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Rajasekaran RB, Kurisunkal V, Stevenson JD, Parry MC, Morris GV, Jeys LM. A pictographic guide for decision making in surgery for pelvic bone sarcoma. J Orthop 2025; 60:71-77. [PMID: 39345686 PMCID: PMC11437611 DOI: 10.1016/j.jor.2024.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2024] [Accepted: 09/02/2024] [Indexed: 10/01/2024] Open
Abstract
Pelvic bone sarcoma surgery is challenging due to complex anatomy, proximity to major neurovascular structures, and, more importantly, the potential for complications. Decision-making is vital in offering patients the best oncological and functional outcomes after surgery. Multidisciplinary teams involved from the stage of diagnosis and treatment planning, followed by surgery by experienced teams have proven to be beneficial. Tumour-free margin clearance is essential, and surgical planning must be tailored to achieve the same. The choice of reconstruction needs to be decided based on the amount of bone resected and the available expertise and resources. Lesions isolated only to PI or PIII region may not need reconstruction. Though pedestal cups and Custom-made prosthesis are useful in reconstruction after periacetabular tumour resections, hip transposition surgery is also widely practiced by surgeons with favourable outcomes particularly after neo-adjuvant radiotherapy/proton beam therapy. Navigation has shown promise in achieving tumour-negative margins and disease-free progression particularly in chondrosarcoma. A flap-based approach can be considered for hindquarter amputations; however, patients need to be counseled regarding the complications following this surgery. This article, with proposed flowcharts, is aimed at providing practicing surgeons with a guide toward decision-making while planning pelvic bone sarcoma surgery.
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Affiliation(s)
- Raja Bhaskara Rajasekaran
- Department of Musculoskeletal Oncology, Ganga Medical Centre & Hospitals Pvt. Ltd, 313, Mettupalayam Road, Coimbatore, India
| | | | | | | | - Guy V. Morris
- Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
| | - Lee M. Jeys
- Royal Orthopaedic Hospital, Birmingham, B31 2AP, United Kingdom
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Singnurkar A, Poon R, Metser U. Head-to-Head Comparison of the Diagnostic Performance of FDG PET/CT and FDG PET/MRI in Patients With Cancer: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2024; 223:e2431519. [PMID: 39016450 DOI: 10.2214/ajr.24.31519] [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: 07/18/2024]
Abstract
BACKGROUND. The available evidence on the use of FDG PET/MRI performed using an integrated system in patients with cancer has grown substantially. OBJECTIVE. The purpose of this study was to perform a systematic review and meta-analysis comparing the diagnostic performance of FDG PET/CT and FDG PET/MRI in patients with cancer. EVIDENCE ACQUISITION. MEDLINE, Embase, and the Cochrane Database of Systematic Reviews were searched for studies reporting a head-to-head comparison of the diagnostic performance of FDG PET/CT and FDG PET/MRI in patients with cancer from July 1, 2015, to January 25, 2023. The two modalities' diagnostic performance was summarized, stratified by performance end point. For end points with sufficient data, a meta-analysis was performed using bivariate modeling to produce summary estimates of pooled sensitivity and specificity. For the remaining end points, reported performance in individual studies was recorded. EVIDENCE SYNTHESIS. The systematic review included 29 studies with a total of 1656 patients. For patient-level detection of regional nodal metastases (five studies), pooled sensitivity and specificity for PET/MRI were 88% (95% CI, 74-95%) and 92% (95% CI, 71-98%), respectively, and for PET/CT were 86% (95% CI, 70-94%) and 86% (95% CI, 68-95%). For lesion-level detection of recurrence and/or metastases (five studies), pooled sensitivity and specificity for PET/MRI were 94% (95% CI, 78-99%) and 83% (95% CI, 76-88%), respectively, and for PET/CT were 91% (95% CI, 77-96%) and 81% (95% CI, 72-88%). In individual studies not included in the meta-analysis, PET/MRI in comparison with PET/CT showed staging accuracy in breast cancer of 98.0% versus 74.5% and in colorectal cancer of 96.2% versus 69.2%; sensitivity for primary tumor detection in cervical cancer of 93.2% versus 66.2%; and sensitivity, specificity, and accuracy for lesion-level liver metastasis detection of 91.1-98.0% versus 42.3-71.1%, 100.0% versus 83.3-98.6%, and 96.5-98.2% versus 44.7-86.7%, respectively. In three studies, management was more commonly impacted by information from PET/MRI (5.2-11.1%) than PET/CT (0.0-2.6%). CONCLUSION. PET/MRI showed comparable or superior diagnostic performance versus PET/CT across a range of cancers and end points. CLINICAL IMPACT. The findings help to identify clinical settings where PET/MRI may provide clinical benefit for oncologic evaluation. TRIAL REGISTRATION. Prospective Register of Systematic Reviews CRD42023433857.
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Affiliation(s)
- Amit Singnurkar
- Department of Medical Imaging, University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Raymond Poon
- Department of Oncology, Program in Evidence-Based Care, Ontario Health, Cancer Care Ontario, McMaster University, Juravinski Hospital and Cancer Centre, 711 Concession St, G Wing, 2nd Fl, Hamilton, ON L8V 1C3, Canada
| | - Ur Metser
- Department of Medical Imaging, University of Toronto, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Choi J, Chae Y, Kang BT, Lee S. An evaluation of the physiological uptake range of 18F-fluoro-2-deoxy-D-glucose in normal ovaries of seven dogs using positron emission tomography/computed tomography. Front Vet Sci 2024; 11:1343695. [PMID: 38371597 PMCID: PMC10869473 DOI: 10.3389/fvets.2024.1343695] [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: 11/24/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024] Open
Abstract
Introduction This study evaluated the physiological uptake range of 18F-fluoro-2-deoxy-D-glucose (18F-FDG) in the normal ovaries of seven dogs using positron emission tomography/computed tomography (PET/CT). Materials and methods The dogs were subjected to general anesthesia and were positioned in ventral recumbency for PET/CT scans. The dosage of 18F-FDG ranged from 0.14 to 0.17 mCi/kg and was administered intravenously followed by 0.9% NaCl flushing; PET/CT images of each dog were obtained precisely 60 min after the injection of 18F-FDG. The regions of interest were drawn manually, and standardized uptake values (SUV) were calculated to evaluate the 18F-FDG uptake in each ovary. The maximum and mean SUVs (SUV max and SUV mean) for all the ovaries of the dogs were then computed. Results The range of SUV max and SUV mean of the normal ovaries of the dogs were 1.28-1.62 and 1.07-1.31 (mean ± standard deviation), respectively. Conclusion This is the first study to investigate the normal 18F-FDG uptake baseline data of normal canine ovaries using PET/CT scans. These data will help clinicians in identifying malignant tumors before anatomical changes in the ovary through PET/CT scans.
