstaged the disease in 38 (48.1 %) patients as compared to CI: stage III to stage IV migration in 14 (17.7 %) patients due to identification of additional sites of distant metastasis, and within stage III upstaging in 24 (30.3 %) patients due to identification of additional regional lymphadenopathy. PET-CT led to a change in management plan in 14 (17.7 %) patients. CONCLUSION PET-CT has a role in identifying additional sites of regional lymphadenopathy and distant metastasis to upstage the disease in a significant number of LABC patients in comparison to CI; this would help in accurate staging, selecting optimal treatment, and better prognostication of disease.
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Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.,Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Delhi, 110095, India
| | - Suryanarayana V S Deo
- Department of Surgical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India.
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Nootan Kumar Shukla
- Department of Surgical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sanjay Thulkar
- Department of Radiodiagnosis, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Ajay Gogia
- Department of Medical Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Daya Nand Sharma
- Department of Radiation Oncology, Dr BRA Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, 110029, India
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The pathogenesis, diagnosis, and management of metastatic tumors to the ovary: a comprehensive review. Clin Exp Metastasis 2017; 34:295-307. [PMID: 28730323 PMCID: PMC5561159 DOI: 10.1007/s10585-017-9856-8] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 07/12/2017] [Indexed: 12/17/2022]
Abstract
Secondary tumors of the ovary account for 10-25% of all ovarian malignancies. The most common tumors that give rise to ovarian metastases include breast, colorectal, endometrial, stomach, and appendix cancer. The correct diagnosis of secondary ovarian tumors may be challenging as they are not infrequently misdiagnosed as primary ovarian cancer, particularly in the case of mucinous adenocarcinomas. The distinction from the latter is essential, as it requires different treatment. Immunohistochemistry plays an important role in distinguishing primary ovarian tumors from extra-ovarian metastases and, furthermore, may suggest the primary tumor site. Despite extensive study, some cases remain equivocal even after assessing a broad spectrum of antigens. Therefore, gene expression profiling represents an approach able to further discriminate equivocal findings, and one that has been proven effective in determining the origin of cancer of unknown primary site. The available data concerning secondary ovarian tumors is rather limited owing to the relative heterogeneity of this group and the practical absence of any prospective trials. However, several intriguing questions are encountered in daily practice, including rational diagnostic workup, the role of cytoreductive surgery, and consequent adjuvant chemotherapy. This review seeks to address these issues comprehensively and summarize current knowledge on the epidemiology, pathogenesis, and management of secondary ovarian tumors, including further discussion on the different pathways of metastatisation, metastatic organotropism, and their possible molecular mechanisms.
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Abstract
Interpretation of 18F-FDG PET/CT studies in breast is challenging owing to nonspecific FDG uptake in various benign and malignant conditions. Benign conditions include breast changes in pregnancy and lactation, gynecomastia, mastitis, fat necrosis, fibroadenoma, intraductal papilloma, and atypical ductal hyperplasia. Among malignancies, invasive ductal carcinoma and invasive lobular carcinoma are common histological types of breast carcinoma. Rarely, other unusual histological types of breast carcinomas (eg, intraductal papillary carcinoma, invasive micropapillary carcinoma, medullary carcinoma, mucinous carcinoma, and metaplastic carcinoma), lymphoma, and metastasis can be the causes. Knowledge of a wide spectrum of hypermetabolic breast lesions on FDG PET/CT is essential in accurate reading of FDG PET/CT. The purpose of this atlas article is to demonstrate features of various breast lesions encountered at our institution, both benign and malignant, which can result in hypermetabolism on FDG PET/CT imaging.
