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Zhao M, Zhou Y. Diagnosis of Pulmonary Sarcoidosis. Clin Chest Med 2024; 45:15-24. [PMID: 38245363 DOI: 10.1016/j.ccm.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024]
Abstract
Diagnosis of sarcoidosis depends on a compatible clinical and imaging presentation, histologic finding of non-necrotizing granulomatous inflammation, and exclusion of alternative causes of granulomatous diseases. This study has reviewed the diagnostic algorithms and approaches of sarcoidosis.
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Affiliation(s)
- Mengmeng Zhao
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital of Tongji University, 507 Zheng Min Road, Shanghai 200433, China
| | - Ying Zhou
- Department of Pulmonary and Critical Care Medicine, Shanghai Pulmonary Hospital of Tongji University, 507 Zheng Min Road, Shanghai 200433, China.
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2
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Chen S, Jin C, Ohgaki R, Xu M, Okanishi H, Kanai Y. Structure-activity characteristics of phenylalanine analogs selectively transported by L-type amino acid transporter 1 (LAT1). Sci Rep 2024; 14:4651. [PMID: 38409393 PMCID: PMC10897196 DOI: 10.1038/s41598-024-55252-w] [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: 12/30/2023] [Accepted: 02/21/2024] [Indexed: 02/28/2024] Open
Abstract
L-type amino acid transporter 1 (LAT1) is a transmembrane protein responsible for transporting large neutral amino acids. While numerous LAT1-targeted compound delivery for the brain and tumors have been investigated, their LAT1 selectivity often remains ambiguous despite high LAT1 affinity. This study assessed the LAT1 selectivity of phenylalanine (Phe) analogs, focusing on their structure-activity characteristics. We discovered that 2-iodo-L-phenylalanine (2-I-Phe), with an iodine substituent at position 2 in the benzene ring, markedly improves LAT1 affinity and selectivity compared to parent amino acid Phe, albeit at the cost of reduced transport velocity. L-Phenylglycine (Phg), one carbon shorter than Phe, was found to be a substrate for LAT1 with a lower affinity, exhibiting a low level of selectivity for LAT1 equivalent to Phe. Notably, (R)-2-amino-1,2,3,4-tetrahydro-2-naphthoic acid (bicyclic-Phe), with an α-methylene moiety akin to the α-methyl group in α-methyl-L-phenylalanine (α-methyl-Phe), a known LAT1-selective compound, showed similar LAT1 transport maximal velocity to α-methyl-Phe, but with higher LAT1 affinity and selectivity. In vivo studies revealed tumor-specific accumulation of bicyclic-Phe, underscoring the importance of LAT1-selectivity in targeted delivery. These findings emphasize the potential of bicyclic-Phe as a promising LAT1-selective component, providing a basis for the development of LAT1-targeting compounds based on its structural framework.
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Affiliation(s)
- Sihui Chen
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Chunhuan Jin
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ryuichi Ohgaki
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, 565-0871, Japan
| | - Minhui Xu
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroki Okanishi
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshikatsu Kanai
- Department of Bio-System Pharmacology, Graduate School of Medicine, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
- Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives (OTRI), Osaka University, Suita, Osaka, 565-0871, Japan.
- Premium Research Institute for Human Metaverse Medicine (WPI-PRIMe), Osaka University, Suita, Osaka, 565-0871, Japan.
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3
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Brito-Zerón P, Pérez-Álvarez R, Ramos-Casals M. Reply. Med Clin (Barc) 2023; 160:278. [PMID: 36707372 DOI: 10.1016/j.medcli.2022.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 01/27/2023]
Affiliation(s)
- Pilar Brito-Zerón
- Research and Innovation Group in Autoimmune Diseases, Sanitas Digital Hospital, Hospital-CIMA-Centre Mèdic Millenium Balmes Sanitas, Barcelona, España; Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España
| | - Roberto Pérez-Álvarez
- Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Medicina Interna, Hospital San Rafael, La Coruña, España
| | - Manuel Ramos-Casals
- Línea de investigación de Sarcoidosis del Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Madrid, España; Servicio de Enfermedades Autoinmunes, Instituto Clínic de Medicina y Dermatología (ICMiD), Hospital Clínic, Barcelona, España; Departament de Medicina, Universitat de Barcelona, Barcelona, España.
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4
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Nakaichi T, Nakamura S, Ito K, Takahashi K, Takemori M, Kashihara T, Kunito K, Murakami N, Iijima K, Chiba T, Nakayama H, Mikasa S, Nishio T, Okamoto H, Itami J, Kurihara H, Igaki H. Analyzing spatial distribution between 18F-fluorodeoxyglucose and 18F-boronophenylalanine positron emission tomography to investigate selection indicators for boron neutron capture therapy. EJNMMI Phys 2022; 9:89. [PMID: 36536190 PMCID: PMC9763526 DOI: 10.1186/s40658-022-00514-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND 18F-FDG PET is often utilized to determine BNCT selection due to the limited availability of 18F-BPA PET, which is performed by synthesizing 18F into the boron drug used for BNCT, although the uptake mechanisms between those are different. Additionally, only a few non-spatial point parameters, such as maximum SUV (SUVmax), have reported a correlation between those in previous studies. This study aimed to investigate the spatial accumulation pattern between those PET images in tumors, which would be expected to either show higher uptake on 18F-BPA PET or be utilized in clinical, to verify whether 18F-FDG PET could be used as a selection indicator for BNCT. METHODS A total of 27 patients with 30 lesions (11 squamous cell carcinoma, 9 melanoma, and 10 rhabdomyosarcoma) who received 18F-FDG and 18F-BPA PET within 2 weeks were enrolled in this study. The ratio of metabolic tumor volumes (MTVs) to GTV, histogram indices (skewness/kurtosis), and the correlation of total lesion activity (TLA) and non-spatial point parameters (SUVmax, SUVpeak, SUVmin, maximum tumor-to-normal tissue ratio (Tmax/N), and Tmin/N) were evaluated. After local rigid registration between those images, distances of locations at SUVmax and the center of mass with MTVs on each image and similarity indices were also assessed along its coordinate. RESULTS In addition to SUVmax, SUVpeak, and Tmax/N, significant correlations were found in TLA. The mean distance in SUVmax was [Formula: see text] and significantly longer than that in the center of mass with MTVs. The ratio of MTVs to GTV, skewness, and kurtosis were not significantly different. However, the similarities of MTVs were considerably low. The similarity indices of Dice similarity coefficient, Jaccard coefficient, and mean distance to agreement for MTV40 were [Formula: see text], [Formula: see text], and [Formula: see text] cm, respectively. Furthermore, it was worse in MTV50. In addition, spatial accumulation patterns varied in cancer types. CONCLUSIONS Spatial accumulation patterns in tumors showed low similarity between 18F-FDG and 18F-BPA PET, although the various non-spatial point parameters were correlated. In addition, the spatial accumulation patterns were considerably different in cancer types. Therefore, the selection for BNCT using 18F-FDG PET should be compared carefully with using 18F-FBPA PET.
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Affiliation(s)
- Tetsu Nakaichi
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Satoshi Nakamura
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.136593.b0000 0004 0373 3971Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita City, Osaka 565-0871 Japan
| | - Kimiteru Ito
- grid.272242.30000 0001 2168 5385Department of Diagnostic Radiology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kana Takahashi
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Mihiro Takemori
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Tairo Kashihara
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kouji Kunito
- Euro MediTech Co., Ltd., 2-20-4, Higashigotanda, Shinagawa-ku, Tokyo 141-0022 Japan
| | - Naoya Murakami
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Kotaro Iijima
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Takahito Chiba
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Hiroki Nakayama
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.265074.20000 0001 1090 2030Department of Radiological Science, Graduate School of Human Health Science, Tokyo Metropolitan University, 7-2-10 Higashi-ogu, Arakawa-ku, Tokyo 116-8551 Japan
| | - Shohei Mikasa
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Teiji Nishio
- grid.136593.b0000 0004 0373 3971Medical Physics Laboratory, Division of Health Science, Graduate School of Medicine, Osaka University, Yamadaoka 1-7, Suita City, Osaka 565-0871 Japan
| | - Hiroyuki Okamoto
- grid.272242.30000 0001 2168 5385Radiation Safety and Quality Assurance Division, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Jun Itami
- grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
| | - Hiroaki Kurihara
- grid.414944.80000 0004 0629 2905Department of Diagnostic Radiology, Kanagawa Cancer Center, 2-3-2 Nakano, Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Hiroshi Igaki
- grid.272242.30000 0001 2168 5385Division of Research and Development for Boron Neutron Capture Therapy, National Cancer Center Exploratory Oncology Research and Clinical Trial Center, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan ,grid.272242.30000 0001 2168 5385Department of Radiation Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045 Japan
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Isohashi K, Kanai Y, Aihara T, Hu N, Fukushima K, Baba I, Hirokawa F, Kakino R, Komori T, Nihei K, Hatazawa J, Ono K. Exploration of the threshold SUV for diagnosis of malignancy using 18F-FBPA PET/CT. Eur J Hybrid Imaging 2022; 6:35. [DOI: 10.1186/s41824-022-00156-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/09/2022] [Indexed: 12/05/2022] Open
Abstract
Abstract
Background
The goal of the study was to evaluate the diagnostic ability of 18F-FBPA PET/CT for malignant tumors. Findings from 18F-FBPA and 18F-FDG PET/CT were compared with pathological diagnoses in patients with malignant tumors or benign lesions.
Methods
A total of 82 patients (45 males, 37 females; median age, 63 years; age range, 20–89 years) with various types of malignant tumors or benign lesions, such as inflammation and granulomas, were examined by 18F-FDG and 18F-FBPA PET/CT. Tumor uptake of FDG or FBPA was quantified using the maximum standardized uptake value (SUVmax). The final diagnosis was confirmed by cytopathology or histopathological findings of the specimen after biopsy or surgery. A ROC curve was constructed from the SUVmax values of each PET image, and the area under the curve (AUC) and cutoff values were calculated.
Results
The SUVmax for 18F-FDG PET/CT did not differ significantly for malignant tumors and benign lesions (10.9 ± 6.3 vs. 9.1 ± 2.7 P = 0.62), whereas SUVmax for 18F-FBPA PET/CT was significantly higher for malignant tumors (5.1 ± 3.0 vs. 2.9 ± 0.6, P < 0.001). The best SUVmax cutoffs for distinguishing malignant tumors from benign lesions were 11.16 for 18F-FDG PET/CT (sensitivity 0.909, specificity 0.390) and 3.24 for 18F-FBPA PET/CT (sensitivity 0.818, specificity 0.753). ROC analysis showed significantly different AUC values for 18F-FDG and 18F-FBPA PET/CT (0.547 vs. 0.834, p < 0.001).