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Affiliation(s)
- Jinyoung Choi
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yeon Chae
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Byeong-Teck Kang
- Laboratory of Veterinary Internal Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Sungin Lee
- Department of Veterinary Surgery, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
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Kessara A, Buyukcizmeci N, Gedik GK. CANCER RISK ESTIMATION FOR PATIENTS UNDERGOING WHOLE-BODY PET/CT SCANS. RADIATION PROTECTION DOSIMETRY 2023; 199:509-518. [PMID: 36856709 DOI: 10.1093/rpd/ncad040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 01/23/2023] [Accepted: 02/05/2023] [Indexed: 06/18/2023]
Abstract
The objective of this paper was to compute the effective dose, as well as the lifetime attributable risk (LAR) of cancer related to whole-body positron emission tomography (PET)/computed tomography (CT) scan for 193 adult patients. The mean effective dose for all patients from a single PET/CT scan was 20.6 mSv. For males aged 40 y, a single PET/CT scan is associated with a LAR of cancer incidence of 0.169%. This risk increased to 0.85% if an annual surveillance protocol for 5 y was performed. For female patients aged 40 y, the LAR of cancer mortality increased from 0.126 to 0.63% if an annual surveillance protocol for 5 y was performed. Since PET/CT scans are associated with a high dose and a risk of developing cancer, it was important to balance the advantages and risks before conducting any scans. This is especially important for younger patients and those who are overweight.
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Affiliation(s)
- Aida Kessara
- Department of Physics, Institute of Science, University of Selcuk, 42130 Konya, Türkiye
| | | | - Gonca Kara Gedik
- Department of Nuclear Medicine, Medical Faculty, Selcuk University, 42131 Konya, Türkiye
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Barbagianni MS, Gouletsou PG. Modern Imaging Techniques in the Study and Disease Diagnosis of the Mammary Glands of Animals. Vet Sci 2023; 10:vetsci10020083. [PMID: 36851387 PMCID: PMC9965774 DOI: 10.3390/vetsci10020083] [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: 12/07/2022] [Revised: 01/12/2023] [Accepted: 01/20/2023] [Indexed: 01/25/2023] Open
Abstract
The study of the structure and function of the animals' mammary glands is of key importance, as it reveals pathological processes at their onset, thus contributing to their immediate treatment. The most frequently studied mammary diseases are mastitis in cows and ewes and mammary tumours in dogs and cats. Various imaging techniques such as computed tomography, positron emission tomography, magnetic resonance imaging, and ultrasonographic techniques (Doppler, contrast-enchanced, three-dimensional and elastography) are available and can be applied in research or clinical practice in order to evaluate possible abnormalities in mammary glands, as well as to assist in the differential diagnosis. In this review, the above imaging technologies are described, and the perspectives of each method are highlighted. It is inferred that ultrasonographic modalities are the most frequently used imaging techniques for the diagnosis of clinical or subclinical mastitis and treatment guidance on a farm. In companion animals, a combination of imaging techniques should be applied for a more accurate diagnosis of mammary tumours. In any case, the confirmation of the diagnosis is provided by laboratory techniques.
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Kurz FT, Schlemmer HP. Imaging in translational cancer research. Cancer Biol Med 2022; 19:j.issn.2095-3941.2022.0677. [PMID: 36476372 PMCID: PMC9724222 DOI: 10.20892/j.issn.2095-3941.2022.0677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 12/12/2022] Open
Abstract
This review is aimed at presenting some of the recent developments in translational cancer imaging research, with a focus on novel, recently established, or soon to be established cross-sectional imaging techniques for computed tomography (CT), magnetic resonance imaging (MRI), and positron-emission tomography (PET) imaging, including computational investigations based on machine-learning techniques.
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Affiliation(s)
- Felix T. Kurz
- Department of Radiology, German Cancer Research Center, Heidelberg 69120, Germany
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7
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Kamal AM, Kamal OA, Sakr HM, Ali SA. Role of 18F-FDG PET/CT in evaluation of recently diagnosed breast cancer patients. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [DOI: 10.1186/s43055-022-00866-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Breast cancer is the most frequent malignant disease in women and usually affects people of all ages, races, socioeconomic classes, and geographic locations. Once breast cancer is diagnosed, tumor staging should be assessed precisely before treatment and prognosis could be determined. The purpose of this study was to determine the diagnostic usefulness of PET/CT in the initial assessment of patients with newly diagnosed breast cancer who were referred for tumor staging, pre-therapeutic or preoperative evaluation.
Results
In the examined 50 patients, PET/CT has higher sensitivity and accuracy compared to CT alone (reaching 100% for PET/CT and 96% for CT) in detecting malignant breast lesions, regional and distant nodal deposits as well as distant deposits, with subsequent upstaging in two patients.
Conclusions
18F-FDG PET/CT is a single valuable technique that detects metastatic illness in newly diagnosed breast cancer patients in an efficient, accurate, and noninvasive manner, resulting in modification of the initial staging, which in turn reflected on the patients' therapeutic plans.
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8
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Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients. Eur J Nucl Med Mol Imaging 2021. [PMID: 34137945 DOI: 10.1007/s00259-021-05307-1.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
PURPOSE FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of 68Ga-FAPI versus standard-of-care 18F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. MATERIAL AND METHODS This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both 68Ga-FAPI and 18F-FDG PET/CT within a median time interval of 10 days (range 1-89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). RESULTS A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. 68Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for 68Ga-FAPI than 18F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, 68Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. CONCLUSION Quantitative tumor uptake is comparable between 68Ga-FAPI and 18F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for 68Ga-FAPI. Thus, 68Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological 18F-FDG uptake.