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Gupta M, Datta A, Choudhury PS, Dsouza M, Batra U, Mishra A. Can 18F-Fluoroestradiol Positron Emission Tomography Become a New Imaging Standard in the Estrogen Receptor-positive Breast Cancer Patient: A Prospective Comparative Study with 18F-Fluorodeoxyglucose Positron Emission Tomography? World J Nucl Med 2017; 16:133-139. [PMID: 28553180 PMCID: PMC5436319 DOI: 10.4103/1450-1147.203071] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Correct staging is the most crucial for the treatment outcome in cancer management. Molecular imaging with 18F-fluoroestradiol (FES) positron emission tomography-computed tomography (PET-CT) targets estrogen receptor (ER) and may have a higher incremental value in diagnosis by aiding specificity. We enrolled 12 female breast cancer patients prospectively and did 18F-FES PET-CT and 18F-fluorodeoxyglucose (FDG) PET-CT within 1 week interval time. Lesion detection sensitivity was compared for a total number of lesions and for nonhepatic lesions only by McNemar test. 18F-FES PET-CT was taken as reference in case of indeterminate lesions. The incremental value reported by identifying 18F-FES exclusive lesions and by characterization of 18F-FDG indeterminate lesions. Spearman rank test was used to correlate ER expression and maximum standardized uptake value (SUVmax). Two ER-negative patients with no 18F-FES uptake were excluded. Ten ER-positive patients with 154 disease lesions were finally analyzed. 18F-FDG picked-up 142 lesions (sensitivity 92.21%), whereas 18F-FES picked-up 116 lesions (sensitivity 75.32%) and this difference was statistically significant. For nonhepatic lesions (n = 136) detectability, 18F-FDG picked-up 124 (sensitivity 91.18%), whereas 18F-FES picked-up 116 (sensitivity 85.29%) lesions and this difference was not statistically significant. Beside 12 exclusive lesions, 18F-FES characterized 41 (27.5%) 18F-FDG indeterminate lesions. Overall 18F-FES impacted 20% patient management. The positive trend was also seen with 18F-FES SUVmax with ER expression and negative with 18F-FDG SUVmax. We conclude, 18F-FDG has overall better sensitivity than 18F-FES PET-CT, however for nonhepatic metastasis difference was not significant. 18F-FES PET-CT better-characterized lesions and impacted 20% patient management. Therefore, 18F-FES PET-CT should be used with 18F-FDG PET-CT in strongly ER expressing patients for better specificity.
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Affiliation(s)
- Manoj Gupta
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anupama Datta
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Partha S Choudhury
- Department of Nuclear Medicine, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Maria Dsouza
- Division of PET Imaging, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
| | - Ullas Batra
- Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India
| | - Anil Mishra
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, New Delhi, India
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Sathekge M, Lengana T, Modiselle M, Vorster M, Zeevaart J, Maes A, Ebenhan T, Van de Wiele C. 68Ga-PSMA-HBED-CC PET imaging in breast carcinoma patients. Eur J Nucl Med Mol Imaging 2016; 44:689-694. [PMID: 27822700 PMCID: PMC5323468 DOI: 10.1007/s00259-016-3563-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 10/21/2016] [Indexed: 01/26/2023]
Abstract
Background To report on imaging findings using 68Ga-PSMA-HBED-CC PET in a series of 19 breast carcinoma patients. Methods 68Ga-PSMA-HBED-CC PET imaging results obtained were compared to routinely performed staging examinations and analyzed as to lesion location and progesterone receptor status. Results Out of 81 tumor lesions identified, 84% were identified on 68Ga-PSMA-HBED-CC PET. 68Ga-PSMA-HBED-CC SUVmean values of distant metastases proved significantly higher (mean, 6.86, SD, 5.68) when compared to those of primary or local recurrences (mean, 2.45, SD, 2.55, p = 0.04) or involved lymph nodes (mean, 3.18, SD, 1.79, p = 0.011). SUVmean values of progesterone receptor-positive lesions proved not significantly different from progesterone receptor-negative lesions. SUV values derived from FDG PET/CT, available in seven patients, and 68Ga-PSMA-HBED-CC PET/CT imaging proved weakly correlated (r = 0.407, p = 0.015). Conclusions 68Ga-PSMA-HBED-CC PET/CT imaging in breast carcinoma confirms the reported considerable variation of PSMA expression on human solid tumors using immunohistochemistry.
