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Eertink JJ, Zwezerijnen GJC, Heymans MW, Pieplenbosch S, Wiegers SE, Dührsen U, Hüttmann A, Kurch L, Hanoun C, Lugtenburg PJ, Barrington SF, Mikhaeel NG, Ceriani L, Zucca E, Czibor S, Györke T, Chamuleau MED, Hoekstra OS, de Vet HCW, Boellaard R, Zijlstra JM. Baseline PET radiomics outperforms the IPI risk score for prediction of outcome in diffuse large B-cell lymphoma. Blood 2023; 141:3055-3064. [PMID: 37001036 PMCID: PMC10646814 DOI: 10.1182/blood.2022018558] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 01/31/2023] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
The objective of this study is to externally validate the clinical positron emission tomography (PET) model developed in the HOVON-84 trial and to compare the model performance of our clinical PET model using the international prognostic index (IPI). In total, 1195 patients with diffuse large B-cell lymphoma (DLBCL) were included in the study. Data of 887 patients from 6 studies were used as external validation data sets. The primary outcomes were 2-year progression-free survival (PFS) and 2-year time to progression (TTP). The metabolic tumor volume (MTV), maximum distance between the largest lesion and another lesion (Dmaxbulk), and peak standardized uptake value (SUVpeak) were extracted. The predictive values of the IPI and clinical PET model (MTV, Dmaxbulk, SUVpeak, performance status, and age) were tested. Model performance was assessed using the area under the curve (AUC), and diagnostic performance, using the positive predictive value (PPV). The IPI yielded an AUC of 0.62. The clinical PET model yielded a significantly higher AUC of 0.71 (P < .001). Patients with high-risk IPI had a 2-year PFS of 61.4% vs 51.9% for those with high-risk clinical PET, with an increase in PPV from 35.5% to 49.1%, respectively. A total of 66.4% of patients with high-risk IPI were free from progression or relapse vs 55.5% of patients with high-risk clinical PET scores, with an increased PPV from 33.7% to 44.6%, respectively. The clinical PET model remained predictive of outcome in 6 independent first-line DLBCL studies, and had higher model performance than the currently used IPI in all studies.
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Affiliation(s)
- J. J. Eertink
- Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - G. J. C. Zwezerijnen
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - M. W. Heymans
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - S. Pieplenbosch
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - S. E. Wiegers
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - U. Dührsen
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - A. Hüttmann
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - L. Kurch
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
| | - C. Hanoun
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - P. J. Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - S. F. Barrington
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s Health Partners, King’s College London, London, United Kingdom
| | - N. G. Mikhaeel
- Department of Clinical Oncology, Guy’s Cancer Centre and School of Cancer and Pharmaceutical Sciences, King’s College London University, London, United Kingdom
| | - L. Ceriani
- Department of Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland
- SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - E. Zucca
- SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
- Department of Oncology, IOSI - Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - S. Czibor
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - T. Györke
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - M. E. D. Chamuleau
- Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - O. S. Hoekstra
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - H. C. W. de Vet
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - R. Boellaard
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. M. Zijlstra
- Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
| | - PETRA Consortium
- Hematology, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, The Netherlands