Conclusion
18F-FBPA PET/CT showed superior diagnostic ability over 18F-FDG PET/CT in differential diagnosis of malignant tumors and benign lesions. The results of this study suggest that 18F-FBPA PET/CT diagnosis may reduce false-positive 18F-FDG PET/CT diagnoses.
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Dhingra VK, Khan D, Kumar R, Basu S. Nonmalignant Thoracic Disorders: An Appraisal of Fluorodeoxyglucose and Non-fluorodeoxyglucose PET/Computed Tomography Applications. PET Clin 2022; 17:495-515. [PMID: 35717104 DOI: 10.1016/j.cpet.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PET/computed tomography (CT) with fluorodeoxyglucose and nonfluorodeoxyglucose PET tracers has established itself in the management of malignant disorders. Its role in the assessment of nonmalignant conditions, such as infectious and noninfectious inflammatory diseases and other benign conditions, has emerged independently and alongside its role being evaluated in malignancy and continues to evolve. It is evident that PET/CT has the potential to play a significant role in various nonmalignant disorders of the thorax. This review highlights current developments and areas where PET/CT has a potential to impact the clinical management of nonmalignant thoracic conditions with special focus on nonfluorodeoxyglucose tracers.
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Affiliation(s)
- Vandana Kumar Dhingra
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand 249203, India
| | - Dikhra Khan
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Rakesh Kumar
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Sri Aurobindo Marg, Ansari Nagar, Ansari Nagar East, New Delhi, Delhi 110029, India
| | - Sandip Basu
- Radiation Medicine Centre (B.A.R.C), Tata Memorial Hospital Annexe, Jerbai Wadia Road, Parel, Mumbai, Maharashtra 400012, India; Homi Bhabha National Institute, 2nd floor, BARC Training School Complex, Anushaktinagar, Mumbai, Maharashtra 400094, India.
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Kanai Y. Amino acid transporter LAT1 (SLC7A5) as a molecular target for cancer diagnosis and therapeutics. Pharmacol Ther 2021; 230:107964. [PMID: 34390745 DOI: 10.1016/j.pharmthera.2021.107964] [Citation(s) in RCA: 72] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/30/2021] [Indexed: 01/13/2023]
Abstract
Cancer cells require a massive supply of nutrients, including sugars and amino acids-the upregulation of transporters for each nutrient contributes to meet the demand. Distinct from glucose transporters, amino acid transporters include ones whose expression is specific to cancer cells. For example, LAT1 (SLC7A5) displays protein expression mostly limited to the plasma membrane of cancer cells. The exceptions are the placental barrier and the blood-brain barrier, where immunohistochemical and mass spectrometric studies have shown LAT1 expression, although their levels are supposed to be lower than those in cancers. The expression of LAT1 has been reported in cancers from various tissue origins, where high LAT1 expression is related to the poor prognosis of patients. LAT1 is essential for cancer cell growth because the pharmacologic inhibition and knockdown/knockout of LAT1 suppress the proliferation of cancer cells and the growth of xenograft tumors. The inhibition of LAT1 suppresses protein synthesis by downregulating the mTORC1 signaling pathway and mobilizing the general amino acid control (GAAC) pathway in cancer cells. LAT1 is, thus, a candidate molecular target for the diagnosis and therapeutics of cancers. 18F-labeled 3-fluoro-l-α-methyl-tyrosine (FAMT) is used as a LAT1-specific PET probe for cancer detection due to the LAT1 specificity of α-methyl aromatic amino acids. FAMT accumulation is cancer-specific and avoids non-cancer lesions, including inflammation, confirming the cancer-specific expression of LAT1 in humans. Due to the cancer-specific nature, LAT1 can also be used for cancer-specific delivery of anti-tumor agents such as l-para-boronophenylalanine used for boron neutron capture therapy and α-emitting nuclide-labeled LAT1 substrates developed for nuclear medicine treatment. Based on the importance of LAT1 in cancer progression, high-affinity LAT1-specific inhibitors have been developed for anti-tumor drugs. JPH203 (KYT0353) is such a compound designed based on the structure-activity relationship of LAT1 ligands. It is one of the highest-affinity inhibitors with less affecting other transporters. It suppresses tumor growth in vivo without significant toxicity in preclinical studies at doses enough to suppress tumor growth. In the phase-I clinical trial, JPH203 appeared to provide promising activity. Because the mechanisms of action of LAT1 inhibitors are novel, with or without combination with other anti-tumor drugs, they could contribute to the treatment of cancers that do not respond to current therapy. The LAT1-specific PET probe could also be used as companion diagnostics of the LAT1-targeting therapies to select patients to whom therapeutic benefits could be expected. Recently, the cryo-EM structure of LAT1 has been solved, which would facilitate the understanding of the mechanisms of the dynamic interaction of ligands and the binding site, and further designing new compounds with higher activity.
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Affiliation(s)
- Yoshikatsu Kanai
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
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Imai H, Kaira K, Hashimoto K, Nitanda H, Taguchi R, Yanagihara A, Umesaki T, Yamaguchi O, Mouri A, Kawasaki T, Yasuda M, Kobayashi K, Sakaguchi H, Kuji I, Kagamu H. Tumor immunity is related to 18 F-FDG uptake in thymic epithelial tumor. Cancer Med 2021; 10:6317-6326. [PMID: 34363337 PMCID: PMC8446555 DOI: 10.1002/cam4.4176] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 12/27/2022] Open
Abstract
Background 2‐deoxy‐2‐[fluorine‐18] fluoro‐d‐glucose (18F‐FDG) positron emission tomography (18F‐FDG‐PET) is a convenient modality to assess the metabolic activity within tumor cells. However, there is no consensus regarding the relationship between 18F‐FDG uptake and the immune environment in thymic epithelial tumors (TETs). We conducted a clinicopathological study to elucidate the relationship between 18F‐FDG uptake and programmed death ligands 1 and 2 (PD‐L1/PD‐L2) expression in patients with TETs. Methods: A total of 108 patients with histologically confirmed TETs classified as thymomas or thymic carcinomas who underwent surgical resection or biopsy or needle biopsy and 18F‐FDG PET before any treatment between August 2007 and March 2020 were enrolled in this study. Tumor specimens underwent immunohistochemical staining for PD‐L1, PD‐L2, GLUT1, HIF‐1α, VEGFR2, VEGF‐C, and β2 adrenergic receptor. Results: High uptakes of SUVmax, SUVmean, MTV, and TLG were identified in 28 (25.9%), 61 (56.5%), 55 (50.9%), and 55 (50.9%) of 108 patients, respectively. High uptake of SUVmax significantly correlated with PS (performance status) of 1–2, thymic carcinoma, and advanced stage, and SUVmax on 18F‐FDG uptake displayed a close association with PD‐L1 and PD‐L2 expressions, but not with MTV and TLG. Our analysis revealed that SUVmax was identified as being significant relationship for positive PD‐L1/PD‐L2 expression. GLUT1, HIF‐1α, and VEGFR2 were significantly associated with the expression of PD‐L1/PD‐L2 from the biological viewpoint. Conclusion 18F‐FDG accumulation was closely associated with the expression of PD‐L1/PD‐L2, which, in turn, was correlated with glucose metabolism and hypoxia. PD‐L1/PD‐L2 could affect the glucose metabolism and hypoxia in thymic tumor cells.
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Affiliation(s)
- Hisao Imai
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Kyoichi Kaira
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Kosuke Hashimoto
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Hiroyuki Nitanda
- Department of General Thoracic Surgery, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Ryo Taguchi
- Department of General Thoracic Surgery, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Akitoshi Yanagihara
- Department of General Thoracic Surgery, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Tetsuya Umesaki
- Department of General Thoracic Surgery, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Ou Yamaguchi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Atsuto Mouri
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Kunihiko Kobayashi
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Hirozo Sakaguchi
- Department of General Thoracic Surgery, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Ichiei Kuji
- Department of Nuclear Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
| | - Hiroshi Kagamu
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, Hidaka-City, Saitama, Japan
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9
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Brandão Calçada M, Montezinho S, Teixeira AM, Gomes B, Macedo B. Sarcoidosis with Rare Extrapulmonary Involvement. Eur J Case Rep Intern Med 2021; 8:002540. [PMID: 34377688 DOI: 10.12890/2021_002540] [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: 04/02/2021] [Accepted: 04/13/2021] [Indexed: 12/18/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disease in which medullary involvement is a rare extrapulmonary manifestation. We present the case of a 37-year-old man with right abdominal and dorso-lumbar pain lasting for months. Computerized tomography showed renal microlithiasis and retroperitoneal, hilar and mediastinal adenopathies. Laboratory results showed an elevated erythrocyte sedimentation rate, IgG, β2-microgobulin and angiotensin-conversion enzyme, serum calcium in the upper limit and hypercalciuria. There was a slight elevation of the CD4/CD8 ratio in bronchoalveolar lavage, without lymphocytic alveolitis. An endobronchial ganglion biopsy was inconclusive. A positron emission tomography scan demonstrated supra and infra-diaphragmatic, splenic and medullary involvement, suggesting lymphoproliferative disease (LPD). A bone marrow biopsy (BMB) revealed sarcoid-like epithelioid cell granulomas, excluding LPD. Sarcoidosis was assumed and corticosteroids were started. Although cytopenias were not present, the extensive ganglion, splenic and medullary involvement made LPD exclusion imperative, while BMB allowed for a definitive diagnosis. LEARNING POINTS Sarcoidosis is a multisystemic granulomatous disease in which medullary involvement is a rare extrapulmonary manifestation.Bone marrow biopsy is rarely performed based on serial blood counts, which may be associated with underdiagnosis.FDG-PET cannot reliably distinguish between sarcoidosis and lymphoproliferative disease as the cause of extensive ganglion, splenic and bone marrow involvement, and so a high index of clinical suspicion is required.
