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Bauckneht M, Checcucci E, Cisero E, Rizzo A, Racca M, De Cillis S, Amparore D, De Luca S, Fiori C, Rescigno P, Porpiglia F. The prognostic role of next-generation imaging-driven upstaging in newly diagnosed prostate cancer patients. Eur J Nucl Med Mol Imaging 2024; 51:864-870. [PMID: 37935995 DOI: 10.1007/s00259-023-06490-z] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/21/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE Phase III evidence showed that next-generation imaging (NGI), such as prostate-specific membrane antigen positron emission tomography/computed tomography (PSMA PET/CT), provides higher diagnostic accuracy than bone scan and contrast-enhanced computed tomography (conventional imaging, CI) in the primary staging of intermediate-to-high-risk prostate cancer (PCa) patients. However, due to the lack of outcome data, the introduction of NGI in routine clinical practice is still debated. Analysing the oncological outcome of patients upstaged by NGI (though managed according to CI) might shed light on this issue, supporting the design of randomised trials comparing the effects of treatments delivered based on NGI vs. CI. METHODS We prospectively enrolled a cohort of 100 biopsy-proven intermediate-to-high-risk PCa patients staged with CI and PSMA PET/CT (though managed according to the CI stage), to assess the frequency of the stage migration phenomenon. Stage migration was then assessed as biochemical recurrence-free survival (bRFS) predictor. RESULTS Three patients were lost at follow-up after imaging. PSMA PET/CT upstaged 26.8% of patients compared to CI, while it downstaged 6.1% of patients. Notably, 50% of patients excluded from surgery due to the presence of bone metastases at CI would have been treated with radical-intent approaches if PSMA PET/CT had guided the treatment choice. After a median follow-up of 6 months of surgically treated patients, 22/83 (26.5%) had biochemical recurrence (BCR). PSMA PET/CT-driven upstaging determined a significant risk increase for BCR (HR:3.41, 95%CI:1.21-9.56, p = 0.019). Including stage migration in a univariable and multivariable model identified PSMA PET/CT-upstaging as an independent predictor of bRFS. CONCLUSIONS In conclusion, implementing NGI for staging purposes improves the prediction of bRFS. Although phase III evidence is still needed, this advancement suggests that NGI may better identify patients who would benefit from local treatments than those who may achieve better oncological outcomes through systemic treatment.
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Affiliation(s)
- Matteo Bauckneht
- Nuclear Medicine Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy.
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy.
| | - Enrico Checcucci
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
| | - Edoardo Cisero
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Alessio Rizzo
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO - IRCCS, Turin, Italy
| | - Manuela Racca
- Department of Nuclear Medicine, Candiolo Cancer Institute, FPO - IRCCS, Turin, Italy
| | - Sabrina De Cillis
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Daniele Amparore
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Stefano De Luca
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Cristian Fiori
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
| | - Pasquale Rescigno
- Department of Surgery, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, TO, Italy
- Translational and Clinical Research Institute, Centre for Cancer, Newcastle University, Newcastle Upon Tyne, UK
| | - Francesco Porpiglia
- Department of Oncology, Division of Urology, University of Turin, San Luigi Gonzaga Hospital, Orbassano, TO, Italy
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Shahait M, Abu-Hijlih R, Farkouh A, Obeidat S, Salah S, Abdlkadir AS, Al-Ibraheem A. Fluorodeoxyglucose positron emission tomography (18F-FDG PET)-computed tomography (CT) in the initial staging of bladder cancer: a single institution experience. J Egypt Natl Canc Inst 2023; 35:21. [PMID: 37455263 DOI: 10.1186/s43046-023-00180-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/18/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND The purpose of this study was to assess the usefulness of fluorodeoxyglucose positron emission tomography (18F-FDG PET)-computed tomography (CT) scan for staging urinary bladder cancer. The study also sought to determine the effect of 18F-FDG PET/CT on management decisions and its implications for patient care. METHODS A total of 133 patients with bladder cancer who had both conventional imaging and 18F-FDG PET/CT for initial staging were identified. All 18F-FDG-PET/CT findings were classified as true positive, true negative, false positive, or false negative based on their potential to impact the intent of treatment. The sensitivity, specificity, positive predictive value, and negative predictive value were calculated using the standard definition. Furthermore, the rate of change in therapy intent was determined for the entire sample and for subgroups with non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) patients. RESULTS The overall concordance rate between PET/CT and conventional imaging was around 54%. On conventional images, 18% of patients had localized disease, which was upstaged in 6.8% of cases using 18F-FDG PET/CT. Pelvic lymph node involvement was detected in 18.8% of cases using conventional imaging, which was downstaged to localized disease in 4.5% of cases using 18F-FDG PET/CT. While 63.2% of patients had systemic disease on a CT scan, 24.7% of cases were downstaged using PET/CT. Overall, the rate of change in therapy intent was 26.3% for the entire sample, 24.5% for NMIBC subgroup, and 27.3% for MIBC patients. CONCLUSIONS The study found that 18F-FDG PET/CT is an effective and accurate tool for staging bladder cancer in newly diagnosed patients. Approximately one quarter of patients had a change in management intent based on 18F-FDG PET/CT results. The study suggests that PET/CT should be used as a standard for newly diagnosed patients, but more research is needed to confirm this.
