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Pishdad R, Treglia G, Mehta A, Santhanam P. Somatostatin receptor imaging of thyroid tissue and differentiated thyroid cancer using gallium-68-labeled radiotracers-a review of clinical studies. Endocrine 2024; 85:566-575. [PMID: 38498126 DOI: 10.1007/s12020-024-03779-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 03/10/2024] [Indexed: 03/20/2024]
Abstract
INTRODUCTION The rise in thyroid cancer incidence, especially papillary thyroid cancer (PTC), has underscored the need for improved diagnostic methods and management strategies. Herein, we aim to comprehensively review the evolving landscape in thyroid cancer diagnosis and the potential utility of Gallium-68 (Ga-68) based somatostatin receptor imaging. METHODS We reviewed the clinical studies involving Ga-68 based radiotracers by looking at the following literature databases -PUBMED, EMBASE, WEB OF SCIENCE and COCHRANE. We employed a detailed search strategy with the following search terms; PubMed: ("gallium Ga 68 dotatate" [Supplementary Concept]) AND ("Thyroid Gland"[Mesh] OR "Thyroid Nodule"[Mesh] OR "Thyroid Neoplasms"[Mesh]), Embase ("gallium 68" AND "Thyroid Disease"), Web of Science: ("Gallium 68 and Thyroid"). RESULTS A comparison between Ga-68 DOTATATE and Ga-68 DOTANOC showed similar sensitivities but a higher uptake for Ga-68 DOTATATE. Studies comparing Ga-68-based SSTR PET with FDG PET highlighted the potential advantages of both approaches, with Ga-68-based SSTR PET being more specific in certain cases. DISCUSSION Ga-68-based somatostatin receptor imaging displays clinical utility in RAI-R DTC, offering valuable insight into detecting skeletal lymph node metastases. Notably, it shows potential as a primary imaging tool, potentially augmenting the role of FDG PET. However, SSTR PET imaging's efficacy in distinguishing benign from malignant thyroid nodules varies, with a complex interplay of factors influencing its specificity, indicating its value as an adjunct to existing methods, warranting further research for a refined role in thyroid cancer management. CONCLUSION Although study variations exist, Ga-based somatostatin receptor imaging holds potential as a complementary tool alongside diagnostic methods in thyroid cancer diagnosis, with particular relevance to RAI-R DTC. In carefully selected patients demonstrating the presence of Ga-68 DOTATATE avid lesions, further exploration, and investigation into the potential utilization of Lu177 DOTATATE are warranted.
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Affiliation(s)
- Reza Pishdad
- Division of Endocrinology, Diabetes & Metabolism, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Giorgio Treglia
- Division of Nuclear Medicine, Imaging Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera italiana, Lugano, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Ami Mehta
- Kasturba Medical College, Manipal, India
| | - Prasanna Santhanam
- Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Castillero E, Camillo C, Erwin WC, Singh S, Mohamoud N, George I, Eapen E, Dockery K, Ferrari G, Gupta H. Somatostatin receptors in fibrotic myocardium. PLoS One 2024; 19:e0304813. [PMID: 39038008 PMCID: PMC11262693 DOI: 10.1371/journal.pone.0304813] [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: 09/07/2023] [Accepted: 05/18/2024] [Indexed: 07/24/2024] Open
Abstract
A patient with a neuroendocrine tumor and history of coronary artery disease underwent PET with 68Ga-DOTATATE PET tracer for tumor visualization. Analysis of the scan showed uptake of 68Ga-DOTATATE in the left ventricle corresponding to previous myocardial infarct. 68Ga-DOTATATE binds by somatostatin receptors (SSTR) and it has been proposed that it may be useful for the detection of cardiac inflammatory lesions. We aimed to test whether SSTR could be upregulated in cardiac fibrotic scar. We analyzed SSTR in cardiac samples from patients with end-stage ischemic cardiomyopathy (ICM, n = 8) and control hearts (n = 5). In mature ICM tissue, SSTR1 and SSTR2 expression was unchanged and SSTR5 expression was significantly decreased in ICM samples vs. control. Immunohistochemistry showed increased SSTR1 and SSTR2 in ICM. Areas with SSTR1 or SSTR2 staining were often adjacent to fibrotic areas. The majority of SSTR1 and SSTR2 staining localized in cardiomyocytes in fibrotic scar-rich areas where CD68 macrophage staining was not present. SSTR are occasionally upregulated in cardiac fibrotic areas. When using 68Ga-DOTATATE PET tracer to detect cardiac sarcoidosis or atherosclerotic plaque, the possibility of tracer uptake in fibrotic areas should be considered.
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Affiliation(s)
- Estibaliz Castillero
- Department of Surgery, Columbia University; New York, NY, United States of America
- Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain
| | - Chiara Camillo
- Department of Surgery, Columbia University; New York, NY, United States of America
| | - W. Clinton Erwin
- Department of Surgery, Columbia University; New York, NY, United States of America
| | - Sameer Singh
- Department of Surgery, Columbia University; New York, NY, United States of America
| | - Nafisa Mohamoud
- Department of Surgery, Columbia University; New York, NY, United States of America
| | - Isaac George
- Department of Surgery, Columbia University; New York, NY, United States of America
| | - Elizabeth Eapen
- Valley Health System; Ridgewood, NJ, United States of America
| | - Keith Dockery
- Valley Health System; Ridgewood, NJ, United States of America
| | - Giovanni Ferrari
- Department of Surgery, Columbia University; New York, NY, United States of America
- Department of Biomedical Engineering, Columbia University, New York, NY, United States of America
| | - Himanshu Gupta
- Valley Hospital Heart and Vascular Institute; Ridgewood, NJ, United States of America
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Lv Y, Lan X, Qin C. Different Ectopic Endocrine Tumors on Renal Hilum Detected by 68 Ga-DOTATATE PET. Clin Nucl Med 2024; 49:e367-e369. [PMID: 38466019 DOI: 10.1097/rlu.0000000000005165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
ABSTRACT Renal hilum is a very rare location for primary adrenocortical adenoma or pheochromocytoma. We report 68 Ga-DOTATATE PET/CT findings of primary renal hilar adrenocortical adenoma in one patient and 68 Ga-DOTATATE PET/MR findings of pheochromocytoma in another patient.
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Roth MA, Leyba K, Garg I, Madrid WH, Quazi MA, Sohail AH, Khan R, Sultan S, Sheikh AB. Mortality and in-patient outcomes in pheochromocytoma patients with hypertensive emergency in the United States: A propensity score matched analysis. Curr Probl Cardiol 2024; 49:102578. [PMID: 38657719 DOI: 10.1016/j.cpcardiol.2024.102578] [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] [Received: 04/12/2024] [Accepted: 04/20/2024] [Indexed: 04/26/2024]
Abstract
INTRODUCTION Pheochromocytoma is a rare cause of hypertensive emergency. The objective of this analysis was to compare the clinical characteristics, comorbidities, and in-hospital outcomes of patients admitted with hypertensive emergencies with and without co-existing pheochromocytoma. METHODS A retrospective analysis of the National Inpatient Sample (NIS) Database from 2016 to 2020 was conducted, encompassing 640,395 patients hospitalized for hypertensive emergencies, including 2535 patients diagnosed with pheochromocytoma. We compared demographics, comorbidities, in-hospital outcomes and resource utilization metrics in patients with and without pheochromocytoma. Propensity-score matching was utilized to account for potential confounders and risk of complications was compared. RESULTS Among the pheochromocytoma cohort (51.9% female), a significant portion (35.7%) were under 50 years of age, with the majority being Caucasian (47.9%). Comorbid conditions such as obesity, diabetes, and smoking were prevalent, with notable differences in cancer (7.5% vs. 2.3%, p < 0.001) and peripheral vascular disease (17% vs. 8.2%, p < 0.001) rates compared to the non-pheochromocytoma cohort. Pheochromocytoma patients had a longer hospital stay (7.5 vs. 6 days, p = 0.002) and higher odds of acute kidney injury (AKI) (1.54, 1.18-2, p=0.001) but lower odds of requiring hemodialysis (0.52, 0.32-0.79, p < 0.001) or experiencing major cardiovascular events (0.5, 0.36-0.69, p < 0.001). No significant difference in inflation-adjusted hospitalization costs was found between the groups. CONCLUSIONS Patients with hypertensive emergencies and pheochromocytoma had a higher incidence of AK, certain comorbidities (cancer, peripheral vascular disease), and more complex hospital courses suggested by longer length of stay. However, the overall cost of hospitalization did not significantly differ between the two cohorts.
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Affiliation(s)
- Margaret A Roth
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87113, USA
| | - Katarina Leyba
- Department of Internal Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Ishan Garg
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87113, USA
| | | | - Mohammed A Quazi
- Department of Biostatistics and Mathematics, University of New Mexico, Albuquerque, NM 87113, USA
| | - Amir H Sohail
- Department of Surgical Oncology, University of New Mexico, Albuquerque, NM 87113, USA
| | - Rozi Khan
- Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Sulaiman Sultan
- Department of Nephrology, University of New Mexico, Albuquerque, NM 87113, USA
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM 87113, USA.
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Ferreira Dalla Pria HR, Sharbidre KG, Virarkar M, Javadi S, Bhosale H, Maxwell J, Lall C, Morani AC. Imaging Update for Hereditary Abdominopelvic Neuroendocrine Neoplasms. J Comput Assist Tomogr 2024; 48:533-544. [PMID: 37832535 DOI: 10.1097/rct.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
Abstract
ABSTRACT Neuroendocrine neoplasms have shown a linear increase in incidence and prevalence in recent decades, primarily due to improved cross-sectional imaging, expanded use of endoscopic procedures, and advanced genetic analysis. However, diagnosis of hereditary neuroendocrine tumors is still challenging because of heterogeneity in their presentation, the variety of tumor locations, and multiple associated syndromes. Radiologists should be familiar with the spectrum of these tumors and associated hereditary syndromes. Furthermore, as the assessment of multiple tumor elements such as morphology, biochemical markers, and presence of metastatic disease are essential for the treatment plan, conventional anatomic and functional imaging methods are fundamental in managing and surveilling these cases. Our article illustrates the role of different cross-sectional imaging modalities in diagnosing and managing various hereditary abdominopelvic neuroendocrine tumors.
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Affiliation(s)
| | - Kedar G Sharbidre
- Abdominal Imaging Section, Department of Radiology, University of Alabama at Birmingham, AL
| | - Mayur Virarkar
- Department of Radiology, University of Florida College of Medicine-Jacksonville, FL
| | - Sanaz Javadi
- Department of Abdominal Imaging, Division of Diagnostic Imaging
| | | | - Jessica Maxwell
- Department of Surgical Oncology, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Chandana Lall
- Department of Radiology, University of Florida College of Medicine-Jacksonville, FL
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Wang Z, Zhong X, Yu J, Li H, Zheng J. Ectopic adrenocortical adenoma characterized by hypogonadism: a case report and review of the literature. J Med Case Rep 2024; 18:276. [PMID: 38863038 PMCID: PMC11167918 DOI: 10.1186/s13256-024-04595-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 05/17/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND Currently, there is a scarcity of cases and diagnostic data regarding ectopic adrenocortical adenomas, particularly in relation to their impact on gonadal function and localization diagnostic techniques. We report a typical case of ectopic adrenocortical adenomas and the data of treatment follow-up, and review the literature of 31 available cases of ectopic adrenocortical adenomas. CASE PRESENTATION A 27-year-old Chinese female patient was admitted to our hospital for hypertension, hyperglycaemia and primary amenorrhea. The patient was functionally diagnosed with ACTH-independent CS and hypogonadotropic hypogonadism. Radiological evaluations, including Computed Tomography (CT) and functional imaging, identified a mass at the left renal hilum. Histological assessments post-surgical excision confirmed the mass to be an ectopic adrenocortical adenoma. A subsequent 3-month follow-up showed no signs of disease recurrence, a swift recovery of the cortisol axis was observed, with a partial recuperation of the gonadal axis. REVIEW Our literature review shows that the most common ectopic areas of cortisol adenomas are renal hilum and hepatic region. The most positive biomarker is Melan A, and only a few cases have been diagnosed with functional localization. CONCLUSION Ectopic adrenocortical adenomas may be asymptomatic in the early stage and can impact gonadal function. Physicians who treat hypogonadism must be aware of the need to test cortisol levels and perform functional localization in patients with lumps present.
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Affiliation(s)
- Zhihua Wang
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xueyu Zhong
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Jiayu Yu
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Huiqing Li
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Juan Zheng
- Department of Endocrinology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
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Brixey AG, McCallum R. Imaging of Large Airway Disorders. Clin Chest Med 2024; 45:489-503. [PMID: 38816102 DOI: 10.1016/j.ccm.2024.02.015] [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: 06/01/2024]
Abstract
Large airway disorders encompass a large variety of diseases and pathology, with broad categories including anatomic variants, congenital abnormalities, acquired abnormalities, inflammatory/infiltrative causes, infection, and tumors. The most common diseases in each category are discussed with a focus on the salient imaging findings. Pitfalls to beware of are discussed through the article, and concludes with a general method to approaching large airways pathology that should provide the reader with a basic framework and understanding of this complex topic.