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Affiliation(s)
- Marta Brandão Calçada
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Sara Montezinho
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Andreia M Teixeira
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bruno Gomes
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
| | - Bernardo Macedo
- Internal Medicine Department, Centro Hospitalar de Entre o Douro e Vouga, Santa Maria da Feira, Portugal
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10
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Chen X, Wang J, Han WL, Zhao K, Chen Z, Zhou JY, Shen YH. Sarcoidosis mimicking metastases in an echinoderm microtubule-associated protein-like 4 anaplastic lymphoma kinase positive non-small-lung cancer patient: A case report. World J Clin Cases 2021; 9:3140-3146. [PMID: 33969101 PMCID: PMC8080747 DOI: 10.12998/wjcc.v9.i13.3140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/07/2021] [Accepted: 03/05/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Rearrangements of the anaplastic lymphoma kinase (ALK) gene (ALK-positive) represent an oncogenic driver in approximately 3%-5% of non-small-lung cancer (NSCLC) patients. Sarcoidosis is a multisystem disease, and its reported incidence in Asia is 1 or less per 100000 people per year. The co-occurrence of sarcoidosis and ALK-positive NSCLC is rare, and ALK-positive lung cancer is likely to spread quickly. Therefore, the co-occurrence of sarcoidosis is more easily misdiagnosed as metastatic lung cancer by radiological examination.
CASE SUMMARY A 50-year-old man had a nodule in the left superior lobe, many small nodules in left superior and right lungs, and enlarged bilateral hilar, mediastinal, and right supraclavicular lymph nodes. Computed tomography-guided pulmonary biopsy of the nodule in the left superior lobe revealed echinoderm microtubule-associated protein-like 4 gene-ALK positive NSCLC with concomitant noncaseating granuloma. This patient was treated with crizotinib. Thirty days later, a chest computed tomography scan revealed a dramatic decrease in the size of the left superior lobe nodule; however, the lesions in the right lung progressed. The right supraclavicular lymph nodes showed granulomas, and no tumor cells were identified in the specimens. The angiotensin-converting enzyme level was high. After 1 wk of methylprednisolone treatment, a significant response of all lesions was revealed. Following radical resection of the lung cancer, noncaseating granulomas were observed in both lung tissues and lymph nodes, which resulted in a diagnosis of echinoderm microtubule-associated protein-like 4-ALK positive NSCLC accompanied with sarcoidosis.
CONCLUSION Our experience illustrates that pathological evidence is needed to confirm metastatic disease, especially when some suspected metastatic lesions are negative for malignancy.
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Affiliation(s)
- Xi Chen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jie Wang
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Wei-Li Han
- Department of Lung Transplantation, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Kui Zhao
- Positron Emission Tomography Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Zhen Chen
- Department of Pathology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Jian-Ying Zhou
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
| | - Yi-Hong Shen
- Department of Respiratory Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
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11
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Koda E, Yamashiro T, Onoe R, Handa H, Azagami S, Matsushita S, Tomita H, Inoue T, Mineshita M. CT texture analysis of mediastinal lymphadenopathy: Combining with US-based elastographic parameter and discrimination between sarcoidosis and lymph node metastasis from small cell lung cancer. PLoS One 2020; 15:e0243181. [PMID: 33264372 PMCID: PMC7710054 DOI: 10.1371/journal.pone.0243181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To investigate the potential of computed tomography (CT)-based texture analysis and elastographic data provided by endobronchial ultrasonography (EBUS) for differentiating the mediastinal lymphadenopathy by sarcoidosis and small cell lung cancer (SCLC) metastasis. Methods Sixteen patients with sarcoidosis and 14 with SCLC were enrolled. On CT images showing the largest mediastinal lymph node, a fixed region of interest was drawn on the node, and texture features were automatically measured. Among the 30 patients, 19 (12 sarcoidosis and 7 SCLC) underwent endobronchial ultrasound transbronchial needle aspiration, and the fat-to-lesion strain ratio (FLR) was recorded. Texture features and FLRs were compared between the 2 patient groups. Logistic regression analysis was performed to evaluate the diagnostic accuracy of these measurements. Results Of the 31 texture features, the differences between 11 texture features of CT ROIs in the patients with sarcoidosis versus patients with SCLC were significant. Among them, the grey-level run length matrix with high gray-level run emphasis (GLRLM-HGRE) showed the greatest difference (P<0.01). Differences between FLRs were significant (P<0.05). Logistic regression analysis together with receiver operating characteristic curve analysis demonstrated that the FLR combined with the GLRLM-HGRE showed a high diagnostic accuracy (100% sensitivity, 92% specificity, 0.988 area under the curve) for discriminating between sarcoidosis and SCLC. Conclusion Texture analysis, particularly combined with the FLR, is useful for discriminating between mediastinal lymphadenopathy caused by sarcoidosis from that caused by metastasis from SCLC.
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Affiliation(s)
- Eriko Koda
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Tsuneo Yamashiro
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- Department of Diagnostic Radiology, Yokohama City University, Yokohama, Kanagawa, Japan
| | - Rintaro Onoe
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hiroshi Handa
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shinya Azagami
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Shoichiro Matsushita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Hayato Tomita
- Department of Radiology, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Takeo Inoue
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
| | - Masamichi Mineshita
- Division of Respiratory Medicine, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Kanagawa, Japan
- * E-mail:
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12
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Keijsers RG, Grutters JC. In Which Patients with Sarcoidosis Is FDG PET/CT Indicated? J Clin Med 2020; 9:E890. [PMID: 32213991 PMCID: PMC7141490 DOI: 10.3390/jcm9030890] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 03/13/2020] [Accepted: 03/20/2020] [Indexed: 12/19/2022] Open
Abstract
Sarcoidosis is a granulomatous disease of which the etiology remains unknown. The diverse clinical manifestations may challenge clinicians, particularly when conventional markers are inconclusive. From various studies, it has become clear that fluorodeoxyglucose (FDG) positron emission tomography (PET)/CT aids in sarcoidosis care. In this article, an update on FDG PET/CT in sarcoidosis is provided. The use of FDG PET/CT in the diagnostic process of sarcoidosis is explained, especially in determining treatable inflammatory lesions in symptomatic patients with indecisive conventional tests. Furthermore, FDG PET/CT for evaluating the potential benefit of additional inflammatory treatment is described and its use in cardiac sarcoidosis is highlighted.
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Affiliation(s)
- Ruth G.M. Keijsers
- Department of Nuclear Medicine, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Jan C. Grutters
- Interstitial Lung Diseases Center of Excellence, Department of Pulmonology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands;
- Division of Heart & Lungs, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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13
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Demaria L, Borie R, Benali K, Piekarski E, Goossens J, Palazzo E, Forien M, Dieudé P, Crestani B, Ottaviani S. 18F-FDG PET/CT in bone sarcoidosis: an observational study. Clin Rheumatol 2020; 39:2727-2734. [PMID: 32198555 DOI: 10.1007/s10067-020-05022-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/30/2020] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Bone sarcoidosis is usually rare. Imaging procedures such as fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) can reveal bone sarcoidosis with better sensitivity than conventional radiography. We aimed to describe bone sarcoidosis involvement detected with 18F-FDG PET/CT. METHODS This was an observational retrospective study of individuals with pulmonary sarcoidosis who underwent 18F-FDG PET/CT. According to the ATS/ERS/WASOG criteria, sarcoidosis was diagnosed by the presence of clinical and/or imaging features of sarcoidosis and evidence of non-caseating epithelioid granulomas on a biopsy. We assessed clinical and 18F-FDG PET/CT characteristics. RESULTS Data for 85 patients with sarcoidosis (56.5% female, median age 47 [range 21-80] years) were analyzed. The median follow-up was 4 years. Among 56 patients, sarcoidosis occurred in more than three organs. According to ATS/ERS/WASOG criteria, bone sarcoidosis was diagnosed in 12 (14%) patients. The spine was the most commonly affected location (92%, n = 11), followed by the pelvis (67%, n = 8), sternum (33%, n = 4), humerus (25%, n = 3), and fingers (17%, n = 2). Only peripheral adenopathy was associated with bone sarcoidosis (p = 0.04). Seven patients had a 18F-FDG PET/CT follow-up, all showing a decrease of bone lesions. CONCLUSION Bone sarcoidosis occurred in 14% of patients with sarcoidosis, affecting multiple bones and mostly the axial skeleton. 18F-FDG PET/CT seems a sensitive tool for diagnosis and follow-up of bone sarcoidosis.
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Affiliation(s)
- Lucie Demaria
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Raphael Borie
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Khadija Benali
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Médecine Nucléaire, Paris, France
| | - Eve Piekarski
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Médecine Nucléaire, Paris, France
| | - Julia Goossens
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Elisabeth Palazzo
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Marine Forien
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Philippe Dieudé
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France
| | - Bruno Crestani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Pneumologie, Paris, France
| | - Sébastien Ottaviani
- AP-HP, Hôpital Bichat-Claude Bernard, Service de Rhumatologie, 46 rue Henri Huchard, 75018, Paris, France.
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Potential of FDG-PET as Prognostic Significance after anti-PD-1 Antibody against Patients with Previously Treated Non-Small Cell Lung Cancer. J Clin Med 2020; 9:jcm9030725. [PMID: 32156047 PMCID: PMC7141299 DOI: 10.3390/jcm9030725] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/03/2020] [Accepted: 03/04/2020] [Indexed: 11/21/2022] Open
Abstract
It remains unclear whether the accumulation of 2-deoxy-2-[18F]fluoro-d-glucose (18F-FDG) before the initiation of anti-programmed death-1 (PD-1) antibody can predict the outcome after its treatment. The aim of this study is to retrospectively examine the prognostic significance of 18F-FDG uptake as a predictive marker of anti-PD-1 antibody. Eighty-five patients with previously treated non-small cell lung cancer (NSCLC) who underwent 18F-FDG-positron emission tomography (PET) just before administration of nivolumab or pembrolizumab monotherapy were eligible in our study, and metabolic tumor volume (MTV), total lesion glycolysis (TLG) and the maximum of standardized under value (SUVmax) on 18F-FDG uptake were assessed. Objective response rate, median progression-free survival and median overall survival were 36.6%, 161 days and 716 days, respectively. The frequency of any immune-related adverse events was significantly higher in patients with low 18F-FDG uptake on PET than in those with high uptake. By multivariate analysis, the tumor metabolic activity by TLG and MTV was identified as an independent prognostic factor for predicting outcome after anti-PD-1 antibody therapy, but not SUVmax, predominantly in patients with adenocarcinoma. Metabolic tumor indices as TLG and MTV on 18F-FDG uptake could predict the prognosis after anti-PD-1 antibodies in patients with previously treated NSCLC.
