Dose-escalation, tolerability, and efficacy of intratumoral and subcutaneous injection of hemagglutinating virus of Japan envelope (HVJ-E) against chemotherapy-resistant malignant pleural mesothelioma: a clinical trial

The hemagglutinating virus of Japan envelope (HVJ-E) is an inactivated Sendai virus particle with antitumor effect and inducing antitumor immunity. However, its dosage and efficacy have not been verified. We conducted a phase I clinical study on chemotherapy-resistant malignant pleural mesothelioma (MPM) aiming to determine the recommended dosage for a phase II study through dose-limiting toxicity and evaluate HVJ-E's preliminary efficacy. HVJ-E was administered intratumorally and subcutaneously to the patients with chemotherapy-resistant MPM. While no serious adverse events occurred, known adverse events of HVJ-E were observed. In the preliminary antitumor efficacy using modified response evaluation criteria in solid tumors (RECIST) criteria, three low-dose patients exhibited progressive disease, while all high-dose patients achieved stable disease, yielding disease control rates (DCRs) of 0% and 100%, respectively. Furthermore, the dose-dependent effect of HVJ-E revealed on DCR modified by RECIST and the baseline changes in target lesion size (by CT and SUL-peak; p < 0.05). Comparing targeted lesions receiving intratumoral HVJ-E with non-injected ones, while no clear difference existed at the end of the study, follow-up cases suggested stronger antitumor effects with intratumoral administration. Our findings suggest that HVJ-E could be safely administered to patients with chemotherapy-resistant MPM at both study doses. HVJ-E exhibited some antitumor activity against chemotherapy-resistant MPM, and higher doses tended to have stronger antitumor effects than lower doses. Consequently, a phase II clinical trial with higher HVJ-E doses has been conducted for MPM treatment. Trial registration number: UMIN Clinical Trials Registry (#UMIN000019345).

"Diffuse Hot Pleura" in a Case of Recurrent Squamous Cell Carcinoma of the Foot: 18 F-FDG PET/CT Findings

ABSTRACT

Cutaneous squamous cell carcinoma (cSCC) is the second most common nonmelanoma skin cancer. Unlike basal cell carcinoma, regional lymph nodal metastases and subsequent distant site metastases are more common. Up to approximately 2% to 5% of cSCCs can result in distant metastases. Prognosis is dismal, and median survival is distinctly shortened in case of distant metastatic disease. Diffuse pleural metastases with distinctive overarching unilateral involvement are uncommon. Cutaneous SCC commonly metastasizes to lymph nodes, lungs, liver, bones, and skin. Diffuse unilateral pleural metastasis of cSCC of the foot is extremely rare. We report the case of a 54-year-old man with recurrent cSCC. On follow up restaging, 18 F-FDG PET/CT revealed diffuse nodular bipleural (visceral and parietal) hypermetabolic right pleural thickening, which was later biopsied and turned out to be diffuse pleural metastases from cSCC giving appearance of "hot pleura."

Endobronchial solitary fibrous tumors: An enigma for diagnosis

Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms constituting less than 2% of all soft tissue tumors. They typically originate in the thoracic cavity, mainly in the pleura, but can also occur in other various sites such as lung parenchyma, pericardium, and bronchus. In this study, a 49-year-old non-smoking female with a history of allergies presented to our pulmonary clinic with a chronic cough. An explorative bronchoscopy revealed an intrabronchial mass in the left superior bronchi, and a 68 Ga-DOTATOC positron emission computed tomography suggested a carcinoid tumor. Subsequent pulmonary segmentectomy unveiled a well-circumscribed polypoid lesion diagnosed as a low-grade bronchus SFT through histopathological and immunohistochemical assessments. The patient was asymptomatic after surgical excision and showed no other lesion during the 6-month follow-up. The endobronchial location of SFT is uncommon, with only a few reported cases in the literature, underscoring the necessity of considering various differential diagnoses, including carcinoid, mucoepidermoid carcinoma, endobronchial pleomorphic adenoma, hamartoma, leiomyoma, and metastasis, depending on location and imaging features. This report underscores the importance of careful histological and immunohistochemical evaluation in understanding and appropriately stratifying the risk associated with polypoid lesions.