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Affiliation(s)
- Anupama Gupta Brixey
- Department of Diagnostic Radiology, Section of Cardiothoracic Imaging, Portland VA Healthcare System and Oregon Health & Science University, 3710 Southwest US Veterans Hospital Road, Portland, OR 97239, USA.
| | - Raluca McCallum
- Department of Diagnostic Radiology, Oregon Health & Science University, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Corti F, Rossi RE, Cafaro P, Passarella G, Turla A, Pusceddu S, Coppa J, Oldani S, Guidi A, Longarini R, Cortinovis DL. Emerging Treatment Options for Neuroendocrine Neoplasms of Unknown Primary Origin: Current Evidence and Future Perspectives. Cancers (Basel) 2024; 16:2025. [PMID: 38893145 PMCID: PMC11171242 DOI: 10.3390/cancers16112025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/21/2024] Open
Abstract
Among neuroendocrine neoplasms (NENs), a non-negligible proportion (9-22%) is represented by sufferers of NENs of unknown primary origin (UPO), a poor prognostic group with largely unmet clinical needs. In the absence of standard therapeutic algorithms, current guidelines suggest that the treatment of UPO-NENs should be based on tumor clinical-pathological characteristics, disease burden, and patient conditions. Chemotherapy represents the backbone for the treatment of high-grade poorly differentiated UPO-NENs, usually providing deep but short-lasting responses. Conversely, the spectrum of available systemic therapy options for well-differentiated UPO-NENs may range from somatostatin analogs in indolent low-grade tumors, to peptide receptor radioligand therapy, tyrosine kinase inhibitors (TKIs), or chemotherapy for more aggressive tumors or in case of high disease burden. In recent years, molecular profiling has provided deep insights into the molecular landscape of UPO-NENs, with both diagnostic and therapeutic implications. Although preliminary, interesting activity data have been provided about upfront chemoimmunotherapy, the use of immune checkpoint inhibitors (ICIs), and the combination of ICIs plus TKIs in this setting. Here, we review the literature from the last 30 years to examine the available evidence about the treatment of UPO-NENs, with a particular focus on future perspectives, including the expanding scenario of targeted agents in this setting.
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Affiliation(s)
- Francesca Corti
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Roberta Elisa Rossi
- Gastroenterology and Endoscopy Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy;
| | - Pietro Cafaro
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Gaia Passarella
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Antonella Turla
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Sara Pusceddu
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Jorgelina Coppa
- Hepatology and Hepato-Pancreatic-Biliary Surgery and Liver Transplantation Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Via Venezian 1, 20133 Milan, Italy;
| | - Simone Oldani
- Gastro-Entero-Pancreatic and Neuroendocrine Unit 1, Department of Medical Oncology, ENETS Center of Excellence, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Venezian 1, 20133 Milan, Italy; (S.P.); (S.O.)
| | - Alessandro Guidi
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Raffaella Longarini
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
| | - Diego Luigi Cortinovis
- Medical Oncology Unit, Fondazione IRCCS San Gerardo dei Tintori, Via G.B. Pergolesi 33, 20900 Monza, Italy; (P.C.); (G.P.); (A.T.); (A.G.); (R.L.); (D.L.C.)
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Qu B, Li X, Ma Y, Wang Y, Han Y, Hou G, Gao F. 68Ga labeled EphA2-targeted cyclic peptide: a novel positron imaging tracer for triple-negative breast cancer? Dalton Trans 2024; 53:7946-7952. [PMID: 38646723 DOI: 10.1039/d4dt00837e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
The absence of better biomarkers currently limits early diagnosis and treatment of triple-negative breast cancer (TNBC). Our previously published study reported that the cyclic-peptide SD01 exhibited specific binding to EphA2 (Ephrin type-A receptor 2) on TNBC. To develop a novel PET imaging agent, we prepared gallium-68 (68Ga) labeled-DOTA-SD01 and evaluated its specificity and effectiveness through micro PET/CT imaging in a TNBC-bearing mouse model. SD01 and a control linear peptide YSA were conjugated to DOTA and subsequently labeled with 68Ga, obtaining 68Ga-DOTA-SD01 and 68Ga-DOTA-YSA. Both showed high radiochemical purity, stability, good hydrophilicity, and high binding affinity to 4T1 cells. Micro PET/CT imaging showed high radioactivity accumulation in tumors; SUVmean (mean standardized uptake value) of tumors in the group of 68Ga-DOTA-SD01 was 3.34 ± 0.25 and 2.65 ± 0.32 in the group of 68Ga-DOTA-YSA; T/NT ratios (target to non-target, SUVmean ratios of tumor to muscle) were 3.12 ± 0.06 and 2.77 ± 0.11 at 30 min, respectively (p < 0.05). The biodistribution study showed that tumor uptake % ID per g (percentage of injected dose per gram of tissue) in the group of 68Ga-DOTA-SD01 was 2.73 ± 0.34, and 1.77 ± 0.38 in the group of 68Ga-DOTA-YSA; T/NT ratios (radioactivity of tumor to muscle) were 3.55 ± 0.12 and 3.05 ± 0.10 for both groups at 30 min, respectively (p < 0.05). All these suggest that 68Ga-DOTA-SD01 may act as a better novel PET imaging agent for EphA2 positive tumors, such as TNBC.
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Affiliation(s)
- Bin Qu
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
- Department of Nuclear Medicine, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Xianjun Li
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
- Department of Nuclear Medicine, Weifang People's Hospital, Weifang, 261041, Shandong, China
| | - Yuze Ma
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
| | - Yanzhi Wang
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
| | - Yeming Han
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, China.
| | - Guihua Hou
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
| | - Feng Gao
- Key Laboratory for Experimental Teratology of the Ministry of Education and Research Center for Experimental Nuclear Medicine, School of Basic Medical Sciences, Shandong University, Jinan, 250012, Shandong, China.
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Ueki Y, Otsuka H, Otani T, Kasai R, Otomi Y, Ikemitsu D, Azane S, Kunikane Y, Bando T, Matsuda N, Okada Y, Takayama T, Harada M. Combined visual and quantitative assessment of somatostatin receptor scintigraphy for staging and restaging of neuroendocrine tumors. Jpn J Radiol 2024; 42:519-535. [PMID: 38345724 DOI: 10.1007/s11604-024-01529-z] [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] [Received: 09/11/2023] [Accepted: 01/03/2024] [Indexed: 04/30/2024]
Abstract
PURPOSE Somatostatin receptor scintigraphy (SRS) using 111In-DTPA-DPhe1-octreotide (pentetreotide) has become an integral part of neuroendocrine neoplasm management. The lack of precise quantification is a disadvantage of SRS. This study aimed to adapt the standardized uptake value (SUV) to SRS, establish the SUV range for physiological uptake in the liver, kidney, and spleen, and elucidate the utility of combined visual and quantitative SRS assessment for staging and restaging of neuroendocrine tumors (NETs). MATERIALS AND METHODS This study included 21 patients with NETs who underwent 111In-pentetreotide SRS. The SUV of physiological and pathological uptake was calculated using bone single-photon emission computed tomography (SPECT) quantitative analysis software (GI-BONE). For visual analysis, the primary and metastatic lesions were scored visually on planar and SPECT images using a five-point scale. We assessed the relationships between the SUVs of the liver, kidney, and spleen in the dual phase, and among quantitative indices, visual score, and pathological lesions classification. RESULTS Sixty-three NEN lesions were evaluated. The mean ± standard deviation maximum SUVs (SUVmax) were liver: 4 h, 2.6 ± 1.0; 24 h, 2.2 ± 1.0; kidney: 4 h, 8.9 ± 1.8; 24 h, 7.0 ± 2.0; and spleen; 4 h, 11.3 ± 4.5; 24 h, 11.5 ± 7.6. Higher SUVmax was significantly associated with higher visual scores on dual-phase SPECT (4 h, p < 0.001; 24 h, p < 0.001) (4 h: scores 3 and 4, p < 0.05; scores 3 and 5: p < 0.01; scores 4 and 5: p < 0.01; 24 h: scores 3 and 4, p = 0.0748; scores 3 and 5: p < 0.01; scores 4 and 5: p < 0.01). CONCLUSION We adapted the SUV to SRS and established the range of SUV for physiological uptake in the liver, kidney, and spleen. Combined visual and quantitative assessment is useful for imaging individual lesions in greater detail, and may serve as a new tumor marker of SRS for staging and restaging of NETs.
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Affiliation(s)
- Yuya Ueki
- Tokushima University Graduate School of Health Sciences, Tokushima, Japan
| | - Hideki Otsuka
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.
| | - Tamaki Otani
- Advance Radiation Research, Education and Management Center, Tokushima University, Tokushima, Japan
| | - Ryosuke Kasai
- Department of Medical Imaging/Nuclear Medicine, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoichi Otomi
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Daiki Ikemitsu
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Shota Azane
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yamato Kunikane
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Takanori Bando
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Noritake Matsuda
- Department of Radiology, Tokushima University Hospital, Tokushima, Japan
| | - Yasuyuki Okada
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tetsuji Takayama
- Department of Gastroenterology and Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Masafumi Harada
- Department of Radiology and Radiation Oncology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Lerner DK, Palmer JN. Personalized Approach to Olfactory Neuroblastoma Care. J Pers Med 2024; 14:423. [PMID: 38673050 PMCID: PMC11050786 DOI: 10.3390/jpm14040423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/08/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024] Open
Abstract
Olfactory neuroblastoma (ONB) is an uncommon neuroendocrine malignancy arising from the olfactory neuroepithelium. ONB frequently presents with nonspecific sinonasal complaints, including nasal obstruction and epistaxis, and diagnosis can be obtained through a combination of physical examination, nasal endoscopy, and computed tomography and magnetic resonance imaging. Endoscopic resection with negative margins, with or without craniotomy, as necessary, is the standard of care for definitive treatment of ONB. Regional metastasis to the neck is often detected at presentation or may occur in a delayed fashion and should be addressed through elective neck dissection or radiation. Adjuvant radiotherapy should be considered, particularly in the case of high grade or tumor stage, as well as positive surgical margins. Systemic therapy is an area of active investigation in both the neoadjuvant and adjuvant setting, with many advocating in favor of induction chemotherapy for significant orbital or intracranial involvement prior to surgical resection. Various targeted immunotherapies are currently being studied for the treatment of recurrent or metastatic ONB. Prolonged locoregional and distant surveillance are indicated following definitive treatment, given the tendency for delayed recurrence and metastasis.
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Affiliation(s)
| | - James N. Palmer
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA
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12
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Symeonidou E, Fouza A, Gkoutziotis I, Nikolaidou C, Petras P, Mpallas K. Two synchronous primary mesenteric neuroendocrine tumors in a patient: a case report. Front Surg 2024; 11:1323468. [PMID: 38638140 PMCID: PMC11024421 DOI: 10.3389/fsurg.2024.1323468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
Primary mesenteric neuroendocrine tumors represent a rare clinical entity, challenging to manage, while a combination of imaging is demanded in order to differentiate it from metastatic disease, and set the diagnosis. If the tumor is resectable, surgery is the fundament of the therapeutic approach. The appearance of a second primary mesenteric tumor suggests an unacquainted scenario. The current article presents a case of a 40-year-old woman, who underwent laparoscopic excision of a mesenteric tumor located close to the left pararenal space. Pathology with immunohistochemistry examination reported neuroendocrine tumor grade 2. No further treatment was necessary. Seven months later, 68-Gallium DOTATATE detected another primary neuroendocrine tumor located at the right retroperitoneal space without other lesions. The second tumor was also resected laparoscopically, and the pathology confirmed the diagnosis of another neuroendocrine tumor G2. The postoperative course was uneventful, and six months later the patient is disease-free. The adequacy of 68-Gallium DOTATATE for the preoperative diagnosis of primary mesenteric tumors, the role of the laparoscopic approach, and the extent of lymph node resection are matters addressed in this article.