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9
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Giesel FL, Kratochwil C, Schlittenhardt J, Dendl K, Eiber M, Staudinger F, Kessler L, Fendler WP, Lindner T, Koerber SA, Cardinale J, Sennung D, Roehrich M, Debus J, Sathekge M, Haberkorn U, Calais J, Serfling S, Buck AL. Head-to-head intra-individual comparison of biodistribution and tumor uptake of 68Ga-FAPI and 18F-FDG PET/CT in cancer patients. Eur J Nucl Med Mol Imaging 2021; 48:4377-4385. [PMID: 34137945 PMCID: PMC8566651 DOI: 10.1007/s00259-021-05307-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/08/2021] [Indexed: 02/06/2023]
Abstract
Purpose FAPI ligands (fibroblast activation protein inhibitor), a novel class of radiotracers for PET/CT imaging, demonstrated in previous studies rapid and high tumor uptake. The purpose of this study is the head-to-head intra-individual comparison of 68Ga-FAPI versus standard-of-care 18F-FDG in PET/CT in organ biodistribution and tumor uptake in patients with various cancers. Material and Methods This international retrospective multicenter analysis included PET/CT data from 71 patients from 6 centers who underwent both 68Ga-FAPI and 18F-FDG PET/CT within a median time interval of 10 days (range 1–89 days). Volumes of interest (VOIs) were manually drawn in normal organs and tumor lesions to quantify tracer uptake by SUVmax and SUVmean. Furthermore, tumor-to-background ratios (TBR) were generated (SUVmax tumor/ SUVmax organ). Results A total of 71 patients were studied of, which 28 were female and 43 male (median age 60). In 41 of 71 patients, the primary tumor was present. Forty-three of 71 patients exhibited 162 metastatic lesions. 68Ga-FAPI uptake in primary tumors and metastases was comparable to 18F-FDG in most cases. The SUVmax was significantly lower for 68Ga-FAPI than 18F-FDG in background tissues such as the brain, oral mucosa, myocardium, blood pool, liver, pancreas, and colon. Thus, 68Ga-FAPI TBRs were significantly higher than 18F-FDG TBRs in some sites, including liver and bone metastases. Conclusion Quantitative tumor uptake is comparable between 68Ga-FAPI and 18F-FDG, but lower background uptake in most normal organs results in equal or higher TBRs for 68Ga-FAPI. Thus, 68Ga-FAPI PET/CT may yield improved diagnostic information in various cancers and especially in tumor locations with high physiological 18F-FDG uptake. Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05307-1.
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Affiliation(s)
- Frederik L Giesel
- Department of Nuclear Medicine, University Hospital Duesseldorf, Duesseldorf, Germany. .,Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.
| | - Clemens Kratochwil
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Joel Schlittenhardt
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Katharina Dendl
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Matthias Eiber
- Department of Nuclear Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Fabian Staudinger
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Lukas Kessler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Wolfgang P Fendler
- Department of Nuclear Medicine, University of Duisburg-Essen and German Cancer Consortium (DKTK)-University Hospital Essen, Essen, Germany
| | - Thomas Lindner
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Stefan A Koerber
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Jens Cardinale
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - David Sennung
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Manuel Roehrich
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany
| | - Juergen Debus
- National Center for Tumor diseases (NCT), Heidelberg, Germany.,Clinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Heidelberg Institute of Radiation Oncology (HIRO), Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Department of Radiation Oncology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.,Heidelberg Ion-Beam Therapy Center (HIT), Im Neuenheimer Feld 450, 69120, Heidelberg, Germany
| | - Mike Sathekge
- Department of Nuclear Medicine, University of Pretoria and Steve Biko Academic Hospital, Pretoria, South Africa
| | - Uwe Haberkorn
- Department of Nuclear Medicine, University Hospital Heidelberg, INF 400, 69120, Heidelberg, Germany.,Clinical Cooperation Unit Nuclear Medicine, German Cancer Research Center (DKFZ), Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, University of California at Los Angeles, Los Angeles, CA, USA
| | - Sebastian Serfling
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Andreas L Buck
- Department of Nuclear Medicine, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Cancer Center Mainfranken, 97080, Wuerzburg, Germany
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10
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Radiation-Induced Metabolic Shifts in the Hepatic Parenchyma: Findings from 18F-FDG PET Imaging and Tissue NMR Metabolomics in a Mouse Model for Hepatocellular Carcinoma. Molecules 2021; 26:molecules26092573. [PMID: 33925109 PMCID: PMC8125521 DOI: 10.3390/molecules26092573] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 04/23/2021] [Accepted: 04/26/2021] [Indexed: 12/27/2022] Open
Abstract
Purpose: By taking advantage of 18F-FDG PET imaging and tissue nuclear magnetic resonance (NMR) metabolomics, we examined the dynamic metabolic alterations induced by liver irradiation in a mouse model for hepatocellular carcinoma (HCC). Methods: After orthotopic implantation with the mouse liver cancer BNL cells in the right hepatic lobe, animals were divided into two experimental groups. The first received irradiation (RT) at 15 Gy, while the second (no-RT) did not. Intergroup comparisons over time were performed, in terms of 18F-FDG PET findings, NMR metabolomics results, and the expression of genes involved in inflammation and glucose metabolism. Results: As of day one post-irradiation, mice in the RT group showed an increased 18F-FDG uptake in the right liver parenchyma compared with the no-RT group. However, the difference reached statistical significance only on the third post-irradiation day. NMR metabolomics revealed that glucose concentrations peaked on day one post-irradiation both, in the right and left lobes—the latter reflecting a bystander effect. Increased pyruvate and glutamate levels were also evident in the right liver on the third post-irradiation day. The expression levels of the glucose-6-phosphatase (G6PC) and fructose-1, 6-bisphosphatase 1 (FBP1) genes were down-regulated on the first and third post-irradiation days, respectively. Therefore, liver irradiation was associated with a metabolic shift from an impaired gluconeogenesis to an enhanced glycolysis from the first to the third post-irradiation day. Conclusion: Radiation-induced metabolic alterations in the liver parenchyma occur as early as the first post-irradiation day and show dynamic changes over time.