Malignant pleural disease

Malignant pleural disease represents a growing healthcare burden. Malignant pleural effusion affects approximately 1 million people globally per year, causes disabling breathlessness and indicates a shortened life expectancy. Timely diagnosis is imperative to relieve symptoms and optimise quality of life, and should give consideration to individual patient factors. This review aims to provide an overview of epidemiology, pathogenesis and suggested diagnostic pathways in malignant pleural disease, to outline management options for malignant pleural effusion and malignant pleural mesothelioma, highlighting the need for a holistic approach, and to discuss potential challenges including non-expandable lung and septated effusions.

FDG PET/CT in a Case of Thoracic SMARCA4-Deficient Undifferentiated Tumor

ABSTRACT

Thoracic SMARCA4-deficient undifferentiated tumor is a rare, newly recognized poorly differentiated tumor with poor prognosis. FDG PET/CT findings of thoracic SMARCA4-deficient undifferentiated tumor are rarely reported. We describe FDG PET/CT findings in a case of thoracic SMARCA4-deficient undifferentiated tumor. The tumor presented as a pleural mass, destroyed the adjacent ribs, and showed intense FDG uptake with SUV max of 12.7. This case indicates that thoracic SMARCA4-deficient undifferentiated tumor should be included in the differential diagnosis of FDG-avid pleural lesions.

The efficacy of 18F-FDG PET/CT in monitoring disease progression in malignant pleural mesothelioma

OBJECTIVE

In the event of suspicion of malignant pleural mesothelioma (MPM) progression, imaging plays an important role. We aimed to evaluate the efficacy of ¹⁸F-FDG PET/CT in monitoring disease progression by comparing it with CT, and estimate median overall survival (OS) according to progression status with CT and ¹⁸F-FDG PET/CT.

MATERIALS AND METHODS

This was an observational, retrospective, single-institution study with MPM patients who had both ¹⁸F-FDG PET/CT and CT for monitoring disease progression from March 2009 to February 2020. Clinical features, radiological findings, and progression status according to CT [radiologic progression negative (RPN), radiologic progression positive (RPP)] and ¹⁸F-FDG PET/CT [metabolic progression negative (MPN), metabolic progression positive (MPP)] were recorded. The discrepancies and concordance between two methods were evaluated. The OS was estimated using the Kaplan-Meier method.

RESULTS

A total of 56 patients were included. There were thirty-one (55.3%) RPN and 25 (44.7%) RPP, while there were 26 (46.5%) MPN and 30 (53.5%) MPP. All RPP patients were also found to be MPP, however, among RPN, 5 patients (8.9% of all patients) were evaluated as MPP. The concordance between two methods in monitoring disease progression was very good (K = 0.423; p < 0.01). The OS was 26 ± 2.6 months in all patients. Kaplan-Meier curves between RPN and RPP, and between MPN and MPP did not show statistically significant differences (p = 0.56 and p = 0.25, respectively).

CONCLUSIONS

Both methods are equally acceptable in monitoring disease progression in MPM, even though ¹⁸F-FDG PET/CT detected more progression than CT did.

Utility of high-frequency B-mode and contrast-enhanced ultrasound for the differential diagnosis of benign and malignant pleural diseases: a prospective study

BACKGROUND

Pleural disease is a prevalent condition. As precision therapy advances, noninvasive imaging modalities play even more important roles in the evaluation of pleural diseases. This study investigated the diagnostic capabilities of high-frequency B-mode ultrasound (US) and contrast-enhanced US (CEUS) in terms of differentiating between benign and malignant pleural diseases.

METHODS

Patients with unexplained thickened pleurae were prospectively analyzed via transthoracic US. High-frequency B-mode US was used to derive the pleural thickness, morphology, and echogenicity. We analyzed the high-frequency CEUS data including the enhancement mode and time intensity curve (TIC). The cause of pleural thickening was confirmed by pleural biopsy and follow-up after the biopsy. We analyzed the differences in various ultrasonic features between the malignant and benign groups. Moreover, we plotted receiver operator curves (ROCs) and obtained the area under the curves, sensitivities, and specificities of all significant continuous variables. Multivariate logistic regression was used to assess the combined usefulness of multiple US indicators in terms of predicting malignant pleurae.