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Affiliation(s)
- Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa.
| | - Thabo Lengana
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Moshe Modiselle
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Mariza Vorster
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - JanRijn Zeevaart
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Alex Maes
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa.,Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Thomas Ebenhan
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa
| | - Christophe Van de Wiele
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Private Bag X169, Pretoria, 0001, South Africa.,Department of Radiology and Nuclear Medicine, University Ghent, Ghent, Belgium
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Invasive Cribriform Carcinoma of the Breast: Radiologic and Histopathologic Features. IRANIAN JOURNAL OF RADIOLOGY 2016. [DOI: 10.5812/iranjradiol.39058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Yang H, Jenni S, Colovic M, Merkens H, Poleschuk C, Rodrigo I, Miao Q, Johnson BF, Rishel MJ, Sossi V, Webster JM, Bénard F, Schaffer P. 18F-5-Fluoroaminosuberic Acid as a Potential Tracer to Gauge Oxidative Stress in Breast Cancer Models. J Nucl Med 2016; 58:367-373. [PMID: 27789715 DOI: 10.2967/jnumed.116.180661] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/07/2016] [Indexed: 12/14/2022] Open
Abstract
The cystine transporter (system xC-) is an antiporter of cystine and glutamate. It has relatively low basal expression in most tissues and becomes upregulated in cells under oxidative stress (OS) as one of the genes expressed in response to the antioxidant response element promoter. We have developed 18F-5-fluoroaminosuberic acid (FASu), a PET tracer that targets system xC- The goal of this study was to evaluate 18F-FASu as a specific gauge for system xC- activity in vivo and its potential for breast cancer imaging. Methods:18F-FASu specificity toward system xC- was studied by cell inhibition assay, cellular uptake after OS induction with diethyl maleate, with and without anti-xCT small interfering RNA knockdown, in vitro uptake studies, and in vivo uptake in a system xC--transduced xenograft model. In addition, radiotracer uptake was evaluated in 3 breast cancer models: MDA-MB-231, MCF-7, and ZR-75-1. Results: Reactive oxygen species-inducing diethyl maleate increased glutathione levels and 18F-FASu uptake, whereas gene knockdown with anti-xCT small interfering RNA led to decreased tracer uptake. 18F-FASu uptake was robustly inhibited by system xC- inhibitors or substrates, whereas uptake was significantly higher in transduced cells and tumors expressing xCT than in wild-type HEK293T cells and tumors (P < 0.0001 for cells, P = 0.0086 for tumors). 18F-FASu demonstrated tumor uptake in all 3 breast cancer cell lines studied. Among them, triple-negative breast cancer MDA-MB-231, which has the highest xCT messenger RNA level, had the highest tracer uptake (P = 0.0058 when compared with MCF-7; P < 0.0001 when compared with ZR-75-1). Conclusion:18F-FASu as a system xC- substrate is a specific PET tracer for functional monitoring of system xC- and OS imaging. By enabling noninvasive analysis of xC- responses in vivo, this biomarker may serve as a valuable target for the diagnosis and treatment monitoring of certain breast cancers.
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Affiliation(s)
- Hua Yang
- Life Sciences, TRIUMF, Vancouver, Canada
| | - Silvia Jenni
- British Columbia Cancer Agency, Vancouver, Canada
| | - Milena Colovic
- Life Sciences, TRIUMF, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | | | | | | | - Qing Miao
- Life Sciences, TRIUMF, Vancouver, Canada
| | | | | | - Vesna Sossi
- Department of Physics and Astronomy, University of British Columbia, Vancouver, Canada; and
| | | | - François Bénard
- British Columbia Cancer Agency, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Paul Schaffer
- Life Sciences, TRIUMF, Vancouver, Canada .,Department of Radiology, University of British Columbia, Vancouver, Canada.,Department of Chemistry, Simon Fraser University, Vancouver, Canada
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Fujioka T, Kubota K, Toriihara A, Machida Y, Okazawa K, Nakagawa T, Saida Y, Tateishi U. Tumor characteristics of ductal carcinoma in situ of breast visualized on [F-18] fluorodeoxyglucose-positron emission tomography/computed tomography: Results from a retrospective study. World J Radiol 2016; 8:743-749. [PMID: 27648168 PMCID: PMC5002505 DOI: 10.4329/wjr.v8.i8.743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 05/02/2016] [Accepted: 06/02/2016] [Indexed: 02/06/2023] Open
Abstract
AIM To clarify clinicopathological features of ductal carcinoma in situ (DCIS) visualized on [F-18] fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT).
METHODS This study retrospectively reviewed 52 consecutive tumors in 50 patients with pathologically proven pure DCIS who underwent [F-18] FDG-PET/CT before surgery. [F-18] FDG-PET/CT was performed after biopsy in all patients. The mean interval from biopsy to [F-18] FDG-PET/CT was 29.2 d. [F-18] FDG uptake by visual analysis and maximum standardized uptake value (SUVmax) was compared with clinicopathological characteristics.