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Affiliation(s)
- Mohammed Shahait
- Surgery Department, Clemenceau Medical Center, Dubai, United Arab Emirates
| | - Ramiz Abu-Hijlih
- Radiation Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Ala'a Farkouh
- Surgery Department, King Hussein Cancer Center, Amman, Jordan
| | - Shahed Obeidat
- Nuclear Medicine Department, King Hussein Cancer Center (KHCC), P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Samer Salah
- Medical Oncology Department, King Hussein Cancer Center, Amman, Jordan
| | - Ahmed Saad Abdlkadir
- Nuclear Medicine Department, King Hussein Cancer Center (KHCC), P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan
| | - Akram Al-Ibraheem
- Nuclear Medicine Department, King Hussein Cancer Center (KHCC), P.O. Box 1269, Al-Jubeiha, Amman, 11941, Jordan.
- School of Medicine, University of Jordan, Amman, Jordan.
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Jiang Z, Fan J, Gan C, Dong X, Gao G, Wang Z, He D, Li L, Duan X, Wu K. Impact of non-regional lymph node metastases accurately revealed on 18F-PSMA-1007 PET/CT in the clinical management of metastatic hormone-sensitive prostate cancer. EJNMMI Res 2023; 13:64. [PMID: 37410264 DOI: 10.1186/s13550-023-01009-x] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 06/06/2023] [Indexed: 07/07/2023] Open
Abstract
BACKGROUND Non-regional lymph node (NRLN) metastases has shown increasing importance in the prognosis evaluation and clinical management of primary metastatic hormone-sensitive prostate cancer (mHSPC). Hence, this study aimed to investigate the concordance rates between 18F-PSMA-1007 PET/CT and conventional imaging (CI) in revealing NRLN metastases, and explore the impact of NRLN metastases on the management of primary mHSPC. METHODS The medical records of 224 patients with primary mHSPC were retrospectively reviewed, including 101 patients (45.1%) only received CI for TNM classification, 24 patients (10.7%) only received 18F-PSMA-1007 PET/CT, and 99 patients (44.2%) received both 18F-PSMA-1007 PET/CT and CI. Among patients who received 18F-PSMA-1007 PET/CT and CI before initial treatment, the concordance rates between 18F-PSMA-1007 PET/CT and CI were analyzed. The high-volume disease was defined as the presence of visceral metastases and/or ≥ 4 bone metastases (≥ 1 beyond the vertebral bodies or the pelvis) based on the findings of 18F-PSMA-1007 PET/CT and/or CI. The primary endpoint was progression-free survival (PFS), and Cox regression analyses were performed to explore independent predictors of PFS. RESULTS A total of 99 patients (44.2%) received both 18F-PSMA-1007 PET/CT and CI, the concordance rate in revealing NRLN metastases between 18F-PSMA-1007 PET/CT and CI was only 61.62%, and Cohen's kappa coefficient was as low as 0.092. Moreover, 18F-PSMA-1007 PET/CT detected an additional 37 of 94 (39.4%) patients with positive NRLNs who were negative on CI. Cox regression revealed that androgen deprivation therapy (ADT), N1, high-volume, NRLN and visceral metastases were associated with worse PFS (all P < 0.05) in 224 patients. Furthermore, in patients with low-volume disease, the median PFS of patients with NRLN metastases was significantly shorter than that of patients without NRLN metastases (19.5 vs. 27.5 months, P = 0.01), while the difference between patients with low-volume plus NRLN metastases and high-volume disease was not significant (19.5 vs. 16.9 months, P = 0.55). Moreover, early docetaxel chemotherapy significantly prolonged the PFS of these patients compared with ADT alone (20.7 vs. 12.3 months, P = 0.008). CONCLUSION NRLN metastases could be accurately revealed by 18F-PSMA-1007 PET/CT, which should be considered a high-volume feature, especially concomitant with bone metastases. Furthermore, patients with low-volume plus NRLN metastases may be suitable for more intensive treatment, such as early docetaxel chemotherapy.