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15
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Multi-organ sarcoidosis like reaction mimics metastatic disease in a microsatellite instability-high melanoma patient treated with checkpoint inhibitors. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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16
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Shimizu K, Kaira K, Higuchi T, Hisada T, Yokobori T, Oyama T, Asao T, Tsushima Y, Shirabe K. Relationship Between Tumor Immune Markers and Fluorine-18-α-Methyltyrosine ([18F]FAMT) Uptake in Patients with Lung Cancer. Mol Imaging Biol 2019; 22:1078-1086. [PMID: 31792836 DOI: 10.1007/s11307-019-01456-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kimihiro Shimizu
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kyoichi Kaira
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan.
- Department of Innovative Immune-Oncology Therapeutics, Gunma University, Graduate School of Medicine, Showa-machi, Maebashi, Gunma, 371-8511, Japan.
- Department of Respiratory Medicine, Comprehensive Cancer Center, International Medical Center, Saitama University Hospital, 1397-1 Yamane, Hidaka-City, Saitama, 350-1298, Japan.
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takeshi Hisada
- Department of Respiratory Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takehiko Yokobori
- Department of Innovative Immune-Oncology Therapeutics, Gunma University, Graduate School of Medicine, Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tetsunari Oyama
- Department of Diagnostic Pathology, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advanced Research, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Ken Shirabe
- Department of General Surgical Science, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan
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17
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Sarcoid-like reaction associated with lung adenocarcinoma: A case report. PROCEEDINGS OF SINGAPORE HEALTHCARE 2019. [DOI: 10.1177/2010105818766363] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 71-year-old woman with a history of left lower lobe lobectomy 4 years ago for adenocarcinoma of the lung presented with new mediastinal and bilateral hilar lymphadenopathy on surveillance imaging, suspicious for disease recurrence. She underwent an endobronchial ultrasound-guided transbronchial needle aspiration of the lymph nodes and histology yielded non-necrotizing epithelioid granulomas with no evidence of malignancy. A diagnosis of sarcoid-like reaction associated with lung adenocarcinoma was made. The significance of this rare condition is discussed.
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18
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18F-FDG and 18F-FAMT PET-derived metabolic parameters predict outcome of oral squamous cell carcinoma. Oral Radiol 2019; 35:308-314. [PMID: 30778900 PMCID: PMC6685918 DOI: 10.1007/s11282-019-00377-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 12/11/2018] [Indexed: 01/23/2023]
Abstract
Objectives L-3-[18F]-Fluoro-α-methyl tyrosine (FAMT), an amino acid positron emission tomography (PET) tracer, complements [18F]-fluorodeoxyglucose (FDG) in the diagnosis of malignancies. We compared the predictive ability of FAMT PET versus FDG PET regarding metastatic oral squamous cell carcinoma (OSCC) outcomes for distant metastasis, including lymph node metastasis, and identified the relevant metabolic parameters for each. Methods We enrolled 160 patients with OSCC who underwent PET/computed tomography using FDG and FAMT before treatment. Outcomes were assessed using clinicopathological characteristics such as the standardized uptake value (SUVmax, SUVpeak), metabolic tumor volume (MTV), and total lesion glycolysis or total lesion retention. Univariate and multivariate Cox proportional hazards models were used to identify the independent predictors of disease-free survival (DFS) and overall survival (OS) during an average follow-up time of 1401.7 and 1646.0 days, respectively. Areas under the receiver operating characteristic curves were analyzed for the accuracy and predictive value of imaging parameters. Results Clinical parameters (excluding age) and PET metabolic parameters were significantly associated with OS. Multivariate analysis showed that an infiltrative growth pattern [p = 0.034, hazard ratio (HR) = 2.30], and the FDG-measured SUVpeak (p = 0.045, HR = 2.45) were independent risk factors for DFS and that lymph node metastasis (p = 0.03, HR = 2.57) and the FAMT-measured MTV (p = 0.004, HR = 3.65) were independent risk factors for OS. Conclusions In patients with OSCC, FDG PET predicted DFS, whereas FAMT predicted OS. The two PET tracers, combined with clinical parameters, provide complementary, outcome-related diagnostic information in OSCC.
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19
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Espejo AP, Ramdial JL, Wilky BA, Kerr DA, Trent JC. A nonrandom association of sarcoidosis in patients with gastrointestinal stromal tumor and other sarcomas. Rare Tumors 2018; 10:2036361318787626. [PMID: 30038741 PMCID: PMC6053863 DOI: 10.1177/2036361318787626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/15/2018] [Indexed: 01/15/2023] Open
Abstract
In patients with sarcoma, concomitant malignancy is found in 1.2% -2.5% of cases. Previous studies have demonstrated conflicting results in terms of positive or negative effects on cancer prognosis with comorbid sarcoidosis. Additionally, there are no data determining whether an association between sarcoidosis and sarcomas exists. Finding an association between the two entities could prevent inadvertent upstaging of a primary sarcoma based on pulmonary nodularity mistaken for metastatic disease. Here, we will describe eight sarcoma patients with concomitant occurrence of sarcoidosis identified since 2007. Eight patients with diagnosis of both sarcoma and sarcoidosis were identified over the period of 2007 -2016 at a single sarcoma center. Clinical and historical data including presentation, histology, treatment, and outcome was tabulated for analysis. The standardized incidence ratio was calculated for the state of Florida and our hospital catchment area. We compared the observed incidence to the expected incidence if the two entities were to be unrelated. Sarcoma subtype was gastrointestinal stromal tumor in five patients, the remaining three cases were unclassified spindled and epithelioid cell sarcoma, uterine leiomyosarcoma, and myxofibrosarcoma. Sarcoidosis was diagnosed before sarcoma in three patients, after sarcoma in four patients, and at the same time of sarcoma diagnosis in one patient. From our series, three patients have shown no progression of sarcoma, two are alive with sarcoma, two died due to progression of sarcoma, and one was lost to follow up. Statistical analyses showed a standardized incidence ratio of 305 (95% confidence interval: 131 -556) for the state of Florida and standardized incidence ratio of 950 (95% CI: 407 -1727) for our catchment area. This case series points to a statistically robust, nonrandom association between sarcoma and sarcoidosis that has not been previously described. Presumed metastatic sarcoma should be considered for biopsy particularly with demographic characteristics or imaging features suggestive of sarcoidosis.
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Affiliation(s)
- Andrea P Espejo
- Jackson Health System, Department of Internal Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jeremy L Ramdial
- Department of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Breelyn A Wilky
- Department of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.,Sarcoma Research Program, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Darcy A Kerr
- Department of Pathology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Jonathan C Trent
- Department of Hematology/Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.,Sarcoma Research Program, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
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20
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Esophageal cancer associated with a sarcoid-like reaction and systemic sarcoidosis in lymph nodes: supportive findings of [18F]-fluorodeoxyglucose positron emission tomography-computed tomography during neoadjuvant therapy. Surg Case Rep 2018; 4:62. [PMID: 29943286 PMCID: PMC6020089 DOI: 10.1186/s40792-018-0473-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 06/14/2018] [Indexed: 01/23/2023] Open
Abstract
Background In patients with esophageal cancer, differentiation between lymph node metastasis and lymphadenopathies from sarcoidosis or sarcoid-like reactions of lymph nodes is clinically important. Herein, we report two esophageal cancer cases with lymph node involvement of sarcoid-like reaction or sarcoidosis. Case presentation One patient received chemotherapy and the other chemoradiotherapy as initial treatments. In both cases, [18F]-fluorodeoxyglucose positron emission tomography–computed tomography (FDG-PET/CT) was performed before and after chemo(radio)therapy. After the treatment, FDG uptake was not detected in the primary tumor, but it was slightly reduced in the hilar and mediastinal lymph nodes in both cases. These non-identical responses to chemo(radio)therapy suggest the presence of sarcoid-like reaction of lymph nodes associated with squamous cell carcinoma of the esophagus. Curative surgical resection was performed as treatment. Conclusions These FDG-PET/CT findings may be helpful to distinguish between metastasis and sarcoidosis-associated lymphadenopathy in esophageal cancer.
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Achmad A, Bhattarai A, Yudistiro R, Heryanto YD, Higuchi T, Tsushima Y. The diagnostic performance of 18F-FAMT PET and 18F-FDG PET for malignancy detection: a meta-analysis. BMC Med Imaging 2017; 17:66. [PMID: 29281996 PMCID: PMC5745915 DOI: 10.1186/s12880-017-0237-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/13/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Arifudin Achmad
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan. .,Department of Nuclear Medicine and Molecular Imaging, Faculty of Medicine, Padjadjaran University, Jl. Professor Eyckman No.38, Bandung, West Java, 40161, Indonesia.
| | - Anu Bhattarai
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Ryan Yudistiro
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan.,Department of Nuclear Medicine, Mochtar Riady Comprehensive Cancer Center, Jl. Garnisun Dalam No. 2-3, Semanggi, Jakarta, 12930, Indonesia
| | - Yusri Dwi Heryanto
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Tetsuya Higuchi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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Metabolic activity by 18F-FDG-PET/CT is predictive of early response after nivolumab in previously treated NSCLC. Eur J Nucl Med Mol Imaging 2017; 45:56-66. [PMID: 28828507 DOI: 10.1007/s00259-017-3806-1] [Citation(s) in RCA: 139] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 08/07/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND Nivolumab, an anti-programmed death-1 (PD-1) antibody, is administered in patients with previously treated non-small cell lung cancer. However, little is known about the established biomarker predicting the efficacy of nivolumab. Here, we conducted a preliminary study to investigate whether 18F-FDG-PET/CT could predict the therapeutic response of nivolumab at the early phase. METHODS Twenty-four patients were enrolled in this study. 18F-FDG-PET/CT was carried out before and 1 month after nivolumab therapy. SUVmax, metabolic tumour volume (MTV), and total lesion glycolysis (TLG) were calculated. Immunohistochemical analysis of PD-L1 expression and tumour-infiltrating lymphocytes was conducted. RESULTS Among all patients, a partial metabolic response to nivolumab was observed in 29% on SUVmax, 25% on MTV, and 33% on TLG, whereas seven (29%) patients achieved a partial response (PR) based on RECIST v1.1. The predictive probability of PR (100% vs. 29%, p = 0.021) and progressive disease (100% vs. 22.2%, p = 0.002) at 1 month after nivolumab initiation was significantly higher in 18F-FDG on PET/CT than in CT scans. Multivariate analysis confirmed that 18F-FDG uptake after administration of nivolumab was an independent prognostic factor. PD-L1 expression and nivolumab plasma concentration could not precisely predict the early therapeutic efficacy of nivolumab. CONCLUSION Metabolic response by 18F-FDG was effective in predicting efficacy and survival at 1 month after nivolumab treatment.