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Affiliation(s)
- Elissavet Symeonidou
- 5th Surgical Department, Aristotle University of Thessaloniki, General Hospital Ippokrateio, Thessaloniki, Greece
| | - Ariadni Fouza
- 5th Surgical Department, Aristotle University of Thessaloniki, General Hospital Ippokrateio, Thessaloniki, Greece
| | - Ioannis Gkoutziotis
- 5th Surgical Department, Aristotle University of Thessaloniki, General Hospital Ippokrateio, Thessaloniki, Greece
| | | | - Panagiotis Petras
- 5th Surgical Department, Aristotle University of Thessaloniki, General Hospital Ippokrateio, Thessaloniki, Greece
| | - Konstantinos Mpallas
- 5th Surgical Department, Aristotle University of Thessaloniki, General Hospital Ippokrateio, Thessaloniki, Greece
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13
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Anitha K, Chenchula S, Surendran V, Shvetank B, Ravula P, Milan R, Chikatipalli R, R P. Advancing cancer theranostics through biomimetics: A comprehensive review. Heliyon 2024; 10:e27692. [PMID: 38496894 PMCID: PMC10944277 DOI: 10.1016/j.heliyon.2024.e27692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 03/02/2024] [Accepted: 03/05/2024] [Indexed: 03/19/2024] Open
Abstract
Nanotheranostics, especially those employing biomimetic approaches, are of substantial interest for molecular imaging and cancer therapy. The incorporation of diagnostics and therapeutics, known as cancer theranostics, represents a promising strategy in modern oncology. Biomimetics, inspired by nature, offers a multidisciplinary avenue with potential in advancing cancer theranostics. This review comprehensively analyses recent progress in biomimetics-based cancer theranostics, emphasizing its role in overcoming current treatment challenges, with a focus on breast, prostate, and skin cancers. Biomimetic approaches have been explored to address multidrug resistance (MDR), emphasizing their role in immunotherapy and photothermal therapy. The specific areas covered include biomimetic drug delivery systems bypassing MDR mechanisms, biomimetic platforms for immune checkpoint blockade, immune cell modulation, and photothermal tumor ablation. Pretargeting techniques enhancing radiotherapeutic agent uptake are discussed, along with a comprehensive review of clinical trials of global nanotheranostics. This review delves into biomimetic materials, nanotechnology, and bioinspired strategies for cancer imaging, diagnosis, and targeted drug delivery. These include imaging probes, contrast agents, and biosensors for enhanced specificity and sensitivity. Biomimetic strategies for targeted drug delivery involve the design of nanoparticles, liposomes, and hydrogels for site-specific delivery and improved therapeutic efficacy. Overall, this current review provides valuable information for investigators, clinicians, and biomedical engineers, offering insights into the latest biomimetics applications in cancer theranostics. Leveraging biomimetics aims to revolutionize cancer diagnosis, treatment, and patient outcomes.
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Affiliation(s)
- Kuttiappan Anitha
- Department of Pharmacology, School of Pharmacy and Technology Management (SPTM), SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Shirpur, 425405, India
| | - Santenna Chenchula
- Department of Clinical Pharmacology, All India Institute of Medical Sciences (AIIMS), Bhopal, 462020, Madhya Pradesh, India
| | - Vijayaraj Surendran
- Dr Kalam College of Pharmacy, Thanjavur District, Tamil Nadu, 614 623, India
| | - Bhatt Shvetank
- School of Health Sciences and Technology, Dr Vishwanath Karad MIT World Peace University, Pune, 411038, Maharashtra, India
| | - Parameswar Ravula
- Amity Institute of Pharmacy, Amity University Madhya Pradesh (AUMP), Gwalior, 474005, Madhya Pradesh, India
| | - Rhythm Milan
- Amity Institute of Pharmacy, Amity University Madhya Pradesh (AUMP), Gwalior, 474005, Madhya Pradesh, India
| | - Radhika Chikatipalli
- Sri Venkateshwara College of Pharmacy, Chittoor District, Andhra Pradesh, 517520, India
| | - Padmavathi R
- SVS Medical College, Mahbubnagar, Telangana, India
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14
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Yang X, Silosky M, Wehrend J, Litwiller DV, Nachiappan M, Metzler SD, Ghosh D, Xing F, Chin BB. Improving Generalizability of PET DL Algorithms: List-Mode Reconstructions Improve DOTATATE PET Hepatic Lesion Detection Performance. Bioengineering (Basel) 2024; 11:226. [PMID: 38534501 DOI: 10.3390/bioengineering11030226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Deep learning (DL) algorithms used for DOTATATE PET lesion detection typically require large, well-annotated training datasets. These are difficult to obtain due to low incidence of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and the high cost of manual annotation. Furthermore, networks trained and tested with data acquired from site specific PET/CT instrumentation, acquisition and processing protocols have reduced performance when tested with offsite data. This lack of generalizability requires even larger, more diverse training datasets. The objective of this study is to investigate the feasibility of improving DL algorithm performance by better matching the background noise in training datasets to higher noise, out-of-domain testing datasets. 68Ga-DOTATATE PET/CT datasets were obtained from two scanners: Scanner1, a state-of-the-art digital PET/CT (GE DMI PET/CT; n = 83 subjects), and Scanner2, an older-generation analog PET/CT (GE STE; n = 123 subjects). Set1, the data set from Scanner1, was reconstructed with standard clinical parameters (5 min; Q.Clear) and list-mode reconstructions (VPFXS 2, 3, 4, and 5-min). Set2, data from Scanner2 representing out-of-domain clinical scans, used standard iterative reconstruction (5 min; OSEM). A deep neural network was trained with each dataset: Network1 for Scanner1 and Network2 for Scanner2. DL performance (Network1) was tested with out-of-domain test data (Set2). To evaluate the effect of training sample size, we tested DL model performance using a fraction (25%, 50% and 75%) of Set1 for training. Scanner1, list-mode 2-min reconstructed data demonstrated the most similar noise level compared that of Set2, resulting in the best performance (F1 = 0.713). This was not significantly different compared to the highest performance, upper-bound limit using in-domain training for Network2 (F1 = 0.755; p-value = 0.103). Regarding sample size, the F1 score significantly increased from 25% training data (F1 = 0.478) to 100% training data (F1 = 0.713; p < 0.001). List-mode data from modern PET scanners can be reconstructed to better match the noise properties of older scanners. Using existing data and their associated annotations dramatically reduces the cost and effort in generating these datasets and significantly improves the performance of existing DL algorithms. List-mode reconstructions can provide an efficient, low-cost method to improve DL algorithm generalizability.
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Affiliation(s)
- Xinyi Yang
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Michael Silosky
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jonathan Wehrend
- Department of Radiology, Santa Clara Valley Medical Center, San Jose, CA 95128, USA
| | | | - Muthiah Nachiappan
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Scott D Metzler
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Debashis Ghosh
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Fuyong Xing
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- The Computational Bioscience Program, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Bennett B Chin
- Department of Radiology, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
- University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
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15
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Melehy A, Agopian V. Treating rare tumors with liver transplantation. Curr Opin Organ Transplant 2024; 29:30-36. [PMID: 37851086 DOI: 10.1097/mot.0000000000001118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
PURPOSE OF REVIEW The success of liver transplantation (LT) in treating unresectable hepatocellular carcinoma (HCC) has resulted in interest in LT for other oncologic conditions. Here, we discuss the role of LT for rare oncologic indications including metastatic gastroenteropancreatic neuroendocrine tumors (GEP-NETs), hepatic epitheliod hemangioendothelioma (HEHE), fibrolamellar hepatocellular carcinoma (FLC), and hepatic angiosarcoma (HAS). RECENT FINDINGS Conditions reviewed have been documented indications for LT in the available literature. We summarize the experience of LT for these indications and proposed management guidelines. SUMMARY GEP-NETs with isolated metastases to the liver can be treated with LT with excellent long-term outcomes (10-year survival 88%) if strict selection criteria are used (low-intermediate grade, Ki-67% < 20%, complete resection of primary tumor, stable disease for 6 months, <50% hepatic involvement). HEHE is a rare hepatic tumor for which LT can be performed with reported 10-year survival around 70%. FLC is a distinct clinical entity to HCC and is optimally treated with surgical resection though experience with LT is described in observational series (5-year survival 50%, recurrence in 10%). HAS is a rapidly progressive tumor with a dismal prognosis with or without treatment, including LT.
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Affiliation(s)
- Andrew Melehy
- Dumont-UCLA Transplant and Liver Cancer Centers, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, California, USA
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16
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Yang X, Chin BB, Silosky M, Wehrend J, Litwiller DV, Ghosh D, Xing F. Learning Without Real Data Annotations to Detect Hepatic Lesions in PET Images. IEEE Trans Biomed Eng 2024; 71:679-688. [PMID: 37708016 DOI: 10.1109/tbme.2023.3315268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
OBJECTIVE Deep neural networks have been recently applied to lesion identification in fluorodeoxyglucose (FDG) positron emission tomography (PET) images, but they typically rely on a large amount of well-annotated data for model training. This is extremely difficult to achieve for neuroendocrine tumors (NETs), because of low incidence of NETs and expensive lesion annotation in PET images. The objective of this study is to design a novel, adaptable deep learning method, which uses no real lesion annotations but instead low-cost, list mode-simulated data, for hepatic lesion detection in real-world clinical NET PET images. METHODS We first propose a region-guided generative adversarial network (RG-GAN) for lesion-preserved image-to-image translation. Then, we design a specific data augmentation module for our list-mode simulated data and incorporate this module into the RG-GAN to improve model training. Finally, we combine the RG-GAN, the data augmentation module and a lesion detection neural network into a unified framework for joint-task learning to adaptatively identify lesions in real-world PET data. RESULTS The proposed method outperforms recent state-of-the-art lesion detection methods in real clinical 68Ga-DOTATATE PET images, and produces very competitive performance with the target model that is trained with real lesion annotations. CONCLUSION With RG-GAN modeling and specific data augmentation, we can obtain good lesion detection performance without using any real data annotations. SIGNIFICANCE This study introduces an adaptable deep learning method for hepatic lesion identification in NETs, which can significantly reduce human effort for data annotation and improve model generalizability for lesion detection with PET imaging.
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Karpuz M, Ozgenc E, Oner E, Atlihan-Gundogdu E, Burak Z. 68 Ga-labeled, imatinib encapsulated, theranostic liposomes: Formulation, characterization, and in vitro evaluation of anticancer activity. Drug Dev Res 2024; 85:e22136. [PMID: 38009423 DOI: 10.1002/ddr.22136] [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] [Received: 08/31/2023] [Revised: 10/28/2023] [Accepted: 11/14/2023] [Indexed: 11/28/2023]
Abstract
Cancer is still a global health problem. Among cancer types, breast cancer is the most frequently diagnosed one, and it causes a high mortality rate if not diagnosed in the early stages. In our study, imatinib encapsulated, nanosized, neutral/cationic liposome formulations were prepared as theranostic agents for breast cancer. After the characterization studies in which all liposomes exhibited proper profile owing to their particle size between 133 and 250 nm, polydispersity index values lower than 0.4, neutral and cationic zeta potential values, and high drug encapsulation efficiency, controlled drug release behaviors with zero-order kinetic were obtained. The higher than 90% radiolabeling efficiency values were obtained thanks to the determination of optimum radiolabeling condition (80°C temperature, 5 mCi radioactivity, and 10 min incubation period). According to the resazurin assay evaluating the cytotoxic profile of liposomes on MCF7 cells, neutral empty liposome was found as biocompatible, while both cationic liposomes (empty and drug-loaded ones) exhibited high nonspecific cytotoxicity at even low drug concentration due to the existence of stearyl amine in the formulations. However, dose-dependent cytotoxic effect and the highest cellular binding capacity were obtained by imatinib loaded neutral liposomes. In conclusion, 68 Ga-radiolabeled, imatinib-loaded, neutral, nanosized liposome formulation is the most promising one as a theranostic agent among all formulations.
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Affiliation(s)
- Merve Karpuz
- Department of Radiopharmacy, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
| | - Emre Ozgenc
- Department of Radiopharmacy, Faculty of Pharmacy, Ege University, Izmir, Turkey
| | - Ezgi Oner
- Department of Pharmaceutical Biotechnology, Faculty of Pharmacy, Izmir Katip Celebi University, Izmir, Turkey
- Thoracic Oncology Research Group, Trinity Translational Medicine Institute, St James's Hospital, Dublin, Ireland
- Department of Clinical Medicine, Trinity School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Zeynep Burak
- Department of Nuclear Medicine, Faculty of Medicine, Ege University, Izmir, Turkey
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18
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Drucker Iarovich M, Hinzpeter R, Moloney BM, Hueniken K, Veit-Haibach P, Ortega C, Metser U. Comparison of 68Ga-DOTATATE Positron Emmited Tomography/Computed Tomography and Gadoxetic Acid-Enhanced Magnetic Resonance Imaging for the Detection of Liver Metastases from Well-Differentiated Neuroendocrine Tumors. Curr Oncol 2024; 31:521-534. [PMID: 38248121 PMCID: PMC10813973 DOI: 10.3390/curroncol31010036] [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] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
This study aimed to compare the detection of neuroendocrine tumor liver metastases (NLMs) in hepatobiliary-specific contrast-enhanced MRI (pMR) versus 68Ga-DOTATATE PET/CT (DT-PET). This retrospective study cohort included 30 patients with well-differentiated neuroendocrine tumors who underwent both DT-PET and pMR. Two readers independently assessed NLMs count, SUVmax on DT-PET, and signal characteristics on pMR. A consensus review by two additional readers resolved discrepancies between the modalities. Results showed concordance between DT-PET and pMR NLM count in 14/30 patients (47%). pMR identified more NLMs in 12/30 patients (40%), of which 4 patients showed multiple deposits on pMR but only 0-1 lesions on DT-PET. DT-PET detected more in 4/30 patients (13%). Overall, pMR detected more metastases than DT-PET (p = 0.01). Excluding the four outliers, there was excellent agreement between the two methods (ICC: 0.945, 95%CI: 0.930, 0.958). Notably, pMR had a higher NLM detection rate than DT-PET, with correlations found between lesion size on pMR and DT-PET detectability, as well as diffusion restriction on pMR and SUVmax on DT-PET. In conclusion, in consecutive patients with well-differentiated NETs, the detection rate of NLM is higher with pMR than with DT-PET. However, when excluding patients whose tumors do not overexpress somatostatin receptors (13% of the cohort), high concordance in the detection of NLM is observed between DT PET and pMR.