- Radiology and Nuclear Medicine, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Methodology, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Department of Hematology, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Klinik und Poliklinik für Nuklearmedizin, Universitätsklinikum Leipzig, Leipzig, Germany
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
- King’s College London and Guy’s and St Thomas’ PET Centre, School of Biomedical Engineering and Imaging Sciences, King’s Health Partners, King’s College London, London, United Kingdom
- Department of Clinical Oncology, Guy’s Cancer Centre and School of Cancer and Pharmaceutical Sciences, King’s College London University, London, United Kingdom
- Department of Nuclear Medicine and PET/CT Centre, Imaging Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland
- SAKK Swiss Group for Clinical Cancer Research, Bern, Switzerland
- Department of Oncology, IOSI - Oncology Institute of Southern Switzerland, Università della Svizzera Italiana, Bellinzona, Switzerland
- Department of Nuclear Medicine, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
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2
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Soffers F, Helsen N, Van den Wyngaert T, Carp L, Hoekstra OS, Goethals L, Martens M, Deben K, Spaepen K, De Bree R, De Geeter F, Zwezerijnen GJC, Van Laer C, Maes A, Lenssen O, Stroobants S. Dual time point imaging in locally advanced head and neck cancer to assess residual nodal disease after chemoradiotherapy. EJNMMI Res 2022; 12:34. [PMID: 35695940 PMCID: PMC9192834 DOI: 10.1186/s13550-022-00905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/27/2022] [Indexed: 11/30/2022] Open
Abstract
Background FDG-PET/CT has a high negative predictive value to detect residual nodal disease in patients with locally advanced squamous cell head and neck cancer after completing concurrent chemoradiotherapy (CCRT). However, the positive predictive value remains suboptimal due to inflammation after radiotherapy, generating unnecessary further investigations and possibly even surgery. We report the results of a preplanned secondary end point of the ECLYPS study regarding the potential advantages of dual time point FDG-PET/CT imaging (DTPI) in this setting. Standardized dedicated head and neck FDG-PET/CT images were obtained 12 weeks after CCRT at 60 and 120 min after tracer administration. We performed a semiquantitative assessment of lymph nodes, and the retention index (RI) was explored to optimize diagnostic performance. The reference standard was histology, negative FDG-PET/CT at 1 year, or > 2 years of clinical follow-up. The time-dependent area under the receiver operator characteristics (AUROC) curves was calculated. Results In total, 102 subjects were eligible for analysis. SUV values increased in malignant nodes (median SUV1 = 2.6 vs. SUV2 = 2.7; P = 0.04) but not in benign nodes (median SUV1 = 1.8 vs. SUV2 = 1.7; P = 0.28). In benign nodes, RI was negative although highly variable (median RI = − 2.6; IQR 21.2), while in malignant nodes RI was positive (median RI = 12.3; IQR 37.2) and significantly higher (P = 0.018) compared to benign nodes. A combined threshold (SUV1 ≥ 2.2 + RI ≥ 3%) significantly reduced the amount of false-positive cases by 53% (P = 0.02) resulting in an increased specificity (90.8% vs. 80.5%) and PPV (52.9% vs. 37.0%), while sensitivity (60.0% vs. 66.7%) and NPV remained comparably high (92.9% vs. 93.3%). However, AUROC, as overall measure of benefit in diagnostic accuracy, did not significantly improve (P = 0.62). In HPV-related disease (n = 32), there was no significant difference between SUV1, SUV2, and RI in malignant and benign nodes, yet this subgroup was small. Conclusions DTPI did not improve the overall diagnostic accuracy of FDG-PET/CT to detect residual disease 12 weeks after chemoradiation. Due to differences in tracer kinetics between malignant and benign nodes, DTPI improved the specificity, but at the expense of a loss in sensitivity, albeit minimal. Since false negatives at the 12 weeks PET/CT are mainly due to minimal residual disease, DTPI is not able to significantly improve sensitivity, but repeat scanning at a later time (e.g. after 12 months) could possibly solve this problem. Further study is required in HPV-associated disease.
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Affiliation(s)
- Frederik Soffers
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.