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Affiliation(s)
- Zhangdong Jiang
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Junjie Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
- Department of Urology, Baoji Central Hospital, Baoji, Shaanxi, People's Republic of China
| | - Chaosheng Gan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Xiaoxin Dong
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Guoqiang Gao
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Zhuonan Wang
- Department of PET/CT Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Dalin He
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - Lei Li
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China
| | - XiaoYi Duan
- Department of PET/CT Imaging, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, #277 Yanta West Road, Xi'an, 710061, Shaanxi, People's Republic of China.
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Diessner J, Anders L, Herbert S, Kiesel M, Bley T, Schlaiss T, Sauer S, Wöckel A, Bartmann C. Evaluation of different imaging modalities for axillary lymph node staging in breast cancer patients to provide a personalized and optimized therapy algorithm. J Cancer Res Clin Oncol 2022. [PMID: 35948829 DOI: 10.1007/s00432-022-04221-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE The reliable detection of tumor-infiltrated axillary lymph nodes for breast cancer [BC] patients plays a decisive role in further therapy. We aimed to find out whether cross-sectional imaging techniques could improve sensitivity for pretherapeutic axillary staging in nodal-positive BC patients compared to conventional imaging such as mammography and sonography. METHODS Data for breast cancer patients with tumor-infiltrated axillary lymph nodes having received surgery between 2014 and 2020 were included in this study. All examinations (sonography, mammography, computed tomography [CT] and magnetic resonance imaging [MRI]) were interpreted by board-certified specialists in radiology. The sensitivity of different imaging modalities was calculated, and binary logistic regression analyses were performed to detect variables influencing the detection of positive lymph nodes. RESULTS All included 382 breast cancer patients had received conventional imaging, while 52.61% of the patients had received cross-sectional imaging. The sensitivity of the combination of all imaging modalities was 68.89%. The combination of MRI and CT showed 63.83% and the combination of sonography and mammography showed 36.11% sensitivity. CONCLUSION We could demonstrate that cross-sectional imaging can improve the sensitivity of the detection of tumor-infiltrated axillary lymph nodes in breast cancer patients. Only the safe detection of these lymph nodes at the time of diagnosis enables the evaluation of the response to neoadjuvant therapy, thereby allowing access to prognosis and improving new post-neoadjuvant therapies.
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Ma TM, Gafita A, Shabsovich D, Juarez J, Grogan TR, Thin P, Armstrong W, Sonni I, Nguyen K, Lok V, Reiter RE, Rettig MB, Steinberg ML, Kupelian PA, Yang DD, Muralidhar V, Chu C, Feng F, Savjani R, Deng J, Parikh NR, Nickols NG, Elashoff D, Czernin J, Calais J, Kishan AU. Identifying the Best Candidates for Prostate-specific Membrane Antigen Positron Emission Tomography/Computed Tomography as the Primary Staging Approach Among Men with High-risk Prostate Cancer and Negative Conventional Imaging. Eur Urol Oncol 2021; 5:100-103. [PMID: 33602654 DOI: 10.1016/j.euo.2021.01.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 01/19/2021] [Accepted: 01/28/2021] [Indexed: 01/25/2023]
Abstract
Prostate-specific membrane antigen (PSMA) positron emission tomography (PET)/computed tomography (CT) is an emerging imaging modality with greater sensitivity and specificity over conventional imaging for prostate cancer (PCa) staging. Using data from two prospective trials (NCT03368547 and NCT04050215), we explored predictors of overall upstaging (nodal and metastatic) by PSMA PET/CT among patients with cN0M0 National Comprehensive Cancer Network high-risk PCa on conventional imaging (n = 213). Overall, 21.1%, 8.9%, and 23.9% of patients experienced nodal, metastatic, and overall upstaging, respectively, without histologic confirmation. On multivariable analysis, Gleason grade group (GG) and percent positive core (PPC) on systematic biopsy significantly predict overall upstaging (odds ratio [OR] 2.15, 95% confidence interval [CI] 1.33-3.45; p = 0.002; and OR 1.03, 95% CI 1.01-1.04; p < 0.001). Overall upstaging was significantly more frequent among men with GG 5 disease (33.0% vs. 17.6%; p = 0.0097) and PPC ≥50% (33.0% vs 15.0%; p = 0.0020). We constructed a nomogram that predicts overall upstaging using initial prostate-specific antigen, PPC, GG, and cT stage, with coefficients estimated from a standard logistic regression model (using maximum likelihood estimation). It is internally validated with a tenfold cross-validated area under the receiver operating characteristic curve estimated at 0.74 (95% CI 0.67-0.82). In our cohort, 90% of patients who had a nomogram-estimated risk below the cutoff of 22% for overall upstaging could have been spared PSMA PET/CT as our model correctly predicted no upstaging. In other words, the predictive model only missed 10% of patients who would otherwise have benefitted from PSMA PET/CT. PATIENT SUMMARY: We analyzed predictors of overall upstaging (lymph node or/and metastasis) by prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) from conventional imaging in men with high-risk prostate cancer undergoing initial staging deemed free of disease in the lymph nodes and distant metastasis by conventional imaging techniques. We found that the pathologic grade and disease burden in a prostate biopsy are associated with upstaging. We also developed a tool that predicts the probability of upstaging according to an individual patient's characteristics. Our study may help in defining patient groups who are most likely to benefit from the addition of a PSMA PET/CT scan.