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Affiliation(s)
- Moran Drucker Iarovich
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Ricarda Hinzpeter
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Brian Michael Moloney
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Katrina Hueniken
- Department of Biostatistics, University Health Network, Toronto, ON M5G 2C4, Canada
| | - Patrick Veit-Haibach
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Claudia Ortega
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
| | - Ur Metser
- Joint Department of Medical Imaging, University Health Network, Sinai Health Systems, Women’s College Hospital, University of Toronto, Toronto, ON M5R 0A3, Canada; (M.D.I.)
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Pekošak A, Windhorst AD, Poot AJ. Enantioselective Synthesis of Carbon-11-Labeled Amino Acids and Peptides. Methods Mol Biol 2024; 2729:15-27. [PMID: 38006488 DOI: 10.1007/978-1-0716-3499-8_2] [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: 11/27/2023]
Abstract
Radiolabeled amino acids (AAs), their derivatives, and peptides are essential radiotracers in nuclear imaging. Despite its potential, the preparation of enantiopure radiopharmaceuticals poses several challenges, demanding a great need for rapid and stereocontrolled reactions. This chapter describes a highly stereoselective carbon-11 alkylation of Schiff bases, to obtain radiolabeled AAs and small peptides. The method uses chiral quaternary ammonium salt phase-transfer catalyst with two alkylating agents, namely, [11C]methyl iodide and [11C]benzyl iodide. This methodology allows the radiolabeling of AAs and peptides with excellent regioselectivity and enantiomeric or diastereomeric excess.
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Affiliation(s)
- Aleksandra Pekošak
- Department of Radiology and Nuclear Medicine, Radionuclide Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Albert D Windhorst
- Department of Radiology and Nuclear Medicine, Radionuclide Center, Amsterdam UMC, Amsterdam, the Netherlands
| | - Alex J Poot
- Department of Radiology and Nuclear Medicine, Radionuclide Center, Amsterdam UMC, Amsterdam, the Netherlands.
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20
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Wright K, Fisher JC, Rothberger GD, Prescott JD, Allendorf JD, Patel K, Suh I. Incidental 68Ga-DOTATATE uptake in thyroid nodules: Is guideline-directed management still appropriate? Surgery 2024; 175:228-233. [PMID: 38563428 DOI: 10.1016/j.surg.2023.04.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 03/21/2023] [Accepted: 04/27/2023] [Indexed: 04/04/2024]
Abstract
BACKGROUND Fluorodeoxyglucose uptake on positron emission tomography imaging has been shown to be an independent risk factor for malignancy in thyroid nodules. More recently, a new positron emission tomography radiotracer-Gallium-68 DOTATATE-has gained popularity as a sensitive method to detect neuroendocrine tumors. With greater availability of this imaging, incidental Gallium-68 DOTATATE uptake in the thyroid gland has increased. It is unclear whether current guideline-directed management of thyroid nodules remains appropriate in those that are Gallium-68 DOTATATE avid. METHODS We retrospectively reviewed Gallium-68 DOTATATE positron emission tomography scans performed at our institution from 2012 to 2022. Patients with incidental focal Gallium-68 DOTATATE uptake in the thyroid gland were included. Fine needle aspiration biopsies were characterized via the Bethesda System for Reporting Thyroid Cytopathology. Bethesda III/IV nodules underwent molecular testing (ThyroSeq v3), and malignancy risk ≥50% was considered positive. RESULTS In total, 1,176 Gallium-68 DOTATATE PET scans were reviewed across 837 unique patients. Fifty-three (6.3%) patients demonstrated focal Gallium-68 DOTATATE thyroid uptake. Nine patients were imaged for known medullary thyroid cancer. Forty-four patients had incidental radiotracer uptake in the thyroid and were included in our study. Patients included in the study were predominantly female sex (75%), with an average age of 62.9 ± 13.9 years and a maximum standardized uptake value in the thyroid of 7.3 ± 5.3. Frequent indications for imaging included neuroendocrine tumors of the small bowel (n = 17), lung (n = 8), and pancreas (n = 7). Thirty-three patients underwent subsequent thyroid ultrasound. Sonographic findings warranted biopsy in 24 patients, of which 3 were lost to follow-up. Cytopathology and molecular testing results are as follows: 12 Bethesda II (57.1%), 6 Bethesda III/ThyroSeq-negative (28.6%), 1 Bethesda III/ThyroSeq-positive (4.8%), 2 Bethesda V/VI (9.5%). Four nodules were resected, revealing 2 papillary thyroid cancers, 1 neoplasm with papillary-like nuclear features, and 1 follicular adenoma. There was no difference in maximum standardized uptake value between benign and malignant nodules (7.0 ± 4.6 vs 13.1 ± 5.7, P = .106). Overall, the malignancy rate among patients with sonography and appropriate follow-up was 6.7% (2/30). Among patients with cyto- or histopathology, the malignancy rate was 9.5% (2/21). There were no incidental cases of medullary thyroid cancer. CONCLUSION The malignancy rate among thyroid nodules with incidental Gallium-68 DOTATATE uptake is comparable to rates reported among thyroid nodules in the general population. Guideline-directed management of thyroid nodules remains appropriate in those with incidental Gallium-68 DOTATATE uptake.
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Affiliation(s)
- Kyla Wright
- NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | | | | | | | | | - Kepal Patel
- Department of Surgery, NYU Langone Health, New York, NY
| | - Insoo Suh
- Department of Surgery, NYU Langone Health, New York, NY.
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21
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Zhang C, Gudmundsdottir H, Takahashi H, Day C, Glasgow A, Wasif N, Starlinger P, Warner S, Grotz T, Smoot R, Truty M, Cleary S, Kendrick M, Nagorney D, Navin P, Halfdanarson TR, Thiels C. Accuracy of DOTATATE PET imaging in the preoperative planning of small bowel neuroendocrine tumor resection. J Surg Oncol 2023; 128:1072-1079. [PMID: 37529970 DOI: 10.1002/jso.27413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/17/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND AND OBJECTIVES We assessed the accuracy of preoperative gallium-68 DOTA-Tyr3-octreotate (DOTATATE) positron emission tomography (PET) imaging in estimating multifocality and nodal metastases of small bowel neuroendocrine tumors (sbNETs). METHODS A multicenter analysis was performed on patients with sbNETs who underwent preoperative DOTATATE PET imaging and surgical resection, with manual palpation of the entire length of the small bowel, between January 2016 and August 2022. Preoperative imaging reports and blinded secondary imaging reviews were compared to the final postoperative pathology reports. Descriptive statistics were applied. RESULTS One-hundred and four patients met inclusion criteria. Pathology showed 53 (51%) patients had multifocal sbNETs and 96 (92%) had nodal metastases. The original preoperative DOTATATE PET imaging identified multifocal sbNET in 28 (27%) patients and lymph node (LN) metastases in 80 (77%) patients. Based on original radiology reports, sensitivity for multifocal sbNET identification was 45%, specificity was 92%, positive predictive value (PPV) was 86%, and negative predictive value (NPV) was 62%. For the identification of LN metastases, sensitivity was 82%, specificity was 88%, PPV was 99%, and NPV was 29%. CONCLUSIONS Although DOTATATE PET imaging is specific and relatively accurate, sensitivity and NPV are insufficient to guide surgical planning. Preoperative use should not replace open palpation to identify additional synchronous lesions or to omit regional lymphadenectomy.
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Affiliation(s)
- Chi Zhang
- Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Hallbera Gudmundsdottir
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Courtney Day
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Amy Glasgow
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
| | - Nabil Wasif
- Department of Surgery, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Susanne Warner
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Travis Grotz
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rory Smoot
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Mark Truty
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean Cleary
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - David Nagorney
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Patrick Navin
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Cornelius Thiels
- The Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota, USA
- Department of Surgery, Mayo Clinic, Rochester, Minnesota, USA
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22
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Singh MK, Mohan VSK, Kaushik C. Operational and Performance Experience with uMI550 Digital PET-CT during Routine Quality Control Procedures. World J Nucl Med 2023; 22:267-275. [PMID: 38152105 PMCID: PMC10751135 DOI: 10.1055/s-0043-1777696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
Introduction The quality control (QC) procedures for positron emission tomography (PET) scanners are covered by National Electrical Manufacturers Association and International Electrotechnical Commission. QC must be carried out at regular intervals according to the specifications of the scanner manufacturer. Daily and weekly QC plays a valuable role in monitoring positron emission tomography (PET) scanner performance changes. This study shares operational and performance experience of QC procedures that do not require a radioactive Ge-68 source to perform daily QC and experience with fluorodeoxyglucose F18 ( 18 F-FDG) as a substitute for germanium-68/sodium-22 (Ge-68/Na-22) source for weekly QC. Method This study was performed on an uMI550 digital positron emission tomography-computed tomography (PET-CT) scanner. In this scanner daily QC checks system temperature and humidity, system count rate, data link status, and voltage. QC was performed at the console control, the position of the scanner table was in the home position pulled out from the gantry, and the room was closed during the quick QC. Weekly full QC check items include look-up table drift, energy drift, time-of-flight status, C-map status, temperature and humidity, and voltage. Weekly full QC was performed with a 18 F-FDG source in a rod phantom source. Results Over 200 daily QC tests without a radioactive source Ge-68 phantom and 50 full weekly QC tests using a 18 F-FDG rod phantom were performed with this scanner according to the manufacturer's instructions and a test report was generated. No daily QC errors or warnings were observed during this period. Conclusion The new approach for the daily PET QC does not expose operators to radiation. This translates into commercial and operational merits with consistent performance and results. Implications for Practice Reduction in radiation exposure to operating staff during QC procedure in PET-CT scanner.
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Affiliation(s)
- Manoj Kumar Singh
- Medikabazaar, Technopolis Knowledge Park, Mumbai, Maharashtra, India
| | | | - Chanchal Kaushik
- School of Health and Society, University of Salford, Manchester, United Kingdom
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23
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Erasmus LT, Strange TA, Agrawal R, Strange CD, Ahuja J, Shroff GS, Truong MT. Lung Cancer Staging: Imaging and Potential Pitfalls. Diagnostics (Basel) 2023; 13:3359. [PMID: 37958255 PMCID: PMC10649001 DOI: 10.3390/diagnostics13213359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/22/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
Lung cancer is the leading cause of cancer deaths in men and women in the United States. Accurate staging is needed to determine prognosis and devise effective treatment plans. The International Association for the Study of Lung Cancer (IASLC) has made multiple revisions to the tumor, node, metastasis (TNM) staging system used by the Union for International Cancer Control and the American Joint Committee on Cancer to stage lung cancer. The eighth edition of this staging system includes modifications to the T classification with cut points of 1 cm increments in tumor size, grouping of lung cancers associated with partial or complete lung atelectasis or pneumonitis, grouping of tumors with involvement of a main bronchus regardless of distance from the carina, and upstaging of diaphragmatic invasion to T4. The N classification describes the spread to regional lymph nodes and no changes were proposed for TNM-8. In the M classification, metastatic disease is divided into intra- versus extrathoracic metastasis, and single versus multiple metastases. In order to optimize patient outcomes, it is important to understand the nuances of the TNM staging system, the strengths and weaknesses of various imaging modalities used in lung cancer staging, and potential pitfalls in image interpretation.
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Affiliation(s)
- Lauren T. Erasmus
- Department of Anatomy and Cell Biology, Faculty of Sciences, McGill University, Montreal, QC H3A 0G4, Canada;
| | - Taylor A. Strange
- Department of Pathology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Rishi Agrawal
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Chad D. Strange
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Jitesh Ahuja
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Girish S. Shroff
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
| | - Mylene T. Truong
- Department of Thoracic Radiology, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (R.A.); (C.D.S.); (J.A.)