RESULTS [F-18] FDG uptake was visualized in 28 lesions (53.8%) and the mean and standard deviation of SUVmax was 1.63 and 0.90. On univariate analysis, visual analysis and the SUVmax were associated with symptomatic presentation (P = 0.012 and 0.002, respectively), palpability (P = 0.030 and 0.024, respectively), use of core-needle biopsy (CNB) (P = 0.023 and 0.012, respectively), ultrasound-guided biopsy (P = 0.040 and 0.006, respectively), enhancing lesion ≥ 20 mm on magnetic resonance imaging (MRI) (P = 0.001 and 0.010, respectively), tumor size ≥ 20 mm on histopathology (P = 0.002 and 0.008, respectively). However, [F-18] FDG uptake parameters were not significantly associated with age, presence of calcification on mammography, mass formation on MRI, presence of comedo necrosis, hormone status (estrogen receptor, progesterone receptor and human epidermal growth factor receptor-2), and nuclear grade. The factors significantly associated with visual analysis and SUVmax were symptomatic presentation (P = 0.019 and 0.001, respectively), use of CNB (P = 0.001 and 0.031, respectively), and enhancing lesion ≥ 20 mm on MRI (P = 0.001 and 0.049, respectively) on multivariate analysis.
CONCLUSION Although DCIS of breast is generally non-avid tumor, symptomatic and large tumors (≥ 20 mm) tend to be visualized on [F-18] FDG-PET/CT.
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van Es SC, Venema CM, Glaudemans AWJM, Lub-de Hooge MN, Elias SG, Boellaard R, Hospers GAP, Schröder CP, de Vries EGE. Translation of New Molecular Imaging Approaches to the Clinical Setting: Bridging the Gap to Implementation. J Nucl Med 2016; 57 Suppl 1:96S-104S. [PMID: 26834109 DOI: 10.2967/jnumed.115.157974] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Molecular imaging with PET is a rapidly emerging technique. In breast cancer patients, more than 45 different PET tracers have been or are presently being tested. With a good rationale, after development of the tracer and proven feasibility, it is of interest to evaluate whether there is a potential meaningful role for the tracer in the clinical setting-such as in staging, in the (early) prediction of a treatment response, or in supporting drug choices. So far, only (18)F-FDG PET has been incorporated into breast cancer guidelines. For proof of the clinical relevance of tracers, especially for analysis in a multicenter setting, standardization of the technology and access to the novel PET tracer are required. However, resources for PET implementation research are limited. Therefore, next to randomized studies, novel approaches are required for proving the clinical value of PET tracers with the smallest possible number of patients. The aim of this review is to describe the process of the development of PET tracers and the level of evidence needed for the use of these tracers in breast cancer. Several breast cancer trials have been performed with the PET tracers (18)F-FDG, 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT), and (18)F-fluoroestradiol ((18)F-FES). We studied them to learn lessons for the implementation of novel tracers. After defining the gap between a good rationale for a tracer and implementation in the clinical setting, we propose solutions to fill the gap to try to bring more PET tracers to daily clinical practice.
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Affiliation(s)
- Suzanne C van Es
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Clasina M Venema
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marjolijn N Lub-de Hooge
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; and
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ronald Boellaard
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Geke A P Hospers
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Carolina P Schröder
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elisabeth G E de Vries
- Department of Medical Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;
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Zaidi H, Thompson C. Evolution and Developments in Instrumentation for Positron Emission Mammography. PET Clin 2016; 4:317-27. [PMID: 27157301 DOI: 10.1016/j.cpet.2009.12.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Molecular imaging using high-resolution PET instrumentation is now playing a pivotal role in basic and clinical research. The development of optimized detection geometries combined with high-performance detector technologies and compact designs of PET tomographs have become the goal of active research groups in academic and corporate settings. Significant progress has been achieved in the design of commercial PET instrumentation in the last decade allowing a spatial resolution of about 4 to 6 mm to be reached for whole-body imaging, about 2.4 mm for PET cameras dedicated for brain imaging, and submillimeter resolution for female breast, prostate, and small-animal imaging. In particular, significant progress has been made in the design of dedicated positron emission mammography (PEM) units. The initial concept suggested in 1993 consisted of placing 2 planar detectors capable of detecting the 511-keV annihilation photons in a conventional mammography unit. Since that time, many different design paths have been pursued and it will be interesting to see which technologies become the most successful in the future. This paper discusses recent advances in PEM instrumentation and the advantages and challenges of dedicated standalone and dual-modality imaging systems. Future opportunities and the challenges facing the adoption of PEM imaging instrumentation and its role in clinical and research settings are also addressed.