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Snene H, Badri I, Mehiri N, Ben Salah N, Blibech H, Aouina H, Belhadj S, Boussen H, Chaouch N, Charfi R, Fenniche S, Gharbi L, Ghrairi H, Hamzaoui A, Megdiche L, Merai S, Mezni F, Tritar F, Daghfous J, Marghli A, Louzir B. [Diagnostic and therapeutic management of operable bronchopulmonary carcinoid tumours]. Rev Mal Respir 2021; 38:249-256. [PMID: 33674138 DOI: 10.1016/j.rmr.2021.02.062] [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: 07/28/2020] [Accepted: 02/10/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Bronchial carcinoid tumours (CT), divided into typical carcinoid (TC) or atypical carcinoid (AC), are rare tumours whose therapeutic management remains unspecified. METHODS Retrospective study collecting cases of bronchial CT operated at the thoracic surgery department of Abderrahmane-Mami hospital of Ariana and recruited from the pneumology departments of Northern Tunisia, during a 12-year period. RESULTS Ninety patients were collected (74 cases of TC and 16 cases of AC). The mean age was 45 years and the sex ratio H/F=0.5. The chest X-ray was normal in 11 cases, as well as flexible bronchoscopy in seven cases. The tumour was classified: stage IA (10 cases), IIA (28 cases), IIB (31 cases), IIIA (15 cases) and IIIB (six cases). Surgery resulted in a complete resection in 78 patients, an extensive resection in six patients, and a conservative resection in six patients. Adjuvant chemotherapy was given in 10 patients. The survival was 84% at five years and 42% at 10 years. CONCLUSION The prognosis of CT depends directly on the histological subtype. It is excellent for TC after complete resection, unlike ACs that are similar to well-differentiated bronchial carcinomas.
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Affiliation(s)
- H Snene
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie.
| | - I Badri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Mehiri
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - N Ben Salah
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Blibech
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - H Aouina
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Charles-Nicolle, Tunis, Tunisie
| | - S Belhadj
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, hôpital régional de Menzel-Bourguiba, Bizerte, Tunisie
| | - H Boussen
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'oncologie médicale, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - N Chaouch
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 2, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - R Charfi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital des forces de sécurité intérieur, Tunis, Tunisie
| | - S Fenniche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon 4, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Gharbi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon D, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - H Ghrairi
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, hôpital Taher-Maamouri, Nabeul, Tunisie
| | - A Hamzaoui
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon B, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - L Megdiche
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon Ibn Nafis, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - S Merai
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie, CHU La Rabta, Tunis, Tunisie
| | - F Mezni
- Faculté de médecine de Tunis, université de Tunis El Manar, service d'anatomie pathologie, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - F Tritar
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie pavillon C, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - J Daghfous
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
| | - A Marghli
- Faculté de médecine de Tunis, université de Tunis El Manar, service de chirurgie thoracique et cardiovasculaire, CHU Abderrahmen-Mami, Ariana, Tunisie
| | - B Louzir
- Faculté de médecine de Tunis, université de Tunis El Manar, service de pneumologie allergologie, CHU Mongi-Slim La Marsa, 2047, Sidi-Daoued, Tunis, Tunisie
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12
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Role of PET/CT in patients with unexplained rising alpha fetoprotein post HCC interventional management. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Positron emission tomography–computed tomography (PET/CT) is considered a powerful modality in the follow-up of hepatocellular carcinoma (HCC) patients. In this study, PET/CT was done in an evaluation of patients with unexplained rising alpha fetoprotein (AFP) post hepatocellular carcinoma (HCC) interventional management in 40 patients (16 females and 24 males); their age ranged from 25 to 82 years, had undergone interventional management for HCC and underwent PET/CT follow-up within an 8-month duration from their intervention. Whole-body PET/CT was performed after injection of (18)-FDG, and the results were read in a masked manner by two specialists, and diagnostic performance was assessed from the results of consensus masked reading. All the results were evaluated with the Barcelona criteria and biopsy correlation.
Results
During the follow-up PET/CT, 24 patients had complete response and 8 patients showed focal residual while the rest 8 patients showed newly developed lesions.
Conclusion
PET/CT is an excellent method for the evaluation of HCC patients with equivocal results after interventional management.
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13
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Duran Derijckere I, Levillain H, Bohlok A, Mathey C, Nezri J, Muteganya R, Trotta N, Lucidi V, Bouazza F, Germanova D, Van Simaeys G, Goldman S, Hendlisz A, Flamen P, Donckier V. The metabolic clinical risk score as a new prognostic model for surgical decision-making in patients with colorectal liver metastases. J Surg Oncol 2020; 121:350-356. [PMID: 31721228 DOI: 10.1002/jso.25763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/04/2019] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Selection for surgery in patients with colorectal liver metastases (CRLM) remains inaccurate. We evaluated if CRLM baseline metabolic characteristics, assessed by [18]F-fluorodeoxyglucose-positron emission tomography/computed tomography (18 FDG-PET/CT), could predict postoperative outcomes. METHODS In a retrospective series of patients undergoing surgery for CRLM, we defined two groups: the long-term survival (LTS) and early relapse (ER) groups, where the postoperative recurrence-free survivals were ≥5 years or <1 year, respectively. We analyzed the patients in whom baseline 18 FDG-PET/CT was available. Clinicopathologic parameters, clinical risk score (CRS), and baseline 18 FDG-PET/CT characteristics were compared between LTS and ER groups. A metabolic CRS (mCRS) was implemented, adding one point to the standard five-point CRS when the highest tumor standardized uptake values (SUVmax )/normal liver mean SUV (SUVmean(liver) ) ratios were >4.3, defining low- and high-risk mCRS by scores of 0 to 2 and 3 to 6, respectively. RESULTS From a series of 450 patients operated for CRLM (mean follow-up of 58 months), we included for analysis 23 and 30 patients in the LTS and ER groups, respectively. Clinicopathologic parameters and CRS were similar in the LTS and ER groups. Median SUVmax /SUVmean(liver) ratios were higher in ER vs LTS patients (4.2 and 2.8, P = .008, respectively). mCRS was increased in ER patients (P = .024); 61% of LTS patients had low-risk mCRS and 73% of the ER patients had high-risk mCRS (P = .023). CONCLUSIONS 18 FDG-PET/CT characteristics combined with traditional CRS may represent a new tool to improve selection for surgery in patients with CRLM.