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Affiliation(s)
- Ting Martin Ma
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Andrei Gafita
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - David Shabsovich
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jesus Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Tristan R Grogan
- Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Pan Thin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Wesley Armstrong
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Ida Sonni
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Kathleen Nguyen
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Vincent Lok
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Robert E Reiter
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA
| | - Matthew B Rettig
- Department of Urology, UCLA Medical Center, Los Angeles, CA, USA; Department of Medicine, Division of Hematology-Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | | | - Patrick A Kupelian
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - David D Yang
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Vinayak Muralidhar
- Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA, USA
| | - Carissa Chu
- Department of Urology, UCSF Medical Center, San Francisco, CA, USA
| | - Felix Feng
- Department of Urology, UCSF Medical Center, San Francisco, CA, USA; Department of Radiation Oncology, UCSF Medical Center, San Francisco, CA, USA
| | - Ricky Savjani
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jie Deng
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Neil R Parikh
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA
| | - David Elashoff
- Statistics Core, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
| | - Johannes Czernin
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Jeremie Calais
- Ahmanson Translational Theranostics Division, Department of Molecular and Medical Pharmacology, UCLA Medical Center, Los Angeles, CA, USA
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, CA, USA.
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Anttinen M, Ettala O, Malaspina S, Jambor I, Sandell M, Kajander S, Rinta-Kiikka I, Schildt J, Saukko E, Rautio P, Timonen KL, Matikainen T, Noponen T, Saunavaara J, Löyttyniemi E, Taimen P, Kemppainen J, Dean PB, Blanco Sequeiros R, Aronen HJ, Seppänen M, Boström PJ. A Prospective Comparison of 18F-prostate-specific Membrane Antigen-1007 Positron Emission Tomography Computed Tomography, Whole-body 1.5 T Magnetic Resonance Imaging with Diffusion-weighted Imaging, and Single-photon Emission Computed Tomography/Computed Tomography with Traditional Imaging in Primary Distant Metastasis Staging of Prostate Cancer (PROSTAGE). Eur Urol Oncol 2020; 4:635-644. [PMID: 32675047 DOI: 10.1016/j.euo.2020.06.012] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/08/2020] [Accepted: 06/29/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Computed tomography (CT) and bone scintigraphy (BS) are the imaging modalities currently used for distant metastasis staging of prostate cancer (PCa). OBJECTIVE To compare standard staging modalities with newer and potentially more accurate imaging modalities. DESIGN, SETTING, AND PARTICIPANTS This prospective, single-centre trial (NCT03537391) enrolled 80 patients with newly diagnosed high-risk PCa (International Society of Urological Pathology grade group ≥3 and/or prostate-specific antigen [PSA] ≥20 and/or cT ≥ T3; March 2018-June 2019) to undergo primary metastasis staging with two standard and three advanced imaging modalities. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The participants underwent the following five imaging examinations within 2 wk of enrolment and without a prespecified sequence: BS, CT, 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP) single-photon emission computed tomography (SPECT)-CT, 1.5 T whole-body magnetic resonance imaging (WBMRI) using diffusion-weighted imaging, and 18F-prostate-specific membrane antigen-1007 (18F-PSMA-1007) positron emission tomography(PET)-CT. Each modality was reviewed by two independent experts blinded to the results of the prior studies, who classified lesions as benign, equivocal, or malignant. Pessimistic and optimistic analyses were performed to resolve each equivocal diagnosis. The reference standard diagnosis was defined using all available information accrued during at least 12 mo of clinical follow-up. Patients with equivocal reference standard diagnoses underwent MRI and/or CT to search for the development of anatomical correspondence. PSMA PET-avid lesions without histopathological