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Ohshimo S, Guzman J, Costabel U, Bonella F. Differential diagnosis of granulomatous lung disease: clues and pitfalls. Eur Respir Rev 2017; 26:26/145/170012. [PMID: 28794143 PMCID: PMC9488688 DOI: 10.1183/16000617.0012-2017] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 05/25/2017] [Indexed: 01/11/2023] Open
Abstract
Granulomatous lung diseases are a heterogeneous group of disorders that have a wide spectrum of pathologies with variable clinical manifestations and outcomes. Precise clinical evaluation, laboratory testing, pulmonary function testing, radiological imaging including high-resolution computed tomography and often histopathological assessment contribute to make a confident diagnosis of granulomatous lung diseases. Differential diagnosis is challenging, and includes both infectious (mycobacteria and fungi) and noninfectious lung diseases (sarcoidosis, necrotising sarcoid granulomatosis, hypersensitivity pneumonitis, hot tub lung, berylliosis, granulomatosis with polyangiitis, eosinophilic granulomatosis with polyangiitis, rheumatoid nodules, talc granulomatosis, Langerhans cell histiocytosis and bronchocentric granulomatosis). Bronchoalveolar lavage, endobronchial ultrasound-guided transbronchial needle aspiration, transbronchial cryobiopsy, positron emission tomography and genetic evaluation are potential candidates to improve the diagnostic accuracy for granulomatous lung diseases. As granuloma alone is a nonspecific histopathological finding, the multidisciplinary approach is important for a confident diagnosis. A multidisciplinary approach is crucial for the accurate differential diagnosis of granulomatous lung diseaseshttp://ow.ly/FxsP30cebtf
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Iijima Y, Sugiyama Y, Sawahata M, Nakayama M, Bando M. Clinical Features of Pulmonary Sarcoidosis Complicated by Lung Cancer. Intern Med 2017; 56:1957-1960. [PMID: 28768963 PMCID: PMC5577069 DOI: 10.2169/internalmedicine.56.7047] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 11/23/2016] [Indexed: 11/06/2022] Open
Abstract
Objective For lung cancer complicated with sarcoidosis, there are no exact features that indicate whether lymphadenopathy is metastatic. This makes the validity of surgery uncertain for clinicians. The aim of this study was to clarify the clinical features of pulmonary sarcoidosis complicated by lung cancer, especially from the viewpoint of evaluating lymphadenopathy. Methods We retrospectively reviewed medical records from 2004 to 2013 at our institution, and 18 patients who were diagnosed with sarcoidosis and lung cancer were thus found to be eligible. We investigated the relationship between the clinical and pathological findings of their swollen lymph nodes. Results Of 18 patients, 11 conducted surgery, and the postoperative pathological evaluation of swollen lymph nodes was done in 8 of the patients. Postoperative N factor in all these patients was 0, even though lymphatic metastasis had been suspected preoperatively because of the unbalanced distribution of lymphadenopathy or the accumulation of fluorodeoxyglucose. Conclusion In patients with lung cancer complicated by sarcoidosis, the clinical assessment of the state of lymphadenopathy is difficult to make. However, as many of them tend to be benign, we suggest that surgical resection should be considered for a complete cure in the absence of any remote metastasis.
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Affiliation(s)
- Yuki Iijima
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Yukihiko Sugiyama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Michiru Sawahata
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Masayuki Nakayama
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Masashi Bando
- Division of Pulmonary Medicine, Department of Medicine, Jichi Medical University, Japan
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Vu K, Atkinson J, Ranganathan P. Bone Lesions, Lymphadenopathy, and Hepatic Granulomas in a Patient With Psoriasis. Arthritis Care Res (Hoboken) 2016; 68:394-9. [PMID: 25941093 DOI: 10.1002/acr.22607] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Revised: 03/30/2015] [Accepted: 04/28/2015] [Indexed: 12/26/2022]
Affiliation(s)
- Khoan Vu
- Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - John Atkinson
- Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Prabha Ranganathan
- Washington University in St. Louis School of Medicine, St. Louis, Missouri
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Abstract
INTRODUCTION Numerous biomarkers have been evaluated for the diagnosis, assessment of disease activity, prognosis, and response to treatment in sarcoidosis. In this report, we discuss the clinical and research utility of several biomarkers used to evaluate sarcoidosis. Areas covered: The sarcoidosis biomarkers discussed include serologic tests, imaging studies, identification of inflammatory cells and genetic analyses. Literature was obtained from medical databases including PubMed and Web of Science. Expert commentary: Most of the biomarkers examined in sarcoidosis are not adequately specific or sensitive to be used in isolation to make clinical decisions. However, several sarcoidosis biomarkers have an important role in the clinical management of sarcoidosis when they are coupled with clinical data including the results of other biomarkers.
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Affiliation(s)
- Amit Chopra
- a Division of Pulmonary and Critical Care Medicine , Albany Medical College , Albany , NY , USA
| | - Alexandros Kalkanis
- b Department of Medicine , Division of Pulmonary and Critical Care Medicine , Athens , Greece
| | - Marc A Judson
- a Division of Pulmonary and Critical Care Medicine , Albany Medical College , Albany , NY , USA
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Wei L, Tominaga H, Ohgaki R, Wiriyasermkul P, Hagiwara K, Okuda S, Kaira K, Oriuchi N, Nagamori S, Kanai Y. Specific transport of 3-fluoro-l-α-methyl-tyrosine by LAT1 explains its specificity to malignant tumors in imaging. Cancer Sci 2016; 107:347-52. [PMID: 26749017 PMCID: PMC4814262 DOI: 10.1111/cas.12878] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 12/27/2015] [Accepted: 01/02/2016] [Indexed: 12/13/2022] Open
Abstract
3‐18F‐l‐α‐methyl‐tyrosine ([18F]FAMT), a PET probe for tumor imaging, has advantages of high cancer‐specificity and lower physiologic background. FAMT‐PET has been proved useful in clinical studies for the prediction of prognosis, the assessment of therapy response and the differentiation of malignant tumors from inflammation and benign lesions. The tumor uptake of [18F]FAMT in PET is strongly correlated with the expression of L‐type amino acid transporter 1 (LAT1), an isoform of system L upregulated in cancers. In this study, to assess the transporter‐mediated mechanisms in FAMT uptake by tumors, we examined amino acid transporters for FAMT transport. We synthesized [14C]FAMT and measured its transport by human amino acid transporters expressed in Xenopus oocytes. The transport of FAMT was compared with that of l‐methionine, a well‐studied amino acid PET probe. The significance of LAT1 in FAMT uptake by tumor cells was confirmed by siRNA knockdown. Among amino acid transporters, [14C]FAMT was specifically transported by LAT1, whereas l‐[14C]methionine was taken up by most of the transporters. Km of LAT1‐mediated [14C]FAMT transport was 72.7 μM, similar to that for endogenous substrates. Knockdown of LAT1 resulted in the marked reduction of [14C]FAMT transport in HeLa S3 cells, confirming the contribution of LAT1 in FAMT uptake by tumor cells. FAMT is highly specific to cancer‐type amino acid transporter LAT1, which explains the cancer‐specific accumulation of [18F]FAMT in PET. This, vice versa, further supports the cancer‐specific expression of LAT1. This study has established FAMT as a LAT1‐specific molecular probe to monitor the expression of a potential tumor biomarker LAT1.
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Affiliation(s)
- Ling Wei
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hideyuki Tominaga
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Ryuichi Ohgaki
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Pattama Wiriyasermkul
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kohei Hagiwara
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Suguru Okuda
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Kyoichi Kaira
- Department of Oncology Clinical Development, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Noboru Oriuchi
- Advanced Clinical Research Center, Fukushima Medical University, Fukushima, Japan
| | - Shushi Nagamori
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yoshikatsu Kanai
- Department of Bio-system Pharmacology, Graduate School of Medicine, Osaka University, Suita, Japan
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Wei L, Tominaga H, Ohgaki R, Wiriyasermkul P, Hagiwara K, Okuda S, Kaira K, Kato Y, Oriuchi N, Nagamori S, Kanai Y. Transport of 3-fluoro-l-α-methyl-tyrosine (FAMT) by organic ion transporters explains renal background in [18F]FAMT positron emission tomography. J Pharmacol Sci 2016; 130:101-9. [DOI: 10.1016/j.jphs.2016.01.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Revised: 12/17/2015] [Accepted: 01/06/2016] [Indexed: 12/21/2022] Open
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Differentiation of sarcoidosis-lymphoma syndrome lesions: a case report on the use of two different positron emission tomography tracers. BMC Med Imaging 2016; 16:1. [PMID: 26746426 PMCID: PMC4706726 DOI: 10.1186/s12880-015-0104-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Sarcoidosis–lymphoma syndrome (SLS) is a rare disease in which both entities coexist. We aimed to study the role of 18F-fluorodeoxyglucose (FDG) and L–[3-18F] α-methyltyrosine (FAMT) positron emission tomography (PET)/computed tomography (CT) in differentiating between these two lesions. Case presentation A 54-year-old female with large liver tumors was referred to our Nuclear Medicine Department for staging using FDG PET/CT. She had a history of primary biliary cirrhosis (PBC) for 15 years and developed lung and mediastinal sarcoidosis 1 year before the liver tumors were noted. Abdominal dynamic CT revealed two well-circumscribed, peripherally-enhancing, low-density masses in the right lobe of the liver with intensive ring-form FDG uptakes at maximum standard uptake values (SUVmax) of 18.3 and 19.5, respectively. In the arterial phase, a hepatic artery was seen penetrating the tumor, a phenomenon known as “angiogram sign”. Chest PET/CT findings showed irregular thickening of the bronchovascular bundles, central peribronchial shaggy consolidations in the right middle and lower lobes (SUVmax, 4.6), and mediastinal and hilar lymphadenopathies (SUVmax, 2.7). After assessment, chemotherapy with rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and prednisone (R–CHOP) was administered for eight cycles. Follow-up imaging studies using FDG and FAMT PET/CT were performed 3 months after the last cycle of chemotherapy, which showed that the two highly FDG-avid tumors in the liver had disappeared. However, faint FDG uptake persisted in the lung consolidations (SUVmax, 6.3), and FDG uptake for the mediastinal lymphadenopathies increased (SUVmax of 5.8). In contrast, there was no significant uptake of FAMT in the liver, as well as in the lungs and the bilateral mediastinal lymphadenopathies. These discrepant uptakes between FDG and FAMT were compatible with sarcoidosis. Conclusion Combination of FDG and FAMT in PET/CT studies may play an important role in the management of SLS patients, especially in differentiating between sarcoidosis and lymphoma lesions.