| | - Nils Helsen
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Tim Van den Wyngaert
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium
| | - Laurens Carp
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Otto S Hoekstra
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | - Michel Martens
- Department of Radiotherapy, AZ Turnhout, Turnhout, Belgium
| | - Kristof Deben
- Department of Otolaryngology, Jessa Hospital, Hasselt, Belgium
| | - Karoline Spaepen
- Department of Nuclear Medicine, Sint Augustinus, Wilrijk, Belgium
| | - Remco De Bree
- Faculty of Medicine and Health Sciences, Integrated Personalized and Precision Oncology Network (IPPON), University of Antwerp, Antwerp, Belgium.,Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank De Geeter
- Department of Nuclear Medicine, AZ Sint Jan, Brugge, Belgium
| | - G J C Zwezerijnen
- Departments of Otolaryngology-Head and Neck Surgery, and Radiology & Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Carl Van Laer
- Department Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Edegem, Belgium
| | - Alex Maes
- Department of Nuclear Medicine, AZ Groeninge, Kortrijk, Belgium
| | - Olivier Lenssen
- Department of Oral and Maxillofacial Surgery, ZNA Middelheim, Antwerp, Belgium
| | - Sigrid Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital, Edegem, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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3
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Eertink JJ, Arens AIJ, Huijbregts JE, Celik F, de Keizer B, Stroobants S, de Jong D, Wiegers SE, Zwezerijnen GJC, Burggraaff CN, Boellaard R, de Vet HCW, Hoekstra OS, Lugtenburg PJ, Chamuleau MED, Zijlstra JM. Aberrant patterns of PET response during treatment for DLBCL patients with MYC gene rearrangements. Eur J Nucl Med Mol Imaging 2021; 49:943-952. [PMID: 34476551 PMCID: PMC8803795 DOI: 10.1007/s00259-021-05498-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/13/2021] [Indexed: 11/29/2022]
Abstract
Purpose MYC gene rearrangements in diffuse large B-cell lymphoma (DLBCL) patients are associated with poor prognosis. Our aim was to compare patterns of 2[18F]fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET/CT) response in MYC + and MYC- DLBCL patients. Methods Interim PET/CT (I-PET) and end of treatment PET/CT (EoT-PET) scans of 81 MYC + and 129 MYC- DLBCL patients from 2 HOVON trials were reviewed using the Deauville 5-point scale (DS). DS1-3 was regarded as negative and DS4-5 as positive. Standardized uptake values (SUV) and metabolic tumor volume (MTV) were quantified at baseline, I-PET, and EoT-PET. Negative (NPV) and positive predictive values (PPV) were calculated using 2-year overall survival. Results MYC + DLBCL patients had significantly more positive EoT-PET scans than MYC- patients (32.5 vs 15.7%, p = 0.004). I-PET positivity rates were comparable (28.8 vs 23.8%). In MYC + patients 23.2% of the I-PET negative patients converted to positive at EoT-PET, vs only 2% for the MYC- patients (p = 0.002). Nine (34.6%) MYC + DLBCL showed initially uninvolved localizations at EoT-PET, compared to one (5.3%) MYC- patient. A total of 80.8% of EoT-PET positive MYC + patients showed both increased lesional SUV and MTV compared to I-PET. In MYC- patients, 31.6% showed increased SUV and 42.1% showed increased MTV. NPV of I-PET and EoT-PET was high for both MYC subgroups (81.8–94.1%). PPV was highest at EoT-PET for MYC + patients (61.5%). Conclusion MYC + DLBCL patients demonstrate aberrant PET response patterns compared to MYC- patients with more frequent progression during treatment after I-PET negative assessment and new lesions at sites that were not initially involved. Trial registration number and date of registration HOVON-84: EudraCT: 2006–005,174-42, retrospectively registered 01–08-2008. HOVON-130: EudraCT: 2014–002,654-39, registered 26–01-2015 Supplementary Information The online version contains supplementary material available at 10.1007/s00259-021-05498-7.
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Affiliation(s)
- J J Eertink
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - A I J Arens
- Department of Radiology, Nuclear Medicine and Anatomy, Radboud University Medical Center, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - J E Huijbregts
- Department of Radiology and Nuclear Medicine, Gelre Ziekenhuizen, Albert Schweitzerlaan 31, Apeldoorn, The Netherlands
| | - F Celik
- Department of Radiology and Nuclear Medicine, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, Deventer, The Netherlands
| | - B de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - S Stroobants
- Department of Nuclear Medicine, Antwerp University Hospital (UZA), Antwerp, Belgium
| | - D de Jong
- Department of Pathology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - S E Wiegers
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - C N Burggraaff
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, The Netherlands
| | - P J Lugtenburg
- Department of Hematology, Erasmus MC Cancer Institute, University Medical Center Rotterdam, Wytemaweg 80, Rotterdam, The Netherlands