verification were rated to be malignant only if there was a corresponding anatomical finding suspicious for malignancy at the primary or follow-up imaging. RESULTS AND LIMITATIONS Seventy-nine men underwent all imaging modalities except for one case of interrupted MRI. The median interval per patient between the first and the last imaging study was 8 d (interquartile range [IQR]: 6-9). The mean age was 70 yr (standard deviation: 7) and median PSA 12 ng/mL (IQR:7-23). The median follow-up was 435 d (IQR: 378-557). Metastatic disease was detected in 20 (25%) patients. The imaging modality 18F-PSMA-1007 PET-CT had superior sensitivity and highest inter-reader agreement. The area under the receiver-operating characteristic curve (AUC) values for bone metastasis detection with PSMA PET-CT were 0.90 (95% confidence interval [CI]: 0.85-0.95) and 0.91 (95% CI: 0.87-0.96) for readers 1 and 2, respectively, while the AUC values for BS, CT, SPECT-CT, and WBMRI were 0.71 (95% CI: 0.58-0.84) and 0.8 (95% CI: 0.67-0.92), 0.53 (95% CI: 0.39-0.67) and 0.66 (95% CI: 0.54-0.77), 0.77 (95% CI: 0.65-0.89) and 0.75 (95% CI: 0.62-0.88), and 0.85 (95% CI: 0.74-0.96) and 0.67 (95% CI: 0.54-0.80), respectively, for the other four pairs of readers. The imaging method 18F-PSMA-1007 PET-CT detected metastatic disease in 11/20 patients in whom standard imaging was negative and influenced clinical decision making in 14/79 (18%) patients. In 12/79 cases, false positive bone disease was reported only by PSMA PET-CT. Limitations included a nonrandomised study setting and few histopathologically validated suspicious lesions. CONCLUSIONS Despite the risk of false positive bone lesions, 18F-PSMA-1007 PET-CT outperformed all other imaging methods studied for the detection of primary distant metastasis in high-risk PCa. PATIENT SUMMARY In this report, we compared the diagnostic performance of conventional and advanced imaging. It was found that 18F-prostate-specific membrane antigen-1007 positron emission tomography/computed tomography (18F-PSMA-1007 PET-CT) was superior to the other imaging modalities studied for the detection of distant metastasis at the time of initial diagnosis of high-risk prostate cancer. PSMA PET-CT also appears to detect some nonmetastatic bone lesions.
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Affiliation(s)
- Mikael Anttinen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland.
| | - Otto Ettala
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Simona Malaspina
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ivan Jambor
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland; Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Minna Sandell
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Sami Kajander
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Irina Rinta-Kiikka
- Department of Radiology, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Jukka Schildt
- Department of Clinical Physiology and Nuclear Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ekaterina Saukko
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Pentti Rautio
- Department of Clinical Physiology, North Karelia Central Hospital, Joensuu, Finland
| | - Kirsi L Timonen
- Department of Clinical Physiology and Nuclear Medicine, Central Hospital of Central Finland, Jyväskylä, Finland
| | - Tuomas Matikainen
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
| | - Tommi Noponen
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | - Jani Saunavaara
- Department of Medical Physics and Nuclear Medicine, University of Turku and Turku University Hospital, Turku, Finland
| | | | - Pekka Taimen
- Institute of Biomedicine, University of Turku and Department of Pathology, Turku University Hospital, Turku, Finland
| | - Jukka Kemppainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter B Dean
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Roberto Blanco Sequeiros
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Hannu J Aronen
- Department of Diagnostic Radiology, University of Turku and Turku University Hospital, Turku, Finland
| | - Marko Seppänen
- Department of Clinical Physiology, Nuclear Medicine and Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Peter J Boström
- Department of Urology, University of Turku and Turku University Hospital, Turku, Finland
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Poodt IGM, Schipper RJ, de Greef BTA, Vugts G, Maaskant-Braat AJG, Jansen FH, Wyndaele DNJ, Voogd AC, Nieuwenhuijzen GAP. Screening for distant metastases in patients with ipsilateral breast tumor recurrence: the impact of different imaging modalities on distant recurrence-free interval. Breast Cancer Res Treat 2019; 175:419-428. [PMID: 30955183 PMCID: PMC6533220 DOI: 10.1007/s10549-019-05205-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 02/05/2019] [Accepted: 03/15/2019] [Indexed: 02/07/2023]