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Abstract
Sarcoidosis is an inflammatory, systemic disease characterized by noncaseating granulomas. We describe a case of a 52-year-old female who presented with fevers, chills, night sweats, and weight loss of four months' duration. Lymphoma was suspected, and results of advanced imaging procedures were also consistent with lymphoma. However, mediastinal lymph-node biopsy, bone-marrow aspiration, and biopsy revealed noncaseating granulomas. She was diagnosed with sarcoidosis and had a positive therapeutic response to drug therapy. This case study illustrates that sarcoidosis can be a pitfall in 18-F-fluorodeoxyglucose (FDG) positron emission tomography (PET) imaging, which may lead to false-positive diagnosis of malignancy. PET-positive lesions do not always indicate malignancy, and histological confirmation of the lesions with biopsy should always be performed.
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Chalayer É, Bachy E, Occelli P, Weiler L, Faurie P, Ghesquieres H, Pavic M, Broussolle C, Sève P. Sarcoidosis and lymphoma: a comparative study. QJM 2015; 108:871-8. [PMID: 25660608 DOI: 10.1093/qjmed/hcv039] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Indexed: 11/13/2022] Open
Abstract
AIM To assess the clinical features and outcome of lymphoma when associated with sarcoidosis and to determine whether this association gives lymphoma a better prognosis. DESIGN Multicentre retrospective cohort study. METHODS Retrospective chart review. RESULTS Twenty-one patients were included (9 males, 12 females). Median age at sarcoidosis diagnosis was 48 years (range: 24-68 years). In 14 cases, lymphoma occurred within a previously known sarcoidosis. Five patients received a concomitant diagnosis of sarcoidosis and lymphoma, whereas lymphoma preceded sarcoidosis in two patients. Three patients were diagnosed with Hodgkin's lymphoma and 18 patients with non-Hodgkin's lymphoma (diffuse large B-cell lymphoma (DLBCL) (n = 11), follicular lymphoma (n = 2), chronic lymphocytic leukemia/small lymphocytic lymphoma (n = 2), anaplastic large cell lymphoma ALK + (n = 1), angioimmunoblastic T-cell lymphoma (n = 1) and T-cell prolymphocytic leukemia (n = 1)). Thirteen patients were alive and in complete remission. Median age at the time of diagnosis of sarcoidosis was lower in patients with concomitant lymphoma compared with patients with sarcoidosis preceding lymphoma (34 years vs. 51 years, P = 0.01). Patients presenting with DLBCL associated with sarcoidosis were compared with DLBCL without sarcoidosis. No statistical difference was found in the risk of death or progression between the two groups (P = 0.685). CONCLUSIONS We report here the largest series of lymphoma associated sarcoidosis patients. As opposed to previous studies, we observed a predominance of patients with DLBCL. Our study confirms the concept of the sarcoidosis-lymphoma syndrome. Large B-cell lymphoma does not have a better prognosis when associated with sarcoidosis.
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Affiliation(s)
- É Chalayer
- From the Service de Médecine Interne, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Etienne Cedex 2, France,
| | - E Bachy
- Service d'Hématologie, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - P Occelli
- Pôle Information Médicale Evaluation Recherche, Hospices Civils de Lyon, 162 Avenue Lacassagne, 69424 Lyon Cedex 3, France
| | - L Weiler
- Service de Dermatologie, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69495 Pierre Bénite, France
| | - P Faurie
- Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - H Ghesquieres
- Centre Léon Berard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - M Pavic
- Service d'Hémato-oncologie, Centre Hospitalier Universitaire de Sherbrooke, 3001, 12 Avenue Nord, Sherbooke QC J1H 5N4, Canada and
| | - C Broussolle
- Service de Médecine Interne, Groupement Hospitalier Nord, Hôpital de la Croix Rousse,103 Grande-Rue de la Croix-Rousse 69317 Lyon, France
| | - P Sève
- Service de Médecine Interne, Groupement Hospitalier Nord, Hôpital de la Croix Rousse,103 Grande-Rue de la Croix-Rousse 69317 Lyon, France
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Differentiation of malignant tumours from granulomas by using dynamic [(18)F]-fluoro-L-α-methyltyrosine positron emission tomography. EJNMMI Res 2015; 5:29. [PMID: 25977883 PMCID: PMC4420762 DOI: 10.1186/s13550-015-0109-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/18/2015] [Indexed: 01/26/2023] Open
Abstract
Background Previous clinical studies have revealed the potential of [18F]-fluoro-L-α-methyltyrosine (18F-FAMT) for the differential diagnosis of malignant tumours from sarcoidosis. However, one concern regarding the differential diagnosis with 18F-FAMT is the possibility of false negatives given the small absolute uptake of 18F-FAMT that has been observed in some malignant tumours. The aim of this study was to evaluate a usefulness of dynamic 18F-FAMT positron emission tomography (PET) for differentiating malignant tumours from granulomas. Methods Rats bearing both granulomas (Mycobacterium bovis bacillus Calmette-Guérin (BCG)-induced) and tumours (C6 glioma cell-induced) underwent dynamic 2-deoxy-2-[18F]-fluoro-D-glucose (18F-FDG) PET and 18F-FAMT PET for 120 min on consecutive days. Time-activity curves, static images, mean standardized uptake values (SUVs) and the SUV ratios (SUVRs; calculated by dividing SUV at each time point by that of 2 min after injection) were assessed. Results In tumours, 18F-FAMT showed a shoulder peak immediately after the initial distribution followed by gradual clearance compared with granulomas. Although the mean SUV in the tumours (1.00 ± 0.10) was significantly higher than that in the granulomas (0.88 ± 0.12), a large overlap was observed. In contrast, the SUVR was markedly higher in tumours than in granulomas (50 min/2 min, 0.72 ± 0.06 and 0.56 ± 0.05, respectively) with no overlap. The dynamic patterns, SUVR, and mean SUV of 18F-FDG in the granulomas were comparable to those in the tumours. Conclusions Dynamic 18F-FAMT and SUVR analysis might compensate for the current limitations and help in improving the diagnostic accuracy of 18F-FAMT.
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Affiliation(s)
- Zain S Gowani
- Vanderbilt Orthopaedic Oncology, 1215 21st Avenue South, Suite 4200, Medical Center East, South Tower, Nashville, TN 37232
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Burger IA, Zitzmann-Kolbe S, Pruim J, Friebe M, Graham K, Stephens A, Dinkelborg L, Kowal K, Schibli R, Luurtsema G, Maas B, Horn-Tutic M, Haerle SK, Wiegers J, Schaefer NG, Hany TF, von Schulthess GK. First clinical results of (D)-18F-Fluoromethyltyrosine (BAY 86-9596) PET/CT in patients with non-small cell lung cancer and head and neck squamous cell carcinoma. J Nucl Med 2014; 55:1778-85. [PMID: 25256060 DOI: 10.2967/jnumed.114.140699] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
UNLABELLED (D)-(18)F-fluoromethyltyrosine (d-(18)F-FMT), or BAY 86-9596, is a novel (18)F-labeled tyrosine derivative rapidly transported by the l-amino acid transporter (LAT-1), with a faster blood pool clearance than the corresponding l-isomer. The aim of this study was to demonstrate the feasibility of tumor detection in patients with non-small cell lung cancer (NSCLC) or head and neck squamous cell cancer (HNSCC) compared with inflammatory and physiologic tissues in direct comparison to (18)F-FDG. METHODS 18 patients with biopsy-proven NSCLC (n = 10) or HNSCC (n = 8) were included in this Institutional Review Board-approved, prospective multicenter study. All patients underwent (18)F-FDG PET/CT scans within 21 d before d-(18)F-FMT PET/CT. For all patients, safety and outcome data were assessed. RESULTS No adverse reactions were observed related to d-(18)F-FMT. Fifty-two lesions were (18)F-FDG-positive, and 42 of those were malignant (34 histologically proven and 8 with clinical reference). Thirty-two of the 42 malignant lesions were also d-(18)F-FMT-positive, and 10 lesions had no tracer uptake above the level of the blood pool. Overall there were 34 true-positive, 8 true-negative, 10 false-negative, and only 2 false-positive lesions for d-(18)F-FMT, whereas (18)F-FDG was true-positive in 42 lesions, with 10 false-positive and only 2 false-negative, resulting in a lesion-based detection rate for d-(18)F-FMT and (18)F-FDG of 77% and 95%, respectively, with an accuracy of 78% for both tracers. A high d-(18)F-FMT tumor-to-blood pool ratio had a negative correlation with overall survival (P = 0.050), whereas the (18)F-FDG tumor-to-blood pool ratio did not correlate with overall survival. CONCLUSION d-(18)F-FMT imaging in patients with NSCLC and HNSCC is safe and feasible. The presented preliminary results suggest a lower sensitivity but higher specificity for d-(18)F-FMT over (18)F-FDG, since there is no d-(18)F-FMT uptake in inflammation. This increased specificity may be particularly beneficial in areas with endemic granulomatous disease and may improve clinical management. Further clinical investigations are needed to determine its clinical value and relevance for the prediction of survival prognosis.
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Affiliation(s)
- Irene A Burger
- Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland
| | | | - Jan Pruim
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | | | | | | | | | | | - Roger Schibli
- Center for Radiopharmaceutical Sciences of ETH, PSI, and USZ, ETH Zurich, Zurich, Switzerland
| | - Gert Luurtsema
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Bram Maas
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Michaela Horn-Tutic
- Department of Thoracic Surgery, University Hospital of Zurich, Zurich, Switzerland
| | - Stephan K Haerle
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Bale, Bale, Switzerland
| | - Johan Wiegers
- Department of Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands
| | - Niklaus G Schaefer
- Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland Division of Medical Oncology, Department of Internal Medicine, University Hospital of Zurich, Zurich, Switzerland; and
| | | | - Gustav K von Schulthess
- Division of Nuclear Medicine, Department of Medical Radiology, University Hospital of Zurich, Zurich, Switzerland
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Abstract
Sarcoidosis is a chronic granulomatous disease of unknown origin. There are several modalities for diagnosis, staging and therapeutic management of patients with sarcoidosis. Among these, whole-body F-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography is found to useful in patients with complex and multisystem forms of sarcoidosis. Other modalities include Gallium scanning, assesment of angiotensin converting enzyme levels in blood, chest radiography, mediastinoscopy etcetera.