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Affiliation(s)
- Habib Zaidi
- Division of Nuclear Medicine, Geneva University Hospital, CH-1211 Geneva, Switzerland
| | - Christopher Thompson
- Department of Medical Physics, Montreal Neurological Institute, McGill University, Montreal, QC H3A 2B4, Canada
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Sponholz S, Schirren M, Kudelin N, Knöchlein E, Schirren J. Results of Pulmonary Resection. Thorac Surg Clin 2016; 26:99-108. [DOI: 10.1016/j.thorsurg.2015.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Xu B, Hu X, Jiang Z, Li H, Chen J, Cui S, Li Q, Liao N, Liu D, Liu J, Lu J, Shen K, Sun T, Teng Y, Tong Z, Wang S, Wang X, Wang X, Wang Y, Wu J, Yuan P, Zhang P, Zhang Q, Zheng H, Pang D, Ren G, Shao Z, Shen Z, Song E, Song S. National consensus in China on diagnosis and treatment of patients with advanced breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:242. [PMID: 26605288 DOI: 10.3978/j.issn.2305-5839.2015.09.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The recently available guidelines on the management of advanced breast cancer (ABC) organized by Chinese Anti-Cancer Association, Committee of Breast Cancer Society (CACA-CBCS) do not elucidate ABC in details. To instruct clinicians in treatment of ABC, a Chinese expert consensus meeting on diagnosis and treatment of ABC was held in June 2014 and a consensus is developed. The following consensus provides the level of evidence and supporting documents for each recommendation, and introduces research topics to be urgently addressed. Notably, the consensus on diagnosis and treatment of ABC in China is developed to be applied nationwide. In different areas, multidisciplinary treatment (MDT) tailored to the each patient and the disease itself should be applied based on the basic principles of modern oncology.
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Affiliation(s)
- Binghe Xu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Xichun Hu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Zefei Jiang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Huiping Li
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Jiayi Chen
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Shude Cui
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Qing Li
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Ning Liao
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Donggeng Liu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Jian Liu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Jinsong Lu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Kunwei Shen
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Tao Sun
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Yuee Teng
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Zhongsheng Tong
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Shulian Wang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Xiang Wang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Xiaojia Wang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Yongsheng Wang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Jiong Wu
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Peng Yuan
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Pin Zhang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Qingyuan Zhang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Hong Zheng
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Da Pang
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Guosheng Ren
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Zhimin Shao
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Zhenzhou Shen
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Erwei Song
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
| | - Santai Song
- 1 Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China ; 2 Cancer Hospital of Fudan University, Shanghai 200032, China ; 3 Beijing 307 Hospital of PLA, Beijing 100101, China ; 4 Cancer Hospital of Peking University, Beijing 100142, China ; 5 Ruijin Hospital of Shanghai Jiaotong University, Shanghai 200020, China ; 6 Henan Cancer Hospital, Zhengzhou 450008, China ; 7 Guangdong General Hospital, Guangzhou 510080, China ; 8 Cancer Center, Sun Yat-sen University, Guangzhou 510060, China ; 9 Fujian Cancer Hospital, Fuzhou 350000, China ; 10 Renji Hospital, Shanghai Jiaotong University, Shanghai 200032, China ; 11 Liaoning Cancer Hospital, Shenyang 110042, China ; 12 First Affiliated Hospital of China Medical University, Shenyang 110001, China ; 13 Cancer Hospital, Tianjin Medical University, Tianjin 300060, China ; 14 Zhejiang Cancer Hospital, Hangzhou 310022, China ; 15 Shandong Cancer Hospital, Jinan 250031, China ; 16 Cancer Hospital, Harbin Medical University, Harbin 150000, China ; 17 West China Hospital, Sichuan University, Chendu 610041, China ; 18 First Affiliated Hospital, Chongqing Medical University, Chongqing 400014, China ; 19 Second Affiliated Hospital, Sun Yat-sen University, Guangzhou 510175, China
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