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Affiliation(s)
- Ivan Duran Derijckere
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hugo Levillain
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ali Bohlok
- Surgical Oncology Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Celine Mathey
- Nuclear Medicine Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Jonathan Nezri
- Surgical Oncology Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Raoul Muteganya
- Nuclear Medicine Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Nicola Trotta
- Nuclear Medicine Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Valerio Lucidi
- Abdominal Surgery Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Fikri Bouazza
- Surgical Oncology Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Desislava Germanova
- Abdominal Surgery Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Gaetan Van Simaeys
- Nuclear Medicine Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Serge Goldman
- Nuclear Medicine Department, Hôpital Erasme-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Alain Hendlisz
- Digestive Oncology Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Patrick Flamen
- Nuclear Medicine Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Vincent Donckier
- Surgical Oncology Department, Institut Jules Bordet-Université Libre de Bruxelles (ULB), Brussels, Belgium
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14
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Targeting uptake transporters for cancer imaging and treatment. Acta Pharm Sin B 2020; 10:79-90. [PMID: 31993308 PMCID: PMC6977162 DOI: 10.1016/j.apsb.2019.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/27/2019] [Accepted: 11/17/2019] [Indexed: 12/11/2022] Open
Abstract
Cancer cells reprogram their gene expression to promote growth, survival, proliferation, and invasiveness. The unique expression of certain uptake transporters in cancers and their innate function to concentrate small molecular substrates in cells make them ideal targets for selective delivering imaging and therapeutic agents into cancer cells. In this review, we focus on several solute carrier (SLC) transporters known to be involved in transporting clinically used radiopharmaceutical agents into cancer cells, including the sodium/iodine symporter (NIS), norepinephrine transporter (NET), glucose transporter 1 (GLUT1), and monocarboxylate transporters (MCTs). The molecular and functional characteristics of these transporters are reviewed with special emphasis on their specific expressions in cancers and interaction with imaging or theranostic agents [e.g., I-123, I-131, 123I-iobenguane (mIBG), 18F-fluorodeoxyglucose (18F-FDG) and 13C pyruvate]. Current clinical applications and research areas of these transporters in cancer diagnosis and treatment are discussed. Finally, we offer our views on emerging opportunities and challenges in targeting transporters for cancer imaging and treatment. By analyzing the few clinically successful examples, we hope much interest can be garnered in cancer research towards uptake transporters and their potential applications in cancer diagnosis and treatment.
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Key Words
- CT, computed tomography
- Cancer imaging
- DDI, drug–drug interaction
- DTC, differentiated thyroid cancer
- FDA, U.S. Food and Drug Administrations
- FDG, fluorodeoxyglucose
- GLUT, glucose transporter
- IAEA, the International Atomic Energy Agency
- LACC, locally advanced cervical cancer
- LAT, large amino acid transporter
- MCT, monocarboxylate transporter
- MRI, magnetic resonance imaging
- NE, norepinephrine
- NET, norepinephrine transporter
- NIS, sodium/iodine symporter
- Neuroblastoma
- OCT, organic cation transporter
- PET, positron emission tomography
- PHEO, pheochromocytoma
- RA, retinoic acid
- RET, rearranged during transfection
- SLC, solute carrier
- SPECT, single-photon emission computed tomography
- SUV, standardized uptake value
- TFB, tetrafluoroborate
- TSH, thyroid stimulating hormones
- Thyroid cancer
- Uptake transporter
- Warburg effect
- mIBG
- mIBG, iobenguane/meta-iodobenzylguanidine
- vHL, von Hippel-Lindau
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15
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Optimized CT Attenuation and SUV Prediction Thresholds for Differentiating Enostoses From Untreated and Treated Metastases on Attenuation-Corrected 18F-FDG PET/CT. Clin Nucl Med 2019; 45:32-37. [DOI: 10.1097/rlu.0000000000002808] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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16
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Sánchez D, Romero L, López S, Campuzano M, Ortega R, Morales A, Guadarrama M, Cesarman-Maus G, García-Pérez O, Lizano M. 18F-FDG-PET/CT in Canine Mammary Gland Tumors. Front Vet Sci 2019; 6:280. [PMID: 31508434 PMCID: PMC6718568 DOI: 10.3389/fvets.2019.00280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 08/07/2019] [Indexed: 12/17/2022] Open
Abstract
Medical imaging techniques play a central role in clinical oncology, helping to obtain important information about the extent of disease, and plan treatment. Advanced imaging modalities such as Positron Emission Tomography-Computed Tomography (PET/CT), may help in the whole-body staging in a single procedure, although the lesions should be carefully interpreted. PET/CT is becoming commonly used in canine cancer patients, but there is still limited information available on specific tumors such as mammary cancer. We evaluated the utility of fluorine-18 fluorodeoxyglucose (18F-FDG)-PET/CT to detect malignant lesions in eight female dogs with naturally occurring mammary tumors. A whole-body scan was performed prior to surgery, and mammary and non-mammary lesions detected either on PET/CT or during pre-surgical physical exam were resected when possible and submitted for histopathological examination. Multiple mammary lesions involving different mammary glands were detected in 5/8 dogs, for a total of 23 lesions; there were 11 non-mammary-located lesions in 6/8 dogs, three of these were lung or lymph node metastasis. A total of 34 lesions were analyzed: 22 malignant (19 mammary tumors and three metastatic lesions), and 12 benign (four mammary lesions and eight of non-mammary tissues). Glucose uptake by maximum standardized uptake value (SUVmax) was analyzed and correlated with tumor size, and benign vs. malignant pathology. We found that the minimum tumor size needed to distinguish malignant lesions according to the SUVmax was 1.5 cm; benign and malignant lesions <1.5 cm did not differ in glucose uptake (mean SUVmax = 1.1). In addition, a SUVmax value >2 was 100% sensitive for malignancy. Combining these data, lesions >1.5 cm with a SUVmax >2 had a positive predictive value of 100%. Finally, we did not find an association between SUVmax and histologic subtype or grade, which may be present in a larger sample. Thus, 18F-FDG PET/CT is useful for distinguishing malignant from benign lesion but further imaging of dogs with diverse tumors, should establish characteristic SUV value cutoffs for detecting primary and metastatic disease, and distinguishing them from benign lesions.