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24
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Fılızoglu N, Ozguven S. Metastatic Esophageal Adenocarcinoma Showing 68 Ga-DOTATATE Uptake. Clin Nucl Med 2023; 48:e535-e536. [PMID: 37756476 DOI: 10.1097/rlu.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
ABSTRACT The role of 68 Ga-DOTATATE PET/CT in the evaluation of neuroendocrine tumors is well defined. Nevertheless, 68 Ga-DOTATATE uptake may be seen in some tumors other than neuroendocrine tumors as a reflection of tumor blood supply and somatostatin receptor expression. Although 68 Ga-DOTATATE uptake has been described in a number of nonneuroendocrine tumors, no case of 68 Ga-DOTATATE uptake in esophagus adenocarcinoma has been reported. We present the case of a 52-year-old man who had a metastatic esophageal adenocarcinoma showing 68 Ga-DOTATATE uptake.
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Affiliation(s)
- Nuh Fılızoglu
- From the Department of Nuclear Medicine, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey
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25
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Murphy R, Chander G, Martinez M, Ward C, Khan SR, Naik M, Barwick T, Aboagye E, Sharma R. Study protocol of LANTana: a phase Ib study to investigate epigenetic modification of somatostatin receptor-2 with ASTX727 to improve therapeutic outcome with [177Lu]Lu-DOTA-TATE in patients with metastatic neuroendocrine tumours, UK. BMJ Open 2023; 13:e075221. [PMID: 37879695 PMCID: PMC10603539 DOI: 10.1136/bmjopen-2023-075221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 09/25/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Suitability for peptide receptor radionuclide therapy (PRRT) for neuroendocrine neoplasia (NENs) depends on presence of somatostatin receptor-2 (SSTR2) determined by [68Ga]Ga-DOTA-peptide-positron emission tomography (PET). Some patients have low or no uptake on [68Ga]Ga-DOTA-peptide-PET, precluding PRRT. The upstream promoter region of SSRT2 is methylated, with percentage of methylation correlating with SSTR2 expression. Demethylating agents increase uptake on PET imaging in vivo such that tumours previously negative on PET become positive, correlating with a dose dependent increase in tumorous SSTR2 expression. LANTana will determine whether treatment with the demethylating agent, ASTX727, results in re-expression of SSTR2 using [68Ga]Ga-DOTA-peptide-PET to image epigenetic modification of the SSTR2 locus, allowing subsequent PRRT. METHODS AND ANALYSIS 27 participants with a histological diagnosis of NEN (Ki67<55%) with no or low uptake on baseline [68Ga]Ga-DOTA-TATE-PET/CT will be recruited. Patients will receive 5 days of ASTX727 (fixed dose 35 mg decitabine+100 mg cedazuridine). [68Ga]Ga-DOTA-peptide-PET/CT will be repeated day 8±2; where there is significant uptake greater than liver in most lesions, PRRT will be administered. Primary objective is to determine re-expression of SSTR2 on PET imaging. Tolerability, progression-free survival, overall response and quality of life will be assessed. Methylation in peripheral blood mononuclear cells and tumorous methylation will be evaluated. ETHICS AND DISSEMINATION LANTana has ethical approval from Leeds West Research Ethics Committee (REC Reference: 21/YH/0247).Sponsored by Imperial College London and funded by Advanced Accelerator Applications pharmaceuticals. Results will be presented at conferences and submitted to peer-reviewed journals for publication and will be available on ClinicalTrials.gov. TRIAL REGISTRATION NUMBERS EUDRACT number: 2020-003800-15, NCT05178693.
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Affiliation(s)
- Ravindhi Murphy
- Department of Surgery and Cancer, Hammersmith Hospital, London, UK
| | - Gurvin Chander
- Department of Surgery and Cancer, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Maria Martinez
- Department of Surgery and Cancer, Hammersmith Hospital, London, UK
| | - Caroline Ward
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Sairah R Khan
- Department of Nuclear Medicine, Hammersmith Hospital, London, UK
| | - Mitesh Naik
- Department of Nuclear Medicine, Hammersmith Hospital, London, UK
| | - Tara Barwick
- Department of Cancer and Surgery, Imperial College London, London, UK
- Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
| | - Eric Aboagye
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rohini Sharma
- Department of Surgery and Cancer, Hammersmith Hospital, London, UK
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26
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Blanc A, Todorovic M, Dude I, Merkens H, Bénard F, Perrin DM. Toward tryptathionine-stapled one-bead-one-compound (OBOC) libraries: solid phase synthesis of a bioactive octretoate analog. Org Biomol Chem 2023; 21:8112-8116. [PMID: 37772608 DOI: 10.1039/d3ob01378b] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
New somatostatin analogs are highly desirable for diagnosing and treating neuroendocrine tumors (NETs). Here we describe the solid-phase synthesis of a new octreotate (TATE) analog where the disulfide bond is replaced with a tryptathionine (Ttn) staple as part of an effort to prototyping a one-bead-one-compound (OBOC) library of Ttn-stapled peptides. Library design provides the potential for on- and off-bead screening. To validate our method, we labelled Ttn-TATE with a fluorescent dye to demonstrate binding to soluble somatostatin receptor subtype-2 and staining of Ar42J rat prostate cancer cells. By exploring this staple in the context of a ligand of known affinity, this method paves the way for an OBOC library construction of bioactive octreotate analogs and, more broadly speaking, tryptathionine-staped peptide macrocycles.
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Affiliation(s)
- Antoine Blanc
- Chemistry Department, UBC, 2036 Main Mall, Vancouver, V6T-1Z1, Canada.
| | - Mihajlo Todorovic
- Chemistry Department, UBC, 2036 Main Mall, Vancouver, V6T-1Z1, Canada.
| | - Iulia Dude
- Molecular Oncology, British Columbia Cancer Agency Research Centre, 675 West10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - Helen Merkens
- Molecular Oncology, British Columbia Cancer Agency Research Centre, 675 West10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - François Bénard
- Molecular Oncology, British Columbia Cancer Agency Research Centre, 675 West10th Avenue, Vancouver, BC, V5Z 1L3, Canada
| | - David M Perrin
- Chemistry Department, UBC, 2036 Main Mall, Vancouver, V6T-1Z1, Canada.
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27
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Postel MD, Darabi S, Howe JR, Liang WS, Craig DW, Demeure MJ. Multiomic sequencing of paired primary and metastatic small bowel carcinoids. F1000Res 2023; 12:417. [PMID: 37954063 PMCID: PMC10632590 DOI: 10.12688/f1000research.130251.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 11/14/2023] Open
Abstract
Background: Small bowel carcinoids are insidious tumors that are often metastatic when diagnosed. Limited mutation landscape studies of carcinoids indicate that these tumors have a relatively low mutational burden. The development of targeted therapies will depend upon the identification of mutations that drive the pathogenesis and metastasis of carcinoid tumors. Methods: Whole exome and RNA sequencing of 5 matched sets of normal tissue, primary small intestine carcinoid tumors, and liver metastases were investigated. Germline and somatic variants included: single nucleotide variants (SNVs), insertions/deletions (indels), structural variants, and copy number alterations (CNAs). The functional impact of mutations was predicted using Ensembl Variant Effect Predictor. Results: Large-scale CNAs were observed including the loss of chromosome 18 in all 5 metastases and 3/5 primary tumors. Certain somatic SNVs were metastasis-specific; including mutations in ATRX, CDKN1B, MXRA5 (leading to the activation of a cryptic splice site and loss of mRNA), SMARCA2, and the loss of UBE4B. Additional mutations in ATRX, and splice site loss of PYGL, leading to intron retention observed in primary and metastatic tumors. Conclusions: We observed novel mutations in primary/metastatic carcinoid tumor pairs, and some have been observed in other types of neuroendocrine tumors. We confirmed a previously observed loss of chromosome 18 and CDKN1B. Transcriptome sequencing added relevant information that would not have been appreciated with DNA sequencing alone. The detection of several splicing mutations on the DNA level and their consequences at the RNA level suggests that RNA splicing aberrations may be an important mechanism underlying carcinoid tumors.
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Affiliation(s)
- Mackenzie D. Postel
- Institute of Translational Genomics, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Sourat Darabi
- Precision Medicine, Hoag Family Cancer Institute, Newport Beach, CA, 92663, USA
| | - James R. Howe
- Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | | | - David W. Craig
- Institute of Translational Genomics, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Michael J. Demeure
- Precision Medicine, Hoag Family Cancer Institute, Newport Beach, CA, 92663, USA
- Translational Genomics Research Institute, Phoenix, AZ, USA
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28
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Feuerecker B, Heimer MM, Geyer T, Fabritius MP, Gu S, Schachtner B, Beyer L, Ricke J, Gatidis S, Ingrisch M, Cyran CC. Artificial Intelligence in Oncological Hybrid Imaging. Nuklearmedizin 2023; 62:296-305. [PMID: 37802057 DOI: 10.1055/a-2157-6810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/08/2023]
Abstract
BACKGROUND Artificial intelligence (AI) applications have become increasingly relevant across a broad spectrum of settings in medical imaging. Due to the large amount of imaging data that is generated in oncological hybrid imaging, AI applications are desirable for lesion detection and characterization in primary staging, therapy monitoring, and recurrence detection. Given the rapid developments in machine learning (ML) and deep learning (DL) methods, the role of AI will have significant impact on the imaging workflow and will eventually improve clinical decision making and outcomes. METHODS AND RESULTS The first part of this narrative review discusses current research with an introduction to artificial intelligence in oncological hybrid imaging and key concepts in data science. The second part reviews relevant examples with a focus on applications in oncology as well as discussion of challenges and current limitations. CONCLUSION AI applications have the potential to leverage the diagnostic data stream with high efficiency and depth to facilitate automated lesion detection, characterization, and therapy monitoring to ultimately improve quality and efficiency throughout the medical imaging workflow. The goal is to generate reproducible, structured, quantitative diagnostic data for evidence-based therapy guidance in oncology. However, significant challenges remain regarding application development, benchmarking, and clinical implementation. KEY POINTS · Hybrid imaging generates a large amount of multimodality medical imaging data with high complexity and depth.. · Advanced tools are required to enable fast and cost-efficient processing along the whole radiology value chain.. · AI applications promise to facilitate the assessment of oncological disease in hybrid imaging with high quality and efficiency for lesion detection, characterization, and response assessment. The goal is to generate reproducible, structured, quantitative diagnostic data for evidence-based oncological therapy guidance.. · Selected applications in three oncological entities (lung, prostate, and neuroendocrine tumors) demonstrate how AI algorithms may impact imaging-based tasks in hybrid imaging and potentially guide clinical decision making..
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Affiliation(s)
- Benedikt Feuerecker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- German Cancer Research Center (DKFZ), Partner site Munich, DKTK German Cancer Consortium, Munich, Germany
| | - Maurice M Heimer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Sijing Gu
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sergios Gatidis
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany
- MPI, Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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29
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Ortega Larrode A, Farrais Villalba S, Guerrero Muñoz C, Blas Jhon L, Martin Relloso MJ, Sanchez-Fayos Calabuig P, Calero Baron D, Varela Silva A, Porres Cubero JC. Detection of Neuroendocrine Tumours by Enteroscopy: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1469. [PMID: 37629759 PMCID: PMC10456339 DOI: 10.3390/medicina59081469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/09/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
We present the case of a 62-year-old patient who developed melenas and in whom conventional endoscopic tests could not detect any bleeding lesion. In our case, capsule endoscopy and enteroscopy were the pivotal elements in establishing the diagnosis of a neuroendocrine tumour with an atypical location. As a result, it was possible to surgically remove the lesions at an early stage of the malignancy without metastatic disease and without the need for adjuvant therapy. Our case demonstrates the need for these new techniques in tumours of atypical location and aggressive course. Otherwise, this malignancy may be underdiagnosed until an advanced stage.
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Affiliation(s)
- Adriana Ortega Larrode
- Department of Gastroenterology, Fundación Jiménez Díaz University Hospital, 28040 Madrid, Spain; (S.F.V.); (C.G.M.); (L.B.J.); (M.J.M.R.); (P.S.-F.C.); (D.C.B.); (A.V.S.); (J.C.P.C.)
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30
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Akay S, Pollard JH, Saad Eddin A, Alatoum A, Kandemirli S, Gholamrezanezhad A, Menda Y, Graham MM, Shariftabrizi A. PET/CT Imaging in Treatment Planning and Surveillance of Sinonasal Neoplasms. Cancers (Basel) 2023; 15:3759. [PMID: 37568575 PMCID: PMC10417627 DOI: 10.3390/cancers15153759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 08/13/2023] Open
Abstract
Sinonasal cancers are uncommon malignancies with a generally unfavorable prognosis, often presenting at an advanced stage. Their high rate of recurrence supports close imaging surveillance and the utilization of functional imaging techniques. Whole-body 18F-FDG PET/CT has very high sensitivity for the diagnosis of sinonasal malignancies and can also be used as a "metabolic biopsy" in the characterization of some of the more common subgroups of these tumors, though due to overlap in uptake, histological confirmation is still needed. For certain tumor types, radiotracers, such as 11C-choline, and radiolabeled somatostatin analogs, including 68Ga-DOTATATE/DOTATOC, have proven useful in treatment planning and surveillance. Although serial scans for posttreatment surveillance allow the detection of subclinical lesions, the optimal schedule and efficacy in terms of survival are yet to be determined. Pitfalls of 18F-FDG, such as post-surgical and post-radiotherapy crusting and inflammation, may cause false-positive hypermetabolism in the absence of relapse.