Abstract
Purpose In patients with ipsilateral breast tumor recurrence (IBTR), the detection of distant disease determines whether the intention of the treatment is curative or palliative. Therefore, adequate preoperative staging is imperative for optimal treatment planning. The aim of this study is to evaluate the impact of conventional imaging techniques, including chest X-ray and/or CT thorax-(abdomen), liver ultrasonography(US), and skeletal scintigraphy, on the distant recurrence-free interval (DRFI) in patients with IBTR, and to compare conventional imaging with 18F-FDG PET-CT or no imaging at all. Methods This study was exclusively based on the information available at time of diagnoses of IBTR. To adjust for differences in baseline characteristics between the three imaging groups, a propensity score (PS) weighted method was used. Results Of the 495 patients included in the study, 229 (46.3%) were staged with conventional imaging, 89 patients (19.8%) were staged with 18F-FDG PET-CT, and in 168 of the patients (33.9%) no imaging was used (N = 168). After a follow-up of approximately 5 years, 14.5% of all patients developed a distant recurrence as first event after IBTR. After adjusting for the PS weights, the Cox regression analyses showed that the different staging methods had no significant impact on the DRFI. Conclusions This study showed a wide variation in the use of imaging modalities for staging IBTR patients in the Netherlands. After using PS weighting, no statistically significant impact of the different imaging modalities on DRFI was shown. Based on these results, it is not possible to recommend staging for distant metastases using 18F-FDG PET-CT over conventional imaging techniques. Electronic supplementary material The online version of this article (10.1007/s10549-019-05205-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ingrid G M Poodt
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands.
| | - Robert-Jan Schipper
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | - Bianca T A de Greef
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Guusje Vugts
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
| | | | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Dirk N J Wyndaele
- Department of Nuclear Medicine, Catharina Hospital, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Faculty of Health Medicine and Life Sciences, Research Institute Growth and Development (GROW), Maastricht University, Maastricht, The Netherlands.,Utrecht Cancer Registry, Netherlands Comprehensive Cancer Organization, Utrecht, The Netherlands
| | - Grard A P Nieuwenhuijzen
- Department of Surgery, Catharina Hospital, Michelangelolaan 2, 5623 EJ, Eindhoven, The Netherlands
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Zattoni F, Incerti E, Colicchia M, Castellucci P, Panareo S, Picchio M, Fallanca F, Briganti A, Moschini M, Gallina A, Karnes JR, Lowe V, Fanti S, Schiavina R, Rambaldi I, Ficarra V, Evangelista L. Comparison between the diagnostic accuracies of 18F-fluorodeoxyglucose positron emission tomography/computed tomography and conventional imaging in recurrent urothelial carcinomas: a retrospective, multicenter study. Abdom Radiol (NY) 2018; 43:2391-2399. [PMID: 29302738 DOI: 10.1007/s00261-017-1443-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the performance accuracy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) after primary tumor treatment for both bladder cancer (BC) and upper tract urothelial cancer (UTUC). To compare the accuracy of FDG PET/CT with that of contrast-enhanced-ceCT and magnetic resonance imaging (MRI). METHODS Data of patients with recurrent urothelial carcinomas (UC) after primary treatment were collected in a retrospective, international multicenter study. Inclusion criteria were (1) patients with a known history of UC in the BC and/or in the UTUC; (2) PET/CT images after curative intent treatment of the primary tumor; (3) conventional imaging modalities (abdominal ceCT or MRI, or total body ceCT, and chest X-ray: called C.I.) performed no more than 3 months from PET/CT; (4) available standard of reference (e.g., histological data or follow-up imaging modalities) for the validation of PET/CT findings. Exclusion criteria were other abdominal tumors, chemotherapy administration prior to and/or concomitant to imaging, and non-urothelial histologic