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Affiliation(s)
- Diana Sánchez
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Departamento de Medicina Genòmica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | - Laura Romero
- Departmento de Patología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sergio López
- Departamento de Medicina Nuclear e Imagen Molecular, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Margarita Campuzano
- Departamento de Medicina Nuclear e Imagen Molecular, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Rocio Ortega
- Departamento de Cirugía y Anestesia, Waldorf Pet Hospital, Mexico City, Mexico
| | - Alfonso Morales
- Departamento de Cirugía y Anestesia, Hospital Kiin, Mexico City, Mexico
| | - Marina Guadarrama
- Departmento de Patología, Facultad de Medicina Veterinaria y Zootecnia, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | | | - Osvaldo García-Pérez
- Departamento de Medicina Nuclear e Imagen Molecular, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Marcela Lizano
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología-Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico.,Departamento de Medicina Genòmica y Toxicología Ambiental, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
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17
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Wong J, Choi SYC, Liu R, Xu E, Killam J, Gout PW, Wang Y. Potential Therapies for Infectious Diseases Based on Targeting Immune Evasion Mechanisms That Pathogens Have in Common With Cancer Cells. Front Cell Infect Microbiol 2019; 9:25. [PMID: 30809511 PMCID: PMC6379255 DOI: 10.3389/fcimb.2019.00025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/24/2019] [Indexed: 12/18/2022] Open
Abstract
Many global infectious diseases are not well-controlled, underlining a critical need for new, more effective therapies. Pathogens and pathogen-infected host cells, like cancer cells, evade immune surveillance via immune evasion mechanisms. The present study indicates that pathogenic bacteria, endoparasites, and virus-infected host cells can have immune evasion mechanisms in common with cancers. These include entry into dormancy and metabolic reprogramming to aerobic glycolysis leading to excessive secretion of lactic acid and immobilization of local host immunity. The latter evasion tactic provides a therapeutic target for cancer, as shown by our recent finding that patient-derived cancer xenografts can be growth-arrested, without major host toxicity, by inhibiting their lactic acid secretion (as mediated by the MCT4 transporter)-with evidence of host immunity restoration. Accordingly, the multiplication of bacteria, endoparasites, and viruses that primarily depend on metabolic reprogramming to aerobic glycolysis for survival may be arrested using cancer treatment strategies that inhibit their lactic acid secretion. Immune evasion mechanisms shared by pathogens and cancer cells likely represent fundamental, evolutionarily-conserved mechanisms that may be particularly critical to their welfare. As such, their targeting may lead to novel therapies for infectious diseases.
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Affiliation(s)
- Jodi Wong
- Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Stephen Yiu Chuen Choi
- Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver, BC, Canada.,Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Rongrong Liu
- Department of Microbiology, School of Basic Medicine, Fourth Military Medical University, Xi'an, China
| | - Eddie Xu
- Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver, BC, Canada.,Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - James Killam
- Vancouver Prostate Centre, Vancouver, BC, Canada
| | - Peter W Gout
- Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, BC, Canada
| | - Yuzhuo Wang
- Department of Experimental Therapeutics, BC Cancer Research Centre, Vancouver, BC, Canada.,Vancouver Prostate Centre, Vancouver, BC, Canada.,Department of Urologic Sciences, The University of British Columbia, Vancouver, BC, Canada
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18
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Cetin Avci N, Hatipoglu F, Alacacıoglu A, Bayar EE, Bural GG. FDG PET/CT and Conventional Imaging Methods in Cancer of Unknown Primary: an Approach to Overscanning. Nucl Med Mol Imaging 2018; 52:438-444. [PMID: 30538775 DOI: 10.1007/s13139-018-0544-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/17/2018] [Accepted: 08/22/2018] [Indexed: 12/12/2022] Open
Abstract
Purpose To compare the performance of fluorine-18 fluorodeoxyglucose positron emission tomography and computed tomography (FDG PET/CT) with conventional imaging methods (CIM), including computed tomography (CT), magnetic resonance imaging (MRI), and mammography (MMG) in cancer of unknown primary (CUP). Methods A total of 36 patients with CUP, who referred to our clinic for a FDG PET/CT scan, were enrolled in this study. Thirty of the patients were also examined through either diagnostic CT/MRI and/or MMG. The diagnostic performance of both methods for the primary cancer location was analyzed. The results of FDG PET/CT and CIM were compared based on the standard reference of the histopathology and/or clinical and laboratory follow-up. Results The primary cancer locations were detected in 24 patients (66.6%, 24/36) by FDG PET/CT, whereas CIM identified the locations in 16 patients (53.3%, 16/30). Sensitivity, specificity, PPV, NPV, and accuracy rates of the detection of the primary tumor localizations were as follows: 83, 70, 89, 58, and 79% for FDG PET/CT; 70, 62, 84, 42, and 68% for CIM, respectively. There was no statistical significance between modalities regarding any of the categories in 30 patients. Conclusion FDG PET/CT detected the primary tumors of the patients with CUP more than CIM did. However, the difference between them was not found to be statistically significant. It may be considered that FDG PET/CT scan can be performed as a first-line tool in the initial diagnosis of the patients with CUP and to add radiodiagnostic imaging in selective cases. We conclude that if the first-line examination of a CUP patient has been already performed by a CIM and the result was negative or inconclusive, FDG PET/CT can be considered to avoid unnecessary imaging procedures.