| | - M E D Chamuleau
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - J M Zijlstra
- Department of Hematology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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4
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Drees EEE, Roemer MGM, Groenewegen NJ, Perez‐Boza J, van Eijndhoven MAJ, Prins LI, Verkuijlen SAWM, Tran X, Driessen J, Zwezerijnen GJC, Stathi P, Mol K, Karregat JJJP, Kalantidou A, Vallés‐Martí A, Molenaar TJ, Aparicio‐Puerta E, van Dijk E, Ylstra B, Groothuis‐Oudshoorn CGM, Hackenberg M, de Jong D, Zijlstra JM, Pegtel DM. Extracellular vesicle miRNA predict FDG-PET status in patients with classical Hodgkin Lymphoma. J Extracell Vesicles 2021; 10:e12121. [PMID: 34295456 PMCID: PMC8282992 DOI: 10.1002/jev2.12121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 12/13/2022] Open
Abstract
Minimally-invasive tools to assess tumour presence and burden may improve clinical management. FDG-PET (metabolic) imaging is the current gold standard for interim response assessment in patients with classical Hodgkin Lymphoma (cHL), but this technique cannot be repeated frequently. Here we show that microRNAs (miRNA) associated with tumour-secreted extracellular vesicles (EVs) in the circulation of cHL patients may improve response assessment. Small RNA sequencing and qRT-PCR reveal that the relative abundance of cHL-expressed miRNAs, miR-127-3p, miR-155-5p, miR-21-5p, miR-24-3p and let-7a-5p is up to hundred-fold increased in plasma EVs of cHL patients pre-treatment when compared to complete metabolic responders (CMR). Notably, in partial responders (PR) or treatment-refractory cases (n = 10) the EV-miRNA levels remain elevated. In comparison, tumour specific copy number variations (CNV) were detected in cell-free DNA of 8 out of 10 newly diagnosed cHL patients but not in patients with PR. Combining EV-miR-127-3p and/or EV-let-7a-5p levels, with serum TARC (a validated protein cHL biomarker), increases the accuracy for predicting PET-status (n = 129) to an area under the curve of 0.93 (CI: 0.87-0.99), 93.5% sensitivity, 83.8/85.0% specificity and a negative predictive value of 96%. Thus the level of tumour-associated miRNAs in plasma EVs is predictive of metabolic tumour activity in cHL patients. Our findings suggest that plasma EV-miRNA are useful for detection of small residual lesions and may be applied as serial response prediction tool.
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Affiliation(s)
- Esther E. E. Drees
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Margaretha G. M. Roemer
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Nils J. Groenewegen
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
- ExBiome B.V.AmsterdamThe Netherlands
| | - Jennifer Perez‐Boza
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Leah I. Prins
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Sandra A. W. M. Verkuijlen
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Xuan‐Mai Tran
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Julia Driessen
- Department of HematologyAmsterdam UMCCancer Center Amsterdam, University of AmsterdamAmsterdamThe Netherlands
| | - G. J. C. Zwezerijnen
- Department of Radiology and Nuclear MedicineCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Phylicia Stathi
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Kevin Mol
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Joey J. J. P. Karregat
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Aikaterini Kalantidou
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Andrea Vallés‐Martí
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - T. J. Molenaar
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Ernesto Aparicio‐Puerta
- Department of GeneticsComputational Epigenomics and BioinformaticsUniversity of GranadaGranadaSpain
| | - Erik van Dijk
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Bauke Ylstra
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | | | - Michael Hackenberg
- ExBiome B.V.AmsterdamThe Netherlands
- Department of GeneticsComputational Epigenomics and BioinformaticsUniversity of GranadaGranadaSpain
| | - Daphne de Jong
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Josée M. Zijlstra
- Department of HematologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - D. Michiel Pegtel
- Department of PathologyCancer Center AmsterdamAmsterdam UMCVrije Universiteit AmsterdamAmsterdamThe Netherlands
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5