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Affiliation(s)
- Sinan Akay
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Janet H. Pollard
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Assim Saad Eddin
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Aiah Alatoum
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Sedat Kandemirli
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ali Gholamrezanezhad
- Department of Radiology, Keck School of Medicine, University of Southern California (USC), Los Angeles, CA 90030, USA
| | - Yusuf Menda
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Michael M. Graham
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
| | - Ahmad Shariftabrizi
- Division of Nuclear Medicine, Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA
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31
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Qi M, Liu Y, Su M, Huang R. Primary Hepatocellular Carcinoma Revealed on 68Ga-DOTATATE in a Patient With Nasopharyngeal Carcinoma. Clin Nucl Med 2023:00003072-990000000-00642. [PMID: 37486702 DOI: 10.1097/rlu.0000000000004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
ABSTRACT A 56-year-old man underwent a prospective study (ChiCTR2300070081), which is a head-to-head comparison of 18F-FDG and 68Ga-DOTATATE PET/MR in EB-positive nonkeratinizing nasopharyngeal carcinoma after chemotherapy. Bilateral cervical abnormal lymph nodes were both detected by 18F-FDG and 68Ga-DOTATATE PET/MRI, whereas 2 hepatic lesions only were shown on 68Ga-DOTATATE, which subsequent pathologically proved to be primary hepatocellular carcinoma.
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Affiliation(s)
- Mengfang Qi
- From the Department of Nuclear Medicine, West China Hospital of Sichuan University, Chengdu, China
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32
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Weber M, Telli T, Kersting D, Seifert R. Prognostic Implications of PET-Derived Tumor Volume and Uptake in Patients with Neuroendocrine Tumors. Cancers (Basel) 2023; 15:3581. [PMID: 37509242 PMCID: PMC10377105 DOI: 10.3390/cancers15143581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/30/2023] Open
Abstract
Historically, molecular imaging of somatostatin receptor (SSTR) expression in patients with neuroendocrine tumors (NET) was performed using SSTR scintigraphy (SRS). Sustained advances in medical imaging have led to its gradual replacement with SSTR positron-emission tomography (SSTR-PET). The higher sensitivity in comparison to SRS on the one hand and conventional cross-sectional imaging, on the other hand, enables more accurate staging and allows for image quantification. In addition, in recent years, a growing body of evidence has assessed the prognostic implications of SSTR-PET-derived prognostic biomarkers for NET patients, with the aim of risk stratification, outcome prognostication, and prediction of response to peptide receptor radionuclide therapy. In this narrative review, we give an overview of studies examining the prognostic value of advanced SSTR-PET-derived (semi-)quantitative metrics like tumor volume, uptake, and composite metrics. Complementing this analysis, a discussion of the current trends, clinical implications, and future directions is provided.
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Affiliation(s)
- Manuel Weber
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - Tugce Telli
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - David Kersting
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
| | - Robert Seifert
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, 45147 Essen, Germany
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Karam E, Hollenbach M, Abou Ali E, Auriemma F, Anderloni A, Barbier L, Belfiori G, Caillol F, Crippa S, Del Chiaro M, De Ponthaud C, Dahel Y, Falconi M, Giovannini M, Heling D, Inoue Y, Jarnagin WR, Leung G, Lupinacci RM, Mariani A, Masaryk V, Miksch RC, Musquer N, Napoleon B, Oba A, Partelli S, Petrone MC, Prat F, Repici A, Sauvanet A, Salzmann K, Schattner MA, Schulick R, Schwarz L, Soares K, Souche FR, Truant S, Vaillant JC, Wang T, Wedi E, Werner J, Weismüller TJ, Wichmann D, Will U, Zaccari P, Gulla A, Heise C, Regner S, Gaujoux S. Endoscopic and Surgical Management of Non-Metastatic Ampullary Neuroendocrine Neoplasia: A Multi-Institutional Pancreas2000/EPC Study. Neuroendocrinology 2023; 113:1024-1034. [PMID: 37369186 DOI: 10.1159/000531712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 05/15/2023] [Indexed: 06/29/2023]
Abstract
INTRODUCTION Ampullary neuroendocrine neoplasia (NEN) is rare and evidence regarding their management is scarce. This study aimed to describe clinicopathological features, management, and prognosis of ampullary NEN according to their endoscopic or surgical management. METHODS From a multi-institutional international database, patients treated with either endoscopic papillectomy (EP), transduodenal surgical ampullectomy (TSA), or pancreaticoduodenectomy (PD) for ampullary NEN were included. Clinical features, post-procedure complications, and recurrences were assessed. RESULTS 65 patients were included, 20 (30.8%) treated with EP, 19 (29.2%) with TSA, and 26 (40%) with PD. Patients were mostly asymptomatic (n = 46; 70.8%). Median tumor size was 17 mm (12-22), tumors were mostly grade 1 (70.8%) and pT2 (55.4%). Two (10%) EP resulted in severe American Society for Gastrointestinal Enterology (ASGE) adverse post-procedure complications and 10 (50%) were R0. Clavien 3-5 complications did not occur after TSA and in 4, including 1 postoperative death (15.4%) of patients after PD, with 17 (89.5%) and 26 R0 resection (100%), respectively. The pN1/2 rate was 51.9% (n = 14) after PD. Tumor size larger than 1 cm (i.e., pT stage >1) was a predictor for R1 resection (p < 0.001). Three-year overall survival and disease-free survival after EP, TSA, and PD were 92%, 68%, 92% and 92%, 85%, 73%, respectively. CONCLUSION Management of ampullary NEN is challenging. EP should not be performed in lesions larger than 1 cm or with a endoscopic ultrasonography T stage beyond T1. Local resection by TSA seems safe and feasible for lesions without nodal involvement. PD should be preferred for larger ampullary NEN at risk of nodal metastasis.
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Affiliation(s)
- Elias Karam
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Marcus Hollenbach
- Medical Department II - Gastroenterology, Hepatology, Infectious Diseases, Pulmonology, University of Leipzig Medical Center, Leipzig, Germany
| | - Einas Abou Ali
- Department of Gastroenterology, Digestive Oncology and Endoscopy, Cochin Hospital, Paris, France
| | - Francesco Auriemma
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Andrea Anderloni
- Gastroenterology and Digestive Endoscopy Unit, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
| | - Louise Barbier
- Hepato-Biliary, Pancreatic and Liver Transplantation Unit, Department of Visceral Surgery, Tours University Hospital, Tours, France
| | - Giulio Belfiori
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Fabrice Caillol
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Stefano Crippa
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marco Del Chiaro
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Charles De Ponthaud
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Yanis Dahel
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Massimo Falconi
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Marc Giovannini
- Department of Endoscopy, Institut Paoli Calmettes, Marseille, France
| | - Dominik Heling
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Yosuke Inoue
- Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Tokyo, Japan
| | - William R Jarnagin
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Galen Leung
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Renato M Lupinacci
- Department of Digestive Surgery, Groupe Hospitalier Diaconesses Croix Saint-Simon, Paris, France
| | - Alberto Mariani
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Viliam Masaryk
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Rainer Christoph Miksch
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | | | | | - Atsushi Oba
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Stefano Partelli
- Department of Pancreatic Surgery, Pancreas Translational & Clinical Research Center, San Raffaele Hospital IRCCS, Vita-Salute University, Milan, Italy
| | - Maria C Petrone
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Frédéric Prat
- Department of Digestive, hepatobiliary and endocrine surgery, Cochin Hospital, APHP, and Université de Paris, Paris, France
| | - Alessandro Repici
- Rozzano, Digestive Endoscopy Unit, Division of Gastroenterology, Humanitas Clinical and Research Hospital, Milano, Italy
| | - Alain Sauvanet
- Departement of Digestive Surgery, Beaujon Hospital, APHP, Clichy, France
| | - Katrin Salzmann
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
| | - Mark A Schattner
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Richard Schulick
- Department of Surgery, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lilian Schwarz
- Department of Digestive Surgery, Hôpital Charles-Nicolle, Centre Hospitalier Universitaire de Rouen, Rouen, France
| | - Kevin Soares
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - François R Souche
- Department of Digestive Surgery, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Stéphanie Truant
- Deparment of Digestive Surgery, Centre Hospitalo-Universitaire De Lille, Lille, France
| | - Jean C Vaillant
- Department of Digestive and HBP Surgery, Groupe Hospitalier Pitié-Salpêtrière APHP, Paris, France
| | - Tiegong Wang
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Surgery, Cangzhou Central Hospital, Cangzhou, China
| | - Edris Wedi
- Department of Gastroenterology and Gastrointestinal Oncology, University Medicine Göttingen, Göttingen, Germany
- Department of Gastroenterology, Gastrointestinal Oncology and Interventional Endoscopy, Sana Clinic Offenbach, Offenbach, Germany
| | - Jens Werner
- Department of General, Visceral, and Transplantation Surgery, Ludwig Maximilian University Munich, Munich, Germany
| | - Tobias J Weismüller
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
- Department of Internal Medicine - Gastroenterology and Oncology, Vivantes Humboldt Hospital, Berlin, Germany
| | - Dörte Wichmann
- Department of General, Visceral and Transplantation Surgery, University Hospital of Tübingen, Tübingen, Germany
| | - Uwe Will
- Department of Gastroenterology, Hepatology, Diabetes and General Internal Medicine, SRH Wald-Klinikum Gera, Gera, Germany
| | - Piera Zaccari
- Pancreato-Biliary Endoscopy and Endosonography Division, Pancreas Translational & Clinical Research Center, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy
| | - Aiste Gulla
- Institute of Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgery, MedStar Georgetown University Hospital, General Surgery, Georgetown, Washington, District of Columbia, USA
| | - Christian Heise
- Department of Medicine I - Gastroenterology, Pulmonology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Sara Regner
- Section for Surgery, Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Sébastien Gaujoux
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Department of Surgery, Sorbonne University, Paris, France
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Haidar M, Al Mahmasani L, Chehade L, Elias C, El Jebai M, Temraz S, Charafeddine M, Al Darazi M, Shamseddine A. Well-differentiated gastro-entero-pancreatic neuroendocrine tumors with positive FDG-PET/CT: a retrospective chart review. Nucl Med Commun 2023; 44:471-479. [PMID: 36897058 DOI: 10.1097/mnm.0000000000001683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
PURPOSE Rarely, well-differentiated gastro-entero-pancreatic neuroendocrine tumors (GEP NETs) can have positive uptake on 18F-fluorodeoxyglucose-PET/computerized tomography ( 18 F-FDG-PET/CT), with or without a positive 68 Ga-PET/CT. We aim to evaluate the diagnostic role of 18 F-FDG-PET/CT in patients with well-differentiated GEP NETs. METHODS We retrospectively reviewed a chart of patients diagnosed with GEP NETs between 2014 and 2021, at the American University of Beirut Medical Center, who have low (G1; Ki-67 ≤2) or intermediate (G2; and Ki-67 >2-≤20) well-differentiated tumors with positive findings on FDG-PET/CT. The primary endpoint is progression-free survival (PFS) compared to historical control, and the secondary outcome is to describe their clinical outcome. RESULTS In total 8 out of 36 patients with G1 or G2 GEP NET met the inclusion criteria for this study. The median age was 60 years (range 51-75 years) and 75% were male. One patient (12.5%) had a G1 tumor whereas 7 (87.5%) had G2, and seven patients were stage IV. The primary tumor was intestinal in 62.5% of the patients and pancreatic in 37.5%. Seven patients had both 18 F-FDG-PET/CT and 68 Ga-PET/CT positive and one patient had a positive 18 F-FDG-PET/CT and negative 68 Ga-PET/CT. Median and mean PFS in patients positive for both 68 Ga-PET/CT and 18 F-FDG-PET/CT were 49.71 months and 37.5 months (95% CI, 20.7-54.3), respectively. PFS in these patients is lower than that reported in the literature for G1/G2 NETs with positive 68 Ga-PET/CT and negative FDG-PET/CT (37.5 vs. 71 months; P = 0.0217). CONCLUSION A new prognostic score that includes 18 F-FDG-PET/CT in G1/G2 GEP NETs could identify more aggressive tumors.