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Affiliation(s)
- Beth Vettiyil
- Radiology Research Fellow, Diagnostic Radiology, Massachusetts General Hospital, Boston 02114, USA
| | - Nikitha Gupta
- Department of Biology (Premed Student), New York University, New York 10012, USA
| | - Rajesh Kumar
- Department of Pharmacology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Treglia G, Annunziata S, Sobic-Saranovic D, Bertagna F, Caldarella C, Giovanella L. The role of 18F-FDG-PET and PET/CT in patients with sarcoidosis: an updated evidence-based review. Acad Radiol 2014; 21:675-84. [PMID: 24703482 DOI: 10.1016/j.acra.2014.01.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 01/12/2014] [Accepted: 01/12/2014] [Indexed: 10/25/2022]
Abstract
RATIONALE AND OBJECTIVES To provide an updated evidence-based review of the literature on the role of fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) or PET/computed tomography (PET/CT) in patients with sarcoidosis. MATERIALS AND METHODS A comprehensive literature search of PubMed/MEDLINE, Scopus, and Embase databases was conducted to find relevant published articles on FDG-PET or PET/CT in patients with sarcoidosis. Only those studies that satisfied all the following criteria were included: (1) FDG-PET or PET/CT performed in patients with histologically confirmed sarcoidosis, (2) sample size of at least 10 patients, and (3) whole-body PET studies performed. Information was collected concerning basic study, patient characteristics, and technical aspects. The main findings of the articles included have been described. RESULTS Reviewing titles and abstracts, 21 articles were selected. The role of FDG-PET or PET/CT was analyzed in assessing disease extent and activity and in treatment response evaluation. Comparison with other tracers had also been investigated. Recent studies evaluated the influence of these methods in the clinical management and their role as predictive tools in patients with sarcoidosis. CONCLUSIONS FDG-PET and PET/CT seem to be useful in staging, evaluating disease activity, and monitoring treatment response in patients with sarcoidosis. PET appears to have higher diagnostic accuracy compared to Gallium-67-citrate scintigraphy. Conversely, there is not enough evidence about the use of other PET tracers in patients with sarcoidosis. FDG-PET and PET/CT seem to have a role as predictive tools and may influence the clinical management in patients with sarcoidosis, but more studies are needed in this regard.
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Biological significance of fluorine-18-α-methyltyrosine (FAMT) uptake on PET in patients with oesophageal cancer. Br J Cancer 2014; 110:1985-91. [PMID: 24667647 PMCID: PMC3992502 DOI: 10.1038/bjc.2014.142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/12/2014] [Accepted: 02/24/2014] [Indexed: 02/06/2023] Open
Abstract
PURPOSE (18)F-FAMT as an amino-acid tracer for positron emission tomography (PET) is useful for detecting human neoplasms. (18)F-FAMT is accumulated in tumour cells solely via L-type amino-acid transporter 1 (LAT1). This study was conducted to investigate the biological significance of (18)F-FAMT uptake in patients with oesophageal cancer. METHODS From April 2008 to December 2011, 42 patients with oesophageal cancer underwent both (18)F-FAMT PET/CT and (18)F-FDG PET/CT before surgical treatment. The immunohistochemical analysis of LAT1, CD98, Ki-67, CD34, p53, p-Akt and p-mTOR was performed on the primary lesions. In vitro experiments were performed to examine the mechanism of (18)F-FAMT uptake. RESULTS High uptake of (18)F-FAMT was significantly associated with advanced stage, lymph node metastasis and the expression of LAT1, CD98, Ki-67 and CD34. LAT1 expression yielded a statistically significant correlation with CD98 expression, cell proliferation, angiogenesis and glucose metabolism. In vitro experiments revealed that (18)F-FAMT was specifically transported by LAT1. CONCLUSIONS The uptake of (18)F-FAMT within tumour cells is determined by the LAT1 expression and correlated with cell proliferation and angiogenesis in oesophageal cancer. The present experiments also confirmed the presence of LAT1 as an underlying mechanism of (18)F-FAMT accumulation.
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Pasquer A, Walter T, Poncet G, Hervieu V, Coopere B, Robert M. Metastatic distant lymph nodes in gastric adenocarcinoma should be determined before excluding curative treatment. Clin Res Hepatol Gastroenterol 2014; 38:e15-6. [PMID: 23796975 DOI: 10.1016/j.clinre.2013.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 05/22/2013] [Indexed: 02/04/2023]
Affiliation(s)
- Arnaud Pasquer
- Department of Visceral Surgery, hôpital Edouard-Herriot, Lyon, France.
| | - Thomas Walter
- Department of Digestive Oncology, hôpital Edouard-Herriot, Lyon, France
| | - Gilles Poncet
- Department of Visceral Surgery, hôpital Edouard-Herriot, Lyon, France
| | - Valérie Hervieu
- Department of Anatomopathology, hôpital Edouard-Herriot, Lyon, France
| | - Brigitte Coopere
- Department of Internal Medicine, hôpital Edouard-Herriot, Lyon, France
| | - Maud Robert
- Department of Visceral Surgery, hôpital Edouard-Herriot, Lyon, France
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Update on the use of PET radiopharmaceuticals in inflammatory disease. Rev Esp Med Nucl Imagen Mol 2013. [DOI: 10.1016/j.remnie.2013.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Gharavi MH, Wu HH, Toms SA. High fluorodeoxyglucose ((18)F)PET-uptake lymph nodes in a patient with chordoma: Tumor metastasis or sarcoidosis? AMERICAN JOURNAL OF CASE REPORTS 2013; 14:373-5. [PMID: 24086794 PMCID: PMC3783480 DOI: 10.12659/ajcr.889329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 05/17/2013] [Indexed: 02/02/2023]
Abstract
Patient: Male, 48 Final Diagnosis: Chordoma Symptoms: — Medication: — Clinical Procedure: — Specialty: Neurology
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Martínez-Rodríguez I, Carril JM. [Update on the use of PET radiopharmaceuticals in inflammatory disease]. Rev Esp Med Nucl Imagen Mol 2013; 32:378-86. [PMID: 24028819 DOI: 10.1016/j.remn.2013.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 07/04/2013] [Accepted: 07/06/2013] [Indexed: 10/26/2022]
Abstract
The use of molecular imaging with PET/CT technology using different radiotracers, especially the (18)F-FDG is currently spreading beyond the area of oncology, the most interest being placed on inflammatory and infectious diseases. This article presents a review of its contribution in different inflammatory conditions in the context of structural and conventional nuclear medicine imaging. Special emphasis is placed on the more significant diseases such as large-vessel vasculitis, sarcoidosis, rheumatoid arthritis and inflammatory bowel disease and the study of the atheroma plaque.
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Affiliation(s)
- I Martínez-Rodríguez
- Servicio de Medicina Nuclear, Hospital Universitario «Marqués de Valdecilla», Universidad de Cantabria, Santander, España.
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Nayak DK, Halder KK, Baishya R, Sen T, Mitra P, Debnath MC. Tricarbonyltechnetium(I) and tricarbonylrhenium(I) complexes of amino acids: crystal and molecular structure of a novel cyclic dimeric Re(CO)3-amino acid complex comprised of the OON donor atom set of the tridentate ligand. Dalton Trans 2013; 42:13565-75. [PMID: 23900487 DOI: 10.1039/c3dt50928a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Radiolabeled complexes of monoamino polycarboxylic, polyamino monocarboxylic and thiol containing amino acid ligands were prepared from a fac-[(99m)Tc(CO)3(H2O)3](+) precursor.The overall radiochemical yield was 94-98%. The complexes exhibited substantial in vitro and in vivo stability. The corresponding Re(I) complexes of the ligands DAPA, Asp and CysH were prepared and characterized by means of IR, NMR, and MS spectroscopic studies, as well as X-ray crystallography (for those containing D,L-DAPA and D,L-Asp). The rhenium complexes have been structurally correlated with the technetium complexes by means of HPLC studies. The reaction of Re(CO)5Cl with D,L-Asp in presence of triethylamine led to the formation of a new class of cyclic dimeric complexes formed by the OON donor atom set of the tridentate ligands. The amino carboxylate ligand system formed well defined complexes with a fac-[M(CO)3(H2O)3](+) core and shows good promise in (99m)Tc(CO)3 tracer development.
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Affiliation(s)
- Dipak Kumar Nayak
- Nuclear Medicine Division, Indian Institute of Chemical Biology (CSIR), 4, Raja S. C. Mullick Road, Jadavpur, Kolkata-700 032, India
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Diagnostic usefulness of an amino acid tracer, α-[N-methyl-(11)C]-methylaminoisobutyric acid ( (11)C-MeAIB), in the PET diagnosis of chest malignancies. Ann Nucl Med 2013; 27:808-21. [PMID: 23824782 PMCID: PMC3830191 DOI: 10.1007/s12149-013-0750-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 06/17/2013] [Indexed: 12/03/2022]
Abstract
Objectives Although positron emission tomography (PET) using [18F]-fluoro-2-deoxy-d-glucose (18F-FDG) is established as one of the first-choice imaging modalities in the diagnosis of chest malignancies, there are several problems to solve in clinical practice, such as false positive uptake in inflammatory diseases. The aim of this study was to evaluate the clinical usefulness of an amino acid tracer, α-[N-methyl-11C]-methylaminoisobutyric acid (11C-MeAIB), in the diagnosis of chest malignancies, in combination with 18F-FDG. Setting Fifty-nine cases (57 patients, 66 ± 12 years old) who consulted to our institution for the wish to receive differential diagnosis of chest diseases were included. Purpose of the studies were as follows: differential diagnosis of newly developed lung nodules, n = 22; newly developed mediastinal lesions, n = 20; and both, n = 17 (including lung cancer: n = 19, lymphoma: n = 1, other cancers: n = 2, sarcoidosis: n = 15, non-specific inflammation: n = 18, other inflammatory: n = 4, respectively). Whole-body static PET or PET/CT scan was performed 20 and 50 min after the IV injection of 11C-MeAIB and 18F-FDG, respectively. Results 11C-MeAIB uptake of malignant and benign lesions was statistically different both in pulmonary nodules (p < 0.005) and in mediastinal lesions (p < 0.0005). In visual differential diagnosis, 11C-MeAIB showed higher results (specificity: 73 %, accuracy: 81 %), compared to those in 18F-FDG (60, 73 %, respectively). In cases of sarcoidosis, 11C-MeAIB showed higher specificity (80 %) with lower uptake (1.8 ± 0.7) in contrast to the lower specificity (60 %) with higher uptake of 18F-FDG (7.3 ± 4.5). Conclusions 11C-MeAIB PET/CT was useful in the differential diagnosis of pulmonary and mediastinal mass lesions found on CT. 11C-MeAIB PET or PET/CT showed higher specificity than that of 18F-FDG PET/CT in differentiating between benign and malignant disease. Our data suggest that the combination of 18F-FDG and 11C-MeAIB may improve the evaluation of chest lesions, when CT and 18F-FDG PET/CT are equivocal.