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Jansen BHE, Bodar YJL, Zwezerijnen GJC, Meijer D, van der Voorn JP, Nieuwenhuijzen JA, Wondergem M, Roeleveld TA, Boellaard R, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Pelvic lymph-node staging with 18F-DCFPyL PET/CT prior to extended pelvic lymph-node dissection in primary prostate cancer - the SALT trial. Eur J Nucl Med Mol Imaging 2021; 48:509-520. [PMID: 32789599 PMCID: PMC7835187 DOI: 10.1007/s00259-020-04974-w] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/23/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE The detection of lymph-node metastases (N1) with conventional imaging such as magnetic resonance imaging (MRI) and computed tomography (CT) is inadequate for primarily diagnosed prostate cancer (PCa). Prostate-specific membrane antigen (PSMA) PET/CT is successfully introduced for the staging of (biochemically) recurrent PCa. Besides the frequently used 68gallium-labelled PSMA tracers, 18fluorine-labelled PSMA tracers are available. This study examined the diagnostic accuracy of 18F-DCFPyL (PSMA) PET/CT for lymph-node staging in primary PCa. METHODS This was a prospective, multicentre cohort study. Patients with primary PCa underwent 18F-DCFPyL PET/CT prior to robot-assisted radical prostatectomy (RARP) with extended pelvic lymph-node dissection (ePLND). Patients were included between October 2017 and January 2020. A Memorial Sloan Kettering Cancer Centre (MSKCC) nomogram risk probability of ≥ 8% of lymph-node metastases was set to perform ePLND. All images were reviewed by two experienced nuclear physicians, and were compared with post-operative histopathologic results. RESULTS A total of 117 patients was analysed. Lymph-node metastases (N1) were histologically diagnosed in 17/117 patients (14.5%). The sensitivity, specificity, positive predictive value and negative predictive value for the 18F-DCFPyL PET/CT detection of pelvic lymph-node metastases on a patient level were 41.2% (confidence interval (CI): 19.4-66.5%), 94.0% (CI 86.9-97.5%), 53.8% (CI 26.1-79.6%) and 90.4% (CI 82.6-95.0%), respectively. CONCLUSION 18F-DCFPyL PET/CT showed a high specificity (94.4%), yet a limited sensitivity (41.2%) for the detection of pelvic lymph-node metastases in primary PCa. This implies that current PSMA PET/CT imaging cannot replace diagnostic ePLND. Further research is necessary to define the exact place of PSMA PET/CT imaging in the primary staging of PCa.
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Affiliation(s)
- B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - G J C Zwezerijnen
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - M Wondergem
- Department of Nuclear medicine, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - T A Roeleveld
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - R Boellaard
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology & Nuclear medicine, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
- Prostate Cancer Network, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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6
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Bodar YJL, Jansen BHE, van der Voorn JP, Zwezerijnen GJC, Meijer D, Nieuwenhuijzen JA, Boellaard R, Hendrikse NH, Hoekstra OS, van Moorselaar RJA, Oprea-Lager DE, Vis AN. Detection of prostate cancer with 18F-DCFPyL PET/CT compared to final histopathology of radical prostatectomy specimens: is PSMA-targeted biopsy feasible? The DeTeCT trial. World J Urol 2020; 39:2439-2446. [PMID: 33079250 PMCID: PMC8332599 DOI: 10.1007/s00345-020-03490-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 10/07/2020] [Indexed: 11/01/2022] Open
Abstract
PURPOSE In primary prostate cancer (PCa) patients, accurate staging and histologic grading are crucial to guide treatment decisions. 18F-DCFPyL (PSMA)-PET/CT has been successfully introduced for (re)staging PCa, showing high accuracy to localise PCa in lymph nodes and/or osseous structures. The diagnostic performance of 18F-DCFPyL-PET/CT in localizing primary PCa within the prostate gland was assessed, allowing for PSMA-guided targeted-prostate biopsy. METHODS Thirty patients with intermediate-/high-risk primary PCa were prospectively enrolled between May 2018 and May 2019 and underwent 18F-DCFPyL-PET/CT prior to robot-assisted radical prostatectomy (RARP). Two experienced and blinded nuclear medicine physicians assessed tumour localisation within the prostate gland on PET/CT, using a 12-segment mapping model of the prostate. The same model was used by a uro-pathologist for the RARP specimens. Based on PET/CT imaging, a potential biopsy recommendation was given per patient, based on the size and PET-intensity of the suspected PCa localisations. The biopsy recommendation was correlated to final histopathology in the RARP specimen. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for clinically significant PCa (csPCa, Gleason score ≥ 3 + 4 = 7) were assessed. RESULTS The segments recommended for potential targeted biopsy harboured csPCA in 28/30 patients (93%), and covered the highest Gleason score PCa segment in 26/30 patient (87%). Overall, 122 of 420 segments (29.0%) contained csPCa at final histopathological examination. Sensitivity, specificity, PPV and NPV for csPCa per segment using 18F-DCFPyL-PET/CT were 61.4%, 88.3%, 68.1% and 84.8%, respectively. CONCLUSIONS When comparing the PCa-localisation on 18F-DCFPyL-PET/CT with the RARP specimens, an accurate per-patient detection (93%) and localisation of csPCa was found. Thus, 18F-DCFPyL-PET/CT potentially allows for accurate PSMA-targeted biopsy.