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Affiliation(s)
| | - Layal Al Mahmasani
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Laudy Chehade
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Charbel Elias
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Sally Temraz
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Maya Charafeddine
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Monita Al Darazi
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Internal Medicine, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
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Eklund MJ, States LJ, Acord MR, Alazraki AL, Behr GG, El-Ali AM, Morin CE, Saigal G, Shet NS, Thacker PG, Trout AT. Imaging of pediatric pancreas tumors: A COG Diagnostic Imaging Committee/SPR Oncology Committee White Paper. Pediatr Blood Cancer 2023; 70 Suppl 4:e29975. [PMID: 36215203 PMCID: PMC10642208 DOI: 10.1002/pbc.29975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 11/10/2022]
Abstract
Primary pancreatic tumors in children are rare with an overall age-adjusted incidence of 0.018 new cases per 100,000 pediatric patients. The most prevalent histologic type is the solid pseudopapillary neoplasm, followed by pancreatoblastoma. This paper describes relevant imaging modalities and presents consensus-based recommendations for imaging at diagnosis and follow-up.
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Affiliation(s)
- Meryle J Eklund
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lisa J States
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Michael R Acord
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Adina L Alazraki
- Departments of Pediatrics and Radiology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Gerald G Behr
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Alexander M El-Ali
- Department of Radiology, NYU Grossman School of Medicine, New York, New York, USA
| | - Cara E Morin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Gaurav Saigal
- Department of Radiology, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Narendra S Shet
- Department of Diagnostic Imaging and Radiology, Children's National Hospital, Washington, District of Columbia, USA
| | - Paul G Thacker
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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Krasnovskaya OO, Abramchuck D, Erofeev A, Gorelkin P, Kuznetsov A, Shemukhin A, Beloglazkina EK. Recent Advances in 64Cu/ 67Cu-Based Radiopharmaceuticals. Int J Mol Sci 2023; 24:ijms24119154. [PMID: 37298101 DOI: 10.3390/ijms24119154] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/12/2023] Open
Abstract
Copper-64 (T1/2 = 12.7 h) is a positron and beta-emitting isotope, with decay characteristics suitable for both positron emission tomography (PET) imaging and radiotherapy of cancer. Copper-67 (T1/2 = 61.8 h) is a beta and gamma emitter, appropriate for radiotherapy β-energy and with a half-life suitable for single-photon emission computed tomography (SPECT) imaging. The chemical identities of 64Cu and 67Cu isotopes allow for convenient use of the same chelating molecules for sequential PET imaging and radiotherapy. A recent breakthrough in 67Cu production opened previously unavailable opportunities for a reliable source of 67Cu with high specific activity and purity. These new opportunities have reignited interest in the use of copper-containing radiopharmaceuticals for the therapy, diagnosis, and theranostics of various diseases. Herein, we summarize recent (2018-2023) advances in the use of copper-based radiopharmaceuticals for PET, SPECT imaging, radiotherapy, and radioimmunotherapy.
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Affiliation(s)
- Olga O Krasnovskaya
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
| | - Daniil Abramchuck
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
| | - Alexander Erofeev
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
- Research Laboratory of Biophysics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
| | - Peter Gorelkin
- Research Laboratory of Biophysics, National University of Science and Technology (MISIS), Leninskiy Prospect 4, 119049 Moscow, Russia
| | - Alexander Kuznetsov
- Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University, Leninskie Gory, 1, Bld. 2, 119991 Moscow, Russia
- Department of Physics, Lomonosov Moscow State University, Leninskie Gory, 1/2, 119991 Moscow, Russia
| | - Andrey Shemukhin
- Skobeltsyn Institute of Nuclear Physics, Lomonosov Moscow State University, Leninskie Gory, 1, Bld. 2, 119991 Moscow, Russia
| | - Elena K Beloglazkina
- Chemistry Department, Lomonosov Moscow State University, Leninskie Gory, 1/3, 119991 Moscow, Russia
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Abstract
BACKGROUND Pulmonary nodule growth is often measured by volume doubling time (VDT), which may guide management. Most malignant nodules have a VDT of 20 to 400 days, with longer VDTs typically observed in indolent nodules. We assessed the utility of VDT in differentiating pulmonary carcinoids and hamartomas. METHODS A review was performed from January 2012 to October 2021 to identify patients with pathologic diagnoses and at least 2 chest computed tomography scans obtained 6 or more months apart. Visualization software was used to segment nodules and calculate diameter and volume. Volume doubling time was calculated for scans with 1-mm slices. For the remainder, estimated nodule volume doubling time (eVDT) was calculated using nodule diameter. Volume doubling times/eVDTs were placed into growth categories: less than 400 days; 400-600 days; and more than 600 days. RESULTS Sixty nodules were identified, 35 carcinoids and 25 hamartomas. Carcinoids were larger than hamartomas (median diameter, 13.5 vs 11.5 mm; P = 0.05). For carcinoid tumors, median VDT (n = 15) was 1485 days, and median eVDT (n = 32) was 1309 days; for hamartomas, median VDT (n = 8) was 2040 days and median eVDT (n = 25) was 2253 days. Carcinoid tumor eVDT was significantly shorter than hamartomas ( P = 0.03). By growth category, 1 of 25 hamartomas and 5 of 35 carcinoids had eVDT less than 400 days and 24 of 25 hamartomas and 27 of 35 carcinoids had eVDT more than 600 days. Of 4 carcinoid tumors with metastases, 2 had eVDT less than 400 days and 2 had eVDT more than 600 days. CONCLUSIONS Growth rate was not a reliable differentiator of pulmonary hamartomas and carcinoids. Slow growing carcinoids can metastasize. Radiologists should be cautious when discontinuing computed tomography follow-up based on growth rates alone.
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Affiliation(s)
- James W Ryan
- From the Brigham and Women's Hospital, Boston MA
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Grawe F, Rosenberger N, Ingenerf M, Beyer L, Eschbach R, Todica A, Seidensticker R, Schmid-Tannwald C, Cyran CC, Ricke J, Bartenstein P, Auernhammer CJ, Ruebenthaler J, Fabritius MP. Diagnostic performance of PET/CT in the detection of liver metastases in well-differentiated NETs. Cancer Imaging 2023; 23:41. [PMID: 37098632 PMCID: PMC10131442 DOI: 10.1186/s40644-023-00556-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND The aim of this retrospective study was to compare the diagnostic accuracy of somatostatin receptor (SSR)-PET/CT to liver MRI as reference standard in the evaluation of hepatic involvement in neuroendocrine tumors (NET). METHODS An institutional database was screened for "SSR" imaging studies between 2006 and 2021. 1000 NET Patients (grade 1/2) with 2383 SSR-PET/CT studies and matching liver MRI in an interval of +3 months were identified. Medical reports of SSR-PET/CT and MRI were retrospectively evaluated regarding hepatic involvement and either confirmed by both or observed in MRI but not in SSR-PET/CT (false-negative) or in SSR-PET but not in MRI (false-positive). RESULTS Metastatic hepatic involvement was reported in 1650 (69.2%) of the total 2383 SSR-PET/CT imaging studies, whereas MRI detected hepatic involvement in 1685 (70.7%) cases. There were 51 (2.1%) false-negative and 16 (0.7%) false-positive cases. In case of discrepant reports, MRI and PET/CT were reviewed side by side for consensus reading. SSR-PET/CT demonstrated a sensitivity of 97.0% (95%CI: 96.0%, 97.7%), a specificity of 97.7% (95%CI: 96.3%, 98.7%), a PPV of 99.0% (95%CI: 98.4%, 99.4%) and NPV of 93.0% (95%CI: 91.0, 94.8%) in identifying hepatic involvement. The most frequent reason for false-negative results was the small size of lesions with the majority < 0.6 cm. CONCLUSION This study confirms the high diagnostic accuracy of SSR-PET/CT in the detection of hepatic involvement in NET patients based on a patient-based analysis of metastatic hepatic involvement with a high sensitivity and specificity using liver MRI imaging as reference standard. However, one should be aware of possible pitfalls when a single imaging method is used in evaluating neuroendocrine liver metastases in patients.
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Affiliation(s)
- Freba Grawe
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Natalie Rosenberger
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Maria Ingenerf
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Ralf Eschbach
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
| | - Andrei Todica
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Ricarda Seidensticker
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Christine Schmid-Tannwald
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Peter Bartenstein
- Department of Nuclear Medicine, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Christoph J Auernhammer
- Department of Internal Medicine 4, University Hospital, LMU Munich, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Johannes Ruebenthaler
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany
- Interdisciplinary Center of Neuroendocrine Tumors of the GastroEnteroPancreatic System (GEPNET-KUM, ENETS certified Center of Excellence), University Hospital, LMU Munich, 81377, Munich, Germany
| | - Matthias P Fabritius
- Department of Radiology, University Hospital, LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
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Sanli Y, Denizmen D, Subramaniam RM. Gastro-Enteric-Pancreatic Neuroendocrine Tumor Treatment: 177Lu-DOTATATE. PET Clin 2023; 18:201-214. [PMID: 36858745 DOI: 10.1016/j.cpet.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
177Lu-DOTA-TATE therapy is a highly effective therapy in metastatic, well-differentiated, somatostatin receptor-positive GEP-neuroendocrine tumors (NETs) with mostly tolerable adverse effects. Guidelines generally refer to peptide receptor radionuclide therapy as a second-line therapy after SSA in gastroenteric and second- or third-line therapy in pancreatic NETs to improve survival rates and quality of life. Although we do not have sufficient data, 177Lu-DOTA-TATE therapy may also have a role in high-grade NET therapy, mostly in combination with other treatments such as chemotherapy.
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Affiliation(s)
- Yasemin Sanli
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Istanbul 34390, Turkey.
| | - Dilara Denizmen
- Department of Nuclear Medicine, Istanbul Faculty of Medicine, Istanbul University, Millet Caddesi, Istanbul 34390, Turkey
| | - Rathan M Subramaniam
- Dean's Office, Otago Medical School, University of Otago, Dunedin 9016, New Zealand; Department of Radiology, Duke University, Durham, NC, USA
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Kandathil A, Subramaniam RM. Gastroenteropancreatic Neuroendocrine Tumor Diagnosis: DOTATATE PET/CT. PET Clin 2023; 18:189-200. [PMID: 36585339 DOI: 10.1016/j.cpet.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Gastroenteropancreatic neuroendocrine tumors(NETs), which arise from the small intestine, rectum, colon, appendix, or pancreas, have variable malignant potential with clinical behavior determined by proliferative activity according to the Ki-67 index and tumor differentiation. Somatostatin receptor (SSTR) expression by NETs allows SSTR imaging using 68Ga-DOTATATE PET/computed tomography (CT) and treatment with octreotide or SSTR-targeted peptide receptor radionuclide therapy (PRRT). 68Ga-DOTATATE PET/CT is indicated for localization of the primary tumor in select cases, staging patients with known NET, and selecting patients for PRRT. NCCN guidelines consider imaging with 68Ga-DOTATATE PET/CT appropriate for staging and receptor status assessment.
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Affiliation(s)
- Asha Kandathil
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9316, USA.
| | - Rathan M Subramaniam
- Duke University Medical Center, Department of Radiology, 2301 Erwin Road Box 3808, Durham, NC 27710, USA; Department of Medicine, Otago Medical School, University of Otago, First Floor, Dunedin Hospital, 201 Great King Street, Dunedin 9016, New Zealand
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Ramesh A, Chatterjee A, Subramaniam RM. Neuroendocrine Neoplasms: Epidemiology, Diagnosis, and Management. PET Clin 2023; 18:161-168. [PMID: 36707369 DOI: 10.1016/j.cpet.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Neuroendocrine tumors have variety of biological and clinical characteristics. The classification of neuroendocrine neoplasm has evolved, and the newest 2019 World Health Organization classification outlines a well-differentiated high-grade G3 subtype, recognizing its differences from the poorly differentiated neuroendocrine carcinoma. 68Ga-DOTAT PET has largely replaced somatostatin scintigraphy as the diagnostic workup choice for NENs. NETest, a multi-analyte liquid biopsy, is a promising recent development in the biochemical diagnosis. Management includes wait and watch approach, surgical resection, somatostatin analogs, 177Lu DOTATATE therapy, chemotherapy, radiotherapy or immunotherapy combinations. Further clinical trials are necessary for determining the appropriate sequencing.
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Affiliation(s)
- Ajitha Ramesh
- Dunedin Hospital, 201 Great King Street, Dunedin 9016, New Zealand
| | - Aniruddha Chatterjee
- Department of Pathology, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
| | - Rathan M Subramaniam
- Department of Medicine, Otago Medical School, University of Otago, 201 Great King Street, Dunedin, New Zealand; Department of Radiology, Duke University, Durham, NC, USA.