RESULTS

Thirty malignant and twenty benign thickened pleurae were finally diagnosed via pleural biopsy and at least six months of follow-up. The pleural morphology and enhancement modes significantly differed between the two groups (all P<0.05). The thickness derived from B-mode US and CEUS were significantly thicker in the malignant group (both P<0.05). Arrival time (AT) and the time to peak (TTP) of TIC were significantly shorter in the malignant group, whereas peak intensity and the area under the TIC were significantly higher in the malignant group (all P<0.05). The area under the ROC for pleural thickness derived from B-mode US was 0.819; pleural thickness derived from CEUS was 0.848; AT was 0.804; TTP was 0.750; peak intensity was 0.745; the area under the TIC was 0.743; and the combined various B-mode and CEUS parameter was 0.975.

CONCLUSIONS

Pleural thickness, morphology, enhancement mode, and the TIC of high-frequency US aided the differentiation of benign from malignant pleural diseases. Combined analysis of US indicators further improved the diagnostic capability.

Clinical Utility of F-18 Labeled Fibroblast Activation Protein Inhibitor (FAPI) for Primary Staging in Lung Adenocarcinoma: a Prospective Study

PURPOSE

The purpose of this study was to compare the primary staging of F-18 labeled fibroblast activation protein inhibitor ([18F]F-FAPI) with that of F-18 labeled fluordesoxyglucose positron emission tomography/computed tomography ([18F]F-FDG PET/CT) in patients with lung adenocarcinoma (LAD).

PROCEDURES

We prospectively analyzed the images of LAD patients who underwent [18F]F-FAPI and [18F]F-FDG PET/CT between May 2020 and August 2021. [18F]F-FAPI and [18F]F-FDG uptakes were compared using the paired samples t test, and lesion numbers were compared using the Wilcoxon signed-rank test.

RESULTS

Thirty-four LAD patients were evaluated. Patients showed high [18F]F-FAPI uptake in primary lesions (SUVmax 12.54 ± 3.77). Both [18F]F-FAPI and [18F]F-FDG had 100% detection rates for primary tumors. However, [18F]F-FAPI showed higher SUVmax than [18F]F-FDG in lesions of the lymph nodes, pleura, bones, and other tissues (all P ≤ 0.05). Although the absolute uptake values of [18F]F-FAPI in brain lesions were lower than those of [18F]F-FDG (1.56 ± 2.19 vs.7.34 ± 3.54, P < 0.0001), the tumor-to-background (T/B) ratios were significantly higher than those of [18F]F-FDG (9.53 ± 12.07 vs.1.01 ± 0.49, P < 0.0001). Generally, [18F]F-FAPI PET/CT could visualize more total lesions than [18F]F-FDG (554 vs.464, P = 0.003), especially in lymph nodes (258 vs.229, P = 0.039), the brain (34 vs.9, P = 0.002), and pleura (56 vs.30, P = 0.041). However, contrast-enhanced brain magnetic-resonance imaging (MRI) showed more brain lesions than [18F]F-FAPI PET/CT (56 vs.34, P = 0.002). Compared with the [18F]F-FDG-based TNM stage, the [18F]F-FAPI-based TNM stage was upgraded in six patients (17.6%).

CONCLUSIONS

[18F]F-FAPI PET/CT showed a very high detection rate for primary LAD. In addition, 18F-FAPI PET/CT demonstrated clearer tumor delineation and more lesions than [18F]F-FDG PET/CT, especially in lymph nodes, the brain, and pleura. Therefore, [18F]F-FAPI had an advantage over [18F]F-FDG for primary staging of LAD. However, brain MRI could identify more and smaller lesions than [18F]F-FAPI PET/CT.

Diffuse Large B-cell Lymphoma Presenting as a Primary Pleural Mass: A Case Report and Literature Review

Primary pleural lymphoma is a rare type of lymphoma that accounts for only ​​0.3% of all non-Hodgkin's lymphomas. The rarity and nonspecific clinical presentation of primary pleural lymphomas pose a diagnostic challenge for clinicians. We present an atypical case of primary pleural lymphoma in an elderly patient without any associated pleuro-pulmonary disease, immunosuppression, or history of lymphoma. To our knowledge, this is one of the first described cases of a primary pleural lymphoma with such a presentation.

Image-guided interventional radiological delivery of chimeric antigen receptor (CAR) T cells for pleural malignancies in a phase I/II clinical trial

OBJECTIVES

We describe techniques and results of image-guided delivery of mesothelin-targeted chimeric antigen receptor (CAR) T cells in patients with pleural malignancies in a phase I/II trial (ClinicalTrials.gov: NCT02414269).