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Affiliation(s)
- Neslihan Cetin Avci
- 1Department of Nuclear Medicine, Umraniye Training and Research Hospital, Umraniye, Istanbul, Turkey
| | - Filiz Hatipoglu
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Ahmet Alacacıoglu
- 3Department of Internal Medicine and Oncology, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Emine Ebru Bayar
- 2Department of Nuclear Medicine, Ataturk Training and Research Hospital, Katip Celebi University, Izmir, Turkey
| | - Gonca Gul Bural
- 4Department of Nuclear Medicine, Faculty of Medicine, Akdeniz University, Antalya, Turkey
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19
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Outcome of Head and Neck Squamous Cell Cancers in Low-Resource Settings. Otolaryngol Clin North Am 2018; 51:619-629. [DOI: 10.1016/j.otc.2018.01.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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20
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Huo J, Chu Y, Chamie K, Smaldone MC, Boorjian SA, Baillargeon JG, Kuo YF, Kerr P, O'Malley P, Orihuela E, Tyler DS, Freedland SJ, Giordano SH, Vikram R, Kamat AM, Williams SB. Increased Utilization of Positron Emission Tomography/Computed Tomography (PET/CT) Imaging and Its Economic Impact for Patients Diagnosed With Bladder Cancer. Clin Genitourin Cancer 2017; 16:S1558-7673(17)30215-X. [PMID: 28826932 PMCID: PMC5878135 DOI: 10.1016/j.clgc.2017.07.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND The purpose of this study was to examine temporal nationwide utilization patterns and predictors for use of positron emission tomography/computed tomography (PET/CT) in comparison with magnetic resonance imaging (MRI) and computed tomography (CT) among patients diagnosed with bladder cancer. MATERIALS AND METHODS A total of 36,855 patients aged 66 years or older diagnosed with clinical stage TI-IV, N0M0 bladder cancer from 2004 to 2011 were analyzed. We used multivariable logistic regression analyses to discern factors associated with receipt of imaging within 12 months from diagnosis. The Cochran-Armitage test for trend was used to determine changes in the proportion of patients receiving imaging after cancer diagnosis. RESULTS Independent of clinical stage, there was marked increase in use of PET/CT throughout the study period (2011 vs. 2004: odds ratio, 17.55; 95% confidence interval, 10.14-30.38; P < .001). Although use of CT imaging remained stable during the study period, there was significantly decreased utilization of MRI (odds ratio, 0.60; 95% confidence interval, 0.49-0.75; P < .001) in 2011 versus 2004. The mean incremental cost of PET/CT versus CT and MRI was $1040 and $612 (in 2016 dollars), respectively. Extrapolating these findings to the patients with bladder cancer in the United States results in excess spending of $11.6 million for PET/CT imaging. CONCLUSION We identified rapid adoption of PET/CT imaging independent of clinical stage, resulting in excess national spending of $11.6 million for this imaging modality alone. Further value-based research discerning the clinical versus economic benefits of advanced imaging among patients with bladder cancer are needed.
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Affiliation(s)
- Jinhai Huo
- Department of Health Services Research, Management and Policy, The University of Florida, Gainesville, FL
| | - Yiyi Chu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karim Chamie
- Department of Urology, University of California Los Angeles, Los Angeles, CA
| | - Marc C Smaldone
- Department of Urology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Jacques G Baillargeon
- Division of Epidemiology, Department of Medicine, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Yong-Fang Kuo
- Division of Biostatistics, Department of Medicine, Sealy Center on Aging, Sealy Center on Aging, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Preston Kerr
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Padraic O'Malley
- Department of Urology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Eduardo Orihuela
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX
| | - Douglas S Tyler
- Department of Surgery, The University of Texas Medical Branch at Galveston, Galveston, TX
| | | | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Raghu Vikram
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Ashish M Kamat
- Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Stephen B Williams
- Division of Urology, The University of Texas Medical Branch at Galveston, Galveston, TX.
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21
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Reliability of 18F-FDG PET Metabolic Parameters Derived Using Simultaneous PET/MRI and Correlation With Prognostic Factors of Invasive Ductal Carcinoma: A Feasibility Study. AJR Am J Roentgenol 2017; 209:662-670. [PMID: 28678576 DOI: 10.2214/ajr.16.17766] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The objective of our study was to correlate semiquantitative PET parameters-standardized uptake value (SUV) and total lesion glycolysis (TLG)-derived in simultaneous PET/MRI using MRI-based attenuation correction with clinical and histopathologic prognostic factors in patients with breast cancer. MATERIALS AND METHODS Eighty-two invasive ductal carcinomas in 69 women were included in the study. All the subjects underwent whole-body (WB) PET/MRI (supine WB mode) and dedicated PET/MRI of the breast (prone breast imaging mode) for staging on a simultaneous PET/MRI system. The SUV and TLG values were calculated from 18F-FDG PET data using MRI-based attenuation correction (2-point Dixon sequence for tissue segmentation). Relationships between SUV and TLG values and clinical and histopathologic parameters (i.e., tumor size, tumor grade, Ki-67 status, and hormonal receptor expression status) were evaluated using Spearman correlation coefficient analysis. RESULTS A significant correlation was observed between mean SUV (SUVmean) and maximum SUV (SUVmax) values derived with WB PET and regional PET of the breasts performed simultaneously with MRI (r = 0.88 and 0.89, respectively). A significant difference (p < 0.05) was observed in SUVmean, SUVmax, and TLG values between the grades and molecular subtypes of breast cancer. High SUVmean, SUVmax, and TLG values were found to correlate with larger tumor size (p < 0.01), higher proliferation index (p < 0.05), higher grade (p < 0.01), and triple-negative hormonal receptor status (p < 0.01, p < 0.05). CONCLUSION Semiquantitative FDG parameters derived with MRI-based attenuation correction in simultaneous PET/MRI are reliable and correlate with clinicopathologic features such as grade as well as subtype and thus could be used in the prognostication of breast cancer.