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D'Souza JC, O'Brien SR, Yang Z, El Jack AK, Pantel AR. Widespread micronodular hepatic metastases of neuroendocrine tumor detected by [68Ga]DOTATATE PET/CT. Radiol Case Rep 2023; 18:481-485. [DOI: 10.1016/j.radcr.2022.10.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 11/25/2022] Open
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Patel R, Marano G, Joseph J, Chung J, Plata A, Vos JA. 18 F-fludeoxyglucose positron emission computed tomography ( 18 F-FDG-PET/CT) versus 68 Ga-DOTATATE-PET/CT in patients with head and neck cancer: Comparisons and implications for treatment. Head Neck 2023; 45:347-354. [PMID: 36591637 DOI: 10.1002/hed.27243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/22/2022] [Accepted: 10/28/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Tumor-specific molecular imaging in head and neck squamous cell carcinoma (HNSCC) is not well established. Somatostatin receptors (SSTRs) are found in solid tumors, including HNSCC. 68 Ga-DOTATATE, a commercially available radionuclide that binds SSTRs, may have utility in imaging HNSCC. METHODS Patients with HNSCC received pretreatment imaging with 18 F-FDG-PET/CT and 68 Ga-DOTATATE. Imaging was compared for concordance. When available, surgical resection specimens were compared to pretreatment imaging findings. Historic HNSCC tumor specimens were assessed for both SSTR and p16/human papilloma virus (HPV) expression. RESULTS Twenty patients were imaged. Fifteen had oropharyngeal cancer. Primary tumor site was concordant between imaging modalities for all patients. One of 45 lymph nodes was discordant. Retrospective specimen review showed a significant correlation with SSTR expression and HPV/p16 expression. No adverse events occurred. CONCLUSIONS 68 Ga-DOTATATE imaging is safe and effective in HNSCC. SSTR expression may be increased in HPV-mediated tumors. Targeted therapies to SSTR should be explored.
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Affiliation(s)
- Rusha Patel
- Department of Otolaryngology, Oklahoma University, Oklahoma City, Oklahoma, United States
| | - Gary Marano
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Joe Joseph
- Department of Radiology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffson Chung
- Department of Otolaryngology, West Virginia University, Morgantown, West Virginia, USA
| | - Andrew Plata
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
| | - Jeffrey A Vos
- Department of Pathology, West Virginia University, Morgantown, West Virginia, USA
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Feuerecker B, Heimer MM, Geyer T, Fabritius MP, Gu S, Schachtner B, Beyer L, Ricke J, Gatidis S, Ingrisch M, Cyran CC. Artificial Intelligence in Oncological Hybrid Imaging. ROFO-FORTSCHR RONTG 2023; 195:105-114. [PMID: 36170852 DOI: 10.1055/a-1909-7013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Artificial intelligence (AI) applications have become increasingly relevant across a broad spectrum of settings in medical imaging. Due to the large amount of imaging data that is generated in oncological hybrid imaging, AI applications are desirable for lesion detection and characterization in primary staging, therapy monitoring, and recurrence detection. Given the rapid developments in machine learning (ML) and deep learning (DL) methods, the role of AI will have significant impact on the imaging workflow and will eventually improve clinical decision making and outcomes. METHODS AND RESULTS The first part of this narrative review discusses current research with an introduction to artificial intelligence in oncological hybrid imaging and key concepts in data science. The second part reviews relevant examples with a focus on applications in oncology as well as discussion of challenges and current limitations. CONCLUSION AI applications have the potential to leverage the diagnostic data stream with high efficiency and depth to facilitate automated lesion detection, characterization, and therapy monitoring to ultimately improve quality and efficiency throughout the medical imaging workflow. The goal is to generate reproducible, structured, quantitative diagnostic data for evidence-based therapy guidance in oncology. However, significant challenges remain regarding application development, benchmarking, and clinical implementation. KEY POINTS · Hybrid imaging generates a large amount of multimodality medical imaging data with high complexity and depth.. · Advanced tools are required to enable fast and cost-efficient processing along the whole radiology value chain.. · AI applications promise to facilitate the assessment of oncological disease in hybrid imaging with high quality and efficiency for lesion detection, characterization, and response assessment. The goal is to generate reproducible, structured, quantitative diagnostic data for evidence-based oncological therapy guidance.. · Selected applications in three oncological entities (lung, prostate, and neuroendocrine tumors) demonstrate how AI algorithms may impact imaging-based tasks in hybrid imaging and potentially guide clinical decision making.. CITATION FORMAT · Feuerecker B, Heimer M, Geyer T et al. Artificial Intelligence in Oncological Hybrid Imaging. Fortschr Röntgenstr 2023; 195: 105 - 114.
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Affiliation(s)
- Benedikt Feuerecker
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany.,German Cancer Research Center (DKFZ), Partner site Munich, DKTK German Cancer Consortium, Munich, Germany
| | - Maurice M Heimer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Geyer
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Sijing Gu
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | | | - Leonie Beyer
- Department of Nuclear Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Jens Ricke
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Sergios Gatidis
- Department of Radiology, University Hospital Tübingen, Tübingen, Germany.,MPI, Max Planck Institute for Intelligent Systems, Tübingen, Germany
| | - Michael Ingrisch
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Clemens C Cyran
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
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45
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Stiles ZE, Sarkar J, Schwarz RE. Casting a wider NET: an unexpected finding in two patients with liver masses. ANZ J Surg 2023; 93:346-348. [PMID: 35491977 DOI: 10.1111/ans.17745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/19/2022] [Accepted: 04/16/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Zachary E Stiles
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Joy Sarkar
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Roderich E Schwarz
- Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
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46
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Increased 68Ga-DOTATATE Uptake in Supraclavicular Brown Adipose Tissue. Clin Nucl Med 2022; 47:1112-1113. [PMID: 36342799 DOI: 10.1097/rlu.0000000000004405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
ABSTRACT Characterization of brown adipose tissue (BAT) 18F-FDG uptake has been well reported; however, 68Ga-DOTA-conjugated somatostatin receptor targeting peptides uptake in BAT is rarely documented. Herein, we report an interesting case of increased 68Ga-DOTATATE uptake in supraclavicular BAT in a young boy with paroxysmal hypertension. The low body mass index and increased perfusion of BAT in response to cold may be significant influencing factors.
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47
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Small bowel neuroendocrine neoplasm: what surgeons want to know. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4005-4015. [PMID: 35312820 DOI: 10.1007/s00261-022-03485-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/01/2022] [Accepted: 03/02/2022] [Indexed: 01/18/2023]
Abstract
Neuroendocrine neoplasms of the small bowel are a diverse group of tumors with a broad spectrum of imaging findings and clinical implications. Most tumors originate in close proximity to the ileocecal valve and most commonly metastasize to the mesentery and liver. This review will highlight the imaging findings of primary and metastatic small bowel neuroendocrine neoplasm that are most relevant to the surgical team.
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48
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Epigenetic potentiation of somatostatin-2 by guadecitabine in neuroendocrine neoplasias as a novel method to allow delivery of peptide receptor radiotherapy. Eur J Cancer 2022; 176:110-120. [PMID: 36208569 DOI: 10.1016/j.ejca.2022.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/08/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Somatostatin receptor-2 (SSTR2) is expressed on cell surface of neuroendocrine neoplasias; its presence is exploited for the delivery of peptide receptor radionuclide therapy (PRRT). Patients with no or low expression of SSTR2 are not candidates for PRRT. SSTR2 promotor undergoes epigenetic modification, known to regulate gene expression. We investigated whether the demethylation agent, guadecitabine, could enhance the expression of SSTR2 in NET models, using radioligand uptake/PET imaging as a biomarker of epigenetic modification. METHODS The effects of guadecitabine on the transcriptional, translational, and functional regulation of SSTR2 both in vitro and in vivo using low (QGP-1) and high (BON-1) methylated neuroendocrine neoplasia models was characterised. Promotor region methylation profiling of clinical samples (n = 61) was undertaken. Safety of combination guadecitabine and PRRT was assessed in vivo. RESULTS Pyrosequencing of cell lines illustrated differential methylation indices - BON: 1 94%, QGP: 1 21%. Following guadecitabine treatment, a dose-dependent increase in SSTR2 in BON-1 at a transcriptional, translational, and functional levels using the SSTR2-directed radioligand, 18F-FET-βAG-TOCA ([18F]-FETO) (150% increase [18F]-FETO uptake, p < 0.05) was observed. In vivo, guadecitabine treatment resulted in a 70% increase in [18F]-FETO uptake in BON-1 tumour models compared models with low baseline percentage methylation (p < 0.05). No additive toxicity was observed with the combination treatment of PRRT and guadecitabine in vivo. Methylation index in clinical samples was 10.5% compared to 5.2% in controls (p = 0.03) and correlated with SSTR2 expression (Wilcoxon rank sign -3.75,p < 0.01). CONCLUSION Guadecitabine increases SSTR2 expression both in vitro and in vivo. The combination of demethylation agents with PRRT warrants further investigation.
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Meißner AK, von Spreckelsen N, Al Shughri A, Brunn A, Fuertjes G, Schlamann M, Schmidt M, Dietlein M, Rueß D, Ruge MI, Galldiks N, Goldbrunner R. Case report: Use of 68Ga-DOTATATE-PET for treatment guidance in complex meningioma disease. Front Oncol 2022; 12:1017339. [PMID: 36313670 PMCID: PMC9596965 DOI: 10.3389/fonc.2022.1017339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Currently, contrast-enhanced MRI is the method of choice for treatment planning and follow-up in patients with meningioma. However, positron emission tomography (PET) imaging of somatostatin receptor subtype 2 (SSTR2) expression using 68Ga-DOTATATE may provide a higher sensitivity for meningioma detection, especially in cases with complex anatomy or in the recurrent setting. Here, we report on a patient with a multilocal recurrent atypical meningioma, in which 68Ga-DOTATATE PET was considerably helpful for treatment guidance and decision-making.
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Affiliation(s)
- Anna-Katharina Meißner
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- *Correspondence: Anna-Katharina Meißner,
| | - Niklas von Spreckelsen
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Abdulkader Al Shughri
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anna Brunn
- Department of Neuropathology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Gina Fuertjes
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marc Schlamann
- Department of Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
| | - Matthias Schmidt
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Markus Dietlein
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Nuclear Medicine, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Daniel Rueß
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maximilian I. Ruge
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Stereotaxy and Functional Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Norbert Galldiks
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Juelich, Germany
| | - Roland Goldbrunner
- Department of General Neurosurgery, Center for Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Integrated Oncology (CIO), Universities of Aachen, Bonn, Cologne and, Duesseldorf, Germany
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[ 68Ga]FAPI-PET/CT for radiation therapy planning in biliary tract, pancreatic ductal adeno-, and adenoidcystic carcinomas. Sci Rep 2022; 12:16261. [PMID: 36171444 PMCID: PMC9519639 DOI: 10.1038/s41598-022-20447-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/13/2022] [Indexed: 11/08/2022] Open
Abstract
Biliary-tract-carcinomas (BTC), pancreatic-ductal-adenocarcinomas (PDAC) and adenoidcystic-carcinomas (AC) have in common that they are traditionally treated with large clinical-target-volumes (CTV). The aim of this study is to examine the impact of pretreatment-[68Ga]FAPI-PET/CT on target-volume-definition and posttreatment-[68Ga]FAPI-PET/CT-response-assessment for BTC-, PDAC- and AC-patients referred to radiation-therapy. All consecutive BTC-, PDAC-, and AC-patients who received pretreatment-[68Ga]FAPI-PET/CT±[18F]FDG-PET/CT were included from 01.01.2020 to 01.03.2022. MTV and SUVmax were separately generated based on [68Ga]FAPI- and [18F]FDG-PET/CT-images. A [68Ga]FAPI- and [18F]FDG-based-CTV was defined. Treatment-plans were compared. Treatment-response was reassessed by a second [68Ga]FAPI-PET/CT and [18F]FDG-PET/CT after treatment-completion. Intermodality comparison of lesion-to-background-ratios [SUVmax_lesion/SUVmean_background] for individual timepoints t1 and t2 revealed significant higher values for [68Ga]FAPI compared to [18F]FDG (t1, p = 0.008; t2, p = 0.005). Intermodality comparison of radiation-therapy-plans showed that [68Ga]FAPI-based planning resulted in D100% = 97.2% and V95% = 98.8% for the [18F]FDG-MTV. [18F]FDG-based-planning resulted in D100% = 35.9% and V95% = 78.1% for [68Ga]FAPI-MTV. [18F]FDG-based-planning resulted only in 2 patients in V95% > 95% for [68Ga]FAPI-MTV, and in 1 patient in D100% > 97% for [68Ga]FAPI-MTV. GTV-coverage in terms of V95% was 76.4% by [18F]FDG-based-planning and 99.5% by [68Ga]FAPI-based-planning. Pretreatment [68Ga]FAPI-PET/CT enhances radiation-treatment-planning in this particular group of patients. While perilesional and tumoral follow-up [18F]FDG-uptake behaved uniformly, perilesional and tumoral reaction may differ in follow-up [68Ga]FAPI-imaging. Complementary [68Ga]FAPI- and [18F]FDG-imaging enhance treatment-response-assessment.
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