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Nobusawa A, Kim M, Kaira K, Miyashita G, Negishi A, Oriuchi N, Higuchi T, Tsushima Y, Kanai Y, Yokoo S, Oyama T. Diagnostic usefulness of ¹⁸F-FAMT PET and L-type amino acid transporter 1 (LAT1) expression in oral squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2013; 40:1692-700. [PMID: 23801167 DOI: 10.1007/s00259-013-2477-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 06/03/2013] [Indexed: 02/01/2023]
Abstract
PURPOSE L-[3-(18)F]-α-Methyltyrosine ((18)F-FAMT) was developed as an amino acid tracer for PET imaging to provide better specificity than 2-[(18)F]fluoro-2-deoxy-D-glucose ((18)F-FDG) PET for cancer diagnosis. We investigated the diagnostic usefulness of (18)F-FAMT in oral squamous cell carcinoma (OSCC). The correlation between tumour uptake of (18)F-FAMT and L-type amino acid transporter 1 (LAT1) expression was determined. METHODS The study group comprised 68 OSCC patients who underwent both (18)F-FAMT and (18)F-FDG PET. Resected tumour sections were stained by immunohistochemistry for LAT1, CD98 and Ki-67, and microvessel density was determined in terms of CD34 and p53 expression. RESULTS The sensitivity of primary tumour detection by (18)F-FAMT and (18)F-FDG PET was 98 % and 100 %, respectively. The sensitivity, specificity and accuracy of (18)F-FAMT PET for detecting malignant lymph nodes were 68 %, 99 % and 97 %, respectively, and equivalent values for (18)F-FDG PET were 84 %, 94 % and 94 %, respectively. The specificity and accuracy of (18)F-FAMT were significantly higher than those of (18)F-FDG. The uptake of (18)F-FAMT was significantly correlated with LAT1 expression, cell proliferation and advanced stage. The expression of LAT1 in OSCC cells was closely correlated with CD98 levels, cell proliferation and angiogenesis. CONCLUSION (18)F-FAMT PET showed higher specificity for detecting malignant lesions than (18)F-FDG PET. The uptake of (18)F-FAMT by OSCC cells can be determined by the presence of LAT1 expression and tumour cell proliferation.
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Affiliation(s)
- Aiko Nobusawa
- Department of Stomatology and Maxillofacial Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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Caobelli F, Gabanelli SV, Brucato A, Pizzocaro C, Soffientini A, Giubbini R, Guerra UP. Unsuspected Active Sarcoidosis Diagnosed by 18F-FDG PET/CT During the Search for a Primary Tumour in a Patient with Bone Lesions. Nucl Med Mol Imaging 2013; 47:205-7. [PMID: 24900109 DOI: 10.1007/s13139-013-0203-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/21/2013] [Accepted: 04/01/2013] [Indexed: 11/29/2022] Open
Abstract
Sarcoidosis is a systemic chronic inflammatory disease of unknown aetiology, characterised by granulomatous lesions with heterogeneous clinical manifestations affecting multiple organs and tissues. Although the respiratory system is most commonly affected, the disease may also present with bone lesions. We report the case of a 31-year-old woman who presented with low back pain and no history of cancer and who was found to have suspicious lesions involving the entire spine on magnetic resonance imaging (MRI). The patient underwent 18F-fluorodeoxyglucose (FDG) PET/CT to search for a primary tumour and for staging purposes. 18F-FDG PET/CT revealed a pattern of hypermetabolic activity in widespread skeletal lesions and in a single left cervical lymph node. The primary tumour was not found, thus suggesting a haematologic disorder. Subsequent biopsies of a cervical lymph node and of bone tissue from L4 revealed active sarcoidosis with no evidence of cancer. This underlines the importance of considering all alternatives when hypermetabolic lesions are found on 18F-FDG PET/CT. Furthermore, 18F-FDG PET can be very useful to indicate accessible sites for guiding fine-needle aspiration cytology (FNAC).
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Affiliation(s)
- Federico Caobelli
- Department of Nuclear Medicine, Fondazione Poliambulanza, Via Bissolati 57, 25100 Brescia, Italy
| | | | - Antonio Brucato
- Department of Internal Medicine, Ospedali Riuniti, Bergamo, Italy
| | - Claudio Pizzocaro
- Department of Nuclear Medicine, Fondazione Poliambulanza, Via Bissolati 57, 25100 Brescia, Italy
| | - Alberto Soffientini
- Department of Nuclear Medicine, Fondazione Poliambulanza, Via Bissolati 57, 25100 Brescia, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia, Brescia, Italy
| | - Ugo Paolo Guerra
- Department of Nuclear Medicine, Fondazione Poliambulanza, Via Bissolati 57, 25100 Brescia, Italy
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Inoue K, Goto R, Shimomura H, Fukuda H. FDG-PET/CT of sarcoidosis and sarcoid reactions following antineoplastic treatment. SPRINGERPLUS 2013; 2:113. [PMID: 23543853 PMCID: PMC3610027 DOI: 10.1186/2193-1801-2-113] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022]
Abstract
Sarcoidosis or sarcoid reactions, which appear as FDG-avid lesions in oncologic patients, need to be differentiated from disseminated malignancies. We aimed to promote awareness of development of sarcoidosis or sarcoid reactions after antineoplastic therapy to avoid diagnostic errors with FDG-PET/CT findings and assess the utility of FDG-PET/CT for follow-up. We retrospectively reviewed radiological reports of FDG-PET/CT scans performed between January 2009 and December 2011. Among oncologic patients with more than 2 FDG-PET/CT scans, those with nearly symmetrical increases in FDG uptake in the hilar or mediastinal lymph nodes were identified, and those with known sarcoidosis, concurrent diagnoses of sarcoidosis with malignancy, or histopathologically proven malignancies were excluded. Then, only those cases were selected for which sarcoidosis or sarcoid reactions were diagnosed. Four of 376 oncologic cases met the criteria. At 9 months to 6 years after antineoplastic therapy, abnormal FDG uptakes were observed in the hilar, mediastinal, abdominal, pelvic, and inguinal nodes, and/or spleen and lung parenchyma with SUVmax up to 17.7. On the basis of these findings, 1 patient received anticancer chemotherapy because of tumor recurrence suspicion. A gradual decrease in FDG uptake was observed on subsequent PET/CT scans. Sarcoidosis or sarcoid reactions should be considered in differential diagnosis of oncologic patients who have developed FDG-avid lesions any time after antineoplastic therapy. FDG-PET/CT can be used for follow-up in nondiagnostic situations to detect decreases in FDG uptake due to presence of sarcoidal granulomas.
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Affiliation(s)
- Kentaro Inoue
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ward, Sendai, 980-8575 Japan
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Sarcoïdose vertébrale. Évolution spontanément favorable : une observation et revue de la littérature. Rev Med Interne 2013; 34:42-6. [DOI: 10.1016/j.revmed.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/22/2012] [Accepted: 09/02/2012] [Indexed: 11/20/2022]
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Isoda A, Higuchi T, Nakano S, Arisaka Y, Kaira K, Kamio T, Mawatari M, Matsumoto M, Sawamura M, Tsushima Y. ¹⁸F-FAMT in patients with multiple myeloma: clinical utility compared to ¹⁸F-FDG. Ann Nucl Med 2012; 26:811-6. [PMID: 22903817 DOI: 10.1007/s12149-012-0645-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 07/29/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE L-[3-(18)F]-alpha-methyltyrosine ((18)F-FAMT) is an amino-acid tracer for positron emission tomography (PET), with uptake related to overexpression of L-type amino-acid transporter 1 and proliferative activity in tumour cells. This study evaluated the diagnostic performance of (18)F-FAMT PET compared with 2-[(18)F]-fluoro-2-deoxy-D-glucose ((18)F-FDG) PET in patients with multiple myeloma (MM). METHODS Eleven patients with MM (newly diagnosed, n = 3; relapsed after treatment, n = 8) underwent whole-body (18)F-FAMT and (18)F-FDG PET within a 2-week interval. Magnetic resonance imaging (MRI) of the spine was also performed to assess patterns of bone marrow infiltration. Tracer uptake was semi-quantitatively evaluated using maximal standardized uptake value (SUV(max)). Mean SUV was also determined for normal bone marrow and the aortic arch as mediastinal background SUV to calculate lesion-to-bone marrow (L/B) and lesion-to-mediastinum (L/M) ratios, respectively. Those values were statistically compared using Student's t test. RESULTS In 8 patients showing focal infiltration on MRI, 34 FDG-avid bone lesions were identified, with each showing increased FAMT uptake. Mean SUV(max) and L/B ratio of FDG (3.1 ± 1.2 and 3.3 ± 1.9, respectively) were significantly higher than those of FAMT (2.0 ± 1.0 and 2.6 ± 1.1, respectively; p < 0.05 each). In contrast, the L/M ratio of FDG showed no significant difference to that of FAMT (2.2 ± 1.0 and 2.4 ± 1.2, respectively; p = 0.3). CONCLUSIONS Clear (18)F-FAMT PET uptake was seen in most (18)F-FDG-avid lesions among patients with MM, and an equivalent semi-quantitative value was obtained using L/M ratio. Our preliminary data suggest that (18)F-FAMT PET provides a useful imaging modality for detecting active myelomatous lesions.
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Affiliation(s)
- Atsushi Isoda
- Department of Hematology, National Hospital Organization Nishigunma National Hospital, 2854, Kanai, Shibukawa, Gunma 377-8511, Japan.
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Taralli S, Treglia G, Giordano A. Ruolo emergente nella pratica clinica della PET con 18F-FDG nei pazienti con sarcoidosi. ITALIAN JOURNAL OF MEDICINE 2012. [DOI: 10.1016/j.itjm.2011.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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