MATERIALS AND METHODS

Patients without a pleural catheter or who lack effusion for insertion of a catheter (31 of 41) were administered intrapleural CAR T cells by interventional radiologists under image guidance by computed tomography or ultrasound. CAR T cells were administered through a needle in an accessible pleural loculation (intracavitary) or following an induced loculated artificial pneumothorax. In patients where intracavitary infusion was not feasible, CAR T cells were injected via percutaneous approach either surrounding and/or in the pleural nodule/thickening (intratumoral). Pre- and post-procedural clinical, laboratory, and imaging findings were assessed.

RESULTS

CAR T cells were administered intrapleurally in 31 patients (33 procedures, 2 patients were administered a second dose) with successful delivery of planned dose (10-186 mL); 14/33 (42%) intracavitary and 19/33 (58%) intratumoral. All procedures were completed within 2 h of T-cell thawing. There were no procedure-related adverse events greater than grade 1 (1 in 3 patients had prior ipsilateral pleural fusion procedures). The most common imaging finding was ground glass opacities with interlobular septal thickening and/or consolidation, observed in 12/33 (36%) procedures. There was no difference in the incidence of fever, CRP, IL-6, and peak vector copy number in the peripheral blood between infusion methods.

CONCLUSION

Image-guided intrapleural delivery of CAR T cells using intracavitary or intratumoral routes is feasible, repeatable and safe across anatomically variable pleural cancers.

The Prognostic Value of 18F-FDG PET Imaging at Staging in Patients with Malignant Pleural Mesothelioma: A Literature Review

Malignant pleural mesothelioma (MPM) is an aggressive malignancy, frequently diagnosed at locally-advanced/metastatic stages. Due to a very poor prognosis and limited treatment options, the need to identify new prognostic markers represents a great clinical challenge. The prognostic role of metabolic information derived from Positron Emission Tomography (PET) with ¹⁸F-Fluoro-deoxy-glucose (¹⁸F-FDG) has been investigated in different MPM settings, however with no definitive consensus. In this comprehensive review, the prognostic value of FDG-PET imaging exclusively performed at staging in MPM patients was evaluated, conducting a literature search on PubMed/MEDLINE from 2010 to 2020. From the 19 selected studies, despite heterogeneity in several aspects, staging FDG-PET imaging emerges as a valuable prognostic biomarker, with higher tumor uptake predictive of worse prognosis, and with volumetric metabolic parameters like Metabolic Tumor Volume, (MTV) and Total Lesion Glycolisis (TLG) performing better than SUVmax. However, PET uptake parameters were not always confirmed as independent prognostic factors, especially in patients previously treated with pleurodesis and with a non-epithelioid histotype. Future prospective studies in larger and clinically homogeneous populations, and using more standardized methods of PET images analysis, are needed to further validate the value of staging FDG-PET in the prognostic MPM stratification, with a potential impact on better patient-tailored treatment planning, in the perspective of personalized medicine.

Solitary fibrous tumors: Clinical and imaging features from head to toe

Solitary fibrous tumors (SFTs) are rare fibroblastic mesenchymal tumors that are usually benign with variable malignant potential. They can develop in any organ due to their spindle cell origin. The exact etiology of solitary fibrous tumors is unknown. The majority of SFTs are benign with 10-30% of them exhibiting aggressive and malignant features. The aggressiveness of this type of tumor is not associated with its histological features, which makes surgical resection the treatment of choice. We will review the clinical and radiological features and possible differential diagnoses of SFTs according to their anatomical sites following the World Health Organization 2020 classification.

Added value of diffusion-weighted MRI in assessment of pleural lesions

Background

There are many causes of pleural disease including variable benign and malignant etiologies. DWI is a non-enhanced functional MRI technique that allows qualitative and quantitative characterization of tissues based on their water molecules diffusivity. The aim of this study was to evaluate the diagnostic value of DWI-MRI in detection and characterization of pleural diseases and its capability in differentiating benign from malignant pleural lesions.