variants. Sensitivities, specificities, positive, and negative predictive values were evaluated for all patients and separately for bladder and UTUC. RESULTS Overall, 287 patients were enrolled. Two-hundred thirteen patients underwent cystectomy (74.2%), 35 nephroureterectomy (12.2%), 31 both cystectomy + nephroureterectomy (10.8%), 5 both cystectomy + conservative treatment for UTUC (1.4%), and 3 (1%) other types of nephron-sparing treatments for UTUC. Neoadjuvant and adjuvant treatments were performed in 36 (12.5%) and 111 (38.7%) patients, respectively. Sensitivity and specificity (95% confidence intervals) of PET/CT for the detection of recurrent UC were 94% (91% to 96%) and 79% (68% to 88%), respectively. However, sensitivity was higher for BC than UTUC (95% vs. 85%) while specificity was lower in BC (78% vs. 85% for BC and UTUC, respectively). PET/CT and C.I. findings were available in 198 patients. The results were positively concordant in 137 patients, negatively concordant in 23 patients, and discordant in 38 patients (20 negative at C.I. vs. positive at PET/CT and 18 positives at ceCT/MRI vs. negative at PET/CT) (K Cohen = 0.426; p < 0.001). Sensitivities, specificities, and accuracies (95% confidence intervals) of PET/CT vs. C.I. for the detection of recurrent BC and UTUC were 94% (90% to 97%) vs. 86% (81% to 92%), 79% (67% to 92%) vs. 59% (44% to 74%), and 91% (87% to 95%) vs. 81% (75% to 86%), respectively. CONCLUSIONS FDG PET/CT has a high diagnostic accuracy for the identification of recurrent UC, particularly in patients with BC. Moreover, its accuracy outperforms C.I. for both BC and UTUC.
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Trefan L, Harris C, Evans S, Nuttall D, Maguire S, Kemp AM. A comparison of four different imaging modalities - Conventional, cross polarized, infra-red and ultra-violet in the assessment of childhood bruising. J Forensic Leg Med 2018; 59:30-35. [PMID: 30096460 PMCID: PMC6125673 DOI: 10.1016/j.jflm.2018.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 01/24/2023]
Abstract
Background It is standard practice to image concerning bruises in children. We aim to compare the clarity and measurements of bruises using cross polarized, infra-red (IR) and ultra-violet (UV) images to conventional images. Methods Children aged <11 years with incidental bruising were recruited. Demographics, skin and bruise details were recorded. Bruises were imaged by standard protocols in conventional, cross-polarized, IR and UV lights. Bruises were assessed in vivo for contrast, uniformity and diffuseness, and these characteristics were then compared across image modalities. Color images (conventional, cross polarized) were segmented and measured by ImageJ. Bruises of grey scale images (IR, UV) were measured by a ‘plug in’ of ImageJ. The maximum and minimum Feret's diameter, area and aspect ratio, were determined. Comparison of measurements across imaging modalities was conducted using Wilcoxon rank sum tests and modified Bland-Altman graphs. Significance was set at p < 0.05. Results Twenty five children had 39 bruises. Bruises that were of low contrast, i.e. difficult to distinguish from surrounding skin, were also more diffuse, and less uniformity in vivo. Low contrast bruises were best seen on conventional and cross-polarized images and less distinctive on IR and UV images. Of the 19 bruises visible in all modalities, the only significant difference was maximum and minimum Feret's diameters and area were smaller on IR compared to conventional images. Aspect ratios were not affected by the modality. Conclusions Conventional and cross-polarized imaging provides the most consistent bruise measurement, particularly in bruises that are not easily distinguished from surrounding skin visually. Diffuse bruises may be measured on conventional & cross polarized imaging. Infrared or ultraviolet imaging may not show bruises which are difficult to see in vivo. Measurements of bruises using infrared imaging may be smaller than other modalities.
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Affiliation(s)
- L Trefan
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - C Harris
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - S Evans
- Chief Clinical Photographer, Dental Photography, School of Dentistry, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff, CF14 4XY, UK.
| | - D Nuttall
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - S Maguire
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
| | - A M Kemp
- Division of Population Medicine, School of Medicine, Cardiff University, Heath Park, Cardiff, CF14 4YS, UK.