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Affiliation(s)
- Y J L Bodar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands. .,Prostate Cancer Network, Amsterdam, The Netherlands.
| | - B H E Jansen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J P van der Voorn
- Department of Pathology, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - D Meijer
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - R Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - N H Hendrikse
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands.,Department of Clinical Pharmacology and Pharmacy, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - O S Hoekstra
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - R J A van Moorselaar
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
| | - D E Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centres (VU University), Amsterdam, The Netherlands
| | - A N Vis
- Department of Urology, Amsterdam University Medical Centres (VU University), De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Prostate Cancer Network, Amsterdam, The Netherlands
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7
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Dreijerink KMA, Rijken JA, Compaijen CJ, Timmers HJLM, van der Horst-Schrivers ANA, van Leeuwaarde RS, van Dam PS, Leemans CR, van Dam EWCM, Dickhoff C, Dommering CJ, de Graaf P, Zwezerijnen GJC, van der Valk P, Menke-Van der Houven van Oordt CW, Hensen EF, Corssmit EPM, Eekhoff EMW. Biochemically Silent Sympathetic Paraganglioma, Pheochromocytoma, or Metastatic Disease in SDHD Mutation Carriers. J Clin Endocrinol Metab 2019; 104:5421-5426. [PMID: 31194241 DOI: 10.1210/jc.2019-00202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
CONTEXT Current guidelines do not consistently recommend imaging beyond the head and neck region in succinate dehydrogenase subunit D (SDHD) mutation carriers as long as catecholamine metabolite levels are within the reference range. PARTICIPANTS We report a series of 10 patients carrying pathogenic variants in the SDHD gene from five tertiary referral centers for paraganglioma (PGL) in the Netherlands, who presented with a sympathetic PGL (sPGL), pheochromocytoma (PHEO), or metastases outside the head and neck region in the absence of excessive catecholamine production. Two of six patients with a biochemically silent sPGL/PHEO developed metastatic disease. Additionally, four patients were found to have metastases outside the head and neck region from head and neck PGL. The average interval between the initial diagnosis and discovery of the silent lesions was 10 (range, 0 to 32) years. CONCLUSIONS The absence of excessive catecholamine production does not exclude the presence of manifestations of SDHD outside the head and neck region. These findings suggest that a more extensive imaging strategy in SDHD mutation carriers may be warranted for detection of biochemically silent lesions.
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Affiliation(s)
- Koen M A Dreijerink
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Johannes A Rijken
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HZ Amsterdam, Netherlands
| | - C J Compaijen
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Henri J L M Timmers
- Division of Endocrinology, Department of Internal Medicine, Radboud University Medical Center, GA Nijmegen, Netherlands
| | | | - Rachel S van Leeuwaarde
- Department of Endocrine Oncology, University Medical Center Utrecht, GA Utrecht, Netherlands
| | - P Sytze van Dam
- Department of Internal Medicine, OLVG Hospital, AC Amsterdam, Netherlands
| | - C René Leemans
- Department of Otolaryngology/Head and Neck Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HZ Amsterdam, Netherlands
| | - Eveline W C M van Dam
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Chris Dickhoff
- Department of Surgery and Cardiothoracic Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Charlotte J Dommering
- Department of Clinical Genetics, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Pim de Graaf
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - G J C Zwezerijnen
- Department of Radiology and Nuclear Medicine, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | - Paul van der Valk
- Department of Pathology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
| | | | - Erik F Hensen
- Department of Otolaryngology/Head and Neck Surgery, Leiden University Medical Center, ZA Leiden, Netherlands
| | - Eleonora P M Corssmit
- Department of Endocrinology and Metabolic Diseases, Leiden University Medical Center, ZA Leiden, Netherlands
| | - E Marelise W Eekhoff
- Department of Endocrinology, Amsterdam UMC, Vrije Universiteit Amsterdam, HV Amsterdam, Netherlands
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