Results

Conventional MRI was able to discriminate benign from malignant lesions by using morphological features (contour and thickness) with sensitivity 89.29%, specificity 76%, positive predictive value 89%, negative predictive value 76.92%, and accuracy 85.37%. ADC value as a quantitative parameter of DWI found that ADC values of malignant pleural diseases were significantly lower than that of benign lesions (P < 0.001). Hence, we discovered that using ADC mean value of 1.68 × 10-3 mm2/s as a cutoff value can differentiate malignant from benign pleural diseases with sensitivity 89.3%, specificity 100%, positive predictive value 100%, negative predictive value 81.2%, and accuracy 92.68% (P < 0.001).

Conclusion

Although DWI-MRI is unable to differentiate between malignant and benign pleural effusion, its combined morphological and functional information provide valid non-invasive method to accurately characterize pleural soft tissue diseases differentiating benign from malignant lesions with higher specificity and accuracy than conventional MRI.

Epidemiology and Clinical Aspects of Malignant Pleural Mesothelioma

Mesothelioma is a cancer predominantly of the pleural cavity. There is a clear association of exposure to asbestos with a dose dependent risk of mesothelioma. The incidence of mesothelioma in different countries reflect the historical patterns of commercial asbestos utilisation in the last century and predominant occupational exposures mean that mesothelioma is mostly seen in males. Modern imaging techniques and advances in immunohistochemical staining have contributed to an improved diagnosis of mesothelioma. There have also been recent advances in immune checkpoint inhibition, however, mesothelioma remains very challenging to manage, especially considering its limited response to conventional systemic anticancer therapy and that no cure exists. Palliative interventions and support remain paramount with a median survival of 9-12 months after diagnosis. The epidemiology and diagnosis of mesothelioma has been debated over previous decades, due to a number of factors, such as the long latent period following asbestos exposure and disease occurrence, the different potencies of the various forms of asbestos used commercially, the occurrence of mesothelioma in the peritoneal cavity and its heterogeneous pathological and cytological appearances. This review will describe the contemporary knowledge on the epidemiology of mesothelioma and provide an overview of the best clinical practice including diagnostic approaches and management.

"Multimodality imaging of the extrapleural space lesions"

Extrapleural space (EPS) is a potential space between the outer layer of the parietal pleura and the inner layer of the chest wall and the diaphragm. Many different pathologies including chronic inflammatory conditions, infections, trauma, neoplastic disease (both benign and malignant) as well as many infiltrative disorders can involve the EPS. It is one of the frequently overlooked entity on imaging due to relative lack of understanding of the anatomy and the imaging appearances of the diseases localized to this space. The knowledge of the EPS is essential for the radiologists as the pathologies which involve the EPS may require different treatment approach compared to pleural or parenchymal lung disease. Additionally, the EPS involvement may influence the staging and treatment planning for chest malignancies. In this review, we give an overview of the anatomy and various pathologies involving EPS, utility of different imaging modalities in the evaluation of EPS lesions with emphasis on cross sectional imaging and emerging technologies like spectral CT and its role in recognizing the imaging features which enable specific diagnosis of various pathologies.

Malignant Pleural Effusion: From Diagnostics to Therapeutics

Malignant pleural effusion is a common complication of cancer and denotes a poor prognosis. It usually presents with dyspnea and a unilateral large pleural effusion. Thoracic computed tomography scans and ultrasound are helpful in distinguishing malignant from benign effusions. Pleural fluid cytology is diagnostic in about 60% of cases. In cytology-negative disease, pleural biopsies are helpful. Current management is palliative. Previously, first-line treatment for recurrent symptomatic malignant pleural effusion was chest drain insertion and talc pleurodesis, with indwelling pleural catheter insertion reserved for patients with trapped lung or failed talc pleurodesis. However, catheter insertion is an increasingly acceptable first-line treatment.

Phenotyping malignant pleural effusions

PURPOSE OF REVIEW

Patients with malignant pleural effusions (MPEs) are heterogenous in their disease course, symptom severity, responses to cancer therapies, fluid recurrence rates, and thus need for definitive fluid control measures. To tailor the most appropriate treatment for individual patients, clinicians need to 'phenotype' the patients and predict their clinical course. This review highlights the recent efforts to develop better predictive tools and knowledge gaps for further research.