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Harris C, Alcock A, Trefan L, Nuttall D, Evans ST, Maguire S, Kemp AM. Optimising the measurement of bruises in children across conventional and cross polarized images using segmentation analysis techniques in Image J, Photoshop and circle diameter measurements. J Forensic Leg Med 2018; 54:114-120. [PMID: 29413952 DOI: 10.1016/j.jflm.2017.12.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 08/25/2017] [Accepted: 12/31/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Bruising is a common abusive injury in children, and it is standard practice to image and measure them, yet there is no current standard for measuring bruise size consistently. We aim to identify the optimal method of measuring photographic images of bruises, including computerised measurement techniques. METHODS 24 children aged <11 years (mean age of 6.9, range 2.5-10 years) with a bruise were recruited from the community. Demographics and bruise details were recorded. Each bruise was measured in vivo using a paper measuring tape. Standardised conventional and cross polarized digital images were obtained. The diameter of bruise images were measured by three computer aided measurement techniques: Image J (segmentation with Simple Interactive Object Extraction (maximum Feret diameter), 'Circular Selection Tool' (Circle diameter), & the Photoshop 'ruler' software (Photoshop diameter)). Inter and intra-observer effects were determined by two individuals repeating 11 electronic measurements, and relevant Intraclass Correlation Coefficient's (ICC's) were used to establish reliability. Spearman's rank correlation was used to compare in vivo with computerised measurements; a comparison of measurement techniques across imaging modalities was conducted using Kolmogorov-Smirnov tests. Significance was set at p < 0.05 for all tests. RESULTS Images were available for 38 bruises in vivo, with 48 bruises visible on cross polarized imaging and 46 on conventional imaging (some bruises interpreted as being single in vivo appeared to be multiple in digital images). Correlation coefficients were >0.5 for all techniques, with maximum Feret diameter and maximum Photoshop diameter on conventional images having the strongest correlation with in vivo measurements. There were significant differences between in vivo and computer-aided measurements, but none between different computer-aided measurement techniques. Overall, computer aided measurements appeared larger than in vivo. Inter- and intra-observer agreement was high for all maximum diameter measurements (ICC's > 0.7). CONCLUSIONS Whilst there are minimal differences between measurements of images obtained, the most consistent results were obtained when conventional images, segmented by Image J Software, were measured with a Feret diameter. This is therefore proposed as a standard for future research, and forensic practice, with the proviso that all computer aided measurements appear larger than in vivo.
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Affiliation(s)
- C Harris
- University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
| | - A Alcock
- Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK.
| | - L Trefan
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - D Nuttall
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - S T Evans
- Dental Photography, School of Dentistry, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK.
| | - S Maguire
- School of Medicine, College of Biomedical & Life Sciences, Cardiff University, Heath Park, Cardiff, UK; Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
| | - A M Kemp
- Division of Population Medicine, College of Biomedical and Life Sciences, Cardiff University, Heath Park, Cardiff CF14 4YS, UK.
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Cheng CL, Lin CH, Liu NJ, Tang JH, Kuo YL, Tsui YN. Endoscopic diagnosis of cervical esophageal heterotopic gastric mucosa with conventional and narrow-band images. World J Gastroenterol 2014; 20:242-249. [PMID: 24415878 PMCID: PMC3886015 DOI: 10.3748/wjg.v20.i1.242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Revised: 08/23/2013] [Accepted: 09/17/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the diagnostic yield of heterotopic gastric mucosa (HGM) in the cervical esophagus with conventional imaging (CI) and narrow-band imaging (NBI).
METHODS: A prospective study with a total of 760 patients receiving a CI examination (mean age 51.6 years; 47.8% male) and 760 patients undergoing NBI examination (mean age 51.2 years; 45.9% male). The size of HGM was classified as small (1-5 mm), medium (6-10 mm), or large (> 1 cm). A standardized questionnaire was used to obtain demographic characteristics, social habits, and symptoms likely to be related to cervical esophageal HGM, including throat symptoms (globus sensation, hoarseness, sore throat, and cough) and upper esophageal symptoms (dysphagia and odynophagia) at least 3 mo in duration. The clinicopathological classification of cervical esophageal HGM was performed using the proposal by von Rahden et al.
RESULTS: Cervical esophageal HGM was found in 36 of 760 (4.7%) and 63 of 760 (8.3%) patients in the CI and NBI groups, respectively (P = 0.007). The NBI mode discovered significantly more small-sized HGM than CI (55% vs 17%; P < 0.0001). For the 99 patients with cervical esophageal HGM, biopsies were performed in 56 patients; 37 (66%) had fundic-type gastric mucosa, and 19 had antral-type mucosa. For the clinicopathological classification, 77 patients (78%) were classified as HGM I (asymptomatic carriers); 21 as HGM II (symptomatic without morphologic changes); and one as HGM III (symptomatic with morphologic change). No intraepithelial neoplasia or adenocarcinoma was found.
CONCLUSION: NBI endoscopy detects more cervical esophageal HGM than CI does. Fundic-type gastric mucosa constitutes the most common histology. One-fifth of patients have throat or dysphagic symptoms.
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