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22
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Skovgaard D, Persson M, Kjaer A. Urokinase Plasminogen Activator Receptor–PET with 68 Ga-NOTA-AE105. PET Clin 2017; 12:311-319. [DOI: 10.1016/j.cpet.2017.02.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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23
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Jena A, Taneja S, Singh A, Negi P, Mehta SB, Ahuja A, Singhal M, Sarin R. Association of pharmacokinetic and metabolic parameters derived using simultaneous PET/MRI: Initial findings and impact on response evaluation in breast cancer. Eur J Radiol 2017. [PMID: 28624017 DOI: 10.1016/j.ejrad.2017.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
PURPOSE To study relationships among pharmacokinetic and 18F-fluorodeoxyglucose (18F-FDG) PET parameters obtained through simultaneous PET/MRI in breast cancer patients and evaluate their combined potential for response evaluation. METHODS The study included 41 breast cancer patients for correlation study and 9 patients (pre and post therapy) for response evaluation. All patients underwent simultaneous PET/MRI with dedicated breast imaging. Pharmacokinetic parameters and PET parameters for tumor were derived using an in- house developed and vendor provided softwares respectively. Relationships between SUV and pharmacokinetic parameters and clinical as well as histopathologic parameters were evaluated using Spearman correlation analysis. Response to chemotherapy was derived as percentage reduction in size and in parameters post therapy. RESULTS Significant correlations were observed between SUVmean, max, peak, TLG with Ktrans (ρ=0.446, 0.417, 0.491, 0.430; p≤0.01); with Kep(ρ=0.303, ρ=0.315, ρ=0.319; p≤0.05); and with iAUC(ρ=0.401, ρ=0.410, ρ=0.379; p≤0.05, p≤0.01). The ratio of ve/iAUC showed significant negative correlation to SUVmean, max, peak and TLG (ρ=0.420, 0.446, 0.443, 0.426; p≤0.01). Ability of SUV as well as pharmacokinetic parameters to predict response to therapy matched the RECIST criteria in 9 out of 11 lesions in 9 patients. Maximum post therapy quantitative reduction was observed in SUVpeak, TLG and Ktrans. CONCLUSION Simultaneous PET/MRI enables illustration of close interactions between glucose metabolism and pharmacokinetic parameters in breast cancer patients and potential of their simultaneity in response assessment to therapy.
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Affiliation(s)
- Amarnath Jena
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India.
| | - Sangeeta Taneja
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Aru Singh
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Pradeep Negi
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Shashi Bhushan Mehta
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Aashim Ahuja
- Department of Molecular Imaging and Nuclear Medicine, Indraprastha Apollo Hospitals, SaritaVihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Manish Singhal
- Department of Medical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India
| | - Ramesh Sarin
- Department of Surgical Oncology, Indraprastha Apollo Hospitals, Sarita Vihar, Delhi-Mathura Road, New Delhi 110076, India
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De Scheerder MA, Rottey S, Mariman A, Praet M, Vogelaers D. How far to investigate presumed psychosomatic symptoms: Lessons from a particular case…. Acta Clin Belg 2017; 72:138-141. [PMID: 27593992 DOI: 10.1080/17843286.2016.1218178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe a 43-year-old patient with subacute appearance of neurological and atypical complaints of anergia, anorexia and weight loss six months earlier. In spite of several admissions in different hospitals, no underlying somatic cause could be found and he was admitted to a psychiatric hospital with a tentative diagnosis of major depressive disorder. Subsequently, he was referred to the unit of medically unexplained physical symptoms within the department of general internal medicine for assessment by the psychiatrist, involved in this programme. Based on clinical suspicion and red flag symptoms such as involuntary weight loss, a broader internal medicine reassessment, including FDG whole-body PET-CT was requested. Neurological clinical exam showed minor deviations, but neither brain imaging nor a lumbar puncture were contributory. However, FDG PET-CT revealed abnormal moderately to intensely FDG positive lymph nodes in the retroperitoneum. Laparoscopic lymph node biopsy indicated germ cell tumour metastasis. Anti-NMDA antibody positivity allowed a diagnosis of paraneoplastic anti-NMDA encephalitis. Treatment of the underlying disease, a pure seminoma stadium II, consisting of orchidectomy and chemotherapy, resulted in a spectacular regression of 'psychosomatic' symptoms with long-term ability to return to work, and documented disappearance of the anti-NMDA antibody response.
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Affiliation(s)
| | - Sylvie Rottey
- Department of Medical Oncology, University Hospital Ghent, Ghent, Belgium
| | - An Mariman
- Department of General Internal Medicine, University Hospital Ghent, Ghent, Belgium
| | - Marleen Praet
- Department of Pathology, University Hospital Ghent, Ghent, Belgium
| | - Dirk Vogelaers
- Department of General Internal Medicine, University Hospital Ghent, Ghent, Belgium
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The prognostic value of tumor shadow disappearance rate on integrated PET/CT evaluation of solitary pulmonary nodules with low glucose metabolism. Nucl Med Commun 2016; 37:356-62. [PMID: 26796032 DOI: 10.1097/mnm.0000000000000446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to determine the prognostic value of the tumor shadow disappearance rate (TDR) on integrated PET/computed tomography (PET/CT) evaluation of solitary pulmonary nodules (SPNs) with low glucose uptake. MATERIALS AND METHODS From January 2008 to September 2010, 99 patients who underwent fluorine-18 fluorodeoxyglucose PET (F-FDG-PET)/CT scanning for the evaluation of SPNs with a maximum standardized uptake value (SUVmax) below 2.75 (2.5+10%) were retrospectively reviewed. Among the 99 SPNs from these patients, 67 were malignant and 32 were benign, based on surgical pathology. Differences in baseline characteristics between the two groups were examined by means of the independent t-test, the Mann-Whitney U-test, and the χ-test. To test the efficacy of TDR for determining malignancy, the sensitivity, specificity, positive predictive value, negative predictive value, accuracy, and positive and negative likelihood ratios (LR+ and LR-, respectively) with 95% confidence intervals were calculated using the pathological test as the gold standard. RESULTS Patients with malignant nodules were older than those with benign nodules (64.5 vs. 55.1 years, respectively, P<0.001) and had higher TDRs (0.8 vs. 0.3, respectively, P<0.001). The optimal cutoff point for the TDR was 0.4886 where the sensitivity, specificity, positive predictive value, and negative predictive value were 0.851, 0.844, 0.919, and 0.730, respectively, and the LR+ and LR- were 5.443 and 0177, respectively. A significant negative correlation between TDR and SUVmax was found only in the malignant group. CONCLUSION The diagnostic value of TDR complements the PET/CT evaluation of SPNs with a low F-FDG uptake.
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