RECENT FINDINGS

The LENT scoring system, which includes pleural fluid lactate dehydrogenase, performance status, serum neutrophil-to-lymphocyte ratio and tumor type, allows prediction of the survival of patients with MPE. Symptomatic response after therapeutic pleural drainage is highly variable; ongoing studies aim to identify those who would derive symptomatic benefit from fluid drainages. Multivariate analysis found that patients with low pleural fluid pH [odds ratio (OR) 37.04], large effusions (OR 3.31), and increasing age (OR 1.02) were more likely to require pleurodesis or indwelling pleural catheter placement for fluid control. Better predictive tools for rate of fluid recurrence and likelihood of successful pleurodesis would help guide clinical decision-making.

SUMMARY

Phenotyping MPE would guide the formulation of optimal management for individual MPE patients.

Construction and Evaluation of a Targeted Hyaluronic Acid Nanoparticle/Photosensitizer Complex for Cancer Photodynamic Therapy

Photodynamic therapy (PDT) is a novel treatment modality that is under intensive preclinical investigations for a variety of diseases, including cancer. Despite extensive studies in this area, selective and effective photodynamic agents that can specifically accumulate in tumors to reach a therapeutic concentration are limited. Although recent attempts have produced photosensitizers (PSs) complexed with various nanomaterials, the tedious preparation steps and poor tumor efficiency of therapy hamper their utilization. Here, we developed a CD44-targeted nanophotodynamic agent by physically encapsulating a photosensitizer, Ce6, into a hyaluronic acid nanoparticle (HANP), which was hereby denoted HANP/Ce6. Its physical features and capability for photodynamic therapy were characterized in vitro and in vivo. Systemic delivery of HANP/Ce6 resulted in its accumulation in a human colon cancer xenograft model. The tumor/muscle ratio reached 3.47 ± 0.46 at 4 h post injection, as confirmed by fluorescence imaging. Tumor growth after HANP/Ce6 treatment with laser irradiation (0.15 W/cm², 630 nm) was significantly inhibited by 9.61 ± 1.09-fold compared to that in tumor control groups, which showed no change in tumor growth. No apparent systemic and local toxic effects on the mice were observed. HANP/Ce6-mediated tumor growth inhibition was accessed and observed for the first time by ¹⁸F-fluoro-2-deoxy-d-glucose positron emission tomography as early as 1 day after treatment and persisted for 14 days within our treatment time window. In sum, our results highlight the imaging properties and therapeutic effects of the novel HANP/Ce6 theranostic nanoparticle for CD44-targeted PDT cancer therapy that may be potentially utilized in the clinic. This HANP system may also be applied for the delivery of other hydrophobic PSs, particularly those that could not be chemically modified.

Preclinical Evaluation and Monitoring of the Therapeutic Response of a Dual Targeted Hyaluronic Acid Nanodrug

Chemotherapy is a powerful cancer treatment but suffers from poor biocompatibility and a lack of tumor targeting. Here, we developed a CD44-targeted polymeric nanocomplex by encapsulating 10-hydroxycamptothecin (HCPT) into hyaluronic acid nanoparticles (HANP) for targeted cancer therapy. In vitro, the HANP/HCPT showed improved cytotoxicity to five cancer cell lines including HT29, A549, MDA-MB-231, HepG2, and MDA-MB-435 versus free HCPT. After systemic administration into MDA-MB-231 breast cancer xenograft, tumor growth was significantly inhibited 5.25 ± 0.21 times in the HANP/HCPT treated group relative to the nontreated group. In addition, the treatment response was also accessed and confirmed by 18F-fluoro-2-deoxy-D-glucose ([18F] FDG) positron emission tomography (PET). The MDA-MB-231 tumors responded to HANP/HCPT 7 days after the first treatment, which benefits treatment strategy adjustment and personalization. No apparent systemic toxic effects were seen in mice treated with HANP/HCPT. In summary, the HANPs have great promise as a targeted drug carrier for cancer chemotherapy. Our HANP platform can also deliver other hydrophobic chemotherapy agents.

Solitary Fibrous Tumors of Chest: Another Look with the Oncologic Perspective

Solitary fibrous tumors are mesenchymal lesions that arise at a variety of sites, most commonly the pleura. Most patients are asymptomatic at diagnosis, with lesions being detected incidentally. Nevertheless, some patients present due to symptoms from local tumor compression (eg. of the airways and pulmonary parenchyma). Furthermore, radiological methods are not always conclusive in making a diagnosis, and thus, pathological analysis is often required. In the past three decades, immunohistochemical techniques have provided a gold standard in solitary fibrous tumor diagnosis. The signature marker of solitary fibrous tumor is the presence of the NAB2-STAT6 fusion that can be reliably detected with a STAT6 antibody. While solitary fibrous tumors are most often benign, they can be malignant in 10-20% of the cases. Unfortunately, histological parameters are not always predictive of benign vs malignant solitary fibrous tumors. As solitary fibrous tumors are generally regarded as relatively chemoresistant tumors; treatment is often limited to localized treatment modalities. The optimal treatment of solitary fibrous tumors appears to be complete surgical resection for both primary and local recurrent disease. However, in cases of suboptimal resection, large disease burden, or advanced recurrence, a multidisciplinary approach may be preferable. Specifically, radiotherapy for inoperable local disease can provide palliation/shrinkage. Given their sometimes -unpredictable and often- protracted clinical course, long-term follow-up post-resection is recommended.

Solitary Fibrous Tumors: 2016 Imaging Update

Optimal management of solitary fibrous tumor requires a multidisciplinary approach with proper histopathological mapping and use of various imaging modalities for exact delineation of primary tumor and metastatic disease if present. In this article, the authors present a comprehensive review of the spectrum of imaging findings of solitary fibrous tumors involving various organ systems and discuss the role of molecular targeted therapies in the management of metastatic disease.

Stereotactic Comparison Study of (18)F-Alfatide and (18)F-FDG PET Imaging in an LLC Tumor-Bearing C57BL/6 Mouse Model

This study aimed to stereotactically compare the PET imaging performance of (18)F-Alfatide ((18)F-ALF-NOTA-PRGD2, denoted as (18)F-Alfatide) and (18)F-fluorodeoxyglucose (FDG) and immunohistochemistry (IHC) staining in Lewis lung carcinoma (LLC) tumor-bearing C57BL/6 mouse model. (18)F-FDG standard uptake values (SUVs) were higher than (18)F-Alfatide SUVs in tumors, most of the normal tissues and organs except for the bladder. Tumor-to-brain, tumor-to-lung, and tumor-to-heart ratios of (18)F-Alfatide PET were significantly higher than those of (18)F-FDG PET (P < 0.001). The spatial heterogeneity of the tumors was detected, and the tracer accumulation enhanced from the outer layer to the inner layer consistently using the two tracers. The parameters of the tumors were significantly correlated with each other between (18)F-FDG SUV and GLUT-1 (R = 0.895, P < 0.001), (18)F-Alfatide SUV and αvβ3 (R = 0.595, P = 0.019), (18)F-FDG SUV and (18)F-Alfatide SUV (R = 0.917, P < 0.001), and GLUT-1 and αvβ3 (R = 0.637, P = 0.011). Therefore, (18)F-Alfatide PET may be an effective tracer for tumor detection, spatial heterogeneity imaging and an alternative supplement to (18)F-FDG PET, particularly for patients with enhanced characteristics in the brain, chest tumors or diabetes, meriting further study.

Malignant pleural mesothelioma: an update on diagnosis and treatment options

Malignant pleural mesothelioma (MPM) represents a significant diagnostic and therapeutic challenge and is almost always a fatal disease. Imaging abnormalities are common, but have a limited role in distinguishing mesothelioma from metastatic pleural disease. Similarly, minimally invasive biomarkers have shown promise but also have limitations in the diagnosis of mesothelioma. In experienced centers, cytology and immunohistochemistry are now sufficient to diagnose the epithelioid subtype of mesothelioma, which can reduce the need for more invasive diagnostic investigations. Prognosis of MPM is modestly impacted by oncological treatments. Chemotherapy with cisplatin and pemetrexed is considered the standard of care, though the addition of bevacizumab to the platinum doublet may be the new standard of care. New targeted therapies have demonstrated some promise and are being addressed in clinical trials. This review focuses on the current data on the diagnostic and therapeutic issues of MPM.

FDG PET/CT in the management of colorectal and anal cancers

OBJECTIVE

CT remains the imaging modality of choice in the diagnosis of colorectal cancer (CRC) and anal cancer. However, advances in imaging have expanded the role of MRI and PET/CT. This article focuses on the evolving role of FDG PET/CT in the diagnosis, radiation therapy planning, therapy assessment, and posttherapy monitoring of CRC and anal cancer.

CONCLUSION

FDG PET/CT is a valuable imaging modality that impacts the clinical management of patients with CRC and those with anal cancer.